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SEASON 1
002: Certified Nurse Midwife Role with Angela
003: Obstetrician-Gynecologist Role with Abby
004: Certified Professional Midwife Role with Ray
006: Registered Nurse Role with Maggie
008: Maternal Mortality in the US
011: COVID-19, Black Maternal Health Week, & Caring for Each Other
012: National Infertility Awareness Week
013: Nurses as Advocates and Change Leaders
014: Being a Doula during a Pandemic
SEASON 2
015: Hope & Partnering Together
016: State & Future of Birth Care
020: B.I.R.T.H.-Respected, Trusted, Heard
021: Birth Professionals & Liability
022: Relating and Caring: Birth Pros & Clients
023: Perinatal Mental Health & COVI-19
024: “A Womb of Their Own” Q&A: Trans & Non-binary Birthcare
025: Trauma-Informed Birth Care
026: Cultural Humility in Birth Care
027: Professionalism & Activism in Birth Care
028: History & Future of Collaborative Birth Care
SEASON 3
029: Unpacking Pelvic Biomechanics & Birth
030: Masculine-Identified Birthworkers
031: Postpartum Care Failings & Foundations
032: Bias in Pregnancies Over Age 35
033: Pregnancy and Birth Support for Young Parents
034: Unbiased & Representative Birth Education
035: Chiropractic Care for Pregnancy & Birth
036: The Rebozo & Beyond: Cultural Appropriation & Birth 1
037: Accountability, Allyship, & Anti-Racism: Cultural Appropriation in Birth 2
038: Harm Reduction in Pregnancy & Birth
039: Who Needs a Pelvic Floor PT Around Birth?
040: Supporting Birth At Every Size
041: Navigating Homebirth to Hospital Transfer
Season 4
042: Holding Space for Perinatal Mental Health
043: Supporting Parents on a NICU Journey
044: Birth Nurses: Unique Position & Power
045: Honoring Pregnancy & Infant Loss
046: Preventing & Processing Birth Trauma
047: Managing PCOS: Fertility, Nutrition, & Beyond
048: Power of Reflection for Birthworkers
049: Holding Space for High Risk Pregnancy
050: Inclusive Care for Gender-Diverse Birthing People
051: Intimate Partner Violence in Pregnancy & Postpartum
052: Supporting Lactation Triumphs & Challenges
053: Doulas: Collaborative Care and Advocacy
SEASON 1
001: Community within Birth
Maggie Runyon, RNC-OB:
Hello. Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so glad we’re here to learn together. This week in our inaugural episode, we are excited to tell you more about ourselves, what we hope you’ll gain from being here and part of this community, and start to break down the issues that surround supporting birth in all of its different forms. On to the show!
Maggie Runyon, RNC-OB:
A few months ago, I had the privilege of attending a multi-disciplinary birth conference. I really appreciated the interactive nature of the event and the efforts the keynote speakers went into to engage the audience. During several of the round table discussions, I heard around the room, people genuinely interested in learning about each other’s point of view, especially from disciplines other than their own. I heard choruses of “Oh, I didn’t realize that” or “I’ve never thought of that before.” As nurses listened to doulas, OBs listened to mental health professionals ,and midwives listened to childbirth educators. I was so inspired by the sense of togetherness and everyone working towards the same goal: safe and empowered pregnancies, births and postpartums. I came home buzzing with inspiration for how to harness that energy and expand the reach to create a space solely focused on drawing birth workers together. From that, Your BIRTH Partners was born. We are here to give you a jumping off point for conversations to have your colleagues. We’re here so you can broaden your knowledge of care options throughout the birth continuum. We’re here so you can ask questions and engage with birth professionals from different backgrounds, different cultures, educations. And we’re here to support you in transforming birth culture in the United States. Your BIRTH Partners is a for-purpose non-profit 501c3 organization. I’m Maggie Runyon, birth nurse, yoga instructor, educator, and mama of two. And I’m thrilled to be starting this community with all of you. I’ll pass the mic to the rest of the podcast team now. Pansay?
Pansay Tayo, Doula:
Beautiful, Beautiful. Um, such a honor. And so much gratitude for being here with you. Thank you. Of course, I am Pansay Tayo. I am a doula since 2014. I am a mom, a mom of two, and, additionally, two beautiful grandbabies that I primarily care for. In addition to my doula work, I do help and assist to train doulas. Also, I have a very big part in the community of assisting moms in their transition through motherhood through ritual and ceremony.
Maggie Runyon, RNC-OB:
That’s beautiful. And what brought you to want to participate in this space?
Pansay Tayo, Doula:
Oh, my gosh. When you approached me, your vision for this was so magnificent. For one, it just incorporated what we need so much in community. And that is, for one getting the information, getting important information to our mothers and to the women. As far as their options, you know, dealing with pregnancy and birth. It’s so much that a lot of women don’t know. You know, I used to be one of those women here. I operated, and I’m birthed my children, with only the knowledge that was passed down from aunts, and you know grandmothers, but it was so much left out. So I feel that you know your vision, we’re filling voids, we’re filling gaps. And it’s our rights. And it’s their right it’s women’s rights to know what all of their options are when it comes to birth. And empowering them, helping them to stand firm in how they want to bring forth life. So that right there I’m excited me so much, you know, to be to be a part of that, and to join you and the other magnificent ladies. That’s, um, that’s in the circle. I really appreciate it.
Maggie Runyon, RNC-OB:
We’re so glad you’re here. Ray?
Ray Rachlin, CPM:
Hi. I’m Ray Rachlin. I am a certified professional midwife, licensed midwife, and a certified lactation counselor. Ah, based in Philadelphia and serving kind of the greater Philadelphia area and South Jersey. And I have a practice that is primarily doing home birth, but also fertility care for LGBTQ families and home insemination and education for healthcare providers about trans-inclusive prenatal care.
Maggie Runyon, RNC-OB:
What kind of brought you to this project?
Ray Rachlin, CPM:
I was really excited to be approached by you, Maggie, because, you know, I got into midwifery from a very political place of seeing people mistreated in the hospital setting. And once I witnessed my first home birth, just being like, ‘Oh, birth can look different and like that’s how I need to do it.’ I chose to train exclusively out of hospital because I wanted to train with normal birth and also train outside the medical model of care, where residents could kind of sweeping it every month, any moment. And really, what I see, like the role of home birth is obviously, you know, people seek this care out, and I’m able to provide really awesome care experiences. But more than that, you know, I want to bring this model of care to like a larger number of people. You know, I don’t think home birth is ever gonna be the norm or the majority in the US, but our model of care of having complete continuity, relationship based care, more time in appointments, time to do informed choice conversations, including partners in care provides, like, really see, we have really good outcomes. And I want to help broaden, how this model of care could be like introduced in maybe larger health systems, especially for folks who are experiencing the largest health disparities. And so, I was really excited when you approached about this podcast. Yeah, let’s let’s talk about what we’re actually doing in home birth and midwifery in the CPM world and broaden our reach for how this model of care could impact everyone.
Maggie Runyon, RNC-OB:
That’s awesome. I love that. And I’m so excited to learn more about that. I think all of us have such varied experiences. It’s gonna be great to kind of broaden our horizons more. Ang?
Angela Mike, CNM:
Oh, all right! I’m Angela Mike. I am, excuse me, a certified nurse midwife, also have a doctorate of nursing practice. I have worked in birth for 14 years, and I have seen it done so many different ways, and it’s a part of what helped me to kind of gather my personal philosophy, which I’ll talk a bit more about later. But I have four small children, and I’m married to my high school sweetheart, and I’m currently, in the Air Force, as an active duty nurse midwife, and I work in a hospital setting. And what inspired me to be a part of, this birth forum, and community was wanting to kind of close the gap because I’ve seen birth done in so many different ways. I appreciate and respect all the different types of birth. I thought it was important for someone like me to kind of be a part of that middle ground speaking. I’m a believer in home birth. I had a home birth with my last baby. I am a believer in hospital births for those who need it. I’m a believer in birth center births. I’m a believer in birth choices, period. Because I trust birth. And when it’s not normal, I treat it like it’s not normal, and when it is, I don’t disturb it. And I think I just want, you know, the birth community to know that you can have a balance of both of those things. And, I want to help to bring that knowledge to the table.
Maggie Runyon, RNC-OB:
Thank you so much. And, Abby, you can close us up!
Abby Dennis, MD:
My name is Abby Dennis. I am a physician practicing ob-gyn. But I’m also board-certified in family medicine. The first baby I delivered, I think was 2002 and I’ve been pretty hooked ever since. I’ve done this job in a lot of different capacities, but pretty much always have practiced in in higher risk settings. My current practice is as a general ob-gyn in the city. I have several awesome partners, which affords me the ability to be at work when I’m at work and be home when I’m home. Home for me is with my husband and my three boys, who are crazy. I used to have lots of interests before them. [laughter] I could tell you about those, but right now it’s a lot of soccer practice and playing fiddle and that kind of stuff n terms of why to this podcast. I did it because you asked me to, Maggie, because I see you as somebody who has tremendous insight into birthing and, why we do certain things, why we don’t do certain things, why certain births are different than others. I also really like the idea of having a forum where we can talk through some of the more challenging things in in birthing and talk about why certain things were done certain ways. I don’t really like being controversial, and I have a little bit of a fear that by joining this I’m going to, say something that’s perceived the wrong way by one of my obstetrician colleagues. I have been trained by amazing physicians who I still learn from on a daily basis. I have a great respect to science and how that applies to birthing and evidence based birthing, but also as a provider and as a mother, I have a real respect for just compassionate birthing and and birthing that educates women and then allows them to really make autonomous decisions about their own bodies and the process that just happening to them.
Maggie Runyon, RNC-OB:
That’s perfect. Thank you so much. And I really, I am so appreciative of all of you being here and sharing, you know of yourself with me. I know it takes a lot to come on here and talk about all this. And some of these things we’re talking about are, you know, they’re kind of like easy and light, and it’s fun to get into and, some of things are heavier and they’re hard, they’re issues, they’re frustrating points that we, you know, we come across in our practice. And that is why this piece of community, it’s so important having various voices on the table so we can all you know, connect and learn more from each other. I really loved a quote from Brian Solace that said, “Community is about doing something together that makes belonging matter” and I have belonged in the birth world for, you know, 10 plus years working as a nurse. But that sense of is what you’re doing, really impacting and growing and, you know, kind of changing things for the better. I felt this calling in the last few years to really kind of be doing a little bit more. With both of my kids births, which Abby was the provider for my daughter, my first, I was able to create health care teams that really balanced out what my personal, you know, values and wishes were and gave me the medical care and the alternative, complementary care to really create this holistic birth experience, and I want for other communities as we kind of pull together this to see that you can really come together and build that referral network, have the people who you talk to who are outside you know of just the people at your organization or just your colleagues from school to really build more, and get a deeper meaning into birth and then transfer that into providing more for our patients and our clients and birth as a whole. So I’m really excited to see how this community can kind of grow and take what, you know, the best of what we’ve all seen in the communities we’ve experienced before and really broaden that to be as inclusive as it can be. So I’d love to ask you kind of what are ways that you all have found community, especially within working within the birth world? Who do you turn to when things are going great or, you know, not great. How do you kind of reach out, Ray? You can go for it.
Ray Rachlin, CPM:
Okay. Yeah. So the certified professional midwife community in Philadelphia is pretty small, you know, we do get together. We participate in peer review, which is similar to like a morbidity mortality review that is done in a hospital. So we review were complex cases. But I really found that in order to build a community that, like, I need to provide good care that I’ve got to go branch out of a lot outside of you know, the four C. P. M’s in Philadelphia. So I participate in the nurse midwifery chapter here. I attend a lot of interdisciplinary events, including a couple of like study groups with family medicine doctors. And I have been working to build collaborative relationships with local hospitals and maternal fetal medicine because, you know, home birth doesn’t exist in a bubble. A lot of my clients, or almost all my clients, get ultrasounds or will interact with another provider over the course of pregnancy. And, you know, I think the research really shows that home worth is safe when we have the ability to transfer well, and early, into the hospital setting. And so it’s my responsibility as a home birth midwife. To build relationships to make that possible, and it’s been really interesting to just continue to have to introduce people to who I am and what I do and ‘alright, you know, like this person is a reasonable health care provider and it’s not like we’re like waving sage around someone in a home birth [laughter] you know, we’re monitoring the baby. So it’s really just continuing to, like, introduced the basics of what happens at a home birth and how we provide safety and then building, you know, mutual trust. So I can transfer and they read my chart and believe me and can kind of continue with what appropriate care looks like and yeah, and I think I also, you know, have the handful of CPMs around the country that, like I’ll text at 4 in the morning. You know to say ‘this is what’s going on. Like I need another set of eyes and ears.’
Maggie Runyon, RNC-OB:
Yeah, I think that’s so important. I know Angela and I are actually, we have a text chain with a bunch of friends who we worked with down in good old Fort Polk, Louisiana, there’s 5 of us on there, and we talk a lot, all the time about clinical things or just kind of checking in with each other about how it is kind of navigating this work. And I love seeing people who really worked to kind of build, you know, that community. I love Ray how you’re talking about branching out outside of, you know, just the people who are kind of in the circle, who kind of have the same birth lens that you do and really expanding that so that you can build more relationships. Because that is, I mean, birth is such a, you know, transformational, relational process on and it’s bizarre sometimes how as a society we kind of treat it in this little box that we put in one little spot.
Angela Mike, CNM:
I think, I don’t know, gosh. My background is so diverse when it comes to other professionals that I reach out to. Certainly within the practice that I am in, you know, I have physicians who work alongside with me and I generally will consult or collaborate with them on more of my complicated or high risk obstetrical patients. Whether it is an antepartum period or intrapartum. The vast majority of the time I do reach out to more of my peers. So I have family nurse practitioner friends, women’s health nurse practitioner friends who are really helpful in that kind of outpatient setting. For inpatient, though I mostly rely on collaborating with a lot of my other midwife friends. And I have a diverse wealth of them because sometimes I have to put myself in check about if I am, like, overdoing something or I am being too conservative or if I really need to be more relaxed. I have girlfriends who are CPMs. So I have girlfriends who are CNM’s who work only in birth center settings. I have some who’ve worked in birth centers and hospitals and using all of them together really helps keep me in check. It helps me to remember that there is a vast array of normal, and in the setting of certain things, that is okay for me to really let go vs being action oriented. Certainly, for the setting I’m in it is easy to become very action oriented. We have a family medicine residency program on and often are the providers who are mentoring these young physicians of your action orient it and then when they are with me, I am I hands off ‘Don’t touch, Don’t do this, Don’t do that.’ And so I it’s easy to kind of feel like you need to be more action-oriented when it’s not necessary. So I feel like I try to keep a healthy balance of those things by reaching out to some of my other colleagues who do birth differently, and then certainly to my physician colleagues who, believe it or not, are super hands-off too, and they trust birth, and they only intervene when it’s abnormal.
Maggie Runyon, RNC-OB:
Wonderful. And you, Pansay?
Pansay Tayo, Doula:
Community is very, very, very important to me. My desire, and my need, and my love for community stems from my own personal childhood growing up without a mother. So my first introduction to true community was when I was introduced to the birth community. You know women they were midwives and doulas and all types of different practitioners, and we would, you know, come together in a very sacred setting, you know, as women. Yes, with the gifts, all with different levels of knowledge and, you know, in different in different avenues of the birth community. But we were there as women, and we all brought our own backgrounds and our love and our passions for our work, but we were able to learn from each other. We were able to uplift each other and not just within our work. It was also within our personal lives. You know, I myself, I credit the community that I stepped into, um, for a lot of my growth and for helping me to get where I am, you know, here now, and definitely helped, too, you know, elevate me and grow me, and give me confidence, you know, in my passion and my work. And that’s something that I’ve definitely you know, it spills over, spills over into your work, into every woman that you come in contact with. Um, so that’s community. It’s almost like, you know, it’s a family. It’s a family you know, dynamic, that’s necessary, for women. You know, that’s it.
Maggie Runyon, RNC-OB:
Thank you. Perfect. And so I think what’s interesting, Pansay and I were able to work when we were, when I was still living in Maryland, we were both part of a really big diverse community there. Really the local birth community was really inclusive to everyone from, you know, from different walks of life. There were certainly a lot of people who operated in the community birth setting. We had a lot of doulas and people who did placenta encapsulation, childbirth educators, with a good mix, you know, of nurses and chiropractors and midwives, um, and people coming from all different walks and kind of pulling together. And I love that especially, you know, in the Baltimore setting, we have a really, we were kind of living right on the outskirts between Baltimore and the suburbs. And so we have a really diverse client population there, and so we were able to learn from these community meetings together when we would come and sit and just talk about issues that were happening and how things were being handled. Whether it was, you know, in home birth settings or in different hospital settings, we were able to keep learning from each other to get a sense of like, ‘Okay, that’s something I wanna be paying attention to in my practice. That’s something I need to tune into a little bit more.’ And it was always done in this very relaxed and, you know, sharing setting. So people felt more at ease and, you know, not under any any pressure to agree to something or to try to change something, but just to be a listen and learn. And I really I miss that, that piece of it. Abby, what do you feel like? Where you find your community?
Abby Dennis, MD:
I am grateful, and sometimes not grateful, to be part of that Maryland birth community I think. I’m really grateful; I have wonderful partners, and I’ve trained with a lot of great physicians who I think I can really turn to when I have a complicated case. I’m also really lucky to be in a teaching hospital. I feel like a lot of bad things have been said already about residents in this podcast and active management of labour, and one of my insecurities out doing this was that I don’t want to be the ob-gyn bad guy. I have a lot of colleagues on the ob-gyn end of things who are really wonderful and providing compassionate care and not over medicalizing birth. And I’m grateful for that. You know, very few people who, let me just back up… I think people who go into this field usually go into it because they’re touched by a birth because they feel like, you know, being able to deliver babies really special and wonderful thing; and it is. I feel like I rely a lot of my physician and professional colleagues to make sure that I am providing the safest and most evidence based care for patients because I think that’s really important and sometimes lost. Interestingly, I think I have a huge community of other birth workers and really my mama friends who have helped me grounded in, um, the sense of making sure that I remember and respect that birth is also such an important life experience for anyone at a given time. And I think my friends, and hearing about their own birth experiences and birth preferences and things have gone well and things haven’t gone well. And just the process of being a parent having my own birth experiences there has really shaped how I how I think about the care that we provide.
Maggie Runyon, RNC-OB:
Yeah, absolutely. And I know obviously I worked and I worked with you and I have had the privilege of working with so many different, you know, physicians who, from residents who I have absolutely, you know, loved working with and who it is great, especially when I was, you know, a new nurse learning alongside of them, um, it’s provides a really unique experience. And I have had the opportunity to work with so many physicians who clearly have dedicated decades, you know, of their lives to birth. And I think in birth, you know, one of my big reason for doing this is because I feel like, personally, I’ve been able to make relationships with people from all these different disciplines and been able to really connect and try to kind of see their side of it and understand what their experiences are and what their education is and how that’s led to how they practice. I think it’s really easy in, you know, in birth, and I think right now in our birth culture here in the US that there’s kind of this like line drawn in the sand and people are supposed to be on one side or another. And that’s just not, you know, that’s not real, you know. It’s not realistic. Birth is not, life is not, black and white, it’s not. You know, we can’t just say, ‘Oh, this is always how things were supposed to be’ in one direction or another. And so I am really grateful Abby for you being here because I know there’s a lot of pressure kind of to try to balance all of it out. I want this space to be one where we can really openly talk about things that are going on and that we’re going to, you know, that we’re gonna disagree on things. We don’t all see things in exactly the same way, and that’s good. And that’s important because all of our clients and patients, everyone who were taking care of, and helping through this journey, they don’t feel the same way about anything either. And so we need diverse practitioners. We need people to see things from a different view, so that we can best meet everyone where they’re at. And that’s why I really want, you know, this strong community. And I want to see community just expanding all over so that we can have better referral networks, you know, within our local communities that when you meet with a client and you realize, ‘Oh, we’re not quite, you know, lined up with this. But I know someone who I think would really resonate with that and would be able to provide you with this beautiful experience’ that we feel comfortable referring people and talking about it. As Ray was talking about, you know, when we’re co-managing care, that we’re seeing more of that going on, so people can really get the best of, you know, of both worlds, and they can have the advantages that come from living in a great country like we do where we have access to so much different, you know, medical and midwifery care and that they can have, you know, all of that to create their kind of ideal birth experience
Angela Mike, CNM:
I think you said something that is just very well said, because I’m listening to everyone and their backgrounds, and what their experiences are… It it is definitely, in my opinion, a wonderful reminder that we do all come from a very diverse background. We all have different experiences. And despite the fact that we have different experiences, there is the circle of energy that connects us. And that energy is that we all have gone into this profession to help people, to help women, to advocate for women and advocate for birth, and to ensure the health and well being of women and their babies. And despite, I think our concern for maybe things that we have seen go awry in the past with certain birth workers. I think that the most important thing is that we’re all here in this community to discuss that, to learn from it, to grow from it and to hopefully eliminate or at least decrease some personal biases that we have. I know I come from, I’ve grown a lot in the last several years on my practice, but I had such strong, biases against certain types of providers in health care and birth, and where it come froms. Men and birth, family medicine providers being in birth or attending birds, having very action oriented providers, not understanding what CPMs or LMs were, and not feeling, not understanding, the roles that all of these people play. Now, having worked across this country in so many different hospitals, with so many types of birth workers, it really just opened my horizon. I had a midwife for my first birth, two family medicine providers for my second and third, which was phenomenal. And I had a CPM with an MFM backup for my home birth. I mean, I just I could not imagine, you know, 10 years ago I could not have imagined that my mind would be so open and so accepting of so many different types of people being birth workers. And so I am grateful to be here in the circle of incredibly smart and dedicated women who have such strong diverse backgrounds. And I’m hoping that what we are doing here, uh, really helps to impact birth community and birth workers in a positive way.
Pansay Tayo, Doula:
From my position ,as a doula, I am the support and the help to women for whatever the choice of how they want, you know, to birth. Sometimes that is the homebirth setting, sometimes it’s the hospital or birth center. And most times it’s, you know, I have a pleasant welcoming when medical professionals see me. But then there are other times where I can feel the tension, just when they, you know, see me, walking down the hallway with my bag and my birth ball. It’s very unfortunate that we are looked upon in such a negative way when our sole purpose and goal is to be the support, and also to help educate the client on just all of their choices. We just want them to know all of their options. I have ran into, you know, in the hospitals, the hospital setting, where recently some of the hospitals, you know, they’re making us sign forms stating that, you know, we’re kind of, we are to sit quietly in the corner; that’s what it feels like we’re signing, and not to interfere. And some years ago, it was not that way, but more and more, I’m seeing those practices. You know, in certain hospitals, even to the point of certain doctors, you know, kind of talking to our clients almost in a way like, you know, we don’t need a doula. And again, it’s very unfortunate because, you know, we’re not there to make anyone’s job more difficult. We are there to help, you know, to help to ensure the safety of the mother and that her vision for her birth and her wishes, are able to come to play as much as possible. Within the birth community, my birth community, for the most part, most of the time we’re on the same page, but you know, you have some that might consider some of us, like, super crunchy, you know, like ‘well she’s not gonna do you know, you know anything or, you know, maybe she’ll check out the hospital 24 hours after the baby is born.’ But within, you know, within all of that we all have the right to stand our ground for what we want, you know, for ourselves, births and pregnancy looks different for every one of us. And the fact that, you know, just like the finger print on our finger, it is all about our personal preference. It’s something that we will live with, and that will follow us, you know, for all of our days, so we have the right to choose it. Exactly how we want it.
Maggie Runyon, RNC-OB:
Absolutely. It’s so true. And I mean, obviously the whole “why” we’re here. And you know, doing this, that we want to feel that that bigger partnership, you know, that we’re all here to support people, whatever their purposes are, and they’re not always gonna match up. You’re not gonna have the same ones, you know, as your client, necessarily, but that we want to help to partner together with whoever, you know, their provider is for care. If it’s an OB or a midwife, or everyone else who’s in their circle, you know their family, any other practitioners who they kind of welcome in, that we’re all on the same page and that we’re all treating them, you know, with the best, most cohesive, holistic experience we can so that they get, they get more from it, you know? And I truly believe that when we’re coming together to do that, that we do, we each person that’s involved is adding, you know something. They’re not taking it away from anyone else. You know, there is an abundance to go around.
Pansay Tayo, Doula:
That’s right, that’s right. That’s why they won’t see with the birth team, right? Absolutely. Yes, definitely.
Ray Rachlin, CPM:
I really appreciate what you just said. And yeah, I think when I started my midwifery training, I was, you know, I’d been a doula in New York City for a number of years and witnessed a lot of really scary things that I didn’t totally have the information to understand or process. And I was very anti-hospital and, you know, over the course of my training, you know, I had really good preceptorship that really taught me that, you know, hospitals are necessary to be a home birth provider. For me to be able to provide safety, the ability to transfer is absolutely necessary. And I had to little by slowly let go of my biases. And I think a lot of the conversation we hear, like, you know, around birth, you know, in podcasts and books and what not has to do with, you know, low risk birth being over managed, you know. And I am in this very interesting position of, you know, like I think all of us as providers know that, you know, birth does work and then sometimes it really doesn’t. Or sometimes there are just medical things that come up. And I have the privilege of, like, I just do low risk. And if something shifts and it’s no longer normal birth, I’m transferring appropriately. And then when I go to the hospital, I’m like seeing really appropriate use of interventions and guiding my clients through appropriate use of interventions, whether it’s an epidural or pitocin or a C-ection like these things are necessary and sometimes needed, and the balance of people who are maybe getting those procedures when patients, you know, ask for versus caring for high risk people or, you know, the risk status of a birth shifting, you know, during a labor process. And I think having more conversations and more perspective amongst like various providers is only gonna help healthcare get better. You know, I think there’s always going to be the niche that’s doing kind of what I’m doing. But you know, what about the majority of folks who are giving birth in hospitals? And how do we bring in more perspectives to help folks have a better experience, both with normal birth in hospital and also with medicalized birth, and with birth that is more complicated, that needs that, and maybe bringing in just like aspects of informed consent so people can have more. Yeah, I guess, like understand when things are going awry, like kind of what needs to happen. And I think some of a lot of the conversation I notice is maybe just people not understanding, you know, when medical conventions necessary, and how do we navigate that cause you know you’re still experiencing something in your own body. I don’t know if I said that well, but it’s kind of what’s going through my mind right now.
Angela Mike, CNM:
Yeah, I think you did.
Abby Dennis, MD:
I think navigating those transfers of care is an important thing, and that’s I mean, we could do such a better job of building communities between different categories of birth providers between home birth providers and midwives providing care in birth centers and in hospitals and physicians. There’s a real antagonism that I think has arisen. You know, this isn’t a competitive thing. You know, one place or situation to have a birth isn’t necessarily better or worse than another. It has so much to do with the patient and their preferences and their ideas about birth and their medical background. But I do think when things shift abruptly, when you have a low intervention birth that suddenly isn’t going well, we certainly don’t do an adequate job of transferring care and communicating all the time, and that needs to be done better. And it needs to come, I think, from a place of mutual respect amongst birth workers because unfortunately, people, I think, feel like they need to take sides, feel like they need to believe in one model of birthing or another. And that’s not at all the way that this should be. And this is a U. S. Phenomenon, which is interesting.
Ray Rachlin, CPM:
Yeah, I always wonder, like the way that our system evolved, like, so differently and more antagonistically than, you know, other European models and where that’s left us today. How do we undo that?
Abby Dennis, MD:
Yeah. Oh, and how do we do that in the context of a malpractice climate really, unfairly burdens us when there’s an outcome that’s not perfect. You know, everybody expects that a birth is gonna end in not just a perfect birth story, but a healthy mom and a healthy baby. And when that doesn’t just happen, the system penalizes us, which, you know, as if we’re not affected personally or emotionally by that outcome and birthing. Also, that really you know, from just a survival standpoint, I think affects how a lot of ob-gyns have to practice.
Ray Rachlin, CPM:
Yeah, yeah, that’s a huge stressor. And I think that’s also like for me one of the biggest shifts or differences I see with the home birth population. I don’t know, I guess some of you have seen a home birth informed consent before. But it’s really like ‘you’re choosing a birth experience where we believe this is inherently normal. These are the risks. If we have one of these emergencies out of hospital like your baby might not live.’ You know, you’re choosing to have a different risk picture than what’s available in the hospital. You know, home birth clients tend to take a lot more ownership and agency over that decision and it’s a different model of care that really provides for clients or patients being in the driver’s seat versus, you know, the hospital system where you know there’s maybe less agency, less like people, like taking responsibility for their decisions. And then there’s this expectation that, you know, all people will be healthy, all babies will live, which has never been true in human history and probably never will be.
Angela Mike, CNM:
No, it won’t.
Ray Rachlin, CPM:
I think the shift of this is one of the things that, like I feel safety of around malpractice in a homebirth setting is really my clients taking a lot more responsibility for their choices, which is not like the model in the hospital, that doesn’t preclude for that. And then we also don’t care for people with children with disabilities, so they have to sue. And there’s just all these ways that people are getting set up for that, you know, with more shared decision making could be different.
Abby Dennis, MD:
I agree completely.
Angela Mike, CNM:
You guys are so smart, l love smart women; it makes me feel empowered.
Maggie Runyon, RNC-OB:
And I love seeing how, you know all of this, how we’re gonna come from these different perspectives and will be able to draw in, you know, different guests to talk about issues that come up with this. Because it’s such a multi factorial issue, and there is, it would be aweseome, but there is no quick fix. There’s no Band Aid to put on the situation. It is, you know, centuries of this, getting to where we are right now, and so it’s gonna take time to try to get to a different place. If that’s where we all as you know, as a community, as a country want to be with our, you know, care around birth. And so as we wrap up, I just want to, you know, reiterate our kind of call out to everyone here listening. You know, we believe in the power of people coming together to connect and share and grow, and we want to learn more about you and the issues facing your community. So please share your thoughts. You can go to our show notes blog on our website, yourbirthpartners.org, or our Facebook page, we’re Your BIRTH Partners on all of the social media platforms. And as Margaret J. Wheatley says, “There is no power for change greater than a community discovering what it cares about.” And we can’t wait to hear about what you care about.
Maggie Runyon, RNC-OB:
Thank you so much for tuning in to our first episode of Your BIRTH Partners. We love having the chance to talk and share about birth,and we are grateful for the opportunity to connect with you. We greatly appreciate you continuing the conversation and growing our community on social media. You can find us on Facebook, Instagram and Twitter at Your BIRTH Partners. Please follow and share with your friends. Until next time!
002: Certified Nurse Midwife Role with Angela
Maggie, RNC-OB: (00:05)
Hello, welcome to Your BIRTH Partners. We are here to breakdown barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we have our own Angela Mike, certified nurse midwife. You will learn more about Angela and her path to pursue midwifery, how she’s worked as a birth worker, and how she’s practicing today. And you’ll also gain a greater understanding about the roles that certified nurse midwives play in care during pregnancy, birth and postpartum. On to the show!
Maggie, RNC-OB: (00:44)
So Angela, I’m so glad to be talking to you today. Tell us a little bit about yourself.
Angela, CNM: (00:48)
Well, um, thank you. Maggie it is good to talk to you too. I am a 37 year old married mother of four. Um, I am originally from Chattanooga, Tennessee. I currently live in Las Vegas. I started my career off as a labor and delivery nurse in the U S Army. I was on active duty for about eight years and left, became a midwife, got my doctorate in nursing. I worked in private practice for about a year and a half before I returned to active duty, which is how I ended up in Vegas. I’m currently in the Air Force and I practice full-scope midwifery. I am also the nurse manager of our clinic. So that’s my life in a nutshell.
Maggie, RNC-OB: (01:38)
You are busy for sure.
Angela, CNM: (01:40)
Yup.
Maggie, RNC-OB: (01:42)
Okay. So tell us a little bit more about, you know, what brought you to this field, kinda your whole, your journey.
Angela, CNM: (01:51)
Believe it or not, it was actually the army, um, that introduced me to women’s healthcare. I always thought I wanted to be a trauma nurse; that was my goal. I was at Walter Reed at the height of the war and we saw all of these soldiers coming straight from the battlefield with these wounds. And I thought, I need to do this type of hig speed medicine. But about, uh, three months into my first assignment they needed nurses on L&D. They were short staffed and I was forced into it. I cried like a baby. Um, I thought it was boring. I just didn’t get it. And then I don’t know, I just fell in love with it. And here I am 14 years later living my best life and taking care of women. So.
Maggie, RNC-OB: (02:43)
I love it. And so tell us more about like kinda what are you think like if you had like the touchstones that have really like shaped your professional journey?
Angela, CNM: (02:51)
I think the things that have helped to shape my professional journey, um, has a lot to do with the, the women and the families in general that I’ve encountered over the years. Some of the other nurse midwives that I’ve worked with, some of the nurses who trained me, and some of the obstetricians that I trained with as well. It was, has, been very much of a blessing to have lived all over this country. And I worked in all types of um, birth settings and all those things, the good experiences and the negative ones have all helped to mold my personal practice philosophy and how I choose to care for women and what I think is most important when it comes to women’s healthcare.
Maggie, RNC-OB: (03:42)
Absolutely. And then how do you feel like you kind of balance and weigh in kind of like personal experience and intuition with kind of the schooling and what you, you know, you’ve learned both theoretically and clinically.
Angela, CNM: (03:55)
Okay. I think the biggest balance or the biggest thing that I had to remember to sort of balance all this stuff is that I can only do one thing at a time. And so it can be really overwhelming. And I, it has been a very learned and practice behavior. There are certainly times where I had complete total meltdowns thinking that I can’t, I can’t do all the things that I want to do. I can’t cause I want them to happen now and I want to be able to put all of me into it. But I also want it to be that for myself cause I need time for myself and my children and my husband. And it’s just a matter of making lists and I prioritize things like which things will I tackle today and which of these things take priority so that even if I don’t get through my list, this one or two things, these things have to be done today. So, and just taking the time to breathe and learning to say no.
Maggie, RNC-OB: (04:58)
Yeah, I think learning to say no is a lesson. We’re all probably continually learning for the rest of our lives. And then in your, you know, when you’re acting as a midwife, how do you feel like intuition plays into it?
Angela, CNM: (05:14)
Oh wow. It’s so funny that you asked that because I’m, I’m always reflecting on that. Um, as a clinician you learn medicine. You learn what you’re supposed to do, what you’re not supposed to do. And that’s great. That’s the black and white portion of it. But in the middle of that, black and white of that science, is an art. And that is where the gray area is. The art of midwifery, the art of birth, the art of medicine, is so gray and it truly is, anyone can do this, anyone can do this. Um, if you go to school and learn it. Yeah. Intuition is something that you develop over time. And it is something that I truly feel that my higher power has gifted all of us with and learn. It’s a listen to that gut instinct and intuition. Um, it’s probably one of the most important aspects of my practice. I know all the signs. I know when things aren’t quite going a certain way, but I will tell you and every instance where I’ve had a really beautiful outcome or I’ve had, um, outcomes that were not optimal, I always knew it in my gut, and I listened to my gut; to call in the people I needed or to calm down people when there was no need to be concerned. It has worked out every single time.
Maggie, RNC-OB: (06:46)
That’s wonderful. And then, so, you know, future dreaming here, where do you see yourself in 10 years?
Angela, CNM: (06:53)
Oh wow. You know, I’ve always thought that once I finished, um, doing birth in a hospital setting that I would always kind of resort back to, um, this ideal of a women’s health care, um, in birth outside of the hospital setting. But I think as I grow older in years, wiser in years and in my practice, my philosophy just continues to evolve. I think that I need to stay in the hospital birth setting. Um, and I need to teach, I need to teach other midwives to trust birth and I need to teach other midwives that birth can be done differently, and still safely, and teaching them to, to watch birth because that, it doesn’t happen often. We don’t watch it; we seem to be very action oriented. So yeah, in 10 years I see myself being a birth educator in a school setting, in the university setting and, hopefully as a preceptor to midwives because currently I don’t do that. I precept family medicine residents and first year OB residents.
Maggie, RNC-OB: (08:25)
Oh, I just, I love hearing you talk about that. Like, gives me chills. I can totally see you being just an outstanding professor and a mentor to other, you know, midwives who are coming up and who, who want to see us, you know, make hospital birth, everything that it can be in kind of the best of both worlds. So. Yay. And so we’re going to just switch gears a little bit just to tell us about more about kind of midwifery and what it means to be like a certified nurse midwife kind of generally. So if you could just talk a little bit more about like the schooling training that goes into becoming a CNM.
Angela, CNM: (08:55)
Oh yeah, definitely. Um, so I do want to just add that there are also certified midwives. These are board certified midwives who are not nurses. We have the same exact, um, schooling and we take the same boards. So I just want to put that out there. But, to become a certified nurse midwife, you have to be a nurse first. There are many routes. I’m just going to explain my route. I got my bachelor’s of science in nursing first, from the University of Tennessee to be exact. And then, um, once I decided to go to midwifery school, I found a university that did not require me to take a GRE, just a certain grade point average, with my bachelor’s and I basically applied to the program. I spent three years exactly working on my master’s degree. Once I finished the didactic portion of my master’s, we started the the clinical portion, which was, almost 700 hours, 40 births that I had to attend and a ton of outpatient visits with different expectations. And then my preceptor had to sign off on my declaration of safety, and they have to sign off on that before I can even take the, um, the final exam for midwifery school. So it is everything that you’ve learned in the last three years. And so I took that and passed it. Once you pass that, the school releases, your name saying that you can sit for boards. Boards was a six hour test as well. You find out if you pass right away and once you become board certified, you can practice medicine in your state. And then with my doctorate, it was a 15 month program full time. I did my DNP project on substance use disorder, specifically in pregnancy and specifically opioid abuse. And I created a program, that was evidenced based to support women, pregnant women who are addicted to opioids. And I developed a provider toolkit so that those counselors who work with substance use disorder can now care for pregnant women appropriately. So that’s it.
Maggie, RNC-OB: (11:29)
That’s amazing. So, it definitely is, I mean a huge journey and tons of time invested into that, both, you know, theory and clinical. And so, you know, as you kind of grow into your midwifery practice, do you find, like, what are the professional organizations that kind of back up certified midwives and how do they kind of work? Do they, how do they guide your practice or do they have certain kind of conferences you’re doing or, you know, mission statements that they’re on? How does that influence kind of as an organization?
Angela, CNM: (12:00)
Okay, wow. So there are so many organizations that influence, um, my practice because you think midwifery is not just birth, it is primary care. It is adolescent care. My youngest patients are sometimes 11 and 12 years old cause they start getting their periods. It is geriatric care because I’m caring for women through the lifespan all the way through menopause. So when it comes to organizations that kind of support or back our practice, obviously, the American College of Nurse Midwives, help to set a standard of care and clearly defines what our scope of practice is. For just baseline midwifery practice, ACOG, which is kind of like the “OB Bible” is what we generally call it, the American Congress of Obstetrics and Gynecology. They put out practice bulletins on a regular basis. They help to guide our practice in medicine, the CDC, the American Academy of Pediatrics, even, I mean there are so, so, so many organizations I could list just, I mean continuous….family medicine, these are the vast majority of organizations that I lean on for how to practice and care for my patients.
Maggie, RNC-OB: (13:36)
Yeah, that’s great. I mean, cause you need it, obviously we need to have so many different resources that back up for each individual patient is going to be different and you know, you need a different, a different lens to look at it sometimes. That’s great. And then if you could just kind of talk through a little bit more about like what the role is, you know, for a midwife in, you know, pregnancy, birth and postpartum, that whole continuum.
Angela, CNM: (13:55)
Oh yeah, absolutely. So, um, depending on the state you’re in, it’s going to determine your scope of practice. Of course, dependent on your knowledge base, will either expand or minimize your scope of practice. But in general, I care for mostly low risk women during the antepartum, intrapartum, and postpartum period. Though I do care for moderate risk patients, sometimes independently, sometimes with co-management and I care for high risk patients as well. This includes preconception counseling all the way to infertility treatment and intervention. We care for them; we usually do anywhere between 10 and 12 visits during the pregnancy screening and changing or modifying their plan of care depending on, you know, what’s going on in their pregnancy. For intrapartum periods, we induce labor or we just care for our patients who are spontaneously laboring. We also assist with C-sections whether that’s primary, repeats, or crash C-section; so I first assist in those procedures or cases. And as far as the delivery goes, I am completely responsible for the management and safety of mom and baby during the birth and being able to control any potential complications that may arise, during that intrapartum and close postpartum period. I generally will call in my OB backup, if I’m concerned about potential for adverse outcomes or if there’s like a very severe laceration that I can’t repair or don’t feel comfortable repairing.
Maggie, RNC-OB: (15:51)
Awesome. And then if you could just, I often hear confusion with this amongst consumers, and even amongst other birth workers, about the distinction between midwife and doula. If you could just highlight how that, how that role is different.
Angela, CNM: (16:03)
Okay. So, as far as doulas go, and I actually consider myself a doula as well, because of the work that I do and the time I spend with patients. But doulas are not licensed professionals. They don’t have to have any formal certification to be considered or to call themselves a doula legally. But there are certified doula programs that you can go through and basically they are non healthcare professionals whose sole purpose is to support them, the woman and her family during her pregnancy, during her labor and during the postpartum period. They offer emotional and physical support to the entire family. They offer, they assist with breastfeeding in the postpartum period as well. And they help the families kind of adjust and transition to that postpartum period. They may be able to assist with advocating for personal wants, goals, needs; they help with planning for the birth and delivery aspect as well. But by no means do they offer, or should they offer, medical advice about management or appointments, et cetera. They are truly there just to support the woman or her family during the process.
Maggie, RNC-OB: (17:33)
Thank you very much. And then, you know, what do you find as a midwife? What’s the most challenging piece of that role?
Angela, CNM: (17:45)
Um, ironically enough, the most challenging piece of my role, one of the most challenging pieces of my role as a midwife is with my staff nurses. Um, I always thought that it would be a battle actually with other physicians. But no, I have found that since becoming a midwife, they, my physician colleagues, truly do value and respect what I do and they respect my practice and they trust me and they treat me like an equal. But it is actually my nurses that I struggle with and I can relate to that because I’ve been a staff nurse, I was for 10 years. And the battle of not trusting the provider because you don’t know them or maybe their practice style is different or even the personal bias, “you know what, they are fresh out of residency, they are fresh out of midwifery school, they’ve only been doing this for three years. I’ve been a nurse 14 years, 20 years, 30 years. I’ve probably delivered more babies than them.” And, you know, undermining you in front of the patient or other staff and you try to be extremely professional and just prove through actions that you are more than capable, and you have the training and the education and knowledge to take care and manage for these family members.
Maggie, RNC-OB: (19:22)
Yeah, I mean it’s obviously there’s so many, you know, we navigate all these different relationships during, you know, care. There’s so many different people who come into play. And like you said, obviously as a, you know, as a nurse, I totally get that because I’ve certainly, I’ve been on the other side of it where you’re looking at someone and you’re like, “Ah, I know this is, technically this is your job, but I’m not feeling a hundred percent.” And I think obviously being able to develop, you know, relationships and openness and that, you know, in a professional way, being able to have conversations and say “Eh, I’m not comfortable with that. Can you explain a little bit more about that?” And kind of trying to get into it. It’s really easy I think in, you know, labor delivery can feel very fast paced and everything needs to happen right now. And so sometimes I think people have a hard time, like, pausing and stepping back and having rational conversations instead of kind of like snap judgments, which is unfortunate, and obviously something we keep working to improve and to change. And so if there was one thing that you could tell, you know, the birth worker community about your role, what would it be? Like, if you wish everyone knew inside, you know, the midwife’s head?
Angela, CNM: (20:23)
Mmm. I think for me the one thing that I would probably want people to know is that I am more than just a baby catcher, I am highly educated, highly trained, and extremely competent in my ability to care for women in low risk and high risk settings.
Maggie, RNC-OB: (20:59)
That’s great. Absolutely true. I love it. And so, kind of close this out, what is the future of this role? Like why would someone want to become a nurse midwife?
Angela, CNM: (21:10)
I think that, certainly think midwifery is growing. It’s rapidly growing. It is, it is kind of the, it’s the foundation of birth work, you know, not just in this country, but in the entire world. Midwives are not new; we’ve always been with women. We have always practiced medicine, whether, you know, formally recognized it as that or not. But I think that midwifery will always be here. And I think that is the most important part is to not be discouraged. And if you are passionate about women, passionate about women’s healthcare, you are passionate about, um, the population of this world, our country, then you have to recognize and you have to accept that the fate of our population lies in the ability to keep our moms and our children healthy because without women and children the future of our world is non-existent. And so that’s what I believe wholeheartedly.
Maggie, RNC-OB: (22:39)
But anyway, you’re completely right, obviously midwives have been around for forever, for millennia and I think ideally in our country you’re going to just see a resurgence of, you know, them and the valuable role that they play as you know, as equal members of the healthcare team. And helping to kind of grow that model that we see midwives do so well to improve the way that we deliver care to all patients. You know, even those who aren’t seeking out particularly, you know, midwife care during birth. Well, thank you so much for sharing about yourself and telling us a little bit about what it means to be a CNM. I love your passion for from birth, so thank you. We’ll talk soon.
Angela, CNM: (23:17)
Right. Thank you.
Maggie, RNC-OB: (23:22)
Thanks for tuning in to Your BIRTH Partners. We love to talk birth, and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter; we’re Your BIRTH Partners on all platforms, or comment on our show notes blog at yourbirthpartners.org. We would love to hear any questions you have about certified nurse midwives, the roles they play during birth, and we’d also love to hear from our certified nurse midwife friends, you know, what are the challenges that are facing you? How are you living out this role? Till next time.
003: Obstetrician-Gynecologist Role with Abby
Maggie, RNC-OB: (00:05)
Welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we have our very own in house physician, Abby Dennis. You’ll learn more about what drew Abby to this work, how she’s pursuing it right now, and also you’ll gain a greater understanding
Maggie, RNC-OB: (00:05)
about the role that OBs play in healthcare and especially when it comes to taking care of people during pregnancy, birth and postpartum. Onto the show!
Maggie, RNC-OB: (00:37)
So Abby, hello. Welcome, welcome!
Abby, MD: (00:43)
Thank you.
Maggie, RNC-OB: (00:45)
So we’d love to just, you know, kind of start off, just tell us a little bit more about yourself. I know we’ve heard from you, you know, a little bit, but kind of more about, you know, what are your, what are your qualifications, your alphabet soup behind your name? What is it all, what does it all mean?
Abby, MD: (00:58)
Absolutely. So I’m a physician, which means after college I went to, actually five, but four years of medical school and a fifth year that was more fun. I, after that actually did, I knew I wanted to deliver babies. I thought I wanted to do that as a family physician. So I did a residency in family medicine, which is three years, with the intent that I was going to do a fellowship in just women’s health care. But I realized through that process that I really liked taking care of women who are pregnant but also medically more complicated. So after a lot of discussion and debate, I actually switched fields and did a four year residency in obstetrics and gynecology, which means four years in training in both of those fields. So learning how to deliver babies and also learning how to be a surgeon. Since that time I’ve practiced in a couple of different capacities. I’ve practiced as an academic OB GYN. I’ve practiced as a hospitalist/laborist, meaning supporting midwives and physicians on labor and delivery and helping with births and with births that are more complicated. And now I’m in my own practice with several partners.
Maggie, RNC-OB: (02:16)
That’s great. And so what, you know, what was the, what brought you into this field? You’ve had quite a little journey throughout kind of figuring out where you wanted to settle within it, but what was that first, you know, inspiration?
Abby, MD: (02:26)
Yeah, I feel like that journey continues. Um, but I’ll tell you that when I caught my first baby in medical school, I was completely hooked. I actually remember being on labor and delivery as a second year medical student, just sort of shadowing and watching because I wanted to see a baby born. And I remember there was a complicated delivery of triplets and literally everybody in this academic teaching institution started gravitating towards the operating room where these babies were going to be delivered. And an OB-GYN just tapped me on the shoulder and was like, “Hey, have you actually seen a baby be born?” And I was like, “no.” And she’s like, “you’re going the wrong way.” So she grabbed me and pulled me into the delivery, which was I think the fourth baby of one of her friends. And she put her hands on top of mine and she let me deliver. Well in retrospect, as an academic physician, I know I didn’t really do much, but in my brain at the time, she let me deliver a baby and it was beautiful and it was just such an awesome, powerful, magical moment. And I knew I wanted to do that. How I wanted to do that has continued to evolve though.
Maggie, RNC-OB: (03:35)
Aww I love it. That’s beautiful. And I think it is like I know we talked about before, you know, we all have that kind of that calling something that just hooks us and tells us that like, yes, this is absolutely where, you know, it’s our passion, it’s what fires us up and makes us want to have, have more, even though that changes as we, you know, as we grow through it. So you talked a little bit about going in, you know, different residencies and how do you feel like, had there been like certain defining things that have happened that really shaped your professional journey, like moments or you know, experiences that kind of led you on this path. If you were, you know, if you were 20 years ago, you, you know, as a medical student looking again at all of that, what do you think you would see?
Abby, MD: (04:16)
Sure. I think there have been deliveries on the way that have certainly shaped the journey. I remember as I was really struggling to figure out if I had figured, you know, chosen the wrong path within medicine. In the middle of my family medicine residency I had a very challenging, fairly traumatic delivery, a hard delivery, which really opened my eyes to the fact that I didn’t have the full skill set that I wanted to, to be able to deliver babies. I think that was one of the things that really made me recognize that I wanted to push myself further and get more training so that I could help out situations where birth wasn’t going exactly as planned. I think another really like defining moment for me in terms of, of training and figuring out the skill set that I wanted, um, came the first time I did a C-section on somebody who had pushed for six hours. It sounds really dumb, but I had only delivered babies as a family medicine physician. And I remember, you know when you start training as an OB GYN, you also do C-sections. And I remember the first C-section I did when somebody had essentially pushed too long, had really had obstructed labor and a baby that wasn’t going to fit. And I remember walking away from that delivery with a real recognition of how hard that C-section was and how if you push things too far in obstetrics, you actually can really put people at risk. On the other side of this, I think my own journey to motherhood has really shaped how I practice obstetrics. Particularly in being very aware of, you know, little things like having an IV placed and the medical interventions of birth. I think I’ve tried really hard since then to think about what is necessary and what’s not and how, how can we be making this amazing life experience for women feel like such, while also providing good care.
Maggie, RNC-OB: (06:27)
Yeah, I think that, I mean, that balance, obviously we’re all, you know, we’re all trying to kind of hit that magic mark, kind of the Goldilocks, you know, piece of it where we’re providing, you know, exactly the right amount of safety and support and guidance. While still, you know, preserving as much of that, really just kind of broad transformational power of birth as we can. And I love that you, you know, you talk about kind of the different trainings that you went through and how they prepared you because obviously in this, you know, in this industry, in this world, we need people who love taking care of, you know, really low risk, low intervention, they feel most at home, you know, in that kind of piece. And that’s where, that’s what just sets their heart on fire. And we need people who are, you know, willing and able to do a tremendous amount of studying to really be experts in complicated birth and to be able to help when things are not going right. And I love that you in your personal journey that you’ve been able to see kind of both, you know, both sides of that and kind of grow within that piece of it.
Maggie, RNC-OB: (07:29)
So tell us a little bit more about, you know, kind of, you talked a little bit about your, your births and how they impacted it, but how do you feel, like, do you feel like, like intuition plays a role in it versus kind of the book learning? How does those kind of go back and forth, you know, as you’re practicing.
Abby, MD: (07:44)
I feel like the longer you do this and the better you get, the more intuition and like the art of medicine plays into things. I really do believe that people who deliver babies really need a solid background and, and a background that relies on the expertise of people who have done this before us. But I always laugh. I think about, you know, the point in training where you’re really like book smart and detail smart. And then the part in training, you just get to a point where you can start to close your eyes and do it. And then I look at some of my more senior colleagues, people that have been doing this for a really long time, one of my partners in particular, she can just call things before they happen. You just, you get this real sense and, I don’t know, that comes with experience. So I do think intuition plays, plays a role. Yeah, I do.
Maggie, RNC-OB: (08:48)
I think it’s, as you said, obviously there’s, you know, we all kind of go through these different transformations as we’re practicing and each, you know, each birth that you get to be part of certainly shapes, you know, your understanding of what birth can look like and what can happen. And that, you know, I think you get a lot of value between people who are, you know, obviously paying attention to, you know, the best research and what is, you know, evidence based care showing us about stuff. And then still remaining that, that you’re there in the room and you’re, you know, you’re listening to what you know and what, you know, what the patient’s telling you, what your body’s telling you about what’s going on.
Abby, MD: (09:20)
I think there’s a real art to reading people, you know, to being able to meet people where they’re at, read them, figure out what their goals are and help them safely meet those goals.
Maggie, RNC-OB: (09:34)
Yeah, absolutely. And then, so I think, you know, it’s complicated as we’re kind of getting diving into what are all these different, you know, these different professions, kind of what is your role within, you know, within the birth world? I think in an ideal world, you know, we have lots of people involved in the care of, you know, each person going through pregnancy and birth and postpartum because none of us can be the one person for, you know, for anyone else. We really, we function best, you know, when we have that, that community, that village of support really surrounding someone. So can you just, you know, kind of talk a little bit more about the role of, you know, an OB within birth?
Abby, MD: (10:11)
Sure. So I think our role in maybe a better day sometimes is to take care of, you know, the births that don’t need as much intervention, to be there and to catch babies and to just get to celebrate in that moment with, with patients and their families. But we are also qualified to take care of women who become pregnant and have medical complications or women who suddenly develop a medical complication of pregnancy and need to be delivered, you know, falsely induced or have a C-section. We are the surgeons who do C-sections when, you know, labor arrests or there’s an emergency that arises. Um, and we are often the end point of transfers of care. So, you know, in situations where providers who do only vaginal birth have an emergency, we are there to be the backup to do, you know, vacuum deliveries, forceps deliveries, C-sections, those things.
Maggie, RNC-OB: (11:20)
Great. And then what are the, like if you can speak to what professional organizations that help to kind of, you know, guide or you know, kind of lead your practice as, as an OB?
Abby, MD: (11:31)
Sure. I mean American I guess they call themselves the Congress now or college of OB GYN. ACOG is really the national sort of governing bodies of OB GYN. We’re very lucky; it’s a very well organized group that you know, provides literature and guidelines, really helps obstetricians practice well. Um, and they practice, they’re hand in hand with American board of OB GYN, which is the governing body that makes sure that we know the things we need to know to practice and they take care of making sure that the obstetricians are certified. I think those are probably the biggest organizations; within family physicians who deliver babies, there’s American Academy of Family Physicians. It also is just a very wonderful group that provides a lot of evidence based information to physicians.
Maggie, RNC-OB: (12:31)
Yeah. And then, so, you know, do they have kind of, you know, I know as a nurse, like there’s code of ethics or kind of mission guiding principles, you know, like how do they, how do you feel like that kinda gets pulled together for, you know, OBs to kind of feel like they’re practicing kind of in concert with, you know, a larger idea? Or is that not present as much?
Maggie, RNC-OB: (12:49)
I mean, it is, I think really just jumping back when you graduate from medical school, I think there’s a real expectation and obligation that all of us practicing evidence-based, compassionate care and that you’re always doing what’s in the best interest of your patient, which can be sometimes a complicated thing to figure out.
Maggie, RNC-OB: (13:13)
Yeah, absolutely. Um, and then, you know, during, you talked about during birth the role you play, but how does your role play out during pregnancy and then in the postpartum period?
Abby, MD: (13:24)
So during pregnancy we do multiple visits with patients where, you know, we do exams and counseling about what to expect and same postpartum. Um, there’s been an effort for more postpartum care in the past few years, which is great. Because right now I think a lot of postpartum, I think we could step up how much postpartum medical care is provided to patients and support is provided just to new parents as they transition. Y.
Maggie, RNC-OB: (13:58)
Yeah. I think that’s something we’re definitely seeing, you know, internationally, but especially I think here in the US there’s a lot of groups that are starting to really work, you know, focus on that, that fourth trimester period and how we can, you know, across several different disciplines, really come together to provide a better, a better postpartum experience. You know, for people that’s more than just kind of a few touchstones, you know, here and there. All right. And so what do you, what do you feel is the most challenging piece, you know, for your role?
Abby, MD: (14:23)
Sure. I think I struggle a lot with time. I struggle with, um, having enough time with patients too. You know, not only make sure that I’m examining them and making sure their prenatal labs are right and that kind of stuff, but making sure that I’m really educating them, helping them make the best decisions, um, as those decisions relate to childbirth and time to build the relationships that we need, um, to make sure that we get patients’ trust going into the process of childbirth. That last one comes up a lot when we accept transfers of care as obstetricians. I think, um, you know, I am sometimes the recipient of a patient who has been managed by their beloved midwife an entire pregnancy and then things aren’t going well and it’s very hard to step in and you know, gain trust and get people to really believe that I’m making the next steps in care that are, that are necessary. Um, especially when things aren’t going as planned.
Maggie, RNC-OB: (15:33)
Yeah, obviously it’s a very, that’s a challenging situation, you know, to be in for, for everyone involved. And I think again, you know, in the magic theoretical world, it would be great to have, you know, have people know, kind of who the backup provider might potentially be. So you would have a chance to kind of already have a little bit of a, you know, established relationship when people aren’t in a scary situation, in pregnancy when something’s going awry or in labor when you know, if things have changed quickly. Um, cause it is a hard headspace for, you know, for the birthing person to all of a sudden just kind of pivot. And be accepting and trusting of someone else kind of coming into such a personal experience. And I wanted to see, you know, what do you wish, you know, the birth community knew about, about OBs you know, if you could kind of clarify, you know, misconceptions or, you know, something that you sometimes hear as, you know, issues that people have. What do you think?
Abby, MD: (16:27)
Most of us absolutely love what we do. Most of us love delivering babies. Many of us had one or two delivery experiences that, you know, sort of sealed our fate and made us realize that, you know, we really wanted to do this going forward. Um, probably really important to point out that we also don’t like love doing C-sections. That’s not really how most of us get our jam. That’s all.
Maggie, RNC-OB: (16:58)
Yeah. That’s great. And then what do you see kind of like the future of this role? You know, do you see anything changing with it over the next, you know, several years? Why would someone want to kind of pursue becoming an OB at the time?
Abby, MD: (17:10)
Yeah, I don’t know. I’m not going to be surprised if at some point there obstetricians and gynecologists, people that um, practice one or the other. Um, but I don’t see the field changing tremendously. I am hopeful that within the field we are able to move forward and make some changes that allow us to still be providing really safe and evidence based care for patients. And also, you know, make changes so that we are able to reduce morbidity and mortality, which is far too high in obstetrics and in this country. I’d like us to see, I’d like to see us cut down our C-section rate and I think this podcast will probably hopefully, you know, at some point go into the sort of why, why that is.
Maggie, RNC-OB: (18:15)
Yeah, absolutely. I think, you know, OBs, you know, are responsible for, is it 95%? of births in our country [editors note: physicians were responsible for 91% of US births in 2018¹]. You know, obviously the vast, vast majority are cared for by OB-GYNs. Um, and then, you know, smaller amounts by, you know, family physicians and midwives, from there. But I think obviously because of that, you know, there’s this, this great platform with tons of exposure, you know, to making changes, you know, to helping to solve some of these issues that we, you know, we continually see, um, are ending up with, you know, outcomes that aren’t as desirable and, you know, higher morbidity and mortality rates then we want to see. And so I think, you know, coming together so that you can, you know, highlight some of your experience and as we, you know, get into some of these topics and we’re bringing in guests and other people who have, you know, experience within that to share kind of, you know, best practices and what you’re seeing that has worked, you know, to help mitigate some of those issues and how we can kind of help, you know, spread and make some change.
Abby, MD: (19:12)
And I think it’s important to acknowledge that there’s not an easy or necessarily a universal fix to some of these problems.
Maggie, RNC-OB: (19:18)
And that’s the hard part, right? It would be awesome. We would all love to have like the one thing we could do that just like, yes, that would, that would turn this on its head and everything. You know, everyone would have great, you know, experiences and everything would just be, you know, just flow. But we also know that, you know, that’s not life, you know, because things constantly come up and birth is certainly, you know, one of the most unpredictable, you know, pieces of that. That’s, you know, things are going to, you know, change throughout pregnancy and birth at that alter from kind of what the goal or the hoped planned for was.
Abby, MD: (19:55)
It’s the first exercise in parenthood, right?
Maggie, RNC-OB: (19:57)
Right, exactly. It’s true. And you know, there’s, there’s so much we could do in terms of providing support to people while they’re in birth though and, and to each other. Cause this is hard. It’s hard work to be involved in and it’s hard to constantly deal with something that is, that is changing and so much out of our, our control that has such high stakes at the same time attached to it. So I look forward to kind of seeing, hearing more from you and you know, other OB colleagues, to kind of share, you know, share your experiences and make moves.
Abby, MD: (20:30)
I’m excited to be part of this.
Maggie, RNC-OB: (20:31)
Thank you so much for sharing. I appreciate it. Abby.
Maggie, RNC-OB: (20:37)
Thank you for tuning in to Your BIRTH Partners. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, we’re Your BIRTH Partners on all platforms, or comment on our show notes blog at yourbirthpartners.org. We would especially love to hear from any of our OB colleagues out there about their experiences and challenges that they’re facing, and we would also love to have particular questions you have about interacting with OBs during birth care. Till next time.
¹ Births: Final Data for 2018. National Vital Statistics Reports, Vol. 68, No. 13. Hyattsville, MD: National Center for Health Statistics. 2019.
004: Certified Professional Midwife Role with Ray
Maggie, RNC-OB: (00:05)
Hello, welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth, and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today we have our very own Ray Rachlin, certified professional midwife. You’ll learn more about their background, what brought them into pursuing birth as a career, and also you’ll gain a greater understanding about the roles that CPMs play in birth, how they are integrated, or not, into our healthcare system, and a little bit more about what we see as their future. On to the show!
Maggie, RNC-OB: (00:42)
Alright, so welcome. So Maggie here, I am interviewing Ray today to talk about what it means to her to be a midwife and her profession and learn a little bit more about her. Welcome, Ray!
Ray, CPM: (00:56)
Thanks for having me!
Maggie, RNC-OB: (00:58)
Yay. I’m so excited to be working on this with you.
Ray, CPM: (01:01)
Me too. I’m really excited to be doing this.
Maggie, RNC-OB: (01:04)
Great. Alright, so we’ll talk about just yourself a little bit. So tell us about yourself. What are your qualifications? What do they mean? Kind of how are you as a person?
Ray, CPM: (01:14)
Sure. So my name is Ray Rachlin. I use the pronouns she and they, I’m a certified professional midwife, a licensed midwife, and also a certified lactation counselor. And what does that all mean? So I trained as a certified professional midwife out in Oregon a few years ago. There are a couple of routes to becoming a midwife and I was a doula in New York city hospitals before this and I really kinda came to the conclusion with myself that I needed to train with normal birth. I needed to train with autonomy and, you know, I knew I was going to do home birth. So after a lot of research and talking to midwives and an internship, I decided that I needed to do all of my training out of hospital and also train outside the system. When I decided to become a midwife, it was before the ACA, so a lot of people were uninsured and I was curious about what, you know, midwifery would look outside the insurance system. On the other side of that, it’s definitely more complicated, but it does provide a lot more autonomy. So, um, in 2013, I moved across the country from New York City to Portland, Oregon to train at Birthingway College of Midwifery. There’s a couple of routes to becoming a CPM and I chose to attend a MEAC-accredited school. So I went to a three year program of like kind of butt in the chair coursework and then did my clinical training or apprenticeship at a busy birth center attending birth center and home birth. And I think one of the main differences with CPMs and CNMs is that we train with complete continuity of care. So I was training for, you know, seeing people from their first prenatal to, you know, their birth and all the way through six weeks postpartum. We also do a lot of postpartum care in our training as well as are trained to be primary care providers for well newborns. And you know, the birth center I was at also had an insemination program. So I got trained in that as well. And that’s been a lovely part of my practice. So it took me about three and a half years to become a midwife.
Maggie, RNC-OB: (03:18)
Okay. And did you work as a doula during that time or were you focused just on school and then apprenticeship?
Ray, CPM: (03:25)
I thought I was going to work as a doula, but there was no time, you know. And I remember at one point in my apprenticeship I like looked at my calendar and there was like, it was like this January and I was like, there is one day this month that I’m not going to be at school or work or my apprenticeship and I also will be on call for six births. So like, you know…
Maggie, RNC-OB: (03:45)
[laughter] there was not really a day off!
Ray, CPM: (03:46)
I did a lot of weird things in midwifery school, like I worked as a placenta courier. I nannied, I did tailoring, just a lot of odd jobs to get by. I was on call for like four to six births a month and was attending them from start to finish, in addition to a full clinic schedule, and like lots of postpartum home visits and you know, like eight to 15 hours of classes.
Maggie, RNC-OB: (04:14)
A very full schedule. I think the on-call lifestyle, you know, we’ll talk more about this, but I mean the on-call lifestyle, it, it takes a lot out of you to be able to, you know, balance everything else in your life along with supporting birth.
Ray, CPM: (04:27)
It’s, yeah, it’s intense. When I was done with my training, like my body just like fell apart was like, you can’t do that again. Um, but yeah, after like three and a half years I was able to sit for NARM, which is the certifying exam for a certified professional midwives. And that gives me the ability to get a license. I believe in now 33 States, uh, in the U S where we can practice, you know, independently. In New Jersey where I’m licensed, I can only attend home births, and in some States I also can work in birth centers. And then I also practice in Pennsylvania, which is really interesting. There’s a statute from 1929 that says that direct-entry midwives, you know, are a part of health care and that we should exist and we should be regulated. And then they’ve never written regulations. So we practice in a weird legal gray area, but also can do all the things midwives need to do, like filing birth certificates and newborn screening and you know, congenital heart defect screenings. So we’re like somewhat integrated, but pretty poorly.
Maggie, RNC-OB: (05:28)
Okay. All right. Obviously plenty of work to do. Yes. So what, like what brought you, you were a doula at first in New York, What brought you to the birth field?
Ray, CPM: (05:39)
I started off in politics. Um, I worked, you know, in the labor movement, or the other labor movement, and was really, you know, looking to like I guess change the world through community organizing and just felt this like real gap in between, you know, maybe ideals and you know, tangible like how people live and the support they needed. And you know, I was kind of having maybe like a little bit of a crisis of faith with what I had chosen to do. And a friend of mine had suggested, becoming a doula and I spent a couple months ruminating on it and I was like, you know, if I took money off the table, I want to learn how to support people. I knew nothing about childbirth. I was like 21. Um, but I was like, I want to learn how to support people and see where that goes. And I didn’t think I was going to change fields, I didn’t know birth work was a job, but it all kind of unfolded really incredibly. Like a week before the doula training I signed up for, I found out I was going to get laid off from my job, which, and then I went to this training and was like blown away where I’m like, ‘Oh, this amazing thing happens to our bodies and it’s designed to work. And then you provide this arc of support and it really changes things and it’s a job.’ So I, yeah. So I had the opportunity to like build a doula practice while collecting unemployment, which was really amazing. And I then became a postpartum doula, and then I was doing placenta encapsulation, all the things that start unfolding when you’re doing birth work and, but you know, I was attending really intense, rough, violent births in New York city hospitals and, you know, I didn’t know it could be different until I attended my first home birth. SO it was probably about a year into doula-ing, and it was the absence of intervention that was really startling to me. And it’s not that, you know, the midwife was providing the same safety that we do and they can provide in a hospital setting, like monitoring the baby, monitoring the parent’s vitals, but the person in labor wasn’t having to work around the hospital systems. They weren’t being like, “Oh, we lost the baby, come back to the bed and get on the monitor.” Um, it was, you know, just leaning over, you know, or under or through just all these ways that like midwives work around people and labor, and birth looked completely different. Like, I didn’t know birth could look like that. I didn’t know people could have that kind of, I mean all birth is beautiful and amazing and like meeting your child is incredible, but what it looks like to be treated with respect and have autonomy in that process really was mind blowing.
Ray, CPM: (08:14)
It was unlike anything I’d ever saw and by the time I left, you know, this birth in this basement apartment in Brooklyn, you know, the next morning I was like, that’s what I need to do. I’m doing the wrong thing. Like I need to be a midwife because I want to help people have this experience. I think this experience changes things. And also if hospitals have to compete with what I’m doing, they’re going to have to behave better. You know? Cause like 1.36% of births happen at home in the U S, like, that’s probably not going to change dramatically. But when I trained in Oregon, what I was really startled by was how Portland had a 4.5% out of hospital birth rate and hospitals behave differently. They behave better. They have to compete. Midwives, they’re more patient, they’re more kind. They asked for consent, NICUs have rooming in. Like it’s, you know, I think this model of care emanates. And so I am really excited about this podcast because I think helping this model of care like is gonna not that like I’m, I don’t need to convince people to have home births or whatever, but making this like more accessible and also more mainstream is going to change how hospitals provide care and that’s going to help everyone.
Maggie, RNC-OB: (09:24)
Absolutely. I don’t think, I think a lot of people who search out home birth are not necessarily hooked on the idea of having their baby in, in their actual home, in their domicile. What they want is the type of care that goes along with that kind of focused, you know, delivery. And so I definitely think there’s, you know, there’s definitely work to be done with that. And I think so much of it is seeing, I love how that’s like that exposure shaped your professional journey. And I agree that through, you know, the podcast and as we talk about these topics and get into options out there that both, you know, birth workers and providers and also consumers just get more exposure to what what is possible and how birth can look so that they can line it up with their own values and what their goals are, you know, from the experience. And so I love that. Yeah. How do you feel like, you know, we talked about your professional qualifications. How do you feel like personal experience and intuition kind of play into your practice?
Ray, CPM: (10:18)
What a good question. Let’s see. Yeah, I think they’re probably the unique thing about being a home birth midwife or a certified professional midwife is, is how much relationship based care I get to provide. And you know, it’s like we have the like clinical training. I’m screening for the same things the hospital-based providers do, but I really get to know how someone looks, what, how they operate, what they’re like, the quality of their baby’s heart tones. Um, and it really, it really allows to like notice more subtle shifts that I think is really unique. Um, I think there’s, you know, like I’ve, I’ve talked to folks before about how, you know, oftentimes when my clientele, when someone’s developing preeclampsia, you can see it in their face before you see it in their blood pressure. And that only comes from like seeing someone for like an hour every month and then every two weeks and then every week. And when we can detect things earlier, we can help do more preventative things to help maintain their blood pressure and get their baby to term.
Maggie, RNC-OB: (11:29)
I love that. That’s awesome.
Ray, CPM: (11:30)
Yeah. And then it also allows for like that kind of, you know, just having a relationship and connection and labor. So if someone starts sounding their quality, their sounds are different. Like I notice that there’s a shift. I can notice that there’s a shift towards birth or also that there’s a shift that like something is stuck and maybe what we’re doing isn’t working. And it’s like time for a change either in what’s happening at a home birth or in environment to a hospital, ,where there’s, you know, bigger tools.
Maggie, RNC-OB: (11:55)
Right.
Ray, CPM: (11:56)
And you know, I think there’s an aspect of like midwifery that has like a very spiritual component that, you know, I don’t know if I can articulate very well, but also I really, the longer I do this, the more I’m able to like kind of tap into of like, you know, it’s not my job to like make people have this experience or that experience. It’s just like I’m holding space and like going as deep as, as needed to like to see people through. And yeah, there’s like, maybe it’s like this is a really long tradition that people have been doing for, you know, birthing folks for as long as humans have existed and like, and I dunno, maybe the longer I do this I get to like kind of tap into that lineage. Yeah. I don’t know. I feel like I’m pretty protocol-based as a midwife, you know, it’s just like this is what I do. And there’s like, this is where I can provide safety and this is when you know, when that situation has changed. And I think a hospital transfer or hospital birth is safer and I’m always really clear with folks about that. But then there’s all the things I can hold that are really like unique and special. And I think so much of it comes from just really knowing the families that I work with.
Maggie, RNC-OB: (13:03)
That’s beautiful. I love it. So, future visioning here, where do you see yourself in 10 years?
Ray, CPM: (13:10)
Ah, I don’t know. I think, I think midwifery is going to continue to change in the U S like it’s not a given. The system is a mess. It’s really poorly integrated and we see that because we don’t have good outcomes in the U S.
Maggie, RNC-OB: (13:22)
Right.
Ray, CPM: (13:23)
I would like to see midwifery change, and also there’s a lot of barriers to getting there. But you know, I, I have a lovely solo home birth practice in Philadelphia. You know, I get to serve my neighbors as well as, you know, families, you know, far out in like this County or that County. Yeah, I did like two home visits an hour away yesterday. And, and I really, I really love the care that I get to provide and the community I can build from having a solo practice where like, you know, I have like potlucks for like my clients and like, um, I organize get togethers for queer families that are trying to conceive just because a lot of them have a lot of isolation in this process. And I want to, I’m so curious of like what we can do to like bring the community building around birth and families forward as well as how do we move this profession forward to where everyone has a midwife and can access the care that they want and need.
Maggie, RNC-OB: (14:21)
I love it. I can’t wait to see all of that come to fruition. So kind of pivot a little bit to talk just a little bit more about your role and your profession. So you talked about your schooling. So what kind of the professional organizations that back up being a CPM, being a licensed midwife, how does that work?
Ray, CPM: (14:38)
Yeah, so our accrediting body is the North American Registry of Midwives and so I just had to renew my certification and that was, you know, expensive like paperwork, CEU-filled process. And so probably much like other providers, I had to take a bunch of classes and renew my CPR and NRP, which is neonatal resuscitation and update all my protocols because I could get audited. So you know, in the CPM world we have like a scope of practice, but we also get to like have a lot of independence and practice. So it just being like “this is how I manage anemia, this is how I manage gestational diabetes.”
Maggie, RNC-OB: (15:17)
Okay.
Ray, CPM: (15:18)
There are some places, like in New Jersey, where I have criteria that are my risk out criteria, which is great. And then in Pennsylvania I don’t, so I use my Jersey criteria, things like that. And then there’s also a couple of professional organizations. So we have MEAC or Midwifery Education Accreditation Council that accredits our education programs. There is, I believe only like nine CPM programs right now that are accredited. Don’t take my word for it. It could be 10, it could be eight. Um, some are distance, and some are kind of button butt-in-the-chair, which is what I did. And then there’s also a couple of professional organizations. So MANA which is the Midwife Alliance of North America has been around for a really long time and it holds space both for like CPMs, nurse midwives and traditional midwives. So people who’ve chosen maybe not to get a credential and have only trained through apprenticeship in one form or another. And I don’t participate in MANA. I felt kind of complicated about some of their politics or lack thereof in the last few years. But I do participate in uh, the National Association of Certified Professional Midwives or NACPM and a, it’s an organization that has taken the CPM credentials like, yeah, like how do we make this, you know, like midwifery care, like, you know, evidence-based, like justice-based and accessible. And part of that has been through supporting licensure campaigns so we can get Medicaid, um, or you know, and also be better integrated into health systems. So, you know, my state has a state chapter of NACPM, which is the Pennsylvania Association of Certified Professional Midwives and I am our chapter’s president. So I am pretty involved in just yeah, organizing midwives throughout the state of Pennsylvania to, you know, be connected to larger midwifery efforts and also have opportunities to organize for our own licensure when they arise.
Maggie, RNC-OB: (17:21)
That’s great. I think that having that community piece, it’s, you can’t beat it. You really need to be able to have, you know, people that draw from and learn from each other and what you’re experiencing. And I think it’s interesting how you were talking about the different, you know, you have kind of criteria in New Jersey but not in Pennsylvania. And I think being able to discuss that amongst, you know, midwives who are working in so many different States every year, there are so many different layers and how they’re able to provide care, what they’re allowed to do legally. And I think as we keep working on legislation to kind of, yeah, level the playing field a little bit, there’s going to be a ton of growth there.
Ray, CPM: (17:53)
Yeah. The scope questions are, yeah, really crazy. You know, like what I can do in Maryland as a CPM is different than what I can do in Delaware, which is different than I could do in Jersey, which is different than what I can do in Pennsylvania. Yeah. Like we all have the same trading and like, you know, there’s a BMI cutoff here and there’s like, no breeches here or, and yes to twins here, but you can’t carry oxygen like it’s all over the place. Yeah.
Maggie, RNC-OB: (18:21)
And so what do you, what do you feel like the most challenging pieces for the role for being a CPM right now in the U S?
Ray, CPM: (18:27)
The lack of understanding of my profession and integration. You know, I think the ability to consult and transfer with hospital-based providers is essential to me providing safety, and it is a fight every step of the way. Um, and it can be simple things like it took me seven weeks to get an ultrasound from a patient in New Jersey that I ordered, where I’m legally able to practice, you know, and I just like want to be able to counsel my client on her anatomy scan…to, you know, misunderstanding or mistrust when you know, greeted at a hospital, if during the labor transfer. I think, yeah, better understanding and ability to work together will elevate our profession, make home birth safe. You know, I think the data is really clear that like home birth is safe in well-integrated health settings where you know, providers can collaborate and transfer well. And so as a CPM and someone providing home birth, it’s my responsibility to seek out those relationships. But it’s really individual and based on like, you know, this midwife I know here or this person I know there versus it just being system-wide and like why, you know, when I have a client who’s giving birth like in the suburbs or rural area that the best way I can transport her is to bring her to the city. It’s just not, it’s not acceptable like right.
Maggie, RNC-OB: (19:46)
Yeah. That’s not that. It doesn’t help the safety piece. And I think like you said, that integration in the system, that’s, that’s what we see as crucial. It’s not about home birth in and of itself. It’s about how it works within, you know, the rest of the system and how we’re able to transition care, you know, back and forth when needed.
Ray, CPM: (20:04)
Yeah. And then it’s like I’m not scared of the hospital. Like I really, you know, I have a transfer rate of 20% I feel really good about that because like I’m having like safe normal births at home and when, when the situation changes, I don’t, I don’t hesitate to go in. And that’s what makes home birth safe. But what is the next step, right. No to like making, you know, our welcome like us to be well received for me to easily be able to get a non-stress tests for me to not have to like fight with my client’s insurance companies to cover labs that I drew because I can’t be in-network because of our licensure or lack thereof.
Maggie, RNC-OB: (20:39)
It’s incredibly frustrating.
Ray, CPM: (20:39)
And then even in NJ though I have a license or, and I can’t take Medicaid, there’s just all these places that, you know, I think the CPM movement really started from a place of “let’s create our own credential before we’re regulated upon.” It was, you know, the 1970s like white people starting to attend each other’s birth because they didn’t like what was happening in the hospital. And while black midwifery was kind of being pushed out, there are like a lot of, you know, awesome black midwives in this movement as well. But this has definitely been like, a white-dominated process.
Maggie, RNC-OB: (21:11)
Yes, absolutely.
Ray, CPM: (21:14)
And you know, we created this credential, we’ve created our own, you know, we’ve self regulated, which I feel so excited and proud about. And also we’re not integrated, you know, and I think there’s a lot that’s really gained in being independent healthcare providers that are more outside of this system. And also it makes, because of the resistance to us, and like assessing as incompetent or whatever kind of prejudices that come about. It makes it a lot harder to do my job well.
Maggie, RNC-OB: (21:44)
Absolutely. So I think the last question I have for you is just, we’ve touched on this a little bit, but like what is the one thing, because I think there’s just a lot of misunderstanding about all these roles. Um, you know, what do you wish the birth community knew about your role? What is, like, the one, the nugget of knowledge you can give them that would help them to have better awareness of what you really do and provide for birth?
Ray, CPM: (22:04)
I think I want to say like the words of Christy Santuro who’s an amazing CPM here in Philadelphia has been practicing for like 20 years, is that this is not, “this is a model of care. It’s not a place of birth.” You know, it’s a model of care that’s like deep relationship building. Really learning about our client’s needs, providing informed choice in really unique ways. Like going beyond like this is… I think a doctor once asked me what the difference between informed consent and informed choice is and that we’re giving people the information for them to make their medical decisions, not consenting them to do what I want.
Maggie, RNC-OB: (22:37)
Absolutely.
Ray, CPM: (22:38)
What it means to like really trust the families I work with to make the right medical decisions for their pregnancy and their family and how I’m doing that to translate into empowered parenthood and you know, and then I provide, I mean, you know, awesome attentive care during birth but more importantly a come to their house, you know, at one day and then three days and then seven days and then two weeks I check on them and their baby, I am sent pictures of people’s belly buttons or baby’s belly buttons even be like, “is this normal? What do I do? This just came out of me!” Like every body part and fluid that can be attached to that. I’ve gotten a text picture of and it’s about that kind of care and seeing people through, so they’re confident, comfortable and supported and empowered parents. On the other side of this, you know, a big part of like postpartum mood disorders is the lack of support. And this is about, I’m building a relationship prenatally, having a birth experience where someone is like respected and heard and then having the support afterwards to prevent mood disorders and ultimately like help people have healthier parenting. So that’s, that’s why I do this. It’s to prevent and reduce trauma and heal the next generation of kids.
Maggie, RNC-OB: (23:50)
I love it. I think that is so important. I think the idea of that support that it’s lasting all the way through, that’s a huge thing. Uh, I’m working on a project, the hospital that I work at right now to do that as well because it’s something that is really sorely missed in typical hospital settings just because of the way care is, you know, arranged. And I love that in community birth it’s just, it is such a strong current all throughout so people know where to turn at any point during, you know, pregnancy, birth and then postpartum and I’m sure much beyond that typical, you know, six weeks to a year of postpartum time. I’m sure you hear from clients past that as well.
(24:22)
Oh yeah. People texting me about their toddlers and I’m like, I am not an expert, but that’s what it’s like to be trusted with this time.
Maggie, RNC-OB: (24:30)
I love it. That’s wonderful. Well, thank you so much Ray, for sharing about yourself and about CPMs and I am very excited to see where the profession is going to grow.
Ray, CPM: (24:37)
I’m so excited to be a part of this podcast. Thanks for including me.
Maggie, RNC-OB: (24:42)
Thank you, Ray, talk soon.
Ray, CPM: (24:49)
Talk soon.
Maggie, RNC-OB: (24:49)
Thanks for tuning in to Your BIRTH Partners. We love to talk birth, and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, we’re Your BIRTH Partners on all platforms, or comment on our show notes blog yourbirthpartners.org. In particular, we would love to hear any questions you have about CPMs and the roles they play during birth, and from our CPM colleagues. Please tune in with your experiences, and challenges you’re facing, and the path you’re paving to take care of people during birth. Till next time.
005: Doula Role with Pansay
Maggie, RNC-OB: (00:06)
Hello, welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we have Pansay Tayo on the line. She is our doula and we are going to learn a little bit more about her background, what drew her to birth and how she lives that out in her many different roles. And you’ll also gain a greater understanding about the roles that doulas play during birth, and hopefully clear up some misconceptions that we often find about what their role is. Onto the show!
(00:45)
Hello, Pansay! Tell us about yourself.
(00:49)
I am Pansay, and yes, I am, I’m a doula. In addition to, a placenta encapsulator, I also assist at home births. I do take great pride in assisting my moms through ritual and ceremony for pregnancy and birth, and also, you know, beyond. What does it mean to be a doula? When I think about my position as doula, just like majority of my other work, I model it, um, after how I seen my grandmother protect our family. And her role in the family. So for me, um, she was number one… She, I felt safe, you know, she, she was the protector. Um, she always made sure that we were, um, nourished, well, you know, through food, um, spiritually, she made sure that we were nurtured and nourished. It was, you know, through her that I really knew what strength was, you know, and what it looked like. So being a doula, you know, I take the words very seriously, you know, saying that I mother the mother because the reality is that in this day and time, our family dynamics are not set up the same. We have, you know, we have lost a lot of our sacred rituals and ancient traditions when it comes to rights of passage in pregnancy, you know, in birth. For me, even in my childhood, you know, it was, I was taught, you know, to be strong, you know, you sick, suck it up, keep going. It was that way through everything, but with that we suppress so much. We suppress fears, we suppress traumas. What happens, and I, you know, I really learned this through home birth. What happens when it comes to pregnancy and birth from us not, you know, tending to our inner selves from us, not attending to our spiritual selves, um, is that when we go through life, um, disregarding those parts of our being, it shows up and it impacts your birth because we are so open and vulnerable at birth. If you have, you know, fears or, using my myself as an example, being raised without a mother at that moment, I want my mother and, and the sadness, it comes up. And when that sadness comes up or that fear comes up, what happens? Our sphincters close up. So just as much as, um, you know, the midwives or the OBs, they tend to the physical body, who’s tending to the whole woman? And, um, throughout my doula training and midwifery training, that was the part, um, that I felt was missing, you know?
Maggie, RNC-OB: (04:16)
Yeah.
Pansay, Doula: (04:16)
You know our midwives take a very personal, um, role, with our mothers, but, you know, but even with that, I think we need to, I’ve seen that we need a little more mothering, you know, so, um, being a doula, it is, it is truly, truly from the moment I meet a client, it is mothering the mother. And my goal is to nurture and nourish her whole being, her spirit, her mind, you know, and her body. And throughout our time together, um, I introduce her to practices, you know, so that she can do that. And most of us, you know, it’s, you know, it’s work tending to the kids, tending to, you know, husband, um, we do not incorporate time for sacred space, sacred solitude for journaling to, um, to get to know ourselves, to even address our fears and traumas and those things. So that is, um, the foundation, you know, of my doula work and what I have found and I, I know a book or something is coming, cause I just have all of these, all these women that I see all these amazing transitions, but I’ve see the birth of the mother when you mother them through this sacred, you know, time. So yes, baby is born, which is a magnificent thing. But when you see the birth of the mother, the new woman that is born and all the realizations and you know, her even, um, wrapping her mind around the strength that she had to bring forth that life to accomplish this task, that she didn’t think she was capable of. Especially our moms who have been in a presence of, you know, an OB, who have told them that they cannot, you know, bring forth this baby in the way that they, you know, want to. So when they have those naysayers and those, those people that were against them, and then we meet and it’s, you know, with that nurturing, you’re building them up and you’re building them up. And the more you make them feel safe, the more confidence, you know, they have. Bringing them, um, you know, through that, it’s really seeing a new woman, you know, um, that’s birth. So that’s, you know, that’s much bigger than what I was taught in my training.
Maggie, RNC-OB: (06:46)
And what shaped your professional journey, kind of what has been your, your path through it?
Pansay, Doula: (06:52)
Oh, boy what shaped it? It was my own, my own personal taumas and um, and loss, so many miscarriages. And even to the point where I was told I could not have another child. So you know, from that, you know, I, I met a, um, a chiropractor, a naturopath, you know, doctor and he couldn’t even believe somebody even told me that, but he said, “no, no, Okay. I know that you can.” Like, really? “Yes, but what do you need to do?” And he gave me those things you need to tend to your whole self. So that was getting my nutrition in order. That was dealing with, you know, my trauma. Um, so I had to get the whole woman together and once I got my, my whole self together, um, my baby girl is 10, now, you know, she’s here. So that was one of the biggest, um, components or experiences that shaped my, you know, work, um, for, you know, how I doula my moms.
Maggie, RNC-OB: (08:03)
I love that. And then how do you feel like, you know, that weighing back and forth between kinda, like that professional side of what you’ve learned in trainings and, you know, kind of your approach and how do you weigh that with, you know, personal experience and intuition and how they play into your practice?
Pansay, Doula: (08:17)
Well you can probably imagine that, you know, when you take a training, um, for a specific profession, but your intuition, um, or you know, spirit is telling you to do things differently and you’re not seeing anybody else, you know, do that. Um, you tend to wonder if you are making a mistake, you know. But I truly felt that it was so needed and I felt that if I had had, you know, that same mothering that things would have been, you know, so different. So, you know, me trusting for one, my own experience with, you know, bringing my daughter here. That had to be, you know, trust. I had to, to truly trust and believe and having people around to support that, yes, she’s fine. You know, you’re going to, you know, bring her forth that, you know, encouraged me and built my, you know, intuition. So those experiences help, you know, helps me to relay or give that, you know, give that same love and support, you know, to my clients to instill in them the importance that your body knows exactly what to do. And for the most part, all of our answers are within, you know, so giving them the tools to even realize what intuition is, you know, giving them the tools, the tools to tap into it, you know, sacred space, um, in those types of things. But the importance of it when it comes to pregnancy and birth of trusting, you know, yourself and trusting your intuition when it comes to such a sacred time.
Maggie, RNC-OB: (10:02)
Yeah. So powerful. And so then big like future planning. Where do you see yourself in, you know, 10 years? What does the next decade look like?
Pansay, Doula: (10:14)
I hope the next decade definitely, um, brings me fully into my midwifery training. I know the little ones will be, you know, growing up, you know, so fast. So once I get them to a certain place, I will love to dive back into my midwifery studies. Um, I am getting more requests to travel, to bring, you know, sacred ceremony and ritual. So that is a goal of mine is to take it, take those trainings, um, to wherever it’s needed so I can fill those voids in communities. Um, just like I’m doing here in Maryland.
Maggie, RNC-OB: (10:55)
That’s awesome; that’s wonderful. I can’t wait to see how, how your journey grows through that. And then, so kind of switching away from you personally a little bit, but tell us, you know, you can a little bit more about just kind of doulas, what, you know, what does that role and profession mean? What kind of like schooling or training options are there for people if they’re thinking that, you know, all of this sounds great and they want to learn more about either what it means to be a doula, kind of how that works.
Pansay, Doula: (11:19)
Okay. Well, I took my training, excuse me, here in Maryland with Nilajah Brown, which she is definitely a blessing to our community. She’s trained, um, majority of the black doulas here. So I think it’s in this day and time it’s more, it’s, it is easier to find all the trainings. I’m starting to see, you know, more and more, I’ve even seen online, um, training, but, um, yes, through doula trainings and then from there, um, you know, expanding your services, which means you have to, um, you know, look for more training specific encapsulation, um, and you know, other, other things like that.
Maggie, RNC-OB: (12:05)
Alright. And then how many, um, how many births is it typical for doulas to kind of, to observe and participate in before they’re, they’re out practicing on their own.
Pansay, Doula: (12:15)
Oh, okay. We are required to attend three births before, you know, before we’re certified. Um, there are, you know, it’s a list of other prerequisites before you get that certification that you have to do, you know, read books and, um, classes, you know, breastfeeding classes and you know, all that. But three births before you can get up there.
Maggie, RNC-OB: (12:38)
Perfect. Okay. That’s great. And then what do you feel like, are there, you know, are there any professional organizations that kind of help to guide or kind of shape, you know, what, how doulas can kind of practice. How does that, how does that like bigger doula community kind of interact in and play in with each other as you’re practicing? Do you see a lot of kind of, kind of go back and forth between people exchanging ideas and tips or are there different like conferences or how do you kind of find your spot within that?
Pansay, Doula: (13:09)
I have to say that, you know, when, when I first became a dual, I felt that it wasn’t a lot of support there. You know, what the saying is if, you know, if you don’t have it, you know, created yourself. Thankfully, you know, as I grew in my position that I, you know, more relationships were built, you know, with midwives and other doulas. I then created a mentorship program because, you know, I know I struggled, I can remember being in hospital room and just so nervous and just having a question and didn’t have anybody to call and that type of thing. So, I now have a mentorship program hoping to, you know, expel that for all, all the new doulas so that they have, um, they have ongoing support, you know, and also, you know, it increases, their experience, you know, within this new career that they are taking, you know, within Maryland, um, as you know, we do have a very nice birth community.
Maggie, RNC-OB: (14:22)
Absolutely.
Pansay, Doula: (14:22)
Yeah. So, you know, we have Maryland birth network, which is beneficial to moms and also, you know, birth practitioners. I do have a monthly doula support group virtually and sometimes you know, in person where we kind of, you know, get together and allow those doulas to kinda like mothering the doula, you know, them, you know, talking about their birth experiences and different traumas they might’ve experienced, you know.
Maggie, RNC-OB: (14:53)
Sure. Yeah. And I think that’s, I think it’s so important to have that sense of being able to kind of come together and talk with other people who are experiencing that. I know a lot of times obviously as you know, as a doula you are working one on one with a client. Um, and so we usually are there with the other birth workers, providers, whoever is taking care of, you know, of the client. But you don’t necessarily, you’re not processing, you know, things with them. And then, you know, the birth experience ends and you know, then you’re kind of on your own. And it’s so important to be able to have those people to turn to and try to get ideas for how to, how to handle situations as they keep progressing. So I love that. And I love that you’re developing a mentorship program. And so let’s see what else, you know, can you just tell us a little bit more kind of generally about, like what the role is that doulas play during pregnancy, you know, through birth and then into postpartum? Like how are, how does that service kind of play through?
Pansay, Doula: (15:47)
It plays, I know, you know, um, unlike what so many people I that I see, think would doulas are right. So, you know, they think that we show up at births and we rub backs and you know, that’s what I hear.
Maggie, RNC-OB: (16:01)
Okay, sure. Yeah. [laughter]
Pansay, Doula: (16:02)
Which we do, but it’s so much bigger; it’s so much bigger than that. Again, getting back to that family dynamic, you know, everybody’s so busy, you know, so, sometimes it’s very difficult for clients to have that one person that they can call anytime, you know, for the most part that they, you know, when they have questions, when they are feeling, you know, fearful. So for one, we are the support, we’re their support, we’re the moms, you know, we’re their ear. I attend, you know, attend doctor’s appointments, you know, with my clients. I definitely find that some of my clients, I’m sorry, a lot of my clients are very nervous about asking, you know, asking doctors certain questions, you know, um, and they asked me to come, well for this particular appointment, can you, you know, come cause I want to ask, you know, X, Y, and Z. So, you know, we’re, we’re their little confidence in a corner, you that support, um, with that. So we attend, you know, doctor’s appointments with them. We educate them on everything dealing with, you know, pregnancy. In addition to, you know, um, natural and holistic remedies, if the client is trying to stay away from, you know, synthetics and medication and those things. In addition to helping them to prepare, we want them to prepare for the best birth and for the birth that they want. So educating them, what are the things that you can do to stay healthy throughout the pregnancy? How nutrition, you know, in food, is so important with a healthy pregnancy and birth. Giving them all of the options, you know, from, from the time they are pregnant, until you know, postpartum. “Okay; what are all my options, you know, with this?”. Even the locations, you know, where I can have a baby, you know, it’s so many different locations and it’s, you know, you meet some clients and they have no idea what a birth center is, you know, and didn’t think that they could, you know, go to a birth center. So it’s really, support, you know, education. Just reminding, reminding them of their power because they, you know, they’re already powerful. Just being a reminder that they can, that they were built for the task of bringing forth life, that they’re capable. The education, you know, the education piece, childbirth, education and preparation, and also most importantly, you know, postpartum, we kind of drop our moms off, post- baby, you know.
Maggie, RNC-OB: (18:46)
YES.
Pansay, Doula: (18:46)
But the importance of tending to themselves, um, you know, for postpartum and how, you know, if it’s not done, how it affects us in later years and even when we, you know, once you conceive again, so, the importance of nutrition and resting, and you know, breastfeeding, even to the extent of, you know, choosing pediatricians, you know, it’s a lot. It’s a very beautiful relationship.
Maggie, RNC-OB: (19:17)
Yeah. Yeah. I love it. And I love it. I love the relationship quality of it and how I think that piece of going all the way through postpartum and then obviously, you know, beyond that initial piece of it, I think it’s so important for people to feel like they have an ear, they have someone who can, you know, who they can send a quick text or a picture, you know, whatever, to and know that they have someone who is, who is still invested in, you know, in them and their baby’s wellbeing. And really still wants the best for them beyond birth. So that’s beautiful. All right. And then if you could just kind of tune us in a little bit. What, what do you feel is the biggest challenge, you know, facing your role?
Pansay, Doula: (19:55)
I truly, truly feel that, with the climate being what it is, with my sisters, black women dying in childbirth, the challenge is really getting that word out to them, um, to having my sisters understand that it’s not, you know, as simple as choosing a OB, having my baby and coming home.
Maggie, RNC-OB: (20:22)
Mmmhmmm.
Pansay, Doula: (20:24)
It’s, it’s real. The numbers are there, you know, to prove it. So, um, you know, childbirth education, you know, getting, stressing the importance that women, black women, you know, get that education, you know, beforehand. In addition to, you know, going to these doctor’s appointments with them, you know, helping them to understand what’s being said, um, by the doctor, you know, assisting when I need to, you know, assist, you know, asking questions about, you know, pros and cons and benefits and, you know, options, period. But there is a large, um, number of us that think that, you know, that the hospital and doctors have our best interests at hand. Um, so that challenge is, you know, really stressing the, you know, the importance that this is a serious crisis and, you know, we have to really be vested, um, put the energy, you know, the monetary finances, you know, into it, getting a doula, you know, taking time to finding the right provider, you know, for you. So right now that’s, you know, that’s, that’s it. Yeah.
Maggie, RNC-OB: (21:48)
Yeah. It is. I mean, it’s obviously, it’s a huge challenge and our, you know, in our country we’re not doing a good enough job across the board, um, for maintaining, you know, maternal health during birth. And we, there’s a huge disparity. You know, we see so many more, it impacts our communities of color so much higher than, than anyone else. And that’s, you know, it, it’s hard I think for, you know, providers to accept that sometimes because we don’t want that to be the reality. But it’s really important for us to look at those numbers and realize that and then turning our attention so that we can actually do better. You know, by these communities that are being most impacted by these policices. And like you said, I think, you know, it’s, in every area of healthcare we need to be, we need to have autonomy, we need to take ownership of our health. So every one of us has different goals and different desires, you know, for our health and then in birth. And so it’s unrealistic to go to anyone, you know, provider and expect them to know that and to be able to provide everything you know, that we need. And so, like you said, empowering ourselves with education and making sure people understand that, you know, they need to really be able to have conversations, you know, with their provider to make sure that they’re on the same page because everyone doesn’t want the same thing and you can’t expect anyone else to read our minds. So we need to be, you know, as, as patients and as advocates, you know, for our clients, we need to be able to step up and make sure that whatever their desires are, there’s a range, that they’re being met. And I mean, absolutely, I think for that, it’s a huge challenge for doulas to find that, that balance, you know, between advocating, um, you know, for their patient without stepping over these lines. And it is, I think it’s, you know, there’s a ton of work being done all throughout the country as people are really tuning in and seeing these disparities in healthcare and how they’re impacting, um, you know, our world and it’s, we’re not gonna, like I know we’ve talked about before, but we’re not getting anywhere without our moms and babies along for the ride with us. And we need to, we need to do a better job on earth about setting us up for a positive, you know, dynamic going forward.
Pansay, Doula: (24:07)
Yeah. And you know what the other thing I see is, you know, really teaching them to advocate for themselves, you know, generationally. You know, I know for my generation, before I got to this work, it took my father a while before he, you know, I’m telling him, okay, you need to ask questions. You just don’t take what they say and just walk out, walk out the room, so what’s being passed down. What we are being told from maybe our mothers or, you know, “just go to the hospital, just have that, you know, C-section.” Really reclaiming our position in birth that, you know, and the naturalness of it and how well we used to, you know, do it, you know, on our own and trusting, you know, trusting our instinct. So, um, you know, with helping moms to get that position back, it’s a beautiful thing because they need it, you know, they need to be able to advocate, period. Just for motherhood, you know, for your child. Um, so switching that mindset, you know, that you need to take charge, that this is your baby, your body, you know, your birth. It should be your way. Yeah. Thankfully I see it’s working, you know. Um, but yes, that definitely a challenge.
Maggie, RNC-OB: (25:15)
Yeah. And I do, I think, I mean doulas are, I know they are, I think they’re just such a great tool for people to really help and step into their confidence. So having someone who’s really 100% in your corner, um, it helps to give you a little bit more of your voice and you know, just start to regain that, which is so important. Obviously as you go through parenthood and you’re constantly advocating for your child and what’s in their best interest. And I mean, you know, we just, we see so many positive impacts that, you know, doulas have both on birth and then kind of that longterm sequalae as they go on? So, and then what do you think if there’s, you know, a misconception, you know, what would you, what would you want the birth community should know about the role of, of the doula?
Pansay, Doula: (25:59)
I think the misconception, you know, when even when I say the word misconception within the birth community, I, it takes me to the hospital setting. You know, cause that’s where, um, you know, we get our, you know, that negative feedback. Um, but I believe that misconception is, is that we are, you know, that we come to disrupt, you know, the, the work of the doctor or the work of the nurse. And that’s, that’s not the case. It’s not the case. Um, my goal and what I feel like it’s missing, is the sacred-ness of it all. Specifically for the woman. And that is my goal, is to keep that intact. You know, when it comes to the environment, when it comes to how she’s treated, when it comes to, you know, this is a question that, you know, that I ask myself, how will she remember, you know, how will a mother remember her birth experience, you know, will she remember being yelled at? You know, I’ve been in some birth situations and you know, the nurse is like, you know, yelling at the woman or you know, very disrespectful. It’s a very sacred event and I believe it should be handled as such with everybody involved and the woman should be the lead. It is her birth. So I believe that that’s the, the misconception that I am there for, you know, just to be a disruption or interference to the doctors and nurses. And that is not the case. That’s not the case.
Maggie, RNC-OB: (27:48)
No, absolutely. Yeah. And I do, I think it’s hard. I think, um, as, you know, as those have come up and we’re seeing so much more access to doulas and, you know, more doulas are being present, there’s, I think there’s a lot of work to be done just in terms of everyone understanding that, you know, that unique role that we play, you know, within it. And that, like we said before, you know, there’s, there’s enough work to be done in a birth for everyone to have a role and be, you know, be realized in that there is plenty of support needed. I think it is, it’s about, you know, building those relationships and so that everyone is understanding what, you know, how we can all, you know, work together.
Pansay, Doula: (28:23)
As a team.
Maggie, RNC-OB: (28:23)
And, and that we, exactly. You know, it’s beautiful. Well, that’s great. And then, so what do you think is kinda, like, the future of, you know, of the doula role? Where do you, you know, why would someone want to pursue it at this point?
Pansay, Doula: (28:36)
Oh my gosh. Um, thankfully it’s catching on, you know, I’ve had a few women reach out to me, you know, so like, “I don’t have a baby yet, but, you know, when I even start thinking about it…” and that, right there, I’m like, okay, we are doing what we need to do. We are spreading the word and getting it out there even to, you know, our younger moms. And that’s, that’s where the education, you know, comes in for the younger generations, you know, for my daughter, she’s witnessed homebirth, she’s been to hospital birth, but she knows that there are different ways, you know, to give birth. And I think that is so important, you know, for women that, that, that we should teach them at a young age, these things so that they’re not, you know, coming up thinking it’s just, you know, one way. The future of, you know, of being a doula, it’s, you know, right now it’s becoming very, very common and I hope to see it, you know, where everyone, everyone has a doula, everyone has access to, you know, a doula in some, you know, some shape or form. I’ve, you know, even, um, you know, seen virtual, you know, virtual doulas, right? We, so I love that, that it’s growing. And for me, I believe it’s an ancient practice. This is, this is how we gave birth. You know, we, we had the woman in the village, you know, the medicine woman, and then you had, you know, her assistant or it was somebody that was right there for the mother to be the mother’s support. So I truly believe we’re just stepping back into, you know, our ancient traditions that were lost.
Maggie, RNC-OB: (30:25)
Yeah, absolutely. Yeah, I know. I think there’s, I totally agree. I think there’s going to be a lot more just growth and continued access. You know, people realize what, you know, what it can be, what birth can look like. Well, that’s beautiful. Well, thank you so much for sharing about yourself. Is there anything else you wanted to tell everyone?
Pansay, Doula: (30:45)
I just wanted to say thank you to you. I thank you for your vision, um, for this. And for, you know, for you, for you bringing it forth. You know, it’s one thing for us to think about things and you know, dream about things, especially when you have busy schedules like, you know, like you do. But I thank you for um, you know, for incorporating myself, and the other ladies, you know, and it’s, you know, creating this circle of women for us to help you, and also to help the community. So, thank you.
Maggie, RNC-OB: (31:14)
Well, thank you so much. I really; this is such important and meaningful work to me, and I’m just so grateful to have you all on this as we keep learning more about how to, how to make birth better.
Pansay, Doula: (31:24)
Oh, thank you so much.
Maggie, RNC-OB: (31:26)
Thank you! Talk soon.
Pansay, Doula: (31:27)
All right. Bye. Bye.
Maggie, RNC-OB: (31:32)
Thanks for tuning into Your BIRTH Partners. We love to talk birth, and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter. We’re Your BIRTH Partners on all platforms, or comment on our show notes, blog at yourbirthpartners.org. We would especially love to hear any questions you have about doulas, how they can be integrated into care, and any questions that you have in particular for Pansay. Look forward to hearing from all of our doula friends out there. Till next time.
006: Registered Nurse Role with Maggie
Maggie, RNC-OB: (00:05)
Hello, welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today I had the pleasure of handing the reins over to Angela Mike as she asks me, Maggie Runyon, registered nurse questions about what it means to be a birth nurse. You’ll learn more about my background and what drew me to follow and be inspired by birth and you’ll also gain greater understanding about the roles that nurses play during pregnancy, birth and postpartum. Onto the show!
Angela, CNM: (00:47)
Good afternoon, Maggie. It’s so wonderful seeing you per usual. Um, hello. Just want to ask you a few questions. But first if you could just tell us a little bit about yourself.
Maggie, RNC-OB: (01:01)
Sure! So, I’m Maggie Runyon. So I have been a nurse for over a decade now, mostly within kind of the maternal child health range. I started out as um, an Army nurse. I did ROTC during college while I was in school and then started out working at Walter Reed, taking care of, you know, wounded warriors coming back from Iraq and Afghanistan and then through the Army’s training program was able to become a labor delivery nurse. And then I’ve, you know, since then I’ve been able to work in that capacity at a few different healthcare facilities and then also in the home birth setting. And so in addition to that, I mostly identify as labor and delivery nurse, but I’ve also had the chance of being a nurse educator working with university students to do clinicals and teach college classes online and in person. And I’m also a certified yoga instructor. So I currently lead prenatal yoga about once a week, with women in my community.
Angela, CNM: (02:05)
You are such a wildflower. I love it. So what brought you into this field?
Maggie, RNC-OB: (02:12)
Yeah, so I, you know, back when I was in high school, uh, to be honest, you know, watching, reruns of the show ER, were what really brought me to become a nurse. I loved the role that nurses played in that TV show and just seeing the really strong characters, you know, that they were and how they got to spend so much time, you know, with the patients, getting to know them, being intimately involved in that and then still being, you know, incredibly just sharp, intelligent people who are also, you know, working right alongside their, you know, physician colleagues and other providers. And I love that, that balance, you know, kind of between the, the science and the humanity piece of it. So that, you know, brought me to become a nurse. And then during nursing school I had started to think that I, you know, wanted to support moms and babies. I actually thought I wanted to be a NICU nurse. I did my final practicum for nursing school for our last semester in the NICU. And I absolutely loved it. I love taking care of, you know, tiny, fragile babies who need absolutely all the extra love and support that they can get from us. But I started to realize that I, you know, at the same time had watched women giving birth and I just thought like, wow, birth is just such an incredibly powerful process and a miracle every time. And there was just this part of me that felt like, Oh, I want to take care of the mom, you know, the birthing person and the baby. I don’t want to just have it be, you know, afterwards when things have gone awry. And so I love that being part of, you know, labor and delivery, it gives me a chance to see birth in so many different different forms and keep it moving. So that’s where I, that’s kind of where I landed.
Angela, CNM: (03:52)
Excellent. Well, what do you think has kind of shaped or molded your professional journey?
Maggie, RNC-OB: (04:00)
So I would say when I did my kind of course through the army and became a, you know, an OB nurse through there, it was like two months in classroom and then two months clinical component involved in it. I really just was just struck by kind of the options that are available. They had a fair, you know, range between, you know, kind of high risk and low risk births. And I, I really wanted to be able to kind of learn more because I realized in that moment like, “Oh, I’ve done this for four months now and I, I still really don’t know as much as I want and need to know to really be able to support birth well.” And so then I was really lucky that my next assignment in the army brought me to Fort Polk, Louisiana, which is a tiny community hospital, um, for the army. And because we’re small and kind of a pretty remote rural area there, I was able to get just a ton of exposure and really had to hone my practice cause I didn’t have as much other kinds of support staff, you know, available. We didn’t have separate NICU, we didn’t have, um, a lot of other stuff going on and that kind of being thrown in the fire. It really helped me to get comfortable, you know, we have to do some triage visits there and I got to really feel like I started to understand more pregnancy and kind of some of the antenatal care piece of it. And then certainly being able to bond, you know, with people after birth when they, you know, come in through labor and delivery, you get to see someone’s baby and then help take care of them and their baby, you know, for the next couple of days. That really solidified how much I love kind of the community piece of birth and really feeling connected to the people. I love being able, I started a community support organization there along with another colleague to help kinda with the transition. And I adore just spending more time with, you know, pregnant people and their babies and you know, kind of being on the journey of, you know, of motherhood and pregnancy, you know, with them. So I feel like those, that very beginning of my OB career really kind of set me on this path to want to focus, you know, on community and also on really getting that, that breadth of understanding, you know, for each of us to know, I know more about, you know, about birth and everything that goes on with it.
Angela, CNM: (06:10)
Absolutely.
Maggie, RNC-OB: (06:10)
And then also having, you know, having great support system and colleagues to help to back you up on that so that you can be providing as much, you know, safety as possible.
Angela, CNM: (06:19)
So how do you think your personal experience, you know, traveling from all these different places and being exposed to all of these different types of settings like play into your personal practice or into your intuition?
Maggie, RNC-OB: (06:37)
Yeah, so I mean certainly I think for all of us, you know, the longer that you, the longer you practice something, you know, the more you realize you know, and the more you realize you don’t know. And so I think as I moved from, um, you know, the community setting and then I worked next in Baltimore in a really high risk population there in the city. And, uh, which was a great, it was a great switch. Having those two experiences back to back really like taught me a ton about kind of seeing when, when something isn’t normal and really getting more comfortable with quickly reacting to that and balancing, you know, heavier patient loads so that as a nurse, I feel like I really grew during that experience.
Angela, CNM: (07:16)
Sure.
Maggie, RNC-OB: (07:16)
And now working again at a community health setting again, at the hospital that I work at now, you know, we are blessed to generally have kind of lower risk, mostly patient population, um, and you know, some, you know, better staffing ratios. And so I feel like, again, I’m able to really like connect and spend more time with, you know, with my patients while they’re in labor. And so I feel like that whole transition, certainly each birth I’m a part of it goes into the next one, you know? And so seeing all of that and you know, the hundreds of births that I’ve been able to be a part of so far, each of those, you know, leave a little tiny piece that goes and makes me think a little bit more carefully about something the next time. And then, of course, I feel like, you know, the birth of my own children absolutely, you know, has impacted how I think about birth and, you know, the experience of being pregnant. And, and I think probably especially about, you know, being postpartum.
Angela, CNM: (08:11)
Absolutely.
Maggie, RNC-OB: (08:11)
I think it’s given me a chance to just better connected; I think you understand something differently. Obviously, you know, I think there are wonderful providers who haven’t given birth and they do a phenomenal job. But I, I know that I connect differently with my patients now because I’ve experienced a lot of what they’re going through at times. And that helps me to be more empathetic, and to really see, you know, where they’re at when I’m sending someone home who’s, you know, overdue and really excited about having their baby. And it’s not quite time. I am been there. I’ve, I’ve been nine days late and my baby’s still hasn’t come. And so I know how desperately in their heart, they just wanted me time to meet their baby. And so I feel like I’m able to make a deeper connection, you know, with them than I was able to as a, you know, as a very junior nurse before I had my own little ones. And I think intuition absolutely plays a part of it. You know, there’s that little, that gut feeling that comes in, um, you know, in both kind of positive and, and you know, potentially negative ways, it’s something you just know in your heart like this ‘something is just not right about this’ and we need to look more carefully at something. And I think that’s always, you know, that’s that feeling that you trust, and you follow up on and at the same time, sometimes you just, you know, you’re looking at everything and you feel like, yep, this is all fine. This is going to be OK. And I think that that will only grow, you know, as I continue to practice and, and see more and experience more and continue to kind of hone that, that inner piece of me.
Speaker 3: (09:31)
So where do you see yourself in 10 years?
Speaker 2: (09:33)
[laughter] It’s funny. So I felt like as a college student, you know, you did a lot of thinking about, ‘Oh my gosh, where are we going to be?’ And then, especially as a, you know, as a junior nurse in the army, there’s a lot of career focus. And so I think I was always kind of working on, like, the next plan. And so I feel like now I’ve really gotten to the place that everything that had always been on those plans I have, I’ve been able to do, which is phenomenal and wonderful. But I’ve been doing a lot of soul searching about what that kind of next piece looks like. And honestly, this organization, Your BIRTH Partners, is, you know, a huge realization of that. Me feeling like kind of stepping into a new role. So I, I genuinely hope that in 10 years I’m still doing this. I hope I am advocating, you know, for pregnancy and birth and postpartum and helping to connect people. I love being an educator and I love, you know, talking about all of this and helping to learn and share, you know, from other people. So I hope I’m still working as a nurse at the bedside because I love having that connection that I, you know, I can’t get that close to birth anywhere else. And so I still really want to be supporting birth there, but ideally, you know, in a decade I’ll have, you know, my kids will be teenagers. Good Lord. [laughter] And, I’ll be, you know, I’ll probably be trying to pursue more of this, you know, more full time really getting into more advocacy and, you know, education work on a broader scale.
Angela, CNM: (10:52)
So can you tell us a little bit about your role or profession and a little bit of about the schooling and training that it took.
Maggie, RNC-OB: (11:00)
Sure. Yeah. So I am, I’m a registered nurse and there’s a couple of, you know, different pathways people go through for that. There’s people who can come, a registered nurse with an associate’s degree, which takes, you know, around two years of school. You can have a bachelor’s degree, which takes about four years, and that’s the path that I had, you know, pursued. And then there’s also people who go, you know, have a different degree and kind of fast track back into a nursing. So there’s a lot of different ways to become a nurse. I did four years of school. I went to a college that had a lot of, you know, a liberal arts school, so we had a lot of the, kind of the core things right out of the way, and the last couple of years are more focused on your, you know, your theory classes, learning, um, you know, about the body and how it works and how we interact and care for people. And then, you know, putting that all into play in, you know, hospital and community settings. So I did that piece of it, and then got into the army, like I mentioned before, they, for all of their specialties within the army, they have people go off to, all the nurses go off to, like four months of training to kind of learn more, both, you know, book work and then clinical work. So I was able to do that to really start to kind of master my practice as an OB nurse. And then I have my certification in inpatient obstetrics. So that’s essentially, I’ve just, you know, I did some more studying and through my, you know, professional experience, um, was able to take an exam that just says, you know, kind of shows that I have studied, you know, a lot and know how to care for people in a diverse range of low risk and high risk settings during the obstetrical period. Then as far as other options, you know, for nurses, there’s so many things and I’ve said it, you know, forever. I’m really lucky that it’s, this career has afforded me a lot of different, different options. You know, within the profession. I also chose to go back for my master’s in nursing education, um, because I really, I love, I love sharing, you know, what I’ve learned and I love mentoring younger nurses and helping them to kind of find their path through it. So I’ve been able to work in teaching, you know, people during, during the university school I’ve taught, um, obstetrical nursing and then done it in the clinical setting a couple of times as well. And then I’ve taught also a lot of other, some of the generic nursing classes online. So there are nurses who kind of fill all of these different, you know, roles. Um, and you’ll see nurses as, you know, clinical educators in hospital settings and, you know, working on the community, connecting people, working for government resources. So there’s obviously there’s, you know, there’s school nurses, there’s a million, a million ways you can, you can be as a nurse.
Angela, CNM: (13:34)
Awesome. That is so, so, so incredible. It’s amazing how we, as career-oriented women, are able to balance so many different things, um, to include family. It’s amazing how we do that stuff in enough time. So what current professional organizations help to kind of lead or define your practice?
Maggie, RNC-OB: (13:59)
So, you know, the American Nurses Association is kind of the big, you know, the broadest one that goes, you know, across every, you know, every nurse who’s practicing. And I think their, you know, their biggest thing obviously you learn a lot about them when you’re in school and kind of focused on it. They have a code of ethics, you know, that they’ve put out. It has like nine different provisions that they, you know, kind of recommend us to follow and really to kind of live by. And I was looking over it today, kind of thinking about like, ‘Oh, what does it really mean to be, you know, a nurse in all these ways.’ And I liked the provision. Number eight says, “the nurse collaborates with other health professionals and the public to protect and promote human rights, health, diplomacy and health initiatives.” And I feel like that’s totally like where I’m at, you know right now, and feeling like I’m really living out that piece of it and really trying to make those connections and grow that community. And then I, within the birth world, AWHONN is the Association for Women’s Health Obstetrical and Neonatal Nurses. And so they are our big, you know, they do big conferences, they have a journal, they put out a lot of our kind of professional, kind of guidelines and best practices. They do a lot of like infographics about, um, different ways to educate, you know, patients and clients about what’s going on for them during, you know, pregnancy and birth and postpartum. So they’re our huge, you know, resource. And then, you know, like you said, also obviously, you know, the World Health Organization, they put out tons of relevant information that really helps us to bring, you know, stuff from all around the world into the U S and see how we can apply stuff there. And then certainly, you know, ACOG for obstetricians and gynecologists. And then, ACNM for like with nurse midwives, we tend to see a lot of their information kind of flows into our practice as well since we work with those colleagues a lot in the hospital setting.
Angela, CNM: (15:40)
So, your role as an inpatient obstetrical nurse and as a nurse educator, like how does that play out when you are caring for women during the antepartum, intrapartum, and postpartum period?
Maggie, RNC-OB: (15:58)
Sure. So, you know, we, again, we have a big role, so obviously there’s gonna be nurses throughout, um, the antepartum period, you know, working with people when they come in first pregnant. They’re going to do a lot of their intakes at, you know, whether it’s with providers, whether that’s a, you know, an OB or a family medicine physician or a midwife. There’s nurses working in, you know, in concert with them to help people to kind of get settled in and get comfortable. Usually you’re going to see a nurse at most of your appointments kind of just to check in on your, you know, overall health and you know, see how you’re doing. During that antepartum period, we also, you know, we teach a lot of childbirth classes and especially in, you know, in the hospital setting, often those are taught by, you know, nurses. We get to kind of start to develop those relationships. I feel like when I was in Fort Polk, again in that like really intense community setting, it was great cause I think I really got to know a lot of our patients before they came in to labor delivery just between seeing them for, you know, random triage visits and teaching classes. So we get to develop those relationships. And then in, during labor, you know, we’re the ones who get to spend typically the most time with you, you know, out of anyone because generally the way the kind of patient and provider ratios go, midwives, OBs, and other physicians often have, you know, several patients they are helping to care for during labor and delivery. And typically our, you know, our nursing assignments are going to be smaller. So, hopefully we’re only taking care of, you know, one or two patients at a time. So that lets us really have a lot more hands on time with them and really get to know them a little bit better and understand kind of what their goals and their preferences are for birth and, and hopefully help them to, you know, meet that to the best of our abilities. So we get to spend time with them during that. And then, you know, once babies are, you know, delivered, we’re there to help out and, you know, administer any medications that are needed. Help them to bond with their baby, help breastfeeding to know, get off to a start if that’s what they’re doing or otherwise. Helping them to learn how to bottle feed their baby. Um, so we’re, you know, we’re at the bedside with them throughout all of that, kind of working through that initial piece. We’re helping them to…
Angela, CNM: (18:03)
Hard work.
Maggie, RNC-OB: (18:03)
It is. You know, it’s meaningful work. They, you are so connected to someone in this just incredibly vulnerable time for them. So it’s really an honor to get, to get to know people, you know, that well in such a special way. So we worked through that whole, you know, piece of them getting them comfortable, you know, after the initial period, helping them to kind of transition to how their body feels and works after, you know, pregnancy and delivery and then, you know, we’ll also see them for, you know, followup visits, outside, you know, at their provider’s office or at, you know, community health clinics as they kind of transition and become a parent.
Angela, CNM: (18:38)
So what do you think is the most challenging part of your role?
Maggie, RNC-OB: (18:42)
Okay. Ah, I think the most challenging part is playing, probably playing off of kind of what hospital policy is, and what, and what the patient, you know, wants and what we see is actually, you know, evidence based care. Healthcare is, it’s slow to change; it’s difficult to get things changed at times. And so sometimes we know that something is, you know, that there’s new research out or something is kind of heading in a different way than the way we’ve always practiced. And it’s hard sometimes to get that introduced to the facility you work at, so you really feel like you’re kind of giving your, your best self out there and that you’re providing the best care and that you’re really advocating for what your patient wants and what we know is best for them. So I think that probably that rub between kind of the real world and then the theoretical hospital policy is probably the biggest challenge.
Angela, CNM: (19:39)
So what if you get share one thing that the birth community knew about your role, what would it be?
Maggie, RNC-OB: (19:47)
Yeah, I mean I think we’re probably lucky out of, you know, the different roles that we’re kind of featuring in this series. I think nurses generally are viewed pretty positively by, you know, the world. Most people have a good impression about what we do. I think this is like our 18th year that like the Gallup poll voted nurses as like the most trusted profession, which is such an honor and just, it’s so good to know that the hard work that we put into, you know, being a nurse is recognized and that people really appreciate, um, the way that we, that we work. And so I think I wish that for, you know, for birth workers out there to just know that like, we are acting for the patient. You know, we are really trying to advocate and uplift, you know, their voice and what they want, which may be very different than what we ourselves would want, you know, during birth and what, you know, or what we think is even necessarily the, you know, the thing to do. We’re really there to help them to be as, you know, as comfortable as they can because they trust us and you know, they know that we’re there for them. So when we’re interacting with other healthcare providers, absolutely we can make mistakes and mess up and have our own things going on. But you know, the vast majority of time we’re really trying to do what, what we’re seeing is the best for our patients based on what they want.
Speaker 3: (20:58)
So what do you think the future of your role is?
Speaker 2: (21:01)
Uh, you know, I, I love it honestly. So, you know, the world health organization 2020 is the year of the nurse and midwife, which is incredible. It’s awesome. And so I love that. I feel like on a national, and an international scale, we are really, you know, recognizing that as just all of the possibilities that exist, you know, within this role. I think nursing is only, you know, I think it’s going to continue to be a strong presence. Obviously, you know, throughout healthcare. I think as we continue to see nurses pursuing advanced practice roles, you know, certainly, we continue to get stronger, you know, as a profession. And I think we’re just going to see us hopefully pull together more as we realize like the collective power we have as you know, one of the biggest bases of, you know, health care professionals. So I’m excited for that. And I always tell people, I mean, I love being a nurse. I love the flexibility that you know, is inherent in it and as you grow and change and find your passion. So I always tell people who are pursuing it, you know, like, absolutely look into it more. There are so many things that you can do, so many ways for you to impact people’s lives. So it’s, I truly believe it’s one of the best jobs out there.
Angela, CNM: (22:09)
That is so incredible. Thank you so, so much, Maggie, for sharing. I’m telling you, just listening to you discuss your history, how you came to this profession, and your passion. I’m telling you, it’s just, it’s so inspiring and it just makes me want to get out there and just work harder and make a big difference and show the world the possibilities in women’s healthcare.
Maggie, RNC-OB: (22:37)
Oh yeah. And thank you. And I really, I feel like that passion that we capture when we’re talking amongst ourselves, that’s what I want this to be. I want, you know, Your BIRTH Partners to really be this continuation of that conversation on a bigger scale so we can all connect and share that passion and you know, rev each other up so we can do more.
Angela, CNM: (22:54)
Perfect. Well, thank you so much.
Maggie, RNC-OB: (22:57)
Yay! All right, well thank you so much for interviewing me and letting me share a little bit more about myself.
Angela, CNM: (23:03)
Not a problem.
Maggie, RNC-OB: (23:04)
Talk soon. Thanks, Ang. Maggie, RNC-OB: (23:10)
Thanks for tuning in to Your BIRTH Partners. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, we’re Your BIRTH Partners on all platforms or comment on our show notes blog yourbirthpartners.org. In particular, we would love to hear from our nurse colleagues, how are you functioning in birth? What is your role in the pregnancy, birth, postpartum continuum, and any questions that our audience has for nurses and their role. Till next time.
007: Bias in Birth
Maggie, RNC-OB
Hey there. Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth, and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we’ll be getting into a topic that I think is really crucial. To moving forward as our country works on perinatal healthcare. So we are talking about bias and particularly bias that happens amongst birth professionals between each other amongst people, professionals and consumers alike, about the idea that there is one right way to give birth. You’ll learn a little bit more about kind of the status about what we see happening in our interactions with each other as professionals, and get a greater understanding about some things that you can do both as a consumer and as a professional to counter act when you see that going on. On to the show!
Maggie, RNC-OB
All right, everyone so welcome, welcome. Today I want to do something that we were able to touch on in our first community episode and just dig into it a little bit more so kind of the idea of bias. And there are a lot of different ways that that plays into health care and how we work, you know, as professionals. But particularly today, I want to have a chance to talk about kind of that bias that we all hold, and that sometimes our clients and our patients hold as well about, there kind of being this one right way to give birth. Or that there is one way that a pregnancy or postpartum is supposed to look, so how those kind of ideas about bias that we have towards birth and towards certain providers and birth professionals and what they might kind of bring into that mix and dive a little bit deeper into that. I saw a quote from Ina Catrinescu, and she said, “confirmation bias is our most treasured enemy. Our opinions, our acumen, all of it are the result of years of selectively choosing to pay attention to that information only which confirms what are limited minds already accept as truth. So I would just love for you guys to kind of tune a little bit, you know, let us know. How do you feel like bias, do you see it, you know, coming up in your practice when you’re when you’re talking with people, when you’re working, you know, with other birth professionals. How do you feel like it’s impacting care?
Angela, CNM
Biases that I see in my clinical setting is when a patient says “I have a birth plan.” I wish that everyone’s perspective or views about patient choices and desires were not viewed in such a negative light, because it really helps us to understand the things that are important to the patient and their family. And it helps us to develop our plan of care. In order to potentially, you know, help to meet some of those goals. Obviously, as long as it’s safe and responsible I feel like, I always need to say that because anytime I don’t backlash, for not saying, you know, “as long as it’s normal.”
Abby, MD
Birth plans make me a little sad. I think they, you know, evolved as this wonderful tool to help people think about their priorities in their births and in their health care. But as an obstetrician, they tend to be often perceived as something people give us because they don’t trust our judgment or because they’re very worried or scared that we’re gonna be overly interventional. There can’t be an exact plan for your birth because you don’t know what’s gonna happen. Just like as a parent, you don’t know what’s gonna happen. You know, it has to be an exercise in being flexible. And I think for people to have overall goals or visions about how they want things to look, that’s very reasonable. But unfortunately, birth plans are often only set up to accommodate the perfect birth, you know, and when things aren’t that, it’s hard.Yeah, I definitely think there’s been something in kind of the way that the birth plan probably the vocabulary we use around it has contributed to some of that bias. I think a birth plan, you know, plan sounds very structured. I think when we, you know, as we if we can start to think of them as birth preferences, as you know, ideal ways that things are going to go that helps to kind of decrease that bias. But I’ve absolutely I’ve seen that you know, over and over again with, you know, with colleagues, and even with other, you know, other people who are giving birth that they’ll refer to someone else’s choices like, “Uhh, well, they’re just set on all of these things happening.” And so it’s, you know, it’s too much kind of to ask for all that. And I think we need to be really, you know, conscious about the language that we use when we’re explaining about potential courses that happen, you know, during labor and delivery to help set people up to understand how preferences might play into what’s going on. And then we really need be active as birth professionals, too, to pause and to look at each, you know, each new birth plan that comes across us and take it in for what it is that this is their you know, their best way of presenting what their goals are, what they hope will happen, and try to keep some of our bias about “every other time that we’ve seen X, Y and Z on the sheet, this happens.” Because that’s not, you know, that again that goes back in that confirmation bias. That’s that idea that we’re kind of cherry picking those moments in our mind, in our memory, that affirm that idea that “Oh, if someone’s asking for all these things, you know, it’s asking too much of the universe, and they’re gonna end up having, you know, a higher intervention birth.”
Ray, CPM
Well that’s so interesting so I think, like, you know, my population is obviously different and part of their like birth plan or preferences is choosing this different health care setting where they’re like, yeah, a lot of the things they’re like, guarantees it unspoken like, yeah, like skin to skin, delayed chord clamping, delayed newborn interventions, doing newborn interventions on parents,, like all that stuff just happens. And then they can, like, really going to, like, the nitty gritty of like what they want. I do think the population that chooses home birth is taking this, like, extra steps…”I want these things, and then I’m gonna choose a different environment.” And then when I’m like, guiding people towards thinking about if there’s a need to transfer, you know, we’re going for interventions, it’s gonna be a really appropriate use of interventions. Choose a couple preferences: what are the big things that you want to like hold from the home birth experience. Like, is it low lights? Is it that your partner catches the baby? Is it? You know, delayed newborns interventions? Like what? Like the three big things. And then in the event of a C section, Like what are the two or three big things. So it’s kind of like a stage thing because, you know, I’m just like this is your reasons that we transfer. And if we’re going, we’re going for interventions. So I help guide you through that. But also, what are the most important values there?
Angela, CNM
I think that is so important whenever we are thinking about or discussing birth plans. For example, I think that often people think about them as being this rigid idea, but I truly visualize them as preferences and like, “What are the things that are important to you?” Because it helps me to understand my patients and their families values. And I think the biggest thing is that well, patients just want to be heard. So often they feel like they haven’t been heard. And so then there are some who come across as being very firm about things. And then there are some who are very relaxed about things. And what I found in my practice is just listening to patients, listening actively listening without interrupting so that I get the whole picture and then validating them and then “hey, well, I want you to think about this because what if this doesn’t happen? Would you be comfortable with this? And I’ll explain to you why we would recommend X, Y, or Z. So I wish, what I hope for is that as birth leaders that we take a different perspective on what this birth plan could be because it’s not about…it is sometimes, unfortunately, about patients not trusting us, but rightfully so in many, many cases. But it is also giving us an opportunity to validate, help to clear up anything that maybe they thought was accurate, that is not accurate, and explain the rationale for things. Because I have plenty patient when I said “Okay. Why do you feel that way? Why don’t you want this or why do you want that?” And then I give them a different perspective and they’re like, “oh, I didn’t know that, I didn’t think about it that way, I don’t know that with an option,” you know?
Maggie, RNC-OB
Absolutely. And so you know what are ways that you all when you’re working and you’re interacting with other, you know, colleagues. If you see people kind of showing some of that bias, you see that maybe they’ve had a little switch is flipped, and they are perhaps not really kind of seeing the perspective of what’s actually happening in front of them. What are some ways that you have been able to kind of help, like guide, you know, the conversation to, you know, try to eliminate a little bit of that bias?
Abby, MD
I think in my case, sometimes just going in and having a conversation in front of a nurse or a resident or person who hasn’t necessarily been comfortable with somebody’s birth plan helps. I think just a really open conversation with the patient, where everybody in the room can realize that the patient’s actually not that unreasonable and where we can talk through, you know, the parts of the worst plan that are gonna make a birth special for somebody but also the parts of the birth plan that are really getting at the heart of what things are you worried about? What things are going to be really hard for you? And if those things happen, you know, how are we gonna work through that? You know, I don’t know if that makes sense, but…
Angela, CNM
It makes perfect sense. Absolutely.
Pansay, Doula
I want to add that, from my perspective, you know, as the doula going into the medical facility that, it happens to us a lot where, you know, once the client presents the birth plan, if she arrives before I do, or once I present the birth plan to them that you automatically see the switch in the face. Oh okay, you’re one of them.
Maggie, RNC-OB
Mmm, the guard goes us.
Angela, CNM
Oh, my God, yes.
Pansay, Doula
Exactly. Exactly. And you know whether or not the birth plan is there because the client does not trust the medical facility. That’s the truth. A lot of our sisters go into the hospitals and they don’t come back. Yeah. Okay. So we might not trust medical facility. Yeah, we have horror stories from my grandmother’s, from our mothers. We might not trust the medical facility. So we feel like if we at least put the desires down, the things that we have researched, we have looked at the outcomes, we have looked at whether not if we minimize this intervention I may come home alive. That should be respected. This is a human being with rights. This is a very sacred time. We’re not just another number. We’re not just another bed. And all of that should be looked at as a whole, as a woman, as a human being. These are her rights and her choices that she has researched. And, yes, she wants to say, these are my preferences with my body and my baby. That should be totally okay. Totally okay.
Maggie, RNC-OB
Absolutely.
Pansay, Doula
Especially when I see, where I have clients of a different race at the same exact hospital. And they do not receive the type of treatment where we have those those you know. You have those nurses…”Oh, she wants to use, you know, holistic modalities.” They will massage her scalp. It’s big. It’s like, oh, okay. I never see that with [my black clients]. So why? It’s like, yes, it should be as woman to woman. You know, nurse, I’m a female, okay, you’re a woman who is bringing forth life. You have a right. This is an experience that you can never get back. We cannot turn back time. Yes, I’m going to respect your preferences and your wishes. Of course keeping in mind that birth is so unpredictable. I’ve educated my client on that. Things can go awry at any time and again with normal with things going normal, a normal birth.
Angela, CNM
Absolutely.
Pansay, Doula
Yes. So we’re not being unreasonable. We know that. I mean, they know that if they’re coming to a medical facility we’re there just in case something goes wrong, they are trained, you know, to treat it. Okay, that’s why we’re here. But as long as everything is normal, “okay, these are my preferences. And this is what I like.” And we just, we just want that respect.
Abby, MD
Yeah, yeah, yeah. It’s sad, though, because those preferences shouldn’t have to be voiced. We should be treating every woman period across the board, with respect. I mean…
Angela, CNM
Yeah.
Abby, MD
Early skin to skin, delayed cord clamping, those kinds of things and then a much broader just respect of our patients, listening to our patients, figuring out who our patients are, and what their needs are, that’s the important part. And you shouldn’t have to come with a plan. You know, you don’t get that treatment if you don’t show up with somebody who’s gonna advocate for you. That part of this makes me really sad.
Angela, CNM
Yeah, same. You know it, the part of having to have someone advocate for you. You are absolutely right. Like we should, it should just be a natural thing. As people who have chosen the path of caring for other humans, as women caring for women, as males who are choosing to care for women. It should be a natural thing to just advocate for the right thing for each and every individual, despite their circumstances, despite their background, despite how they have ended up in the situation that they ended up in. And I don’t know how we have gotten to such a point in our community and health care where we are biased on certain things, and choose to neglect our patients because of it.
Maggie, RNC-OB
Yeah. I mean, as we look at at birthing people, we need to be seeing who they are, you know, as an individual and absolutely what you’re saying, Pansay, about the fact that that’s not seen and then that sets people up to feel like they need to come in, and really fight for what’s going on, and it creates this….We have created this system of, you know, perinatal health care that we have created in our country has led people to feel like they have to go in and fight for themselves, and that’s absolutely not how it should be. People shouldn’t have to feel like they’re going in ready, too, you know, dig their heels on and stand for all of this. That should be like Abby was saying, those should be standard of care and so many of those things they are, there is every reason for those to be happening in every birth, they are evidence based, they are what is actually the right, you know, thing to do in those normal circumstances. And it is unfair that as a system we have, then kind of turned that on its head and chosen to see people who are fighting for themselves and what actually feels right to them and make it seem as if they’re the ones who are a problem when it’s absolutely 100% a systematic problem that we have created and we need to be the ones to fix.
Ray, CPM
I started off as a doula, and I think the reason I kinda hit a wall where I couldn’t do it anymore. And it was because I felt like I was a stopgap measure on this, like, gaping hole or a broken wound like it was like this tiny Band Aid because the care was inadequate. And so people had to hire someone to, like, support them throughout birth. And I just felt like “no, I want to be a partner in people’s care.” I want yeah, I want the care and respect to be like the central part of their perinatal care experience, and it’s unfortunate that the way it’s set up right now is that the people that can access this like partner in care who’s like a person relationship are typically people who have more means because homebirth is more outside the system. You know this model of care isn’t being replicated in other health care settings as much. So it’s still like, being in a setting where you don’t have to, like, advocate for yourself or feel a need to advocate or you don’t have a relationship is like less common unless you’re hiring this like one-on-one midwife relationship? Or like working with a really small practice, which is not accessible to a lot of folks in a lot of places.
Abby, MD
That’s often why you see this discrepancy that you talked about, Pansay. I think in health care settings where women are getting really different kinds of care. It’s funny, I was late on labor & delivery one night recently where some of our nurses were having a conversation where they sort of said, “I wish we just had a doula, I wish we had, like, a couple doulas on our unit who were people that really helped us understand our patients, who helped patients through labor, who helped patients, you know, with strategies for pain management in labor, particularly patients who wanted unmedicated births, but also people who recognize that we’re all part of the same team.” I thought that was interesting. I mean, certainly we have those doulas that show up in labor and delivery, and I know them well, and I know that we’re going to collaborate together. And then that’s not always the case. Just like I’m sure when you show up on labor and delivery with certain patients you you don’t feel accepted and you don’t feel like you’re part of a team.
Pansay, Doula
Definitely.
Maggie, RNC-OB
Yeah. And I think as we’re [continuing], I love that some of the nurses were talking about that and having that, you know, that acceptance piece of it, cause I know we talked a little bit about, you know, kind of that bias that most of us we come into, however we came into birth work, you know, we were informed by our own cultural and educational experience about what that means and who should be involved, and how it all is supposed to work. And then as you keep working through it ideally, constantly. For the next 80 years, we’re all growing and we’re learning new stuff. And we’re not just accepting what we learned was in school or what someone once told us one time.
Pansay, Doula
Right, exactly.
Maggie, RNC-OB
es.
Maggie, RNC-OB
es.
Maggie, RNC-OB
nd so I love that, you know, these nurses are, you know, accepting and advocating and wanting to see doulas and recognizing the wonderful role that they can help to play, because it’s very much complimentary. I am always psyched if one of my patients has a doula, because I know. “Okay, great. There are even more people who are here dedicated to this person having an amazing birth that meets their needs.” And, you know, a lot of time there’s a lot of, you know, pressure on the people who are taking care of someone during birth. Because it is a high stakes situation, and this is gonna last with someone for their entire life.
Pansay, Doula
Yes.
Maggie, RNC-OB
And so we want it to be everything. And so the more people we have in there who are dedicated to, you know, making that happen, it helps. And I feel I from where I came up in birth I didn’t have, I alwasy saw doulas in a very like, positive light, but I absolutely know that for some nurses, that’s hard. It feels like people are coming into kind of their territory. And it can feel, you know, difficult that you’re worried about how care is going to be, how we share and that you don’t want to have to be, you know, fighting about anything. And so I would love it if you guys can peak to kind of, What are some of the situations where you have seen your own practice kind of grow and shift to be perhaps more accepting? Because obviously, you know, as I was reaching out in starting this organization I wanted all of you to be a part of it, because I see you all as such accepting people who really see the team approach, you know, behind. But I know we all didn’t necessarily start feeling that way.
Angela, CNM
I would say the biggest thing that I personally done is remind myself that ultimately it is not about me. And when I was in private practice, it’s just so different that in military medicine Everyone has access to good collaborative health care, right in one setting. You literally can come in with 10 issues and you walk out the door wrapped in a bow because we fixed it already. When you work in the real world, you see and hear everything, and you are working with providers who have come from all over the place who don’t necessarily maybe have the same beliefs or standards, are not held to the same standards, because they’re not basically, they’re not run by the government so to speak. And so, what I really had to do is learn to humble myself, not let myself get so upset about the things that I have no control over or no power over and just accept that this is the way this person is going to be, this position is going to be, this midwife is going to be, this patient is going to be, and I need to calm down and meet them in the middle somewhere. And maybe, just maybe, if I respect them, then they will grow to listen to me and to trust me and even, you know, take my opinion for certain things, and maybe we can work together collaboratively. I build a lot of bridges that way with patients who absolutely didn’t trust midwives. Even the first practice I worked in, she never worked with midwives before. She had been a physician for 30 years, and she ended up hiring two more midwives to work with her practice. You know, it was just about building the bridge and being humble, and it hurts sometimes, you know? Because sometimes people people don’t come to meet you half-way, no matter how much you try.
Ray, CPM
Yeah, I really relate to the last part of what you said. I think something I want to mention before I talk about overcoming my own biases is some of the really extreme biases against home birth and the people who provide home birth care and the clients that seek home birth care. And how hostilely many of my clients have been treated when interacting with other health care providers. When I have sent someone in for an ultrasound or had to, you know, get an NST at three o’clock in the morning…And, yeah how much that impacts care. And also, like, ends the conversation and that, like, it doesn’t seem like anything I say or do can change that. And how much people dislike home birth, and the people who provide home birth, and the people who believe that this is a reasonable option. So I think for me, like a lot of my bias has shifted in having good transfers, in having and also letting go of my ego and seeing how yeah, I don’t know, planning a home birth is not about the place of birth. It’s about providing safety and shepherding people through this tremendous experience of meeting a child. And sometimes you know, and sometimes we need more help. To have been met many times now by sometimes providers I didn’t know, and sometimes providers I did know with open arms who helped us use these interventions that are feared in really good ways to help provide safety. And also for some of my clients, who have had to have births that were the exact opposite of what they had planned and intended on and were cared for so lovingly has really helped me remember that we want the same things. We want people to like have good care. We want people to have like healthy outcomes. We want people to be safe and be able to bond with their baby. And the way that the systems do that is different and there’s a lot of barriers in each system to providing that. But we have the same goals and, like the folks who have bias towards me, also have those goals and just don’t realize that were in alignment on those things. And I think that’s kind of I think I got both, like, continue to have these, like, positive experiences and then have these experiences that give me pause and that kind of [breath sucking in] feeling of, like, how are we gonna go forward? And it’s kind of a challenging line to walk.
Angela, CNM
That was very well said, Ray. Oh, my gosh, it is. It’s so crazy how, like you will sometimes feel like “Oh my gosh, I’m making all these leaps and bounds, moving forward, progressing.” And then, yeah, one thing happens, and it like stains the entire picture of all the great things that you built. It is scary because sometimes, it’s difficult to come back from it and you build a wall and you start not trusting again. And it just it further creates the divide with bias and tears down the relationships that that should be built between interdisciplinary clinicians.
Ray, CPM
It really does. And I think I want to maybe name an experience I had recently in the last few months. Which is, I was in an area I don’t attend births commonly and needed to transfer to the hospital quickly so we couldn’t go to our preferred backup hospital. So I called the local hospital to give report. A midwife picked up the phone and I told her why we’re coming in, she said, “I don’t accept your transfer.” And I was like “Wait, what? Like that’s illegal. Like what? And I was like, I I need to come in now. I’m transferring for heart tones.” And she’s like, “we do not accept your transfer,” And I was like, “Okay, um, we’re gonna be there in 10 minutes by ambulance, so I’ll see you soon.” Oh, and it’s just like, you know, my client was treated fine and we had an okay outcome. But that level of hostility is gonna stay with me for years. And I have this, like, initial impact of like, “Oh, my God, I do not want to attend births in that area anymore. I do not want to be near this hospital.” It was, like, a nonstarter. And it was with a midwife. I think there are these little and big pieces of trauma that we catch and carry, as you know, people who attend birth. And, like, you know, the 20 great transfers I’ve had to the local hospital in Philly are totally overshadowed by this, like, one really scary experience. And it was scary because of how I was treated as this person trying to transfer care.
Maggie, RNC-OB
Oh, my gosh. I mean, I’m so sorry that you experience that and that, you know, as a result, your client was a part of what was already a scary and unexpected transition in care becomes so much worse when we don’t just come together. And you know, I think it’s like you said, obviously, it’s two steps forward, one step back, and it does it makes such an impact when we have these really negative experiences. And, you know, people get used to seeing things in, you know, in their one sight. And so it’s really unfortunate that whatever has kind of fueled that midwife, that provider’s experience about transfers that resulted in them having such a terrible interaction with you. And I will speak, again personally obviously, at one part of my career, I was probably less comfortable with, you know, home birth. It’s certainly not talked about in nursing school, you know, that’s not, that wasn’t ever a part of, you know, how we viewed birth and how it could look. And certainly though then, as I continue my practice and learned more and and I had to actively seek out and understand that safety, you know, there was at one point that I was really, I was biased. I was really uncomfortable with whatever the CPM qualification meant. I didn’t understand that you know, I knew what nurses were, I knew what nurse midwives were, and I was unclear about the safety that would be provided by a CPM. Or you know, by another midwife who didn’t go through, you know, the same training. And so I had to really actively search for that information. I had to take on that responsibility to better inform myself so that I could have a better understand of care. And I think the problem comes when we’re not able to do that or we’re not willing to put in that work to better create understanding and to eliminate that bias. Because obviously now I feel very comfortable with understanding CPM’s and the education and, you know, qualifications that you all do and have and the safety really provide during birth. And I am so desperate for us as a perinatal health care system to do better, to better inform everyone who is involved in care so that we understand these roles that people have, and we’re able to be accepting of each other and not have these kind of egregious acts that go against everything we believe in, you know, as as health care providers,
Abby, MD
it’s funny this conversation’s making me think of, like, the systems-based things we could do to improve this cause I think, I mean, home birth is not going away. And, you know, I think as a physician, I’ve been on the other end, I am often on the receiving end of deliveries that haven’t gone well. And when you’re dealing with a mom and a baby who are sick and you’re not the one who’s provided the initial care and you don’t have a bond of trust with that patient, and we’re living in a malpractice environment that’s really broken and serves to penalized physicians, and not help families that have babies in need, so I feel it’s the system is really broken. It’s funny, though, Ray, the delivery, the experience that you were talking about makes me think I mean little tiny things like, “Wow, if you have a home birth in the area where the local hospital is one that you don’t know, like should we be having a phone call that says there’s somebody laboring and they may be coming in. And here’s their background, just in case.” And I think that the unfortunate answer is that a lot of physicians will be like, “No way. I don’t want that liability.” There’s not gonna be a simple fix to this, but I think that we have to do something to improve care for patients and relationships and communication,
Angela, CNM
Yes.
Ray, CPM
So much of it has to do with relationships among providers because at the wonderful Hahneman Hospital in Philadelphia, which has since closed. You know, there’s a midwife who is in town for many years, Christy Santoro, who built a real relationship of trust with the primary obstetrician and midwives in that practice. And so when I had a birth that I was like, “I don’t love what’s happening here…” I would just call the midwife on labor and delivery and be like, you know, I have this situation and I’m not sure if I’m gonna come in, we would like, chat about it, and they’re like, “Yeah, I can see, like maybe I’ll see you later. Maybe give it a little bit more time.” And, you know, just like the relationship of trust the relationship of, like those folks that have, like, a one appointment with that practice. So they were in their system and that, like, I would send records that, like, felt good to them and they, you know, asked us for what they liked, which was an anatomy scan and GBS, which sometimes our cliennts consented to, and sometimes they didn’t, and because of that, when I, you know, had transferred people there for heart tones urgently, we were received well, because they trusted me and they trusted my judgment. And so I definitely understand, like being in an area where they don’t know me and they, like, receive something scary, that it would feel scary. But also, there’s this general mistrust that, like home birth, is bad and dangerous and that home birth providers are unskilled and that, like people, were like making these crazy decisions that are gonna kill their babies. And like, those biases are, you know, you could not understand, you cannot agree, you could be like, “yeah, that’s not the decision for me,” and also be like this person was making autonomous decision with their body, and we’re now transferring because it’s no longer appropriate for home birth.
Maggie, RNC-OB
And we’re going to continue to support them in making decisions that best respect them and the actual situation they’re in.
Angela, CNM
And not treating them like trash.
Maggie, RNC-OB
And I know, we’re definitely going to talk about this more and, a future episode we have planned is for kind of that idea about hospital birth and out of hospital birth and safety and how we we build, you know, that trust and and talk about transfer care because it’s a huge issue. And I’m sure there are people potentially listening right now who have no idea that it would be that complicated, that providers aren’t able to have those conversations openly in every environment, because that seems very logical that we would all be supporting each other, you know, in this and the fact that it’s not happening is, you know, it’s a huge detriment to our clients and outcomes that they end up having. And so, you know, I know we obviously we talk about this forever. But I want us to be able to kind of just close and think about, how we care for each other during birth. Those relationships that we create between other birth professionals, and us all actively working to fight against our own bias about what we think birth is supposed to look like, what we would like our birth to look like. Whatever ideal birth means in our head that we need to realize that’s fine to have those, but we need to kind of put that aside and be, you know, in the moment where we are with the person that we’re caring for. I liked this quote by Anais Nin who said, “we don’t see things as they are, we see things as we are.” And that is something that we need to be very aware of and conscious, as we, you know, provide care and try to direct how things go that we’re making sure that all of our own, you know, biases aren’t getting in the way of what’s actually happening in front of us. Well, thank you all so much for talking about this with me today. It’s always a pleasure to see you.
Angela, CNM
Thank you. Thank you. I love these conversations. Real talk, girl talk, yes.
Maggie, RNC-OB
All right. We’ll talk soon.
Maggie, RNC-OB
Thanks for tuning in. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. We also recommend you check out our show notes blog will be detailing some of the information we discussed today on our episode about bias and how you can hopefully kind of get away from that, what the research shows about bias. And as we work to kind of continue to reach out and get this message out to as many people as possible, we really appreciate you sharing with friends or colleagues or consider donating to our non profit as we work to increase our reach. Thanks for your support.
008: Maternal Mortality in the US
Maggie, RNC-OB
Hey there. Welcome to Your BIRTH Partners. We’re here to breakdown barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today we’re talking about something that’s been on a lot of hearts and minds throughout the birth community in the last few months. We are going to be discussing our maternal mortality and morbidity rates in our country. So you’ll learn a little bit more about the facts, what we’re seeing, what are the numbers, how do they compare to other countries around the world that are having better outcomes, and get a greater understanding about some of the particular tasks that we need to take both as, you know, as consumers, as birth professionals, and as a society at large as we’re considering this issue. On to the show!
Maggie, RNC-OB
So today we’re talking about a pretty heavy topic, and it’s not one that anyone really wants to really acknowledge. But we have to, because our maternal mortality rates are continuing to rise. Over the last several decades, they’ve gone up considerably from 2000 to 2018 our right here in the U. S. rose from 12 deaths per 100,000 live births to 17.4 deaths per 100,000 lives birth. Which means that our personal rate in that 18 years went up 45% in the United States. Similarly, that same time frame when we look from 2000 to 2017 which is when the most recent global maternity mortality rates are available, their ratio declined 38%. So why the world as a whole has gone down 38% in deaths, we as our country are rising. There are several different elements that play into it. But I want to make sure that we’re being clear that this is happening. And then it’s also happening with great inequality across our country. So we see that black women in our country die at a rate of 37.1 deaths for 100,000 live births. And when we compare that to white, non Hispanic women that rate for white women is only 14.7, which means that black women are dying at 2.5 times higher rate. And when we compare it to Hispanic women whose rate is 11.8, that means that they’re dying it 3.1 times more often their hispanic counterparts. There are several different issues that play into that. Obviously systematic racism and how that causes implicit bias throughout birth professionals when they’re taking care of women of color is a huge component of it. We’re also seeing that across the board, you know, we’re having more health complications, that there’s a lot more chronic conditions that play into pregnancy, and then how people recover both during the initial labor and delivery period and in the significant postpartum period after that. And we’re also seeing just a rise in interventio; our cesarean rate has risen right along with those rates. And so I wanted to just have a chance, you know, today to just kind of dissect that a little bit and talk about that and kind of talk from our personal practices, what we’re what we’re seeing along those lines.
Abby, MD
I think the easiest part of this conversation is the part of a conversation that reflects women with more medical comorbidities getting pregnant in our country: women who are older getting pregnant, women who are obese, women who have hypertension and diabetes and other long term medical issues. And assisted reproductive technology, getting women pregnant, older and with more medical comorbidities. I would love it if that was the only part of this conversation, and we could argue away the numbers with that. And I know we can’t, and I think as you get into issues of race and implicit bias and such, my job as a provider right now is to probably sit back and listen a little bit because I don’t know what the answer is. And I would like to be providing better care to my patients.
Pansay, Doula
In my practice with the issue being so real, kind of right in our face. First of all, this was a reality for my family, many, many years ago, before I even knew this was a thing. My brother’s wife went into the hospital and they were very young, you know, early twenties or so, and she had a, you know, uncomplicated pregnancy. You know, birth was going okay until it, you know, wasn’t. But she kept saying that something wasn’t right. “Please look at me. Something’s not right.” And they felt very much that because off, you know, their age and their race they didn’t pay them any attention. Things weren’t okay anymore. And that was, you know, once it went through a court case and everything, it was proven that it was negligence on the hospital, and we did lose my nephew. So I know, you know, firsthand how it is to, you know, try to advocate for yourself. Try to, um, tell them something’s not going on and they’re just not know listening. You know, in my practice, the way that I feel that I can help is to try to keep my clients out of that setting. How can we spend as little time as possible in that setting? And when you’re thinking about, you know, complications of pregnancy, that brings me to how do we prevent complications of pregnancy? So we don’t have to go there before you know we need to. So focusing very heavily on the naturalness of pregnancy and birth. Food is medicine. How do we get back to those ancient, you know, ancestral ways that kept us very, you know, healthy? From the beginning of my doula practice, you know, to now, shifting, shifting the way I doula, it’s working. You know, I see that very heavily as far as the amount of days that, you know, we stay in the hospital as far as, you know, just laboring, majority of the time we’re not showing up until Mama’s holding baby’s head as we’re registering, giving them our information. So for myself, it’s the education; educating the client on, you know, how do I stay the healthiest during pregnancy, keeping these complications, you know, at bay, learning how to labor at home effectively so that we don’t have to arrive until it’s time for them to, you know, catch baby. It keeps things simplistic. We have the baby and we, you know, come home. Before I started my midwifery training, I have to say that I did not know a lot of that important information about nutrition. And, um, and how to, you know, secondly, labor at home Um and I and I found that I spent much longer in the hospital setting just days of laboring, you know, in the hospital. So, you know, for me, that’s how I’m battling it from Sacred Butterfly Births and it’s definitely working.
Ray, CPM
I think the two things I want to name on this topic are, you know, why is the U. S. Outcome so much worse? It’s capitalism and racism. You know, we have a for profit health care system that doesn’t adequately provide preventative health care. So the people who are at greatest risk for complications don’t have access to, you know, affordable, comprehensive, preventative, prenatal care. And there is not just the barriers of insurance; it’s also the barriers of time, of child care, of transportation, of getting off of work. These systems aren’t set up well for working parents, and also the systems that are serving the poorest families don’t have, like, long appointments, like there people are not like, believed and listened to. And so, you know, first and foremost like health care is not a right in this country. And secondly, the outcomes of black maternal mortality are so clear that racism and health care providers not believing black women are, you know, leading to worse outcomes. And I always, you know, want to name that I think there’s a lot of ways that, you know, midwives are not the answer to all of this. There are a lot more complicated health issues that are also at play, you know, like women who are having heart failure at birth. But Jenny Joseph, who is ah, British midwife, a British-trained midwife who practices in Florida now, she’s a CPM just like me, created an easy access clinic. And so the idea of trying to provide comprehensive midwifery care to anyone who’s not accessing prenatal care and a one stop shop. Anyone gets to come, we’ll figure out the insurance stuff later, regardless of the place of birth. There are some people who are choosing to birth in their birth center, but many are going to a local hospital, which they have a collaborative relationship with, and the goal of this practice was to end neonatal mortality, which is also way too high in the U. S. And much higher for black women, much higher rates of preterm birth; and it’s working. You know, she does these great webinars and has this JJ Way Model of Care. And the first like item on the JJ Way Model of Care is like we learn people’s names, we learn their partners’ names, and we greet them by their names. And then there’s like, you know how they provide childbirth education, like passive education in the waiting room, we like, create avenues to like listen to people’s needs and concerns, how we like get people set up with the health care that they need. And even if that’s someone who’s had, like, three C sections and is gonna have her fourth, providing comprehensive midwifery care and then making sure she’s set up to like have her fourth c-section, and that if she wants her tubes tied, she gets her tubes tied so she’s not having a fifth c-section. In like having a midwifery centered model of care, regardless of the place of birth, like their outcomes are outstanding and they’re having like black babies go to term and live, and I think that model of care also applies to parents who have more complex health needs. That care that is slower, that is addressing psychosocial needs, addressing financial needs, helping, you know, subvert the barriers versus being like you have to figure out this insurance thing until you can get care is going to like catch those people who could become very complicated pregnancies.
Maggie, RNC-OB
Yeah, I love that they’re doing that, and I think there’s a huge need. So I mean, it’s so wonderful to bring that model of care there, and I think it’s really important to acknowledge, you know, one thing I heard Dr Joia Crear Perry talk about in her testimony in front of the House panel for the “Expecting More Addressing America’s Maternal Infant Mortality and Health Crisis.” They had a big panel in front of the House subcommittee for Health, Employment, Labor, and Pensions. And one of the things that she, you know, kind of just identified blatantly is that for a long time we’ve had this idea that there are different outcomes based on race, you know, perhaps certain people there’s some sort of different genetic component that plays into outcomes, and what we’re seeing very clearly from all the evidence of that, that is not the case. So it’s not an issue of race during birth it’s an issue of racism, you know, during care, and what we’re seeing come through. And so we need to be really conscious of that. As, you know, we’re setting up care, as we’re trying to make sure we’re meeting people and their needs and also realizing that systemic racism and the way that has played into the way our health care system is set up, that absolutely we see people of color have way less access to health care that there are a lot more barriers to getting to, you know, appointments regularly and, you know, maintaining care that are beyond the individual’s control. And so we need to be making systemic changes to help people to have safer pregnancies, to be able to have time for breaks and to be able to get care that they need and that we need that to continue through the late, you know, labor delivery piece of it, that people are getting good access to care, and that also afterwards that during that postpartum that they have support, that they have leave to take from work, so that they can actually be tending to themselves and their baby, and catching some of these, you know, issues that come up health-wise in that initial postpartum period up to that full, you know, year, even after birth. But especially in those 1st 6 weeks that we look, you know, particularly at that high risk time that we need to be doing a better job from a social standpoint. Doctor Neel Shah talks about that, you know, as we are coming together to really support people we’re saying that there are absolutely chronic issues and systemic issues. But the biggest piece of it is that people are able to, that they know how to get support, that they have people in their community, they have, you know, family and loved ones who are checking on them and, you know, taking care of them, and that they also have bigger social components of healthcare that let them be well supported and have resources that they can actually turn to, without, you know, having concern about how that’s gonna affect every other you know, part of their life that falls apart all of a sudden, if they need to get a higher level of care. In our country, we spend the most on, you know, maternal perinatal healthcare across the globe, and our outcomes rank 55th. That’s what we saw in the National Vital Statistics Report that just came out. So we’re spending so much money, and when he we even compare ourselves to other similarly wealthy countries, we rank 10th out of 10. So we spend the most money and we’re not getting any of the return on that investment that we should be. Like you said Ray, there’s definitely the need to from a much bigger scale be really looking at ways that we can change our health care system to better support and to make sure that those health care dollars that we’re investing actually have response in the community, and we’re not just pushing money away.
Abby, MD
It’s sometimes really overwhelming to me how many patients I need to see to cover my malpractice insurance as an obstetrician who does C-sections. And I’m not gonna pretend to understand the business of medicine to the extent that I should. But I can tell you, this system from that standpoint is is very broken because I don’t always have the time that I would like with patients. I think a lot about effective communication. Somebody, who’s a mentor to me, who’s actually now dean of the medical school where I did residency training. I remember on a really busy service as a chief resident, we would round on patients, and she would always make a point of, like, bringing a chair in the room and making sure that as we counsel patients, we sat and made eye contact and really tried to effect good communication. I feel like it’s a theme of so many of the conversations we’ve had in this group already. It’s just we could be better at communicating and educating. I think the respect piece comes next and comes naturally.
Maggie, RNC-OB
Yes absolutely and I think what we need is we need, you know, we need buy-in from the stakeholders, from all of us who are out there providing, you know, direct care to people during this. We need to understand I think where you know we’re struggling. And that’s why I wanted to, you know, talk about some of these facts because it is hard to hear and not all of us like to think in numbers and kind of get in that head space. But we need to realize what a pervasive issue this is, and that this is not something going away on its own. And so we really need to take strong and clear action, like many other countries around the world are doing as well. This is not just our issue, but, ya know, the leading countries Belarus, their mortality rate is 2 for every 100,000 live births compared to our 17.4. Greece and Finland similarly it’s 3 for every 100,000 compared to our 17.4. So you know, there are models you know, around the world, we can look to understand about different ways to deliver health care and different ways to make sure that we’re really catching, you know, the issues that that coming to our clients whether those are chronic conditions that need to be managed or systemic issues, you know that we need to look at, and that respect piece of it is key. And I think it’s probably going to be a huge part of every conversation we have in this group because that’s where we really are seeing that our system falls apart a little bit. Because, like you said, because so many of our birth professionals are really over-taxed because of the way that we pay for health care, you know, here in our country,and the onus there is on providers with malpractice insurance on all of that. We see ratios are set up in terms of how many, you know, patients people are expected to see and care for in any given time, and that that doesn’t always allow us to provide optimal care and to really see people for as long as we need to, to know everything that we need to know about them to help them live through birth.
Abby, MD
We really don’t have a system that facilitates easy access to health care, and I think the way that our health care system is structured. It’s actually pushing providers out of inner city, and other sort of challenging practice environments. I think that we’re seeing sort of a void and vacuum of care in the areas in this country that actually need providers most.
Ray, CPM
Yeah, and also I’ll mention that like there’s only like, 13 states that Medicaid covers home births. And so there’s also like a lack of options because, you know, like this slower model of care that, like can be preventative is also not accessible to the people who are most at risk. But in saying that, I also want to mention the fact that the black maternal mortality statistics are across the board, regardless of income. We can focus definitely on the people who, like have the least amount of access to resource is, but you know, black women with Ph.D’s are also having outcomes that are twice as worse as white women.
Maggie, RNC-OB
Yes; it’s so important to note that, because when we when we accounted for every potential other factor with education and socioeconomic factors, all of that; these rates are still significantly higher for black women. And then I, you know, I do think is important to highlight obviously there is positive work being done. ACOG’s Alliance for Innovation in Maternal health, they’ve developed a lot of these bundles of care that are being pushed out to different hospitals for kind of best practices for how to manage some of the both chronic medical conditions, and, you know, labor and delivery-specific complications that can come up. They have ones for, you know, postpartum hemorrhage and, you know, postpartum kind of care basics. They have those that cover for people who are delivering with opioid use disorder, safe reduction of primary Caesarean birth. And so I think so far, all of the research that goes that is coming out of those we are definitely seeing impact. We are seeing improvements and care on those, but we need to see more use, you know, of the research that we already have that are working at a broader level and, like you said again, that goes into the buy in for people at the bedside, not being resistant to this. Because I know I can speak to that. It is hard, as you know, as a nurse where constantly there’s new policies coming out and things are shifting, and you’re just trying to keep up and make sure that you’re providing, you know, good care. And so I think we have to make sure when we’re educating and telling, you know, birth professionals about these issues, and what we’re seeing come out of research, we need to make sure that they’re understanding why we’re doing it, why we’re changing it, and that it’s not just it’s not arbitrary. We’re not changing things just to change. We’re changing things because, you know, there’s real issues that are happening that need, you know, that need differences to be made. And we see that there are lots of organizations, the March of Dimes, obviously they do a ton of this. Dr Joia Crear Perry, who I talked about earlier, her National Birth Equity Collaborative is focused on reducing the disparity we see for, you know, especially for black people during perinatal health care. So I think we need to make sure that we’re tuning into those resources and these people who are really doing this good hard work and that we’re getting this awareness out there. Well, thank you all so much for having this tough conversation today. And I know we’re certainly gonna explore a lot of these themes further. As we get into what we all can do as birth workers and consumers to try, you know, make progress on this issue. Thanks for tuning in.
Maggie, RNC-OB
We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagramm Twitter, we’re Your BIRTH Partners on all platforms. We’ll be sharing statistics from today’s episode on our show notes blog, yourbirthpartners.org and we really would love for you to share your personal experiences. We know this is a really heavy topic, and we want to hear what’s happening in your community. Whether that’s personal or professional experiences that you’ve had. We’ll be sharing on the show notes blog some of our information about what other countries are doing, and some of the stuff people are taking in, the work they’re doing here in our country to combat this issue. As we work to get this information out as far as it can go, we really appreciate you sharing this with friends or colleagues. And if you feel called, donating to a nonprofit, thanks for your support. Until next time.
009: Shared Decision Making
Maggie, RNC-OB
Hey there. Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we are going to be discussing Shared Decision Making. And we’re using this as a model to kind of give it a sense of how we want conversations to happen when we are discussing options with clients, ways that you can know if a provider is perhaps aligned with really supporting you and what your goals are during birth and give some tips and tricks for what we can do as birth professionals to help, to continue to elevate the conversation around birth and choices and options so that everyone feels inspired, respected, trusted and heard throughout their entire pregnancy, birth and postpartum journey. Onto the show!
Maggie, RNC-OB
So if you are listening to this podcast live, in real time, we are smack in the COVID-19 pandemic. And this is obviously, it is on everyone’s mind, and it’s impacting all of our lives in a myriad of different ways, personally and professionally. And so we plan on discussing as a group a little bit more specifically about COVID-19 and how it’s affecting our practices, our interactions with clients, how we’re kind of seeing birth care being affected by this in one of our next episodes. But I wanted to take the time to share this particular message, which we recorded earlier in February before this was really reaching its peak. And I think Shared Decision Making and the idea of consent and being really clear about what options are available during labor and birth could not be more relevant than in a time where so many people are being swept up and feeling panicked and worried. And there is so much misinformation, and there’s so many sources that we’re getting our information from. I think it’s very hard, it’s very challenging to try to stay grounded in what you want and what matches up with kind of your personal philosophy for care. And I think that’s on both sides; I think that’s both as a birth consumer and as a professional trying to take the best care of people we can in really unprecedented circumstances. So all of that is to say that I hope this conversation really inspires you all to still continue to reflect best practices as you work to support birth, and as you work to give birth during COVID-19. And, you know, during any crisis, that can come up in our world, I know so many of us are concerned. We don’t want to see just this huge, sweeping kind of return to really paternalistic care of birthing people. We want to be able to listen to experts and trust their recommendations. But we also recognize how important it is for the individual people, the families who are giving birth, to be able to make decisions that really best match-up with what their needs are, you know, within established safety parameters. And so I find this conversation to be extremely relevant, everything we’re going through, everything I’m talking about with people who are pregnant right now, and really concerned about what is gonna happen to their care. And to so many of my colleagues in birth, from those who are operating out of hospital, those who are, you know, in hospitals and how we’re balancing just the very quickly changing dynamic playing field we’re in right now in terms of providing the best we can for birthing people. So with all that said, I am going to continue us onto our main discussion, and I really I look forward to hearing from you all about how you’re really helping to navigate these kind of typical conversations and birth choice options, especially in the face of a really challenging time like we’re in right now.
Maggie, RNC-OB
How do we kind of get best practices there for how we talk to our clients about issues that come up or, you know, potential treatment options? So I want to highlight the idea of shared decision making as kind of the method for doing that. So typically, when we think about, you know, consent, we have kind of three different concepts; so there’s informed consent where you know, in essence, it boils down to like, “Hello, I am the person providing care for you. This is the thing I think we should do, for this reason, do you agree?” And we’re hoping that people say, like, “yes, that sounds great.” And they sign that they’ve been consented to that. And, you know, during that process, we’re certainly talking about, you know, the risks and the benefits and what you know goes into it. But potentially we’re leaving out kind of what a lot of the other options are because we’ve kind of come in with a particular care, you know, treatment option plan that we’re hoping I’ll follow. And then there’s kind of informed choice the idea that we just present everyone with “Okay, yes. In the situation, you could do A, B, C, or D, the world’s your oyster here kind of the pros and cons of those,” and, you know, informed choice is great because it’s obvioulsy showing people more depth and breath of what they can possibly do. But it potentially misses out on, kind of the reason that people come to us for care is that they’re looking to have an expert, you know, opinion, kind of that is helping them to evaluate their personal health history and what’s going on with them and what we understand about them. And so a lot of times, people will feel like they’re lacking a little bit with just getting, you know, all of these choices, that they still want someone to kind of help them guide their decisions a little bit more and so share decision making is the idea that we’re kind of taking all of that and kind of meeting the middle. So we’re telling people, “Hey, you have options. You could do A or B or C. Here are the risks and benefits of each of those, in your situation where I understand you have these values and you have this in your medical history, I would probably recommend B.” And then we have a continued conversation. You know, beyond that, where we are able to kind of listen, you know, to the client and what their options are, um and that obviously, at the end of it, ultimately they may choose to do A or C, something that was different than what we thought. You know what’s the best fit for them, but what helps him to have more autonomy about, you know, their health care. So I would like you all to kind of be able to speak to how this conversation goes and how we can kind of do that best to provide for safety while still really respecting people’s, you know, individual choices and autonomy.
Ray, CBM
Yeah. So I could talk about how this works in my home birth practice. So with all the like medical decisions like tests and procedures of pregnancy, I have informed consent document that I share with people before I talk about the test options that I typically like to do things a little bit before they happen. So, like with Group Beta Strep testing, I talk to people around 30-32 weeks about it, with newborn procedures. I talk around 34 weeks. Genetic screening, I talk at the first appointment because often times you know, when people established care of 12 weeks, one of their options is about to close, to do like a nuchal translucency. And, you know, when I share this document and then I talk about what the screening is. So I did a genetic screening inform choice yesterday, and I was like, “this is kind of what’s available, was developed to screen for Down Syndrome. We now have all these other screens that are available. This is why people seek it, this is the information, there is the risk of having a negative positive screen and then like that, adding stress to a pregnancy and seeking diagnostic testing. There’s risks if we don’t have this information, like, if you choose to decline all genetic screening, including an anatomy scan and we don’t know your baby has a heart defect that is born at home like that could affect life.” And so we kind of hold all those things together and, like people sometimes like, reflects on the things that they’re prioritizing, values and reflect that back and then we kinda have to make a decision together but allowing them to really be in the driver’s seat. There are times that you know, as a provider, like I have boundaries around what I can and can’t do so. Like if I have a concern about fetall growth and someone declines an ultrasound like I can’t provide safety in that scenario without the tool of ultrasound, and that’s like one of the boundaries I get to have because people are choose universe at home and then I need to determine that someone is a safe candidate for that, and we’re entering into a partnership to do that together. But if someone does not want to have any ultrasounds in pregnancy and we’re holding together that there’s information we don’t know, and they’re accepting responsibility for that, like I can do that. And I think that kind of like having those conversations together from the beginning, helps to set the stage for home birth. And it allows for, like, more complex conversations, you know, around labor, like if someone’s water was to break first, and they don’t go into labor, to have a bigger conversation about risks and benefits, what’s available at home, what’s available to hospital, what we can do to reduce infection risk. And that the birth would change very significantly quickly if an infection developed and to hold the balance of both and tell them both, like what my comfort level is, and what my boundaries are and also, you know, help them kind of navigate, you know, like someone might choose to transfer way before I would. Or they might kind of push the limits and me being like, “okay, like I can do this for a little bit longer, but not forever. But like I could also respect your choices in this moment or in labor. You know, like if I’ve had someone who’s like “Okay, you were seven centimeters at 10 a.m. And it’s now like 4 p.m. And you’re like seven and 1/2. You know, these are the positional things we haven’t done that we could do. And then we can reassess and see if they work. You know, we could try and help you, like rest for a little while and then get the contractions a little bit more active or this is taking a long time, you know, like there is a balance where the time labor can take can start affecting baby’s well being. And, like the intervention of the hospital might be able to hope more with that or are a lot stronger and so kind of having conversations like that and then making the plan to, like, re-evaluate to see if, you know, hanging upside down over this they’re doing this, like, was effective or not, and then reevaluating and making another decision together.
Pansay, Doula
Yes, within my practice, I feel as though it’s my responsibility because it’s so many decisions that has to be made throughout the pregnancy, you know, labor and birth. So I definitely provide the clients with all of the tests that might be recommended. What are some of the choices with that they’ll come up with with labor, and then also you don’t with the actual birth. What’s important, I feel, is very important is giving them yes, the responsibility of research. Yes, I give them, you know, the risks & benefits on the choices. And I try to do that at the beginning of our relationship so that none of those decisions feel rushed, you know? So they have time to research with that, what I also like to do is have all of my clients join like, support groups, right? So they could see all these different scenarios of what these other women have gone for when they chose this particular, you know, action or did not and let them spend time. You know, with that before it comes before it comes up for them to actually make that decision. And then there is at least 2 to 3 visits that I attend the doctor’s appointments, you know, with them so that we can all sit together, and it’s, you know, to talk about the test to talk about the risks the benefits to get the doctors, you know, point of view. And most times they still have some time to think about it. Um, and make that decision. You know, with that, it seems that the client is much more secure and comfortable with it, with everybody, you know, playing a part and, you know, with a decision that they’ve chosen. You know, of course, you run into things that there needs to be a decision that has to be, you know, made quickly. I try my best to cover as much of those scenarios as possible, you know? Okay. And, you know, that’s what if this this is a possibility. So they so you know, it’s it’s at least not the first time that they’ve even, you know, heard of it.
Maggie, RNC-OB
Yeah, I think covering those possibilities absolutely, you know, helps. You don’t want people to feel overwhelmed, you know, during the prenatal period, with everything that happened. But it’s also important to be realistic about what you know, what we might see and how things could potentially, you know, involves that things aren’t, you know, blindsided. I always I like the the BRAINS acronym as a way for kinda how you think about things. So there’s, like, benefits, risks, alternatives, that sense like what is your intuition telling you? What does your values kind of line up. And then I was like that. The end is now, you know? So is this something that has to be made? A decision has been rain right now is their potential for time to kind of see what happens or let things evolve. Like, you know, Ray was saying, um and then the safety piece of it, Um and so I think it’s very important to understand, you know, obviously that safeties are messy, you know, it’s always gonna be a primary concern for us. We want to make sure that we’re, you know, we’re kind of allowing for things to evolve but also ultimately that we are doing everything in our power and, you know, within our scope to really protect for, you know, safety of, you know, the birthday person and their baby. And you know I would love for you guys too, if you can, um, kind of way in a little bit about how do you How do you deal with this topic of share decision making, especially when it comes into when people are making decision that you don’t necessarily feel comfortable with or where you have safety concerns and what are kind of some ways you work around that.
Abby, MD
I think the unfortunate thing in OB is sometimes these things come up as somebody who just wanted to really quickly. Um, you know, when things aren’t going right, they sometimes aren’t going right really very quickly. So I think having conversations in advance about everything that potentially could happen is an important part of our job. And then I think that also, um, I mean, it’s hard if if somebody wants something that I don’t think it’s the safest thing or that I haven’t necessarily recommended, my job is to educate, and my job is also to make sure that my patient understands the consequences of their decisions. But somebody very wise once said to me, If you’re working a lot harder than the patient, you sometimes need to just step back and, like recognize that you know the patient’s gonna make some of these decisions on their own. It’s harder when there’s a baby and it’s harder when you’ve been doing this for a long time and you know that if you don’t have a healthy baby at the end of this process, that ultimately tends to drive people’s perceptions of their birth more than anything else.
Angela, CNM
Usually what happens is when anyone presents something to me that I know is gonna put them at risk, or I know will lead directly to poor outcomes or potentially poor outcomes, I usually just investigate, you know, why they are feeling a certain way or why they think that they want to do a certain thing. Because most of the times it comes from just lack of knowledge, you know, not understanding completely, or maybe they’ve experienced some trauma in the past that has impacted the way they view their current situation. And usually what happens is I allow them to explain things to me, and I discover where the error in communication or education may have occurred. Or I discover that they genuinely just don’t have trust anymore because of how things happen. Let’s try to educate them about things and explain why and give them rationale, and I would say, man really, like 98% of the time, the patients are like, “Oh, okay. I didn’t know that. No one’s ever explained that to me. Okay, I think that’s reasonable. I’m okay with doing that, or trying this for X,Y,Z reasons” or, you know, “Hey, I hear you, Angela. But I really want to try this way first. And if this way doesn’t work, can we do it the way you recommend?” And usually, you know what, that’s fine. Absolutely. That’s fair. It’s all about shared decision making, and I may not necessarily like those things, but you know what, if the patients is willing to listen to me and trust me enough and respect me enough to share and confide in me about the things that they desire then I just feel like you know what? Like I need to, I need to continue to promote this. And I will just document, you know, we discussed X,Y,Z, the patient still declined, but we are in agreement that if you know things, don’t pan out that she will do this as recommended. You know, and that’s it, and I don’t lose any sleep over that. I usually feel pretty good about those conversations. I feel really good about those conversations because you made the decision together and the patient feels like they have autonomy. And I’ll say, even in those rare cases, sometimes patients will call me back. Like, “you know what? Angela, I was really thinking about it. I talked to my spouse, et cetera. I think we do want to go ahead and do what you recommended.” Yeah.
Maggie, RNC-OB
Yeah, I think that, I love just the idea of just giving more time. You know, I think so many times we’re busy as birth professionals, and you’re just trying to kind of check, check, check and move things along and really have any time to have that conversation. And also then giving your client reminding them that they too have time. You know, every decision is not doesn’t have to be made, you know, right now, and that that’s something that’s beautiful, that then they have time to actually, you know, process and think and, you know, evaluate what makes sense for them.
Angela, CNM
Yeah!
Maggie, RNC-OB
So yeah, you know, I think those conversations it’s hard, though it’s hard to have. I think there’s that little piece, that ego that’s in all of us, who, you know, we know we experienced a lot and we feel like we know you know so much and that sometimes we really just need to take a step back and, you know, realize we know so much about birth, but we don’t know, obviously, as much as that that client does about themselves and about what makes send for for them, and it’s really hard to kind of have that dissonance. But we have to live in that space sometimes.
Angela, CNM
You know, I think the thing that’s interesting to me is that, and I still don’t quite get this, we have so many people, providers, and when I say providers, I am including every level of provider anyone who provides a service or health care to a client, nurses, techs, CNAs. It does not matter. Physicians, nurse practitioners, social workers, everyone. I don’t understand how it is that we get so upset when people say no to what we recommend or suggest. I never feel that way. I genuinely don’t feel that way. I genuinely don’t get worked up personally when someone says “I’m not vaccinating my kid,” for example, or “I don’t want to do the GPS swab” or “I don’t want to take antibiotics.” I don’t get, I don’t get angry. I just ask “okay, tell me what’s going on? Tell me, why do you feel that way?” And when they say no because of this, this, and this I I educate them and they still say no. I say ok. I don’t like walk out of the room feeling upset. And I don’t understand the emotional response that people get over people choosing what happens to their body. I don’t get it. And it makes me completely insane. Your life would be so much better if you just minded your own business. Honestly, even in health care, you know. It’s just people have the right to say what happens to their body, and just because they’re seeking health care from you does not mean that you are now in charge of them. Are you’re offering them a service? They may or may not like all of the service, which is their choice. You certainly have the right to say, You know what? I don’t feel comfortable as the clinician. I don’t feel comfortable with this. Um and I am going to have to dismiss you as a client because this does not align with my personal practice philosophy. And that’s okay, too. Patients can fire practitioners. Practitioners can fire patients if the relationship is not, um it’s not cohesive, you know.
Maggie, RNC-OB
Right. No it isn’t. It’s important to realize that just exactly what you’re saying. Like you said it so well, that just it. It’s not up to that care provider what happened, and that’s hard. And I get it cause we do, we get very invested, obviously, in the outcomes of our clients, which is good. That is appropriate. Of course, you want to care about what happens
Angela, CNM
I go home thinking about these people. Good or bad outcomes, I go home thinking about them, you know.
Maggie, RNC-OB
But realizing that you sometimes have to kind of pocket that up and separate that from your feelings and then what is actually happening and being able to to step back a little bit and just recognize that you absolutely should care about your client. But you can’t care more. You can’t. You know, you have to let any time that you feel like you’re creeping over and you’re trying to impact, like overpower their feelings and their thoughts about a thing you have to realize, like “whoops. Oh, I got too invested in that.” And that’s not appropriate because it is not my experience on that, is it? I mean, it’s obviously it’s harder than something with so many of us, we have to actively work against, you know, and get yourselves in those moments when we realized like “oh, hmmph. I’m going the wrong direction with that…”
Angela, CNM
Yeah, absolutely, absolutely.
Maggie, RNC-OB
So I wonder, Ray, if you could speak. I don’t know how much of this is kind of being fueled by most of my experience coming from being in hospital births and cut into the more paternalistic setting of, you know, hospital policy and how much that kind of dictates that feeling that you know, that kind of investment or fear piece goes into it. If you want to speak a little bit more to kind of the community birth/home birth setting.
Ray, CBM
I have my like kind of how I transfer in my like consent to home birth. And so for me, like I outlined from the beginning, being like, you know, like you’re hiring me, you know, to provide safety and for my judgment to and, you know, I’ve never been in a situation where I’ve recommended transport for a medical concern and someone has declined. But I have in my consent that if you, if I think about a transport for medical reasons, is necessary and you declined, like, I’ll transfer care EMS. Like, I do think people have the right to make decisions that might harm theirselves and their babies. You know, in saying that it sounds judgmental. I think people have the right to make decisions that make me uncomfortable and I disagree with. But it does not mean I need to attend their birth at home. And yeah, it’s kinda like holding that balance of like, you know, for me so much of like, you know, home birth midwifery is like building deep trust with my clients. So you know by the time we get to the birth, most things can be unspoken and also like they really do trust my judgment and trust that I have their best interests at heart and respecting their values. And if there’s a sudden shift, it’s okay and they are going to go with me or like you know, I have the answer. Remember a head of someone where you’re like, What do you do if the bull Santa doesn’t comment on bleeding a lot? I’m like, I get it and you know I like, and that’s a situation where I can’t like. You’re like, May I do this? It’s like I’m sorry. This is an emergency. I need to do this right now And we built the trust that it’s not like it sucks, but it’s not like maybe as traumatic as it would be if you don’t understand why it was happening of you didn’t have a relationship with a provider kind of thing.
Maggie, RNC-OB
Yeah, absolutely, I think that as we continue, you know, it always keeps circling back that that piece that we really want to have those strong relationship so that, I think as we work to improve, you know, perinatal care and especially the care that we’re able to give during that prenatal period that ideally, we would have a shift that, you know providers have longer appointment times, you know, to talk about some of these issues and to develop that trust and to go through more of these questions so that in those those really tricky, you know, situations where you start to feel like these very of life and death issues, and they need be acted on now that there’s more kind of understanding and there’s more of a history there, you know, between the client and provider and I know Pansay was speaking to that, you know, earlier that you had a chance. People talk about it a lot earlier on so that you have a little bit more background and it doesn’t come across, you know, quite as jarring and traumatic as it could otherwise,
Pansay, Doula
With my position, I have to be very clear and comfortable that these aren’t my births. So, you know, with that, doing my part very diligently to educate, you know, once I deliver that information and they have studied and researched, you know themselves they then it is their birth. So it’s, you know, sometimes clients do want an epidural, you know, sometimes they want a c-section, and I have to be comfortable that I’ve done my part, and it’s their right to make that to make that decision. Yeah.
Maggie, RNC-OB
Yeah, absolutely. And I think you know that the key, please, about your decision is that we’re involving. You know, the client in that we’re really listening to their values, which might be very, of course, completely different than our own. Also providing, you know, providing for safety and providing, you know, like Ray was saying that we’re, you know, we’re meeting them, you know where they are. But part of why they’ve chosen, you know, to seek out care is that they want, you know, someone else to be there to help, to guide and provide safety. And, you know, for all that. So I do. I hope, as we you know, as we move forward that we are able to just have more time to have these conversations, you know, with our clients and that, you know, there’s increased education for consumers about options and in the role that they have, you know, as autonomous people you know, in their health care. People feel more able to to ask questions and to get into discussions, you know, with birth professionals and and feel really empowered about what’s going on with their body. I liked a quote from Larry Morrissey: “until we help people think about decisions and what’s important them? We’re not getting at the problems they face.” And so I like that idea that we’re helping people to really see, you know, to see themselves and see what’s going on and then be able to make their own decisions just like we want to do with, you know, everything else that happens in our life. Thank you all so much for weighing in on this today. We’ll talk soon.
Maggie, RNC-OB
Thanks for tuning in. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your Birth Partners on all platforms. We also recommend you check out our show notes blog on our website, yourbirthpartners.org. We’ll be getting into some of the fun topics we’ve discussed today, including a really great video about your decision making and how it might look in health care setting. And we also ask, as we continue to spread this message far and wide, that if you agree and support our mission, you would share this with your friends and colleagues or consider donating to our non-profit. Thanks so much for your support until next time.
010: COVID-19 & Birth Setting
Maggie, RNC-OB
Hello. Welcome to Your BIRTH Partners. We’re here to breakdown barriers and cultivate community as we discuss issues that impact pregnancy, birth, and postpartum. We welcome you, no matter what your background is and are so excited to learn together. Today I am joined by Ray Rachlin, CPM and Abby Dennis, OB-GYN and Family Medicine Physician. So we found that because of extra shenanigans that COVID is throwing into all of our lives, we weren’t all able to get together for the recording session all five of us at this time. And so we still wanted a chance to talk about kind of the ways that COVID is impacting our practice right now and particular to tune into kind of the theme that seems to keep coming up about the idea of, you know, home versus hospital. Where is the safest place to give birth? And how do we help to kind of protect the safety of all involved in, you know, in both environments and as a whole, as we work to make sure that, you know, people get the right level of care that they need. That also matches up with risk picture and and everything else that’s going on in their lives. So we are excited for you to learn more with us about these topics and, you know, get a little bit of a greater understanding about how COVID is impacting births across, you know, all care settings at this time. On to the show!
Maggie, RNC-OB
We are talking about, what is on everyone’s mind, talking about COVID-19 and the impact that it has on our care, which we know has impacted everyone, obviously, on so many different levels, personal and professional, and particularly we wanted to tune in and have a chance to kind of go around the room and share how it’s impacting our practices here. Since we span so many different sides of maternity care. One of these like like I scene just as I’m watching it happen in my own practice and hearing people talking on social media and, you know, on the phone with colleagues that, you know, we’re just seeing that this whole crisis is really just magnifying so many of the things that are already kind of challenging points within our maternity health care system. So, you know, we want to talk about what’s going on and kind of give a, you know, round-table update on that and then also kind of talk about some ideas we have for solutions and, you know, kind of tune everyone in tow different ways that we could maybe kind of helped change the tide of how this has been going so far. So, you know, whoever wants to start it, just gonna share with us. What/how is this changing in the last, you know, 3 to 4 weeks. How has this kind of changed your professional life? How you’re practicing?
Ray, CPM
Abby. You want to go first?
Abby, MD
I’m happy, too. I mean, this is obviously changed things pretty hugely in terms of just modality of practice and the protective equipment that we’re suddenly wearing for deliveries. And, a lot of unknown because a lot of the data on COVID pneumonia and pregnancy, and such is based on really small case reports. So I think we’re working with a disease process that we don’t know much about. It seems not to be like influenza, which has increased morbidity and mortality in pregnancy, but we don’t actually know that, and we don’t know much about potential for vertical transmission. That then is coupled with the changes in visitor policies in hospitals, which has been really hard, you know, on the obstetrics hospital side of things were already working in a climate where people don’t always trust us to make the right decisions and not over medicalize birthing. And suddenly people are being told that, you know, at one point you know you can’t have your doula or support person, and I think there are a lot of fear that patients are gonna have to labor by themselves. I will say, in terms of like, the community of people I practice with, I’ve been hugely impressed by the nurses I work with, the other doctors I work with. People are really functioning, as the team, and people have been so compassionate about, you know, thinking about what it means to labor without a partner and trying to be extremely present for our patients. And to get them through this. So I’ve been very impressed by by that piece of things. But it’s hard and scary, and there’s a lot of unknown involved.
Ray, CPM
Yeah, I feel like on my side of things home birth, you know, myself, and other home birth midwives in Philly when all this started started getting, like 20-30 calls a day from folks that are freaking out about if they should have hospital birth or switch to home birth. And we had to get everything together really quickly to figure out how to manage an influx of home birth in our community and support each other as we expect to get sick, at some point, we’ll need backup care. And, you know, we kind of came up with the community standard for cleaning supplies and for a distance visit. So, you know, now, seeing people in office like half, half as often as we’re used to and like doing zoom appointments in between and limiting different ways that we were in contact with our clients beforehand, like doing less home care and also, yeah, and we’ve all taken on some extra births in that. It’s been it’s been a stressful time. I think I feel really like excited that, like my community, my midwifery communities, like, kind of come together. And, you know, we have the infrastructure in place to help more families, right now, But also, it has just been very intense to like care for people during this crisis and then, like, manage my own risk. And, you know, I have difficulties accessing enough protective equipment for myself. Yeah, and then just all the inquiries. Like, I think for a few weeks it was like, you know, talking to like 20 people, on the phone or getting lots of emails, and it’s maybe slowed down a little bit. But it was mostly people that were due like in April and May, just suddenly, wanting a change.
Abby, MD
You know, it’s interesting; it’s really created support amongst our small communities, but I think in terms of home birth versus hospital births, unfortunately, a lot of this has brought to light the division and antagonism that sort of exists between the two communities. I remember there was somebody on CNN, a doula who was talking about you know, not “it’s unfortunate I can’t be with my women in labor to support them, but it’s unfortunate I can’t be with them because I won’t be there to advocate against the bad care they’re going to get,” which is I mean, that storyline makes me sad, because it’s not all bad care here in the hospitals. I worry about you guys, as homebirth providers taking on patients that aren’t the right patients? Patients that haven’t been thinking about this from the start. I don’t know what that’s gonna mean for your practice in building relationships and everything; that scares me for you.
Ray, CPM
Yeah, I think I’ve never been more discerning. Because like the conversation I have often is like, “you know, like, what did you think about home birth before all this? You know, do you feel safer in the hospital? If so, you should give birth in the hospital.” I am really only taking, like, the lowest of the low risk people. Because I’m attending more births when it typically would. And I’m relying, we’re on, like, you know, back for my community to help me do this. So I want to make sure that we’re setting setting ourselves up well, and that means yeah, like saying no to a lot more people than I’m saying yes to.
Maggie, RNC-OB
Yeah, I do. I feel like that It’s very challenging, and I think initially there was just this whole concern, especially as we’re seeing certain, you know, hospitals who were really just saying no one can have a support person. I think that I’m sure had everyone really just feeling so anxious about what that meant for, you know, their care. And then I think it puts birthing people in such a hard position to feel like they’re choosing the environment and maybe care providers who they had felt most comfortable with, or the other parent to the child you’re about to have or, you know, whoever else, you know, your biggest support person is, And I think that just puts so much extra, you know, anxiety. And, you know, absolutely I think that probably made people who weren’t really great candidates reach out and just kind of a knee jerk reaction like, “Oh, wait. People give birth at home. Maybe that could be me. Maybe I should be doing that. And I think, you know, I’ve heard from home birth midwives definitely in Philly and in Maryland, and I’m sure it’s happening all over, you know, the country who same thing that they’ve had to tell a lot of people that yes, even with everything else that’s going on, you still need to be a good safe candidate for home birth, you know, kind of in your own right that, you know COVID-19 didn’t magically take away all of these other risk factors that we have to look at. Yeah, and I think that’s just like, you know, there’s risks and benefits to home, there’s risks and benefits to the hospital. Keep who choose home birth prefer the risk picture of home. And for some people COVID tipped the scales on that a little bit more on those people, you know, if they’ve also had low risk pregnancies, I can work with. But, you know, if you’re scared of giving birth at home like probably gonna transfer for failure progress. And also that’s not the situation like I want to put myself in as a provider. Like, you know, home birth is really a partnership and, you know, to build a relationship with someone last minute in a partnership to make a safe homebirth experience possible is a lot of work. It’s a lot more work than when somebody comes into my care at 16 weeks.
Maggie, RNC-OB
Yeah, I think obviously the whole relationship-based piece, you know, of home birth like that is what we see in some ways make such a big difference, you know where people feel so safe in, you know, in care. And I think the way that we have to provide care from a public health approach right now, even in the home birth setting, like it definitely is impacting the way that you’re able to build that with shorter appointment times and, you know, and even just, you know, the reality of having to wear a mask when you’re talking with people, like all of that impacts that feeling that you’re really connecting with someone, and definitely, you know, adds just a whole other kind of layer, you know, everything that’s going on and any anxieties anyone would have already. I feel like for many people I know and for myself, you know, I’ve had a hospital birth and a home birth, and they were both great experiences, and very similar things about, you know, both of them and also completely different because of course, you know, every birth is different. I’ve heard from so many people I know who are really, you know, strong home birth advocates that this is an opportunity in many ways to kind of expand the conversation around home and hospital birth. And, you know, who is a good candidate and how you know, how could many of these people who are, in fact great candidates be accessing? You know, those service is normally if that’s saying that you know, really kind of fits with them if they had a better understanding of what it means to give birth at home. But the same time that you know, we want to be so conscious during this crisis that we’re also protecting home birth and the continuation of home birth by making sure that we’re really sticking to the safety guidelines that let us continue to practice it. So we want people to continue to have great experiences at home, and we don’t want to see an increase in, you know, in an unsafe care or bad outcomes that are then gonna ultimately kind of tipped the scales to more people actually, thinking that, you know, home birth isn’t safe. Kind of from like these false things. And I think one of things that I’ve heard some, you know, kind of rumblings is a lot more people are considering unassisted birth because they’re so concerned about not having, you know, the right support at the hospital.
Ray, CPM
Yeah, unassisted birth opens up a whole other can of worms, And I think I, you know, could understand it from an agency perspective. And then also, you know, from a midwife perspective, I see the barriers to having, you know, a home birth midwife, you know, like costs being chiefly among them. But also, we don’t say yes to everyone. And we have small capacities, you know, I’m one person. I can’t go to 20 births a month. But you know, when you’ve done this care and you know how quickly things can shift, you know it does give me a little lump in my throat for sure.
Abby, MD
It’s funny listening to this, I don’t mean to change the subject, but I think themes of like privilege and the common good have come up a lot. And I don’t know how to explain this, but it’s funny when I think about support people and birthing, and the people that I’m most worried about right now are my, you know, teen moms who are having to decide between having the person who really can provide support in labor or like their partner with them when they have their babies. And I also have been thinking a lot about just trying to…our patients are coming to the office and not allowed to bring partners. Right now we see a huge volume of patients a day, and by doubling, you know that number, we put our staff at risk so we have made that decision. I’ve been trying really hard to just thank my patients for that and remind them that they’re doing good by coming in by themselves by agreeing to do you know the visit with their partner with face time by making some harder decisions to benefit everybody. And you know, just like the toilet paper thing. I feel like suddenly, you know, women who are are pregnant have tried to go through. I don’t know. There’s been this process of like what can I do to make sure that I still get my birth experience? And I think that’s a little over the top. I think in general right now, women should be focused on “what can I do to have a healthy baby?” We’re still gonna try to provide women with an amazing life experience, and birth experience. But I think this is going to get worse. And I think that although we have been fighting very hard to make sure women have support people with them in labor, that might change if, if the numbers of people infected with us go up. I feel like ethically this has brought up a lot of issues about birthing options, and what your birthing options are based on how much money and privilege and how many connections you have.
Ray, CPM
Totally. I feel like one of the biggest criticisms I’ve heard was from a black midwife out of New York who was just like “we’ve been talking about, you know, black people, like being denied support in the hospitals for years and receiving or being mistreated for years. And now that, like white people are experiencing adversity like it’s a crisis.” And I was like, “Yeah, that’s that’s really spot on, yeah.”
Maggie, RNC-OB
I know, obviously you know, the social determinants of health that have impacted people for, you know, that hasn’t changed, you know, in COVID, and it’s only kind of magnified that piece of it. And I do think there’s a whole even we know we’ve talked about kind of the ability to socially distance and and to kind of follow the mandates have come out from, you know, public health officials. Not everyone is able to follow that, based on kind of how their life is set up and where they live and myself personally, like, you know, I operate from, you know, a place of privilege, right? I do. I have a house, you know, that I live in where I can kind of isolate myself and my family from the world in a different way than I would be able to if I was, you know, living in the city and had much more proximity to people. And if you know everyone in the household, there’s multiple adults who need to go out and do all of these kind of essential worker jobs, you know, even more so and are not health care providers necessarily, and hence are not getting the same, even if the semblance of, you know, personal protective equipment that, you know, we get doing our job and are still having all that increased exposure, and I think it’s just it continues to pile on just so much heavier for just a lot of people who already don’t have kind of the same access to care. And this is just gonna impact their lives so much more.
Abby, MD
Maybe that’s a good transition, because I feel like before we started recording Maggie you were talking about some of the things that we could be doing to help this be easier for our patients particularly. I mean, you were talking about some options for getting people more support virtually or in other ways in the hospital that maybe it wouldn’t have the same amount of risk in terms of exposure to asymptomatic patients of COVID.
Maggie, RNC-OB
Yeah, I know. I mean, one of these I have been playing around with is just what we’ve seen so many support people, you know, needing to step back to limit exposure. You know, we have tons of people, tons of doulas who are ready and waiting and who obviously still desire to be involved in care and still help people have, you know, great labors and births. And I would I would love to find ways to kind of capitalize on that from a more systematic approach. You know, that people are able to get access to to do, listen to other support and that from the hospital side, you know that that those of us who work in the hospital would really be advocating for that and encouraging that and really embracing that piece of it. And ultimately, I would really love it if hospitals were upping their budget to help to pay for part of it. Um, because I do feel like it’s a public health need, and I think it’s, you know, in so many, like Patient Bills of Rights, you know around that, you know, there’s different ones for each state, you know, in the U. S. But so many of them talk about the need people have that it is a basic right to be able to choose who is there and able to support you, you know, during birth. And so while I absolutely respect the fact that we’ve had to limit that in the end person piece of it because we’re in a pandemic and that, you know, ultimately changes how we have to practice, you know, we’re seeing this limit of, you know, limited numbers of visitors and support staff. You know, we’re seeing that happen in hospitals across the country, but we’re also seeing it in, you know, out of hospital settings. I know, you know, Ray was speaking to how they, you know, they had to limit what’s available to them to down to two support people for the client in order to kind of decrease the risk of, you know, possible spread from asymptomatic carriers. And so we’re seeing that this is affecting care across, you know, the board. This isn’t necessarily a home versus hospital issue, but I think especially as you know, we’re seeing that we know the way that care is divied up and that in the hospital, typically, you know, care providers are caring for a higher number of patients at any given time. You know that there are gonna be these gaps in care when, you know, a trained healthcare professional isn’t in the room with the birthing person and their family. And so you know, what are ways that we can kind of fill in? And, you know, the majority of births do happen in hospitals. How can we kind of build up that dedicated doula support so that there is better access? You know, across the board and kind of help to equalize, you know, the playing field a little bit more. And now I’m rambling. So I would appreciate you think that could, you know, logistically, how we could maybe make something you know, like that happen or what other kind of avenues you all see for kind of bringing a little bit more of the human touch piece of it back to birth where we can.
Abby, MD
I’m listening to your rambling because I love the idea. And I would love to hear it hashed out a little bit more. I think obviously, the limiting peach pieces so much of supporting women through birth does involve touch. And I feel like doulas who are really effective are helping women through the pain component of labor by helping them with position changes and massage and, you know, things that are gonna really help them relax and and get through the process of labor. But that being said, I do think some of that could be provided without an in person, support person, too. Or at least we could be making things a little better than they are.
Ray, CPM
Yeah, it’s so hard. Because I think for me so much of the like, yeah, like the contact, the consistent presence is like what, like we have evidence for like is having someone in the room, like sitting quietly improved outcomes. And that is the exact opposite of what we need right now to control this health crisis.
Abby, MD
I’ve really seen more nurses stepping up to the plate and doing a lot of the hings, which is amazing because they’re also now, you know, their job is so much harder and there’s so much more risk and touch, involves more risk and deliveries are involving all this protective gear. But I really have seen our nurses, like, just be so compassionate and and really try to take on some of the role of support person to while they’re doing their jobs, which has been amazing.
Ray, CPM
Yeah.
Maggie, RNC-OB
Yeah, and I think all of us I know there’s been, you know, a lot of kind of talk about, you know, if and how you know, hospital healthcare staff can replace, you know, your support people. And so I just also want to say, like, we know, we acknowledge that, like, I know, as a nurse, I love being a nurse. I love being part of a team that gets to help, you know, people bring their babies into the world. I know I am not a replacement for anyone’s chosen support person. I am not as good as you know, your partner or, you know, your mom, your sister, your best friend. Like I can’t do that. And, you know, it’s also I love what I doulas do and the fact that their role allows them to be there, you know, right with someone you know, through each contraction and often times because of the logistics of being a nurse, I am not able to be, you know, at the bedside with someone because I’m taking care of, you know, other people often or you know I need to check in on different things. And, you know, we’re managing different aspects, you know, of the whole health picture, and and so I know I’ve seen a lot of, you know, nurses who absolutely are, we’re stepping up and stepping into that role and doing the best that we can in those circumstances. But I also just want to be clear that, like, we know that that’s also not enough. Like it’s not enough in general, and, you know, even now, like we want to do the most that we can. But I also don’t wanna be dismissive of anyone’s, you know, experience when that is not, that’s not what you want. You know?
Abby, MD
And I totally agree. Just like I’m not the best person to be teaching my children right now. So, you know, this is not suggesting that in any way. But I think if we could use this sort of crisis to help uncover what’s not good about the birthing sort of profession in general and make things better. I think that would be a good thing, because this is a limited. I mean, this is not gonna last forever. This is hopefully a short term thing. And yeah it could make us do things better in the long run.
Ray, CPM
Yeah, I feel like it’s really bringing up like all the places where there is not integration is like so much is so much worse. You know, in all the places where there isn’t enough staffing to, like, be able to provide attentive care is, like so much worse, you know. Things that insurance doesn’t cover, like telemedicine, you know, and suddenly we must do telemedicine. Yeah.
Abby, MD
Right.
Maggie, RNC-OB
I was speaking to a lot of doulas earlier in the week who we’re talking about, a kind of credentialing for doulas. You know, if that would be something that potentially comes out of this so that they can really be a more well integrated part of, you know, the health care team, and not just for hospitals to create their own, you know, in house doula programs, because I think that has, you know, pros and cons, like anything else but a way to help that transition kind of piece of it. For if we’re truly seeing, you know them as an integrated part of health team that they would have better, I guess more consistent, expectations and, you know, training. All the concerns that perhaps healthcare institution have now about not allowing, you know, trained labor support in. What are the ways that we can mitigate that so that they feel like they know who is there helping to provide care for their patients. And kind of uplift that role so that they’re able to just be more transparent and in care. So I’m interested to see, like what kind of what will come from them that. You know, Ray, in the, within the home birth kind of community. We’re seeing obviously lots of this, I feel like, even more so the community building, you know, as you’re all reaching out and forming, you know, bigger networks and and everything. What do you feel like is kind of like the big takeaway that, you know, we could have for after this? Again because we all know there will be an after this. We don’t know when, but it will happen.
Ray, CPM
I mean, I think I’m excited with how much more back up I have right now than I’ve ever had, period. So I’m like, one of the first things we did as a midwifery community was set standard pricing for coverage. And that, like having that, like okay, like just knowing where everyone stands and like, feeling like, yes, like that, how we’re gonna, like, help each other, do this job and, like, you know, how people are gonna help me and, like, I’m gonna help other people and then having a lot more people in our pool that we can call on because we used to assist each other births, and now we need to not see each other anymore. It’s really interesting and I’m hoping that the support and community that we’re building will kind of last, and we’ll end up meaning that we have more on call support in the future. And also like more infrastructure to handle things as a community. One of the other interesting things that’s happened is there’s been a couple of emergency licensure bills, and was in the works here in PA. But like in NY, the governor issued an order allowing CPMs with licenses in other states to practice in, and from Canada, to practice until, like, the end of April. And, you know, they’ve been working like New York is one of the hardest states to be a CPM. There are 2 CPM’s that are being, you know, charged with, like, multiple felonies right now. And so the fact that you know there like “this is such a crisis that we need you” and, like other states, are also following suit, could really pave the way for more CPM laws and integration in the future. Which is, like, the more integration we have, the better outcomes we’re gonna have and licensure is a part of that.
Maggie, RNC-OB
Yes. Ray, I am so glad you brought up the point about you know CPM licensure. And there there is such a need for us to have the same access to licensure across the US because we also see that in all times, especially in times like this, in a pandemic where there are, you know, different needs popping up around the country. We need people to be able to provide that same level of access to care all the way across the board. And we know home birth is most safe in every study where they look at this. It is most safe when it is present in an integrated health care system. And so we need to have license so that people can have honest discussions between care provider so that there’s transparency about what’s going on and that we can actually keep birth as safe as it possibly can be. And if people want to just speak a little bit to like the kind of conversations you know, if you want to talk to, you know, any of the podcast listeners, kind of like whata are the conversations you’re having with, you know, with clients. How are you kind of balancing out that feeling of not wanting to be scary, you know, or fatalistic but also being realistic about what you know what’s happening and how things have changed?
Abby, MD
I do think for the most part we can be reassuring. You know, the scary thing about this virus is really that there are people who could be asymptomatic carriers for two weeks and therefore just given the amount of daily contact and touch we have with other people on a daily basis, the potential for many people to be infected is high. Despite lack of still good, solid information, most of my patients and their babies are going to be fine at the end through this and at the end of this. That piece of things at least, is it’s reassuring. It’s gonna be so much harder for them than it is for most women giving birth, but they’re gonna be okay for the most part at the end of this.
Ray, CPM
It’s nice that the little bit of data we have isn’t, you know, we aren’t seeing, like, significantly worse outcomes. Like there may be more preterm births, there may be more C-sections that might also be because of how China was treating pregnant people.
Abby, MD
And because people are asking for them. Yeah.
Ray, CPM
But it’s like it’s nice to be like, “Well, we don’t think there’s vertical transmission yet, like like there’s maybe two case reports, but for the most part doesn’t seem that the case.” I’m just recommending social distancing and, you know, I think good handwashing measures.
Abby, MD
Which are good things in general when you’ve just brought a baby home.
Ray, CPM
Yep.I think the harder part is just, like not having as much postpartum support. You know, family members can’t travel to be here.
Maggie, RNC-OB
Yeah, I know. I feel like that piece of it is like from a again, like the big public health thing. I think both from people, just everyone, obviously, who’s going through this crisis, you know, we all come into it with different resource, available to us, and, I think we’re all concerned about, you know, how we’ll kind of see mental health suffer, you know, through this, and especially as this continues to go on. And I I worry about how that’s gonna play out, you know, within our postpartum community, you know, where we know that there’s already kind of a breeding ground, obviously, for having, you know, more mental health concerns and then having changes that happen during pregnancy and, you know, births and all of those things that kind of set us up to feel like perhaps we failed or, you know, unexpected care delivery that we already know kind of can increase trauma and how people kind of respond to it and then adding, on top of that that you’re returning to, you know, a place where you’re really more isolated and you perhaps don’t have you know, any support? I’m concerned. And again, that’s one of the issues that I would love for there to be kind of more broad strokes efforts to how are we kind of addressing all of these people who are, you know, postpartum and adjusting to just a huge change in, you know, themselves in their family dynamic.
Abby, MD
Amidst all of this other upheaval, I feel like we’re finally making some momentum and acknowledging that there was a void of care after delivery. And yeah, now those are the patients that are easiest to just “okay, you don’t need to be in the office. Just go home.” But again, I think strategizing and figuring out ways that we can support women without actually being physically present is probably going to be an important part of this.
Ray, CPM
Yeah, I think one of the things I’m most excited about through all this is like the advent of, like, online breastfeeding support groups and just being like, “Yeah, why wasn’t this already happening?” Like it is so hard to leave the house with a baby or some people can’t because they’re caring for other children. And it was like, I hope this stays because I think there’s ways that probably these mediums of in person and online can be better mixed.
Abby, MD
Tele medicine in general to for medical care. It’s really interesting how much can be accomplished, not in person.
Ray, CPM
Yeah.
Maggie, RNC-OB
Yeah, I think it will be introducing how that plays out in terms of like when things get back to normal. How much of that will change and kind of for the better. Like, how can we kind of better integrate these different technologies in different ways to kind of help maximize everyone’s, you know, benefit from the situation.
Maggie, RNC-OB
And behalf of all of us obviously just a big shout out to everyone right now who is working through this. So for all of our health care workers in, you know, all of these different settings who are really coming together to try to do more and do better, you know, by the people in our care, even when under, you know, extraordinary circumstances. I really am so encouraged by all the stories we hear of, like more communities coming together. People really kind of stepping up to fill their roles as much as they can. And you know, to all the people who are out there giving birth right now and getting ready to do this like, you’re just so incredibly strong to, you know, be bringing life into the world amidst all of this. And you know that strength is it is not going unnoticed. And so we really applaud you for for stepping up and for also for, you know, letting us know as your care providers what it is that you need and how we can help to get a better support you, you know, and as much as we we can during all this. Thanks you all for being here. I appreciate you.
Maggie, RNC-OB
Yes.
Maggie, RNC-OB
Yeah, absolutely. Be well. Be healthy.
Maggie, RNC-OB
Thanks for tuning in. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, we’re Your BIRTH Partners on all platforms. Especially during this really trying time when things are constantly changing and everything feels very up in the air, we really want this opportunity to connect with you and understand what your concerns are and, you know, band together so we can come up with solutions that help all of us to, you know, improve birth experiences for those in our care. So we would love for you to comment on our show notes blog at yourbirthpartners.org or you know, find us on social media and let us know what your concerns are and how we can all draw together during this time. Till next time!
011: COVID-19, Black Maternal Health Week, & Caring for Each Other
Maggie, RNC-OB
All right, so welcome. So today I am talking with Ms Pan say, and Miss Angela and we are, you know, covering code. Still, it is, you know, this most pressing issue that we’re seeing happening, So I wanted a chance to dive in with them about how this is impacting, you know, they’re they’re practice their professional lives how this is impacting the relations, their clients and then also did a little deeper into kind of the social terminus of health. And how we’re seeing those play out kind of a long Koven and along how this is gonna impact particularly different, you know, care communities within maternal child health. So, yeah, so if you all want to just kind of started to share a little bit about how is this kind of changing the way your offering care so far?
Maggie, RNC-OB
All right, so welcome. So today I am talking with Miss Pansay, and Miss Angela and we are, you know, covering COVID. Still, it is, you know, this most pressing issue that we’re seeing happening…so I wanted a chance to dive in with them about how this is impacting, you know, their practice, their professional lives, how this is impacting the relationships with their clients and then also dig a little deeper into kind of the social determinants of health, and how we’re seeing those play out kind of a long COVID and along how this is gonna impact particularly different, you know, care communities within maternal child health. So, if you all want to just kind of start to share a little bit about how is this kind of changing the way your offering care so far?
Pansay, Doula
For me, it’s just like I do see this with you know, all of the doulas in the Baltimore and, you know, Maryland area. This is a very difficult time for everyone. Very unfamiliar territory, within that, I am so grateful that we do have the home birth option. Like, you know, we have the option to help these women, who are very much afraid of being in the hospital setting right now to give birth. I have seen an amazing shift, like women I know would have never considered home birth, you know have been reaching out, you know, “please give me some options for that.” So, you know, within the crisis, that’s the beautiful part that we have several home birth midwives that have stepped up and taken on, you know, all of these women to give them a safer environment, you know, at home to have their babies. My current client was was due to deliver at Special Beginnings Birth Center in a few weeks and we have transitioned to a home birth. So it’s it’s been a very relieving, you know, shift that they have those options. The other side of that we know we have women who cannot afford, you know, to make that to make that change. So what do they do? You know, they are limiting the support staff, and also the hospitals are going just one person you’re allowed to bring in, you know, with you. But we know that that’s changing daily with all of the hospitals. It’s just, you know, the rules are changing. So a lot of them are preparing to be alone that they might have to you know, give birth by themselves. I am seeing the majority of the doulas offer virtual services to help these women prepare to be there. I have even seen some footage and video, you know, off some doulas, you know, actually, in the middle of that virtual call. You know, some of them even walking mom up to the hospital door and then face timing, taking over, you know, from there. A lot of positive outcomes, but a lot of sad outcomes too, you know. I’ve seen another scene, another situation this morning where a nurse had passed on, you know, corona to mom and baby; baby is in the ICU. So a lot of sad situations, you know, also. But that’s actually you know what, what they know it’s a possibility just going into the hospital, setting. It’s a possibility, you know. So right now I have seen doulas not charging, you know, for virtual services; they are really, you know, gearing up and coming together to try to support the women in Baltimore and Maryland. So you know, in hopes that they have some type of connection, even if it’s virtually so they don’t feel totally alone you know during this. I myself with my client, I am limiting my visits. I probably would have had two more face to face visits with my clients, you know, before the May birth. But because I can’t guarantee, you know, as far as who is coming into my presence and where they’ve been, you know all that. I am limiting my visits, and I will not see her until you know, until the birth. And I, you know, I will be doing everything, dress rehearsal and preparation virtually, a very sad situation. But I am, I’m happy to see everybody pulling together from midwives to doulas, to lactation consultants, you know, really to take care of the women, the women here.
Maggie, RNC-OB
Yeah, absolutely.
Angela, CNM
It’s so incredible to me how how different regions, different hospitals, different areas are seeing so many things for practice and something things differently and seeing things differently in the community that I work in. Well, first off, I live in Las Vegas, and we are very fortunate that we did not get hit as hard with COVDI, like a lot of those big major cities, mainly because they closed down the strip. Early march, like the first week of March, the strip was shut down. And so that got rid of about 70-80% of our tourists. So even more so, working in the military system, I’m only seeing dependents and active duty folks and our population. As of yet, my pregnant women have yet to have a positive COVID. But we do have COVID teams. I’m actually on the COVID labor team as the only midwife on it, and we have three physicians who back me up. I pull the majority of the primary call. And the reason why is so that, because honest to Pete, we need our surgeons we cannot afford for one of our surgeons to get sick. Because if that happens, it is really gonna put a strain on the type of care that we have. So we have gone through the process of now splitting our floors. There are COVID teams and non-COVID teams for every specialty in our hospital now. So basically, the reason why they did that is to save on PPE. So the only people on COVID teams are there because these are the only ones who will get the PPE in the event that we actually take a take care of a patient who is PUI or COVID+. It caused a bit of chaos splitting our labor and delivery units. So now we have two labor and delivery units but the same amount of staff to to cover those units. And so it means that we are on divery a lot, which means that now our patient population is certainly gonna be exposed because the general population here in Vegas there is a high COVID rate. We’ve had, I think, about 57 deaths from COVID, including one at my kids’ school County where they were serving food recently. So, you know, it certainly is concerning when we’re putting our patients out on the economy because they come back to us afterwards and could potentially spread this virus not only to their family members, but to staff is well. Another thing that we have done, which is pretty aggressive, is we went to 50% staffing about three weeks ago and then within a week we went to 100% virtual appointments. This includes all of our pregnant women, all of them. They literally have two appointments where they see us in person, or their entire pregnancy, unless otherwise indicated. And really it is urgent things only. It cannot be, oh even vaginitis, we can’t do anything like that. And if things like that come up, we do have a plan in place to address those issues. But 100% of the appointments occur by phone, even the new Obstetrical Physical Exam (OB PE). And if she’s already had a dating ultrasound, we will not see her for that new OB P. E. If she is going to a high risk doctor because she wants nuchal translucency, that will count as her new OB PE. They don’t get ultrasounds in the hospital. They talk about their labs, you know, the things that come up and at 36 weeks they will come into the office for a self-collection of GB swap and we’re going to do drive through prenatal visits at that point. So we’ll be doing fundal heights and dopp tones, but they’re taking their own blood pressure at home, they’re weighing themselves at home. And once they get to the age where we expect them to have regular fetal movement, that is how we are assessing fetal well being and obviously this is a very tough pill to swallow because we’re so used to being able to see women and touch them. And I find myself with the few virtual appointments I have, I mean, sometimes they last like, 30 minutes because when you have a person, a woman in front of you saying this is bothering me, I can look at it, I can touch it, I can smell it. I can try to reproduce any of those symptoms and evaluate it. And now what I’m seeing is that man, If you’re not really good at your clinical assessment, you are gonna be in trouble because I am asking a ton of questions and going through a ton of differentials when patients say things like, “Oh, I have this mid back pain like on my right side.” And I’m like, “oh my God, is that her kidney? Is it CVA tenderness?” and I have to run through this whole algorithm. Where if I had just been right there in front of her, I could have just touched her, I could have just looked at it, and it would have helped to decrease the amount of time that that appointment took. So there’s, you know, there’s worry that like we missed something, you know what if, you know, these blood pressure tools that the patients are using are not calibrated correctly and we’re missing, you know, the entire reason prenatal visits were established, which was to screen women for preeclampsia. But what if we miss that stuff? What if we miss intra-uterine growth restriction? Like it’s a lot to take in, but I do understand the purpose and the rationale for it; you have to weigh the risk with the benefits. And is it worth being in the office, exposing every last one of my colleagues, potentially exposing every woman who’s pregnant, her children that may come into the appointment as well. A lot of our patients have many co morbidities that will increase their risk for poor outcomes, if not death. So I tell myself the end of the day we have to do what’s right by these women. And I also remind myself, and many of my colleagues that, you know in the vast majority of the world women do not have access to good prenatal care and in the vast majority of the world, pregnancy is normal until it is not. Women don’t get a single day or prenatal care and they come in term, spontaneous labor. And they birth their babies and they take their babies home, you know, and I have to remember that in this country where we have wealth and good access to care and very educated providers, that the majority of our women are still going to be fine.
Pansay, Doula
Yes.
Maggie, RNC-OB
Yeah, I think, you know, in our last episode we talked about a lot of that, like that piece of balancing out the public greater good,
Angela, CNM
Yes
Maggie, RNC-OB
and the individual experience and that, that is, it’s impossibly hard, like it is so hard to to ask these people, these families who are getting ready to have a baby, which is already this, like, hugely transformational experience that they are trying to go through, and they’re trying to navigate so many new dynamics and concerns and, you know, possible issues that come up and then to have to ask them to try to really make these, like, big sacrifices that are so different than what we are used to here it’s really hard on that piece, you know, that you’re talking to, like that relational piece like that is so much of what you know, prenatal care does. It obviouisly helps us to rule-out, you know, massive health issues, and that’s very important. But so much of it too is that you’re helping someone to get comfortable with the idea that you’re gonna be there with them, you know, for this and that’s across all of these different birth professional roles, you know, whether it’s OBs and, you know, midwives providing, you know, prenatal care and doulas doing their appointments. I know we were talking, you know, with the last episode with Ray and, you know, doing home birth, especially that, like so much of their care, is based on the fact that you’ve been able to develop this really unique and tight relationship over, you know, seven or eight months of pregnancy so that you have this really high level of trust when you’re going into, you know, birth, especially in an area where you maybe don’t have as many, you know, access to different, you know, resources and and everything into that that balance. I think what we’re asking of, you know, birthing people is just it’s a lot; like I’m feeling for everyone right now who is pregnant and trying to navigate this and especially because we know, everyone doesn’t come into it with equal resources. Both, you know, mental, emotional, physical, socioeconomic, all of it. You know, we’re not all operating from the same kind of starting place.
Angela, CNM
You know, the other thing that, it’s interesting, I will say; so, we implemented our COVID teams almost exactly two weeks ago, we literally came up with a plan, and the next night it was implemented, and it went from best case scenario to all of a sudden, worst case scenario, all in one shift. We had all these plans about, when we do this, if we do this, if we do that, this is what happens next. And I literally got home from work on a Tuesday night and I got a call saying my first patient, who was PUI was coming in. It was supposed to be a slam dunk delivery because she was a grand multip and it ended up not being a slam dunk delivery. And we ended up in the O. R. We’re contaminating our entire units of now at one in the morning, we’re having to switch all of our non PUI patients down to another floor. And I mean, we had talked about this plan and, like, just barely set it up. And suddenly we were now dealing with worst case scenario. I think what was scariest for me was those precious moments that I lost just trying to get PPE on so I could actually go to the room to the patient, and not being able to comfort and support women the way I like to. I labor sit when my patients are in labor, especially, unmedicated. I am in the room with them pretty much the entire time, especially while they transition and I am in the bed with them. I am doing, you know, double hip squeeze a counter pressure and tell him that breathe and moan and full of this stuff that I can’t do now. You know I can’t do it and I can’t be in the room with them. Continues, like because it increases my risk. You know, I don’t feel like I’m with the women that way, and it’s heartbreaking.
Maggie, RNC-OB
Yes; it is heartbreaking. I mean the whole situation. It’s just like it’s hard to find the wins, like we’re seeing these moments where communities are coming together and where we’re able to come up with all these, you know, inventive plans to provide better support, and those are, you know, the silver lining, the moments that stand out. But it is just, it’s such a hard position…
Angela, CNM
It is.
Maggie, RNC-OB
to be in. I worry about how this plays out as it continues, you know, for a longer time. Like we’re still by most public health guesses in like the beginning.
Angela, CNM
Oh, absolutely.
Maggie, RNC-OB
stage, you know? And so, as this continues on for an indeterminate amount of time, where do we go from here? How does this realistically play out? How does everyone deal with this continuous extra stressors on top of their normal life?
Angela, CNM
Yes. You think about, you know, how immunity works and you know, the ideal is herd immunity, right? And this allows for a small majority to not be vaccinating. So we’re talking about 70-80% of the population, the general population needs to have immunity to whatever bug that’s out there in order for the vast majority of us and those who are not able to be vaccinated or those who choose not to to not be impacted. Well, the only way to get 70-80% of us immune is to be exposed to it, either naturally or through vaccine. And with us trying to stay home to decrease that incidence right now because we can’t handle the workload in the hospital, it’s gonna be a very long time. They are talking about, like doing research for vaccines. A vaccine, if it were, you know, being worked on today may not even be ready to give to the general population for at least a year to a year and 1/2 and then we need to understand the potential risk associated those long term risks, which we may not understand. And you know, that’s a mind blowing thing to consider that we could potentially be in this social distance isolation, self quarantine phase for a very, very long time, a very long time. And that’s the reality of it. It truly is. It’s the reality of it.
Pansay, Doula
I think this suffering. I think both of you kind of touched on this. How this will affect all of us. You know, health care professionals, our clients specifically actually, yeah. You know, the core of our work is connection and touch…
Angela, CNM
Touch. I miss touching women. I miss touching bellies and feeling those babies
Pansay, Doula
That’s hard; that’s hard.
Maggie, RNC-OB
I know, I do. I definitely worry about that. The human touch, the connection piece of it, and where that goes with all this and how we kind of work to maintain that. And I also I also feel like when we’re looking at everyone and just the mental health, you know, repercussions of this and how that’s going to play out. I’ve read some articles about, obviously we’re already seeing just the huge impact it’s having on health care professionals, you know who are dealing with is constantly. The way it’s impacting doulas who aren’t able to be there providing care and then kind of have that, like “survivor guilt,” kind of feeling of not being able to actually be somewhere that they want. And it’s just, you know, it ends up, it’s complicated on so many different, you know, levels. And I also worry about the marginalized communities in, you know, in our care, like we know that health care delivery is not the same across the board.
Angela, CNM
Nope. It’s not equal.
Maggie, RNC-OB
…in our country on a good day. And this is certainly not a good day, you know, like we are not operating anywhere close to that, and I definitely I worry. And, you know, this episode is coming out in, you know, Black Maternal Health Week, and I am really worried about our moms of color. I’m worried about birthing people of color and how all of the different ways that this disease is impacting our public health, how it’s impacting our economy, how it’s impacting all of these different facets of our life, and that is going to definitely impact communities of color in a higher degree because of the systemic racism that exists in our country all the time. And I’m already seeing, you know, reports that the rates of COVID in, you know, black community, their numbers are far higher than their actual, you know, percentage of the population in affected areas. I know in Milwaukee they were talking about how you know, black people are about 27% of the population, but they were 50% of the COVID cases, and they were 87% of the deaths from COVID [~4/3]. And, you know, similar in Michigan, where they’ve started to, you know, do all racial aggregating. They’re talking about their 14% of population and their 35% of cases and 40% of deaths. And I know we’re gonna keep getting more of these results from other states cause it’s just happening. People are calling that we need to break down all of these results by race. We can start to look into some of those the different way that care plays out. I’m worried about how it’s going to impact our women of color who already have higher rates of so many different comorbidities, like we know that because of the effects of racism that we have higher rates of diabetes and asthma and hypertension and all of these different autoimmune diseases, which we know puts people at higher risk then if they actually get COVID, and how that’s gonna impact their care. And how is that gonna impact their care especially they’re pregnant, and then they have this other layer you know of risk added into it.
Angela, CNM
Yup. You know, the thing….we touched on something off line that is just man. It just hits the nail right on the head about how you know this is not a new thing in healthcare having these health disparities that are so so so vividly defined and separated by race and culture and ethnic background, and social status. I think that obviously it’s not surprising that we’re still seeing that with this COVID outbreak, and it has a lot to do with our foundation. You know, it’s getting to the root of the issue, which is, you know, having people who already are underserved, poor access to care, poor access to knowledge or have a knowledge deficit purely because they lack the ability to learn or because of their social surroundings, have certain beliefs about certain things. So you put these people, these same people who are already an at risk group, and they’re exposed to something like COVID, well, their outcomes are gonna be greater because the foundation was laid many years ago. The foundation was laid at birth, it truly was, was laid at birth and they didn’t come out of that. And unfortunately, what I see happen is we tend to in our society, we tend to, not give the people who don’t seem like they have a chance the opportunity. I will say, even as a young adult growing up in this inner city area literally, I could see the projects right down the street from our house and I went to the worst high school in my community. People didn’t put money into our community, into our school because they didn’t think we were worth it. And what I will tell you is that of the five of us in my graduating class who went to college, these were the five people that our school put all the resources into because they were like, “Oh, well, these five people might have an opportunity to do something. Let’s just pour all the resource is into them” and everyone else was ignored. You know, everyone else was ignored, and that’s what continues to happen across the board, even in health care. It’s like, mmmm, I see them. And even when I worked in private practice like my O. B. is a black woman, and she had this thing about people with private insurance. That people who did not have private insurance, who had Medicaid, they were all seen in her Decatur office, and then everyone else was seen in her uppity Johns Creek office because those were the ones with private insurance and the ones in the Decatur office were the ones who were most vulnerable. Those were the ones who never got health care unless they got pregnant. Those were the ones who didn’t have access to routine screening. Those other ones who, if they get sick now with COVID, they’re gonna be left out, they’re gonna be left out alone. They’re gonna die alone because no one’s gonna be able to be around them and no one’s gonna be able to learn from it.
Pansay, Doula
This is hard. It’s just really hard.
Angela, CNM
It is hard.
Pansay, Doula
You know, what can we do? We were already fighting to protect these women, you know, to be respected in birth. You know getting more of them to educate themselves on their options and getting doulas. And now it’s like we’re pulling all of that, and all those resources where they can’t even have that you know now. Where they will be there, you know, alone, and the prior issues still staying, you know? So, I don’t know. It’s just a very scary time. It’s hard.
Angela, CNM
It is. You certainly feel powerless. I will say it is like right now I am so, so grateful to be able to serve my country in the capacity that I am. I absolutely love being in the Air Force. I love being in the military. I love what we do. Man, I wish that I could do more. And when I say more, I mean like with the general population, because military represents about 1% of the population. And guess what? We all have access to good health care. Our people have the very best, you know, the vast majority of this country, don’t. And those are the ones I would like to seeing us serving more, because those are the ones who are vulnerable and most at risk. And if women and babies are not protected, then the livelihood of our future means nothing. Like women and babies are the future. And unless people really wake up and pay attention to that, it doesn’t matter if it is a white woman and a white baby, every woman, every woman, every woman and her baby is the future. And we need to respect that. And we need to protect it. You know, we have to protect it or we have nothing.
Pansay, Doula
Yeah.
Maggie, RNC-OB
Absolutely. I mean, it is, it’s an issue. You know, we see that in our country, because of who founded our country and the way that power fell out from there, that people of color have a harder time in our country, a
Angela, CNM
Oh, for sure.
Maggie, RNC-OB
And that is an issue that everyone needs to take seriously. And I know there’s been a lot of, even in just in the past couple years, you know, a lot more social justice is being talked about from different perspectives and people are realizing that race is not an issue that’s in a box. It’s not something that you get to, like, step into and out of. And it’s something that I think, speaking as a white person, I can somewhat. I can choose to be involved in issues that impact that. But that’s wrong, like, that’s not okay that I get to choose whether I care about these disparities. And so I want to just kind of call out everyone on this issue
Angela, CNM
Yes.
Maggie, RNC-OB
And especially in a time where we’re in a crisis and we know that all care is gonna be diminished a little bit because we’re gonna have staff that are burnt out, and sick and we’re not gonna have the same access and resources that we do any other time, that I just I want all of us, no matter what your ethnic and cultural background, no matter what the color of your skin is, to really be tuned into these inequalities that are present in our system already, to listen a little bit more closely to every person who’s in front of you every time that you’re giving care. And try to get past some of these biases we have that don’t let us see everyone as our equal, that don’t let us see everyone as our family member, that don’t let us put our whole compassionate lens on people. And I’m calling myself out as much as anyone. Like we, you know, none of us are perfect. We all make mistakes. I am certain I have not provided the same degree of care to every single person who’s ever been in my care.
Angela, CNM
Oh, absolutely. I am guilty of that as well.
Maggie, RNC-OB
And so I would just love for us to just all step into that a little bit more consciously, and especially for those of you who have means, those of us who have privilege, those of us who are able to, to just extend a little bit more grace and kindness and awareness to everyone else in our society who is going to suffer more from this, like there are some of us who will be more okay whenever COVID ends than others.
Angela, CNM
Some of us that will not. And I think, Maggie, I love what you said about just being self aware. I think that as human beings, we know we’re not perfect. You know, no one is perfect. And trying to do the right thing is a practiced behavior. You’re gonna fail it some times, some moments, but I think the most important thing is just being aware of our own biases and of our own feelings and attitudes about things and working to change that behavior on on a regular basis so that it becomes habit, it becomes second nature. I like to pride myself on being super open minded and neutral on topics and being this all inclusive person. But sometimes I find myself, thank goodness, you know, I reflect a lot because of the school I went to. And I find myself caught up in these biases, and I really I’m like, “Angela. What are you thinking? Snap out of it right now. Snap out of it and approach this differently.” And what I find is that I generally soften the mood or the conversation that I’m having with this person that I originally was feeling some way about, for whatever reason, usually feel pretty guilty that I had to train myself to do that to begin with, but also relieved that I’m able to recognize that in myself and change the course of the type of care that I give someone. I think we all need to practice doing that on a regular basis, because that is how we at least start to bridge the gap.
Pansay, Doula
Constant self reflection.
Angela, CNM
Self reflection. It’s important, like I think we need to in general, just not be so quick to react. It tends to be so emotional as humans; we cannot read act all the time. There’s usually time to reflect and think about our approach. We need to do that at this time with the health of our entire world in danger, you know, especially when it comes to women of all backgrounds. All race, ethnicity, socioeconomic status. Because we’re all the same.
Pansay, Doula
Yeah.
Angela, CNM
This is a tough conversation.
Pansay, Doula
Yeah, I was just wiping my nose with a sock, haha.
Angela, CNM
[laughter] It’s just, it’s heavy.
Angela, CNM
It’s heavy; yeah, very much.
Maggie, RNC-OB
It is heavy. I don’t know that we’ve had, like, a light conversation yet, but this is definitely a particularly [sigh] heavy one.
Pansay, Doula
For one, it’s gonna be a long road. It’s like it’s no end in sight, right. You know, when you think about you know, what we’re already dealing with, and how we’re already trying to support and, you know, help the women. You know, our [maternal morbidity and mortality] numbers are climbing. Things have been getting worse. So, yes, we can think about how to better, you know, support. And how to better lend ourselves to them. But again, it’s just so scary because the numbers are growing and it’s just I don’t know. Seems to be getting worse, yeah.
Angela, CNM
Yeah.
Pansay, Doula
I guess. You know, one month at a time, one woman at a time. You know, when they’re in your presence, to be present? Yes, with them. And like you said, that self reflection awareness and, the other component to that is that we try better to tend to ourselves.
Angela, CNM
Yeah.
Pansay, Doula
Because how can we even assist them if we’re steady dwindling and, you know, not flourishing? That’s not good. And all of us will have some type of PTSD.
Angela, CNM
Yes, PTSD, absolutely.
Pansay, Doula
from this, you know, on top of what a lot of us already suffer from. You know, our women already have fears and concerns going into this. I can’t wrap my mind around preparing to given birth and just not knowing if I’m coming out because I might…yeah [sigh].
Angela, CNM
Yeah. There are places across the country, I’m in this OB COVID forum, a lot of us have just voiced our concerns about different practices across this country. Specifically, there’s an OB who is sharing how in Florida right now they are just doing C-sections on any woman who test positive for COVID without even given her a trial of labor. And it is mind-boggling. And she was voicing her concerns about this. And she was just like, “I just don’t know what to do in my particular practice in the setting where I’m seeing this.” I’m like, let the midwife tell you that your governing organization says C sections only when medically indicated and COVID does not change that; it does not change that at all. There’s no reason to now start increasing a woman’s risk even more because there’s a virus floating around. It seems outrageous to me, seems outrageous and I think, obviously, if a women comes in an acute respiratory distress that’s totally different, totally different. But if she is stable, and she is able to get to complete. And even if she can’t push effectively, guess what? There’s these beautiful things called forceps that will help to save that Mama and her baby from a major abdominal surgery unless absolutely indicated, you know. I’m so grateful that I’m in the practice. I am because that is all of our OBs. They were like, “well, forceps are making a comeback. We all need to get trained up. We all need to do this because we need to decrease and continue to have an impact on morbidity as it relates to c-sections.” Because COVID, this pandemic, it’s not gonna last forever. But that woman’s uterine scar and the potential risk for all her subsequent pregnancies will, They will, you know, you can have an accreta after one uterine surgery, you can die. Like I just, we can’t do that to women just because we’re afraid.
Pansay, Doula
Right.
Maggie, RNC-OB
I know. I do hope that as we keep going, as the dust is settling on the initial panic that we all felt, because this is something we haven’t experienced in a very long time and certainly not on this level. That as, like you said, as everyone’s getting their policies and procedures down, as we’re getting, hopefully, more access to PPE so that people feel protected and safe caring for people, as all of these things were falling into place… that we will be able to take a collective deep breath…
Angela, CNM
Yes.
Maggie, RNC-OB
Kind of pause and re evaluate a little bit. I know you know, we’ve talked a lot about, you know, we just there’s still so much that’s unknown about COVID, because it’s literally been a couple of months that it’s been out. So people who know the most, only know a couple of months, and that’s a really hard place to be. And that’s not how we’re just operating, you know, from medical point of view.
Angela, CNM
Learning every day.
Maggie, RNC-OB
Yeah, I’m hoping we’ll be able to pause and stop some of those kind of knee jerk reactions that we all had because sure, you’re just trying to kind of think, “Okay, what’s the quickest thing I can do right now?” And so for some pregnancies, and I’ve heard the same thing in different OB forums; people are feeling like, you know, there’s no need for “heroic SVDs” or that, you know, be quick to do epidurals so that there’s lower risk of needing to intubate, under general and all of these things that people put in place. And I don’t think those come from bad intentions.
Angela, CNM
No.
Maggie, RNC-OB
Of course. I think those people are looking at their frame of reference, a small portion that they’re seeing that’s something they can control. Honestly, I think it’s a control thing. We’re all trying to take control to minimize risks. But I’m hoping that as we’re seeing this kind of play out and we’re realizing that, like the kind of care that was being given to, you know, people over in China doesn’t necessarily match up with what we need to do here. That those you know, the higher rates of cesarean that were happening over there are not linked to COVID itself persay.
Angela, CNM
Yes.
Maggie, RNC-OB
And as more of it comes out and everyone, our big kind of governing bodies ACOG, and ACM and all of these different groups that they’re gonna take some time and pause and really look at what’s happening and the care that we typically provide here. And, you know, how can we still mitigate risk as much as we want? Obviously, we want to make this as safe for everyone involved while still being conscious of the fact that this is not happening in like a bubble.
Pansay, Doula
Right.
Maggie, RNC-OB
This is gonna keep going on past then. And, you know, a lot of us have acknowledged that probably, for a number of reasons, because of decreased support, because of infection concerns, we probably we will see higher cesarean rates this year, probably in most places across the country. But we don’t need to like accept that in a fatalistic way.
Angela, CNM
As the norm too; yes.
Maggie, RNC-OB
We can still work towards in all the ways that we can, in situation that do not need it, to, you know, to kind of work to still move to what we ultimately want to see in terms of our, you know, maternal morbidity and mortality rates and not having COVID just be the cherry on the top of this abysmal situation that’s been brewing there.
Pansay, Doula
Yeah.
Angela, CNM
I agree.
Pansay, Doula
My hope is, is through all of this that, with that major shift to home birth that it kind of opens more people. You know, that low risk moms can stay at home and let’s leave the hospitals for what it’s there for. Yeah, you know, since so many women who have shifted and you know, bringing hoping for marvelous outcomes that they look at those numbers and like, “Wow, how well it went, Yeah, a lot of them were late transfers and it went good” and kind of want us to stay there, you know? Yeah, stay with it. So that’s that’s my hope.
Maggie, RNC-OB
Yeah, I definitely think this is highlighting for, you know, for low risk people because not everyone is a good candidate.
Angela, CNM
They can stay out of the hospital.
Maggie, RNC-OB
Of course, you know we recognize that and not everyone wants it, for any number of reasons. And that’s also lovely. But there are significantly more people who are good candidates, if that’s what they desire, for out of hospital birth. So how can we build up home birth practice? How could we have better again, like we’ve talked about over and over, better integration of care. Which means that we need licensure, for people across the board so that we can have open and honest care discussions. You know, how do we integrate that better?
Angela, CNM
We need to be standardized.
Maggie, RNC-OB
And how do we have more birth centers, more free-standing birth centers that, you know, kind of bridge the gap between home and hospital. And, you know, for some people, they feel more comfortable being in a different environment. Great, you know, so how can we kind of build on some of those things to again to turn all of this as like an eye opening moment about what can be done. That we can do all this great telehealth. So how can we use that to reach people who have a hard time getting regular access to an in person appointment? Great. Let’s take advantage! Right, but do they have a phone? Do they have a way that we could do some of this? You know, like, how can we take some of these things that have been hard, find the silver linings, and use that to take kinda change the tide of maternity care. So I definitely hope the same.
Pansay, Doula
Yes.
Angela, CNM
I totally agree. I totally agree. One other thing I just wanted to kind of highlight on something Pansay mentioned is that you know, I am hoping that in the midst of this storm ,that we are able to change attitudes about out of hospital births, specifically homebirths. We have gotten to the point where we are accepting of birth center births, but somehow or another not necessarily home births. One of the issues I see in the middle of this COVID pandemic is that a lot of people are becoming desperate and are either choosing to have an unassisted home birth. Or they may be willing to just birth with anyone who may not necessarily even be a birth professional. And I think that we need to certainly be a voice to advocate for getting quality care no matter what the birth setting is, and also to let women know that in each setting, there are going to be safety nets and guidelines to ensure that your infection risks are decreased and your safety is the priority. There are birth options for every woman, whether she wants to have a hospital birth, a home birth or birth center birth. And I think that it’s really important that we somehow as a birth community, get that out to women and possibly even just answer their questions and decrease their birth fears. You know, because many of them are afraid now to go into the hospital because of it. And I understand that, I mean, that’s a really rational fear. But I certainly don’t want women to put themselves at risk because despite that, some women are still not great candidates for out of hospital births, you know? And I am a huge advocate; I had a home birth with my fourth baby with a Certified Professional Midwife. I had two doulas and I had her birth assistants, and it was incredible, you know, and so I want people, I want women to know that they have options and they need to talk to their health care providers so that they don’t make poor choices in the mist of this chaos because they’re afraid.
Pansay, Doula
Yeah.
Maggie, RNC-OB
Yeah, absolutely. And I hope for people, you know, listening to us talk about all this that they are feeling empowered to have these conversations. Whether you know, you’re birth consumer, you’re a person who is pregnant listening and you feel like, “great. Let me actually talk to people about this.” Let’s not harbor that anxiety just inside of ourselves. And as birth prose that we keep cognizant of all of these different things that are going on and certainly protecting ourselves and being aware of that, but really continuing to just tune in to the people we’re providing care for and what their concerns might be. And I also think, proactively having some of these conversations. I think that’s appropriate to discuss that as a “hey, I know you’re likely concerned about X,Y,&Z. Let’s discuss it. Let’s see, you know what makes sense for you.” Instead of, you know, kind of shirking away or hoping it doesn’t, you know, come up. I think all these conversations are best met just straight on and not, you know, not trying to beat around the bush and pretend that some of these issues aren’t happening, because it doesn’t make them go away. It just means we don’t talk about it. It limits that ability we have to really connect.
Angela, CNM
Always love talking to you ladies. It makes me happy.
Maggie, RNC-OB
I always, even with heavy conversation like this, I always feel uplifted hearing from people who share the same desire to just make birth better and to continue working throughout absolutely incredible circumstances. I’m so grateful for both of you.
Pansay, Doula
You know, the same, just listening to you both. And Angela, you the work; I commend you for the work and the service that you are giving.
Angela, CNM
Same absolutely, same, Pansay. You have no idea. I am so grateful for all of the women I have encountered and met on this journey in this field where we service women and meeting all the incredible doulas across the way who have taught me so much about myself, and were a part of the reason why I even chose to become a birth worker and become a midwife. Just being able to appreciate every aspect of the care that we’re able to offer women and understanding that it works best when we all work together. So I am eternally grateful for all you ladies in this circle.
Maggie, RNC-OB
Absolutely; I love it. Well we will continue to do great things as we all band together. Thank you all! Talk soon.
Maggie, RNC-OB
Thanks for tuning in! We love to talk birth, and we’d love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. You can find more resources about the topics we discussed on our show notes blog: yourbirthpartners.org. We’ll be sharing some organizations there that can benefit from your donations that particularly work to support birth for people of color. And we would like to hear your stories, what’s going on in your community and how we as a broader birth community can help to sway how we provide care and make it better for everyone. Till next time!
012: National Infertility Awareness Week
Maggie, RNC-OB
Welcome to Your BIRTH Prtners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you, no matter what your background is on, are so excited to learn together. Today I am blessed with two special guests on the show. We have Dr Torie Plowden and Jesse Bernstein, who will share a little more about themselves and what brought them to work with people on their fertility journeys and especially with those struggling with infertility. You’re gonna learn a little bit more about some of the stigma that’s associated with infertility. And why this week we’re honoring National Infertility Awareness Week. Hopefully, you’ll gain a greater understanding about how this impacts different communities and different cultural aspects of infertility care. And hear a little bit more about care discrepancies that exist in our country around racial and ethnic lines along with socioeconomic status. We hope you leave this episode with a greater understanding of the issues impacting those struggling with fertility and what you can do as a care professional or loved one to help provide more support and understanding. On to the show!
Maggie, RNC-OB
All right, so today I have the pleasure of welcoming Jesse Bernstein and Dr Torie Plowden into the podcast, and so I’m gonna let them tell that you’re a little bit more about themselves and what you know brings them here. Why they, you know, are inspired to talk a little bit more about infertility and struggles people have around fertility hiccups, and so I’ll let them take it from here.
Jessie, LMT
I am Jessie Bernstein. I am a board certified therapeutic massage body worker and licensed massage therapist in the state of Maryland. I specialize in reproductive health, so I see clients with fertility hiccups, pregnancy, and postpartum. And then I also specialize in oncology, so I see the whole gamut of wellness through all stages of light. And I also run a peer to peer support group called Pineapple Connections in Baltimore. And it’s just pretty much, it’s not your typical support group, but it’s a very casual peer to peer support with everybody, just kind of giving insights and support. Just go with the flow.
Torie, MD
Hi, my name is Dr. Torie Comeaux Plowden and I’m a double board certified physician. I am an OB-GYN and I’m an REI doctor, so a reproductive endocrinology and infertility specialist. I am chief of the OB-GYN department at Womack Army Medical Center and I mean, I guess this work…I have a passion for helping people to achieve their dreams of starting a family. And so that is what kind of brought me into the infertility space in the first place. It has been really, really very rewarding. I also am passionate about trying to educate patients and help them to understand these very complicated topics that they may not have experienced with. The infertility journey is really, really challenging, and it can be a prolonged experience, unfortunately, And so I focus on ways to help my patients deal with that.
Maggie, RNC-OB
Great! And then this episode is being released during National Infertility Awareness Week. So if either of you want to speak to that that movement, why, you know do we need to have a week about this? Why is that important for people?
Torie, MD
So I think that it’s important because of decreasing stigma. About one in eight couples are impacted by infertility, and it can be it could be a very lonely experience. It can be an isolating experience. Often when women are going through infertility, they feel that they are the only person ever who has experienced this. This is not something that people often talk about with their loved ones or even with their circle of friends. So some people really do feel like they’re the only ones struggling with this issue. And when you feel that, so dealing with infertility is already hard, when you feel also isolated on top of that, you feel like you can’t necessarily confide in family members or talk to your friends about it. That makes it that much more difficult. So I think that National Infertility Awareness Week is just to increase awareness, obviously, for people to say, “Hey, infertility is a very common disease. It is something that people can get treated just like any other disease is. It does not mean that there’s something inherently wrong with you as a woman, or that that something’s wrong with your body” and just to increase the idea that many people go through this and you’re not alone.
Jessie, LMT
Yeah, just to expand on that. So I think that what’s really important is that a lot of people, especially during this time of this pandemic, there’s a lot of the conversations around it. It’s like “Oh, so many people are gonna get pregnant during this time and we’re gonna see this massive explosion in nine months.” It’s taking quite a hit on a lot of the people in the TTC (trying to conceive) community. It’s really, really taking an impact. And as someone who works really closely with a lot of the doulas and the midwives in the area, I’m hearing a lot of that, and then I’m hearing it from my support group how frustrating that can be. And so, with the events that I planned for zoom, of course, we’ve definitely made it so that these events are open to general public to learn about how they could be better supporters and advocate for their friends, their clients and their colleagues so that they can kind of have media hint of why this is so challenging for people. And so with this week, you know what? There’s also an intense amount of advocacy on a legislative level for coverage through insurances, through workplace support, and all of that, because there’s a lot that goes into it. People have to take time off work, and they have to miss things and it’s a lack of awareness in the general public. Unless you’ve walked through it, you don’t understand it. And I think from a personal level, you know, I started doing a lot of this work before I had my own infertility hiccups, and I think that my drive kind of really revved up a lot with wanting to make sure that we were able to provide these events for National Infertility Awareness Week to do better with letting people kind of take a peek into the emotional and the physical tolls that going through fertility treatments as well as just the anxiety that’s around all of that.
Maggie, RNC-OB
It is. It’s so necessary, I think. That’s one of the reasons why, you know, for our podcast, we primarily speak about obviously, you know, issues that have to do with pregnancy, birth, postpartum and you know, that whole journey. But obviously it starts with, you know, becoming pregnant, being able to conceive. And so I think so many of us as like birth workers and professionals, like people listening to this podcasts where our head is very baby focused, right, and we kind of already got into that piece. So you know, can you speak to things that we can do to be sensitive for this when we come into contact with people who’ve gone through infertility, whether they’re, you know, currently still working, you know through that or if it’s something they’ve experienced perhaps with that pregnancy. I know I can speak, you know, briefly as a nurse, sometimes when we’re taking care of patients who’ve had infertility along their journey, they have a lot more anxiety going into, you know, labor and delivery and the postpartum period. And, you know, so if you could speak to kind of any tips and tricks, we can use to help increase comfort for them and, you know, show more compassion and awareness around that.
Jessie, LMT
Well, I think from a lot of what I’ve seen, since I haven’t been successful personally yet. But as someone who supported my pineapples, who have gotten pregnant successfully after X amount of cycles, their biggest thing is that there’s the anxiety throughout the entire pregnancy until there’s a child in their arms. And so I think that for care providers, it’s to be validating, which a lot of times people don’t hear the validation that their anxiety and the sadness that goes around it because they been through this journey of all these treatments and that has one set of anxieties. And now the anxiety of carrying to term has a whole other set. And then what will happen when this becomes like then that becomes a whole another set of anxiety. So I think as care providers, the one thing that I hear is that the validation is really, really important, that the journey has been hard, the journey has been challenging and that, you know, they’re being supported however, it is that they need to be and not brushing off any of those concerns. I think that that’s probably the biggest piece and why, sometimes people do tighten up when it comes to labor and delivery is because that they held on to this for so long. And now that it’s here, what happens now kind of thing. And nothing has prepared them for that journey after birth with having had fertility challenges prior. So that’s been like probably the biggest thing is the lack of validation from care providers, and I think that you know it’s great to have affirmations, and it’s great to have like those goals, but they only take someone so far. If they been spending months and years and cycles and monetary struggles to get to that point, it’s probably the biggest thing.
Torie, MD
I agree, and I think that validation is very important. You know, you can go a long way when you say to someone, “Wow, your experience have been long” or “Wow, that must have been really difficult to deal with.” And just kind of opening the door for them to talk about those experiences that they desire. I think that reassurance is important too…so certainly miscarriage is something that’s very, very common, just in general. About 20 to 25% of pregnancies can end in miscarriage, but on the flip side, that means about 75% of pregnancies don’t and so sometimes my patients are super anxious, and just because you’ve had infertility doesn’t in and of itself me that you are at higher risk of having a loss or something like that. And so I tell them, you know, statistically, what is most likely to happen is that all will go well. But I’m here for you at each step of the way, talking them through the process, allowing time for them to ask questions. I often tell people to write down the questions that they have because you know when they get home, they start thinking, they might start spinning and kind of thinking of all these things that they forgot to ask the doctor. And then when they get in front of the doctor, they forget what those questions were. And then they go home and they remember, and then they still have to stew on those questions until they have interaction with a health care provider again, which just revs up anxiety. So a lot of times people just jot down questions that they have just on the note section of their phone or something like that. That way, when they come in, they can have the opportunity to ask those questions and have the questions answered. I think it’s important to sit down when you are talking with your patient, just that body language and kind of getting more down to eye level with your patients. It might sound odd, but I think that it opens up the floor and it makes the patient feel like you are not as rushed. We all are busy. We all have many patients to see. But if you just take that second and say, “Okay, what other questions do you have?” a lot of times it doesn’t take that long to answer the questions that they have. Then that kind of makes the patient feel more reassured as to what is going on with that next step is. These are highly desired pregnancies, many pregnancies are highly desired pregnancies, but in the infertility community they have been trying and trying and trying so long to get to this point. I think that sometimes they have more anxiety than maybe a woman who has conceived spontaneously. They’ve already had a lot of interaction with the medical system that they didn’t necessarily want. And what I mean by that is no one really wants to be infertile. It’s super great if you can just become pregnant with just normal intercourse, that is excellent. But our patients don’t have that same experience. So they’ve already been, you know, I have heard people say, “poked and prodded” a lot, and so they’re already coming into it anxious. So just given that reassurance, taking the time to listen, you know, having open body language and allowing them to ask the questions that they desire.
Jessie, LMT
That’s the biggest part. That probably the next, aside from the validation, is people not feeling that they can ask the questions that they need to ask, or that it’s a repetitive question. Because this is so scary, there’s so many terminologies that fern out in the middle of all of this. But I think that when people feel like they’re not belittled, when you say about the non verbal communication about where you place your body, it’s warmer and it’s a lot more inviting, and you also make yourself seem more welcoming to your patient. And it eases anxiety when interacting with the care provider instead of just looked down to and rushed out the door. Because it is, it is a very sensitive topic to definitely process for both the partner and the gestational carrier together.
Maggie, RNC-OB
Yeah, absolutely. I love all those suggestions. That idea. I think it’s some you know we can all get easily caught up as health care providers and you know it’s “yep, we’re doing this again, like yes check” and kind of forgetting that individual piece of, you know, the journey and who you’re taking care of. And I also, I feel like part of it culturally in our country. There’s this feeling of, like, privacy that we’re supposed to be giving people, and I think part of National Infertility Awareness Week and how we’re trying to kind of break down some of those like barriers and let people be more open and understanding that, like this is something that’s going on. And absolutely people deserve to have privacy, you know, as much as they want along their fertility journey. You know when someone wants to talk about it. You know, if you guys could speak a little bit to some of those kind of cultural expectations around fertility and infertility and how that kind of plays out. I know for, you know, people I’ve spoken to, friends and family who have experienced this, that piece of it to of navigating with loved ones who don’t know what to say or when to say or who are really not in agreement with treatment options that they’ve chosen to pursue, you know, becoming pregnant. I think that can get really complicated for people as well.
Jessie, LMT
We could probably talk an entire podcast, just cultural components, for sure. I mean, I have people who are of various different religions that come to me as a body worker, as well as in the support group. And their religions, or even just the expectations of where they grew up, was that you get married, you have babies and you have more babies and more babies. And it’s like a wham bam type of thing and that you shouldn’t be having any issues and that if you’re not having babies within the first year getting marriage, then there’s clearly something wrong with you and, and then the thought is like there’s a lot that’s wrong with you because you can’t produce a baby within the X amount of time frame. And I think our society as a whole as a cultural component with the expectations, has definitely put a lot of that pressure on family building, so that makes it a little bit more challenging and a lot more isolating when it comes to the topic of family building. And how do you have these conversations? Because not everybody in your family is gonna go through this. But sometimes there will be multiple people in a family, and nobody knows that anybody else has struggled with it because of the clear expectations of what family building is supposed to look like..
Torie, MD
This is a tough questions just because there’s so many different aspects to try to cover. The first thing that I would say, is that in some communities, and in communities of color, infertility is often something that is not really discussed. There have been multiple studies, that have kind of shown that in America, black women and Hispanic women often seek care for their infertility after they’ve had infertility for a more prolonged time period compared to Caucasian women. And there can be many factors related to that, some of it is access, some of it is, you know, not really knowing what the treatment options are. A lot of people have heard of IVF, which is in vitro fertilization, although not everybody knows exactly what it entails, and some people will think what I don’t want all that, and so they think that there are no treatment options for them, which may or may not be true. There are often things that can be done that are less aggressive, than IVF that can help people get pregnant,depending on what the diagnosis is. There have been some studies that have shown that implicit bias and racism played a factor with the health care system. There was a study that showed that even in the setting of cancer, African American women were less likely to be referred for counseling for fertility preservation. And that, referring to infertility specialists with a person who has cancer, is like standard. It’s pretty much what we are supposed to do and all of our society’s agree that that is what is recommended. But even in that setting, those women are less likely to be referred by their providers, which is upsetting and obviously that puts up with an added barrier for access to care. I think that in African American culture, or some African American women, they don’t feel like this is something that other women in their family or the women in their culture have addressed or have encountered. I have heard people say, “Well, I thought that infertility, I didn’t know that we could be infertile. I didn’t know that we could have infertility.” Just a lack of awareness. It is true that there have been studies that have indicated that the typical reasons that African American women can have infertility may vary or may be different than the reasons for Caucasian women. So that is also, you know, the appropriate work up to figure out what what it is that is going on and talk to patients about treatment. Women of color are more likely to have fibroids, for instance, and although fibroids in and of itself is not typically the main reason for infertility it can be, and it can impact their fertility or can be a factor. There was a study that was done years ago. It was Walter Reed National Military Medical Center, and it found that in the in the military setting access to care is a little bit better because all of the people have access to the same way, meaning that they’re all insured, they all have access to primary care doctors, they all have access to OB-GYNs and that sort of thing. And what they found was that in a setting where there was enhanced access to care, African American women did utilize services more within that system than they did on the outside. But they did not find that to be true for Hispanic women. And it wasn’t exactly clear why that was. For the author’s space, they made a conclusion that it could possibly be related to language barriers. So that’s a whole other group of people that might not have access to care or might not be willing to seek treatment. And then, of course, even more disadvantaged groups of people, immigrant women, those women who are maybe not in the country legally, those women may be less likely to seek care because they don’t have, because they’re afraid, essentially. So it’s a very complicated question. So years ago, ASRM, which is American Society for Reproductive Medicine, they put out a statement, and they basically said, you know, define infertility as a disease. This was important because there is this concept that fertility treatments are elective or optional, and that is the reason that some insurance places, some insurance companies kind of used as a reason why these services are not covered. But no one elects to be infertile. No one wants really to be infertile. And so to say that this is elective is not really the appropriate terminology. These treatments are necessary. Just as treatment for any other disease are necessary. And I think that we need to take that stigma way too. These women who must undergo in vitro fertilization are other fertility treatment, and this is just elective and they must pay out of pocket, and you know, it’s their own decision. They can save up for it until they can afford it. And that’s not really fair; that’s not really appropriate. And we have to get away from that sort of thinking, as a nation, as a culture like the American culture.
Jessie, LMT
Yeah, and I was gonna say to hop on to the what the ASRM has been talking about with regards to infertility being a diagnosis, that part of the reason why right now, so many people are struggling with their treatments coming to a halt or not being able to pursue elective procedures because of the guidelines that came out. And I think that’s even more pertinent to celebrate, not necessarily celebrating but honoring and recognizing National Infertility Awareness Week is because community is needed so much more now because people don’t know when you know they’re gonna be able to pick up on their fertility treatments. And that’s a little hard on the mental health that’s taking quite a hit on patients all across the world.
Torie, MD
Unfortunately, that’s so true, COVID has obviously been a quite quite an interesting phenomenon. It has impacted so much of our daily life, and it is not something that any of us have ever dealt with before. And it’s just been, you know, incredibly disruptive and also deadly and scary. You mentioned the ASRM guidelines, and they did put out that we needed to pause or, stop infertility treatment for now. It is hard; ASRM is filled with REI doctors. They certainly want to help patients get pregnant, in this setting it’s very difficult, and I don’t think that any of us would call the procedures that it takes to get women pregnant elective, but I think that we would call it, I think the better word for it would be non urgent, meaning that just as a person might might need to have like a colonoscopy done. Colonoscopy is a medical procedure; it needs to get done, but it doesn’t necessarily have to get done today, versus treatment for an ectopic pregnancy, which must be done urgently, and ASRM, those guidelines are being revisited every couple of weeks because we’re trying to figure out as a group when we can, we all want to start treatment again. We’re trying to figure out, like, when is that going to happen? And it’s harder for our patients because, you know, some of them have been waiting for a time period, a long time period. And I also wonder, and worry that with the COVID impact will be more prolonged even after we have opened up to regular practice again. Because a lot of the costs are out of pocket and with the economy being what it is, some people may have had job layoff, some people may have had pay cuts, some people may have been saving for fertility treatments, and may not be in the same financial position to pursue those treatments when this COVID crisis improves. And so I worry that this will impact our patients for an even more prolonged period of time even after we’re fully up and running again.
Maggie, RNC-OB
Yeah, absolutely, every time I talk to someone in a different line of work or with a different sub-specialty even within health care, it’s just profound all of the different ways that COVID, and the pandemic and all the fallout from that is just making lives a lot harder and, like you said potentially for people for much longer outside of this initial, you know, difficult time. To that point because I know you touched on this briefly, Torie. You know, there’s obviously a vast range of fertility treatment options and different modalities people could do if you want to just kind of briefly touch on some of those, some are highly medicalized and you know certainly you’re gonna be, you know, stopped by these guidelines, but, you know, talking about those options briefly. But then also talking about kind of other other holistic things. Like, what are the things kind of best practice for people to start do or to keep doing before other options become available?
Torie, MD
So I think that part of the problem right now with the COVID crisis is that there is certainly a feeling of loss of control, a lack of control, and that is pervasive for all of us. None of us know, when things are gonna go back to normal, and I think that it’s going to take much longer to get back to quote normal. Then we had initially feared, and so that can cause a lot of anxiety. The whole, like not being in control, not knowing what’s next. If people are waiting to restart their fertility treatments, some things that they could pursue now would be to continue to exercise, move their bodies, continue to eat healthy. There’s no particular diet that must be endorsed to help with fertility, there’s no proven particular diet, but an overall general healthy diet is recommended. To continue to take their prenatal vitamins is important. I think to continue to have some sort of wellness, whatever that means for you. The thing about COVID is that the social distancing is very isolating, obviously, but staying connected with your family and friends in whatever ways that you can. So, for instance, a lot of people are doing like zoom happy hours; I was in a zoom book club last week, and it was actually really great. Staying connected, you know, we’re a social culture, staying connected is important. Even though we can’t physically interact with people in the ways that we typically do. Related to treatment for infertility, it probably depends on what the diagnosis is on and so when patients have infertility to come to us, we work up both partners, the female partner and also the male partner. Certainly, if a person has a female partner, then there are treatment modalities for them as well, they don’t necessarily have to go straight to IVF either. So dependent on the diagnosis that can help us understand what sort of options there are. So for a woman who has a male partner, but she does not ovulate regularly, it could be as simple as giving a tablet, a pill, that she could take on a certain time in her cycle so that she can ovulate and then having timed intercourse at home. Timed intercourse just basically means having sex around the time of ovulation to increase the likelihood of pregnancy. Sometimes if there is a problem with the fallopian tubes, for instance, depending on what that is, it can be surgically treated, or it’s possible that the person may need to go straight to IVF in that setting. With male infertility, depending on the cause, what the sperm count looks like, the semen parameters, there can be some treatment options and sometimes insemination can be used to overcome that. But if it’s severe male factor infertility, typically the couple will need IVF to conceive. With women who have a female partner, often that woman could become pregnant just with insemination, and that typically is something that is, I mean, insemination are fairly not invasive, and people can become pregnant with those in that setting.
Maggie, RNC-OB
I appreciate you going to explain to his options. Like you said, I think people jump kind of feeling either that you’ve just gotten pregnant by, you know, having sex regularly or “great…It’s IVF,” and it’s this whole, you know, very expensive and time consuming and invasive procedure. So it’s good to know there’s, you know, different options and certainly be able to kind of explore those with care professionals and finding out what matches up best with with you and your partner and kind of what your needs are. Do you have anything to kind of add to that, Jessie? What are you seeing people pursuing during this time, and generally?
Jessie, LMT
I think just in general I would definitely say the physical activity. I mean, our bodies were designed to be, we are creatures of movement, not static creatures. And so, our body depends on physical activity and the nutrition piece clearly eating well and also taking care of your mind. I encourage people to seek out mental health professionals, to kind of give them some coping skills and techniques of just kind of working through whatever their journey is taking them on. And then also, acupuncture is definitely a traditional Chinese medicine is really, really supportive for that, from lining to boosting the immune system to helping increase blood flow and balancing out hormones and things like that, and then for bodywork, like the work that I do. I do a lot of scar work for people who are trying to go through fertility treatments. They’ve had repetitive abdominal surgeries and things of that nature with the adhesions that buildup. We kind of work on that to allow more movement and also managing the stress through bodywork as well. That’s usually what I encourage my client to do, in addition to whatever their protocol is with their RE.
Maggie, RNC-OB
And as we close up, if you know there’s any you all can recommend in particular for where people should reach out for support. If this is something that you know, they are going through or a loved one and they want to kind of know and understand more about this.
Jessie, LMT
RESOLVE has a lot of really great information on their website. I think there’s a lot of really great resource is that are out there for people seeking. The two organizations that I refer to a lot are RESOLVE, the National Infertility Organization, as well as the Tinina Cade Foundation, which is based locally, but they provide support nationally for people who are family building. Those are the two big ones I usually refer to.
Torie, MD
ASRM, asrm.org, when you go to that website there’s a portal for positions and there’s also a portal for patients, so there can be really nice patient handouts there that provides some accurate information, kind of break down some of the terminology that we use it. It has frequently asked questions for different issues that a patient may have been diagnosed with, like endometriosis, fibroids, etcetera. The Cade Foundation I was also going to recommend, is run by a very good friend of mine. And they provide grants couples that are family building, whether that money be used towards adoption or that money could be used toward fertility treatments; it’s a great organization. There’s an organization called Fertility for Colored Girls focused on black women. Because again, I kind of mentioned earlier, a lot of black women kind of didn’t know that infertility was something that they might encounter, And so that organization actually provides a lot of support, it actually kind of normalizes infertility, and what I mean by that is to say “yes, you can be a black woman with infertility. And yes, there are treatment options for you. And yes, you could have a family in the future” and kind of addresses a lot of those questions. So it is a really good resource that a lot of patients like. There is a an organization called the White Dress Project. And it’s more about fibroids; they they basically provide a lot of fibroid information. And the reason I bring this up is because, as I mentioned, fibroids can play a factor with infertility, and it does, it’s a condition that is more prominent among women of color. And so it is a good resource, has lots of information about fibroid treatments and options and what you might be able to do in order to treat fibroids.
Maggie, RNC-OB
Awesome. Well, that sounds great. I will link all of those in the show notes so that everyone can find those easily. You know, I really appreciate you, you know, drawing attention to those that gonna reach out to communities of color and help to kinda break down some of those barriers to having awareness and getting, you know, same access to care. And then I know Jessie had mentioned earlier about kind of legislative work, this being done at the same time. If you want to say real quick, Jessie was there, are there bills that are kind of being brought out at this point is RESOLVE like helping to sponsor those or?
Jessie, LMT
It’s mostly state to state depending on what is going on legislatively. I know, at least locally, the big one that got passed now two years ago was, providing fertility coverage for cancer patients on, especially with regards to fertility preservation. So that was like a really big one locally, and New York has been working on surrogacy. So it really depends on really the state by state, as far as making sure that insurances are covering and that infertility is an actual diagnosis. I want to make sure that people are vocal to their legislative representation so that way their wishes are heard so that it is considered a necessity, not just elective.
Torie, MD
I would echo that the advocacy part is super important, and, you know, if we really want to talk about, you know, improving access to care across America because, you know, they there is even access in rural area. Some places don’t have an infertility provider like in their state, and they have to travel across state lines to get treated. We really do need to get infertility treatment covered by insurances. There are only a handful of states that have some sort of mandate that infertility coverage be offered, and even within those states, the mandates vary substantially. So in some places, something has to be covered, but not necessarily IVF, versus some states do have, like a certain number of IVF cycles could be covered, and it can vary. But really, that advocacy piece, that RESOLVE does that ASRM does is also important if we want to break down those barriers in access to care.
Maggie, RNC-OB
Yes. Thank you for highlighting that because it is, as someone who is not, like intimately involved this work day-to-day, I had no idea that it was that low. You know, that it’s not the vast majority of states that are covering that, which is unfair. And it’s obviously I think it does have to do with a lack of understanding and education about what’s really going on, because I feel like most people, if they listened to you all talking, if they listen to, you know, people who have gone through infertility, they would not think that it was elective. They would, you know, I feel like most people’s hearts feel like, of course, it’s someone’s option to choose to grow their family. This is not something that there they need to be paying out of pocket some extreme number in order to do something that comes very naturally to a lot of people. So I do appreciate you calling that out, and will definitely will find some more the stats and put them up on the show notes too so people can can look into that and see kind of where their state is along those lines. Well, thank you both so much for being here and talking with us and sharing about your experience and all of your professional wealth of knowledge. I appreciate you.
Jessie, LMT
Thank you.
Torie, MD
Thanks so much for having me.
Maggie, RNC-OB
Thanks for tuning in. We love to talk all things birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms or comment on our show notes blog at yourbirthpartners.org. On our show notes you’ll find information about the organization we discussed today who are addressing infertility, how you can reach out and support them in that work, how you can educate yourself and others. So please look there, and we just want to recognize everyone out there who’s struggling right now with fertility hiccups and their fertility journey. We see you, we hear you and we’re here for you. Till next time!
013: Nurses as Advocates and Change Leaders
Maggie, RNC-OB
Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we have two wonderful guests on the show, Mandy Irby and Torie Pugh, in honor of Nurses Week. These two nurses both have a strong history in labor and delivery and obstetrical nursing. You will learn more about their journey through nursing and how they have grown in their role as advocates for their patients. You’ll gain a greater understanding about some of the pressing issues that are facing our patient population and the clear and actual steps you can take as a nurse to improve birth for all those in your care. Onto the show!
Maggie, RNC-OB
All right, so I am thrilled today to welcome Torie and Mandy to the podcast. These are two just rock star nurses who I look up to you immensely, and I’m really excited for them to share with us during Nurses Week a little bit more about what it means for them to be a nurse, how they have become a stronger advocate throughout their practice and what they can do to encourage other nurses to step forward and really be change agents and leaders within birth care and obstetrical nursing. So I would love it if you all want to just kind of introduce yourself, tell us a little bit more about who you are and you know your path through nursing
Torie, RNC-OB
Hi everyone, my name is Torie Pugh. And I am a nurse and I’ve been a nurse since 2010. Most of my nursing has been or maternal child health, preferably L&D. I started off as a staff nurse, then I went back to school and got my master’s degree. I taught nursing students. I’ve also been a nurse educator for the actual unit. And as of right now, I’m the Perinatal Program Manager, which means that I’m looking at the entire program at my hospital as a whole, starting from the of obstetrical offices through inpatient through out-patient, so looking at the entire program.
Mandy, RNC-OB
Wow.
Maggie, RNC-OB
I know, right?
Mandy, RNC-OB
That job is amazing and huge
Torie, RNC-OB
Well thank you, Mandy.
Mandy, RNC-OB
and I’m sure very difficult and challenging.
Torie, RNC-OB
[laughter] Yeah, you know.
Mandy, RNC-OB
Yeah. What an effect you may have. That’s awesome.
Torie, RNC-OB
Thank you, Mandy.
Mandy, RNC-OB
Well, Torie and I just met. My name is Mandy Irby. And so I’m like listening. And I’m like, “Oh, wait, I have to talk.” I’m Mandy Irby. I’m a labor and delivery nurse. I am a lamaze childbirth educator, peanut ball trainer, trauma informed nurse educator, Spinning Babies parent educator. Essentially, I am on the education side, instead of the bedside right now. I was a labor and delivery bedside nurse for 11 years, and I just left the bedside a few months ago, and it’s new and different and exciting still. But I now work online mostly to educate families and nurses about trauma informed care and choice and voice at the bedside, mostly online now that we’re in a pandemic, but people like online anyways.
Maggie, RNC-OB
Yes, going with the times.
Torie, RNC-OB
[laughter]. Awesome, Mandy.
Mandy, RNC-OB
That’s wonderful, and I feel like most of our listeners are probably familiar with me already, but I’m Maggie Runyon. I am a labor and delivery nurse. I’ve been working within the maternal child health sphere for over a decade now, predominately as a labor and delivery nurse, and I worked also on, you know, Mother-Baby and Nursery. I have mostly worked per diem since my babies came along a few years ago. I had the opportunity to teach nursing students in clinical and in college settings, and I enjoy educating very much. I feel like that piece of be able to shape kind of the next generation of nurses means a lot to me because I had a couple of nursing instructors who really changed who I am today and really empowered me. And so I love providing education. I love doing parent education. I also do prenatal yoga right now, it’s a really great way to kind of get a little bit more active with the women in my community, the people who are coming in to have babies and get to know them a little bit more, and then it’s always a treat to actually see them when they’re coming in to give birth to their babies. And then through through this work, I feel like part of my journey as a nurse has really been stepping into my role as an advocate. And that was what kind of led me to to found Your BIRTH Partners and to start doing this work a little bit more publicly. I think as nurses, I feel like when I was coming up as a nurse, there was a lot more emphasis, and we had courses about how do we kind of interact and collaborate with physicians and other colleagues within medical sphere and more emphasis on really kind of stepping into that role. I think, that being said, sometimes it still feels challenging as a nurse to really kind of like fully embody everything that we know all the different ways that we care for patients and effectively communicate with our colleagues and other staff and really get into that collaborative practice environment. And so I love that through this podcast, and the people I’ve come to know through kind of getting out there in the birth world a little bit more, I love seeing the connections that we make, the things we share across the disciplines. But I also I really wanted to focus, since this is coming out during Nurses Week and 2020 is, you know, the World Health Organization, “Year of the Nurse and Midwife.” And, of course, with COVID-19 and the pandemic, there is even more attention on nurses and the really important role that we play in health care. And so I would love to just be able to focus a little bit more on, you know, what does it mean to you all to be a nurse?
Torie, RNC-OB
Well for me, being a nurse is life changing. It’s what I’ve literally always wanted to do. I think since I was a little girl playing with my little cabbage patch dolls and having a little doctor set. Ever since then, always wanted to be a nurse. And I knew that coming into nursing that I wanted to work in maternal child health field. I started off in the med-surg world. They say you should do first, but technically, I don’t think that you should have to do that, but did that for about a year to and then migrated over towards Maternal Child Health, and L&D. And I think for me being a nurse, it gives me that empowerment to feel like I’m making actual change. I think nothing is better than seeing someone come in one kind of condition and then seeing them leaving in a totally different one, and that you had a huge impact on that. And, you know, a lot of us don’t get recognition for, but we don’t do it for recognition. I mean, you don’t because you honestly love it. And I remember in nursing school, one of my instructors telling our entire class as a freshman was, you know, “you guys hear that nurses make all these crazy amount of money. Yes, and probably could. But if you’re coming into it just for the money, you should probably leave now, because there’s gonna be times where you’re not gonna make that much money and you’re gonna walk away from your shift and like question yourself being a nurse so you have to really have a passion for it.” And I love what I do. I absolutely love love what I do. And like I said, it’s not just about the patients, it’s about, you know, these nurses and these doctors and everyone that you work with her like your family, you’re with them all the time, and, teamwork is really important. And again, I think nurses are awesome, and I think a lot of nurses, well, the nursing field, I think we don’t get as much credit for a lot of things that we actually do that we should get credit for.
Maggie, RNC-OB
Mmm.
Mandy, RNC-OB
Yeah. Isn’t that true when a family says, “Where’s the doctor?”
Torie, RNC-OB
Oh, you gotta love it. [laughter]
Mandy, RNC-OB
That’s TV, guys, it’s just me.” [laughter]
Torie, RNC-OB
Literally, literally.
Mandy, RNC-OB
They’re like, “Whoa your job is so important.” Best job ever. Yeah. I did not come into nursing, knowing I wanted to be a nurse. I wanted to probably work in a lab. Except I realized I really like people and I wouldn’t be able to see very many that way. So I stumbled into nursing, stumbled into labor and delivery. Someone else had to tell me. “Oh, my gosh, you’re really good at this.” And I was like, “Really?” And of course, love it, and you don’t, yeah, you can’t do it unless you love it. But I think, I think the nurse is the liaison between the patient, their family, who is also your patient, their baby, who is also your patient, and the system that they’re in. So I love that in birth, we don’t have birth centers where I live, well, we don’t have birth centers with RNs or CNMs. I love that RNs, nurses can work in all kinds of different locations, they can be outpatient, that can work in birth centers, they can work in hospitals around birth they can teach and all of that also, they can work online. And they’re always the liaison between where they’re at and the people that they’re helping. And it makes it so incredibly difficult to do what we do because we have so many languages that we have to speak. And we feel like we’re juggling all the plates sometimes. But I think labor nurses have the best job ever. I think they have so many superpowers. I think truly it is the most important job in the entire world because
Torie, RNC-OB
Agreed.
Maggie, RNC-OB
Absolutely.
Mandy, RNC-OB
Because of the life changing things that happen during birth, I mean parents are reborn, people are reborn. Babies are born, humans are coming out, and all of their layers are open, they’re vulnerable, they’re learning, and people listen the nurses. So I think I think it’s an incredible opportunity for helping people heal and move, move into that transformation that is parenthood.
Maggie, RNC-OB
Absolutely. I always think just birth is it’s such an honor. It really is, you know it sounds cliche, but it really is just an incredible like gift to be able to be a part of such a transformational experience, you know, for people. And I think especially, you know, like we said as the nurse, because of the way you know, staffing ratios work and everything, we get to be the ones who are there through so much of that time. And, you know, oftentimes we get to be there longer than you know the provider, the midwife, the OB, or whoever else is caring for them. And that really gives us this really intimate glimpse into a family into how people operate. And getting to see that is, it’s an honor. There comes a lot of responsibility, you know, with that as well in terms of how, what role we actually get to play in how their story unfolds. You know, certainly no one else can make someone give birth, can you know, can make a baby come out if it’s not, you know, working. There are limits, obviously, but we do have a big role in how the story plays out, in how people perceive their experience in, you know, in how the different measures that are necessary to help guide, you know, birth along. And so I would love if you all could speak to that kind of piece, how do we, how can we as nurses kind of step into that that role more? Be stronger advocates and really kind of own that place at the bedside.
Torie, RNC-OB
I think for me, from what I’ve learned is that, you have a totally different experience when you graduate from a novice nurse to a seasoned nurse and all of us remembers being that brand new nurse, timid, didn’t know anything, terrified to even talk to a patient, let alone touch them and then fast forward a year one, year five. All of a sudden you are charge, you are critically thinking, you’re running stuff, you’re making these calls, you’re figuring out what’s gonna happen before it even happens. And I think that kind of empowerment comes with time. And I think it comes with what kind of support that you actually get, even as a seasoned nurse, a few years in, when I, you know, totally, felt empowered totally felt as though I could see this patient, I know what’s gonna happen, I can call the doctor. I had to speak with physicians and, for example, if there was a new nurse on the unit or if I had a nurse that was shadowing me, a brand new nurse, that the doctor will listen losing to me, and only speak to me, and talk to me. And I would have to say, you know, “she’s here too, this is her patient, you know?” And I’ve had doctors tell me “Well, I know you know what you’re doing, but she doesn’t.” And yeah, but you don’t give her the chance, you know? And so I try to be that advocate for newer nurses, for novice nurses, for new graduates that we really don’t have a voice yet and really, you know, don’t have that relationship with these doctors yet, and and other staff yet and try to speak up for them. We’ve all been there, we’ve all been there, as I think it’s important as a nurse, as a seasoned nurse for us to not like you, said “eat are young” and stick up for them and guide them through this journey that we’ve all been through. You know, it shouldn’t be a sink or swim. You know, it shouldn’t be they’re going to sink to the bottom or, you know, that’s it. It should be, let’s help you peddle a little bit. And so again for me, I think empowerment a huge part of it comes from experience, and the other part of it comes from the kind of support that you have.
Mandy, RNC-OB
Mmm. I love that. Yeah, I think, uh, I struggled, still struggle. Not everyone, I think who looked at me. I hear people who I work with say, “Oh, what you can communicate and get your point across and have those discussions with the provider and you talk to him in the hallway sometimes,” and I never felt very confident about that. I wish I was better at that, but to speak to so that takes even longer time and probably some really specific education, leadership, education, communication, education that we can we really have to find on our own. That’s none offered often, but to feel confident in the space that you’re in. I think it takes sitting with physiologic birth. It wasn’t until I was many, many years in that I was forced to sit with physiologic birth for my own birth prep. And I fought it for probably seven years because physiologic birth, untouched birth, birth that’s just watched and not messed with ,birth that you hear about in books that you don’t see very often or it’s those precipitous kind of drive byes that you’re like, “Whoa, what just happened?” That was amazing. I didn’t see it very much in the medical model. I didn’t see it very much in the hospital. I had to go seek it out, and I so I read about it and tried to watch as much as I could try to be at the bedside as much as I could. And it was quickly a feeling of confidence in just birth itself, on the people that I was with the patients and the families because they were looking to me. Of course, they’re looking to the nurse to be like “Is this normal” and in the back of my head for so long, I was like, “I don’t know.” I mean forever, we don’t know, we don’t know it’s normal for each person or what’s expected, right? We don’t know what to expect, but learn, like feeling solid in one’s ability to give birth, or at least most body’s ability to give birth if untouched, and then allowed me to feel confident to just, you know, be with someone instead of feeling nervous about what if sounds came out, or what if someone came in and asked me if everything was okay? Because to me, that felt like maybe things weren’t okay? But when I could sit with birth, I felt like I could really give space for someone’s individual birth situation a little better. My eyes were a little more honest with them about like, yeah, all kinds of things happen, “this is fine; I hope.”
Maggie, RNC-OB
Yeah.
Mandy, RNC-OB
And finding that as a newer nurse, I think requires intention. So someone told me this, and I was exhausted for many, many years, doing it as a new nurse on night shift. But every birth that happens, that is appropriate, and you can find a job to do, you go into the room and you find a job to do and you do it and you experience birth with other people so that you experience that feeling of like “everything’s cool, everything’s cool” because you’re not experiencing it with the patient, necessarily that whole time. So that nurse has a specific, you know, unique relationship with that patient. But to view birth over and over and over, you can get it in faster if you can help support the nurse, like doing all the little jobs if you’re not adding, like extra eyes that are watching the patient. Of course, I don’t advocate from people watching people give birth. But if you can find a job that is helpful and you can support the nurse, be at the bedside, then you’ll see twice as many births maybe as you normally would, so that can speed up your experience factor. I think it’s cool to see how other people support birth too, right? Go ahead. You kind of learn like “oh, I’m not gonna do that…that made me feel weird.”
Mandy, RNC-OB
Yeah, I think, you know, like you both touched on that idea of that support that you kind of find within your workplace and some, you know, some cultures are different in every unit. Every place you work has their own vibe, you know, and there’s different, there’s, you know, challenges in any situation and also really great things. And where have you found, do you feel like it’s been more internal things that have kind of held you back? That feeling of just being being a novice, not having seen enough birth or other kind of extra factors that have made it feel hard for you to kind of step into that role?
Mandy, RNC-OB
I don’t think we’re taught how to advocate for someone, right? Right, ever. Yeah. I was looking back it just now that I’m teaching nurses I’m looking back at, like, where did I miss this information? And AWHONN doesn’t give us a very good definition of how to advocate, my like VNA doesn’t give a very good definition in Virginia. My education from a prestigious university didn’t give a lot of good information about what does it look like and sound like and feel like to advocate for someone inside a hospital. You’re not speaking for them, but sometimes you’re speaking for them from what they’ve told you. But then, for some reason, everyone needs to hear it from the patient again, right? It’s not clear. That was a huge challenge for me to be like what is advocating for a patient? And I decided I can’t go wrong if it’s always the patient’s decision. So then it became education, tons and tons of education with the patient every chance I got. And if they could make a decision from that, then I could stand solid in a decision that they made. And if it was up to the patient than I wasn’t doing wrong by advocating for what the patient said in just repeating “No, this is what she told me. This is what she wanted” and trying to feel confident in that. But there’s not a lot of education for the language to use for advocacy. What what does it mean? What does it look like? What it does it sound like, because a lot of times that feels uncomfortable, right?
Torie, RNC-OB
I think Mandy made a really good point. I think that education is like everything to me. I feel like if you have education, you are empowered to make decisions and so I will say about 90% of my patients that I get a chance to sit down with them at some point. I have this thing where you know, I pull the stool next to them, a chair next to them and sit. And we have education session for good five or ten minutes, and I try to tell them quickly, but “here’s what’s gonna happen, here’s what could happen, here’s what could go wrong, here’s what could go right, here’s what you can say.” And I can’t tell you how many patients at the end of their journey after having a baby went back and said, I remember you told me that that could happen and that did happen. So they felt like they had that that empowerment to be able to speak up for themselves or if things didn’t go the way that they wanted it to go, but it was necessary, they at least felt empowered to, you know, take some of that that being scared away a little bit. And, you know, she did tell me this, that this was a possibility. So now here we are, you know, and I’m I mean all about education. and even teaching nursing students. I usually make this like speech in the beginning, off their semester, which is “Listen, I’m not one of these instructors that does teaching by being meam. So breathe.” And they’re like, ok. “like breathe. It is okay, it’s okay. I said I am about education. That’s why we’re here. And I was where you are. I was terrified. Sitting in that same exact seat that you were sitting in and let’s get through this.” And I teach them things with my students. I would teach them things that they wouldn’t learn for another two or three months like EFM strips on day one we go through that, day one. And so by the time they got into it was like, “Oh, we’ve been going through over that for the past three months.” Now, you know, with my patients, you know, if you get them from the beginning, I believe that education is probably one of the most strongest things that we have as a person that no one can take away from you. I’ve always been told that, no matter what. No one can take away your graduation, no one can take away your MSN, like you’ve earned that. And so that’s what I’ve always had that mindset that as long as they’re educated that they have something that no one can ever take away from them and make actual decisions based off of the current predicament. And, they’re empowered. So absolutely, I do, I definitely agree with being educated, and I don’t think that we are educated. You don’t get that piece, like you said, where is it found like, why do some people have it and some people don’t, you know?
Mandy, RNC-OB
Yeah, it takes a lot of work. Yeah, practice. And when you have education, when parents know how a body gives birth, when parents know what it’s like to be in the hospital, I think they have choice. I don’t think they have a choice unless I don’t know… That’s what I hear afterward a lot is “Oh, my gosh, I had no idea that was gonna be a choice.”
Maggie, RNC-OB
Well you don’t have a choice if you don’t know what your options are, right?
Mandy, RNC-OB
Right?
Maggie, RNC-OB
If you’ve never been told that there are different ways to to do anything, you know?
Mandy, RNC-OB
Right. Because when we say, Do you want to get a gown on? That’s only one of the choices. “Do you want to get this gown on?” and that’s what we’re taught. Just give them the gown. “Okay, here’s the gown. Do you wanna put this on?” We don’t also say, “Or do you want to wear sports for in a skirt? Or do you want to wear two gowns? Or do you want to wear nothing?” We don’t give 16 choices, because who, you know we’re in a system where there’s no time for choices. Please come into this program with some education. And then when we reinforce choice, it’s not overwhelming for either of us. It’s not overwhelming for the nurse to go through every choice because we have other patients. We have the limitations of the work, of our job, of our numbers and things like that, responsibilities. But also it’s not overwhelming for the patient. When they’re like “I’m crumbling under all the choices.”
Maggie, RNC-OB
Right.
Mandy, RNC-OB
It should be empowering to be like, “Oh my gosh, it didn’t go the way I had envisioned, but I made decisions, every single decision along the way with the information that was given to me.”
Torie, RNC-OB
Yup.
Mandy, RNC-OB
I think that feels so good to really lay it out for your patient. And you don’t have a horse in the race like I have no cares what you choose, right? “Wear a gown, be naked. Don’t care.”
Maggie, RNC-OB
That does not impact my experience.
Mandy, RNC-OB
Right? It does not impact my day. I have seen naked bodies, I have seen bodies covered from head to toe. It is totally, I don’t know what your answer is, you have to come up with that answer and then practicing easy things helps them make other more challenging choices.
Maggie, RNC-OB
Yeah, I think I mean, you both raise such good points there. I feel like there. I think a lot of what holds us back from necessarily stepping into that advocacy role is that feeling that, like, the right thing to do, is to say yes, right? Like we go with the flow that’s like everything just keeps going right, like no one likes a squeaky wheel. And I think sometimes we see that, like in certain, in certain practices, and it’s certainly regional as well. Some health care systems, everyone’s expected to just do this, right? There’s the semblance of no choices, right? You’re just, “yup. you do this, and then you get that, and then we do that, and then oh, okay. Great.” It all kind of plays out on this, you know, pre recorded track that everyone’s just plugging into. And…
Mandy, RNC-OB
That’s not birth.
Maggie, RNC-OB
It’s not, that that’s just not real life, you know? Like, I think so many of us, obviously humans, I think a lot we crave control, right? We crave that idea of knowing that, like, “yes, I will do this, that will happen, it will all be this plan. Okay.”But that is all in our head. There are very few things in life that we actually get to control. We get to control the way we respond to something, right? But I think when we as a system try to say that like, this is the role of the nurse, they’re going to do all of these things in this order, and then that’s gonna create this outcome; it sets everyone up for failure. You know, we’re not able to respond dynamically to what our patient actually needs. What they’re saying they want, if we think they were supposed to be going along with a party line for birth and what it’s supposed to look like. And I think like you said, you know it, obviously, I have supported birth over, you know, several years I’ve supported births in several different hospital settings, at home, I feel like I’ve seen birth go a 1,000,000 different ways, and there are so many different great paths to having a baby. And everyone is on, you know, their journey. And I do feel like sometimes you said like, I don’t, “I lovingly don’t care what you choose about this” because it’s not my birth. Like I have had my births and was able to make the choices that I wanted to for those because that was my experience. And I think sometimes there’s this pressure on birthing people that they feel like they’re supposed to do something. They’re looking us as the nurse, they’re looking to the provider or they want to do whatever like the right thing is, and it’s very challenging as a nurse to help them to navigate that and to truly believe that, like no, there isn’t one right decision, the right decision is the one that’s right, you know, for you. And I do, I definitely think that that pressure, that birthing people feel it plays into then how we’re able to help them kind of navigate that winds with more or less ease. When I do think it comes with a price, it would be awesome to see more nursing instructors, you know, do what you’re doing, Torie talking to, you know, having words, honest discussions and preparing students a little bit more. And I know there’s a lot of discussion about kind of what nursing education could look like and things that we need to incorporate into, you know, curriculum. Like you said, at many nursing schools all over the country, there seem to be a lot of gaps with, you know, critical race theory, with advocacy, with how do we actually stand up with social determinants of health. Like there are so many things that we do not address in our nursing education, sometimes not at all, and certainly not to, you know, the degree that they really need the emphasis that they need for how often nurses are gonna be in situations where that’s relevant I think that’s something that to change to advocate for, you know, as nurses on the other side as much as we can. But I also I would love to know, you know, from your perspective, what kind of the critical issues in you know, obstetrical nursing, in maternal child health nursing. You know, what are the torches that nurses could be picking up right now and really trying to help make change, you know, at their level in their units?
Torie, RNC-OB
So there’s been this huge topic that’s been kind of hitting the headlines a little bit in the past few few years, predominately with the amounts of maternal deaths amongst African American women. And I remember being a staff nurse and feeling like beds. I had to advocate more for them, for the other, maybe people that didn’t have as much money, maybe lower income people, or people from different cultures, people who didn’t who didn’t speak English. You know, people who you know, didn’t have these top careers basically all of the, the latter, because you can see how they may have been treated a little bit different. A mom comes in that has history of drug use. Okay, so you automatically pass judgment for it, right? But you don’t look back, you don’t talk to her and find out well, what what like happened? And you’ll find that when you sit and talk to her, it was the car accident that she had been in five years ago that caused her get on this medication, that now caused this…she had this huge job as the top director of this law firm company. And now she is living out on the streets. But you just judge her from living on the streets, not knowing that 3 or 4 years ago, she made three times as much money as you did. She had this huge mansion, she was, you know, this great person. And then this life happened, and we take life for granted and and not knowing that you’re probably one car accident away from the same thing happening to you. I probably spent most of my nursing career being huge advocates for the latter. And then, like I was saying, beginning with African American women are more prone to dying during childbirth more than any other race. And why? Why was that? And I went to a seminar about that and they honestly from the studies they could not figure out why. Because they said that even it was determined that women that even had a doctorate degree were still…because the first thought was that maybe they were just weren’t being as educated. Okay, but then they said that a lot of these women even have like doctorate degrees. But they were still more prone to dying more than any other culture that just had a high school diploma. So why was that? And looking back, as being a staff nurse. I do remember again, advocating more for those women, sometimes feeling like they that their concerns weren’t taking as seriously, that maybe they were just being complainers and then me trying to, me advocating and then turns out that no, it actually was a serious thing that could have went way, way left, had not [I stepped in], you know, and again, just advocating for those type of people. Like I said earlier, low income, whatever the case is. Again, I don’t think we have that education as far as using your best nursing judgement with, you know, like I said, with drug addicts and whatever the case is that as a nurse, you need to throw all that out of the window. They are your patient, they’re here, they’re having a baby. What we’re doing now, don’t just for anything else, just because she acts for some pain medicine with a history of drug use. Now you judge her and say no, she’s probably not really in pain, she just wants medicine, those kinds of things. So that has been, I think the forefront of my thinking going into being a nurse is that I don’t treat anyone different. I will have two different kinds of patients. I’ll have a 30 year old mom who makes all this money, this great career who has done all of her research, went to all of the education classes and go right next door to a 16 year old who knows absolutely nothing, who was living out on the streets, who doesn’t have any money. I’m treating them exact the same way, because that has nothing to do with the current situation that we’re currently in. Which is that you’re my patient, you’re important and let’s get through this, and I think that’s been like a huge, huge passion of mine since the very beginning.
Mandy, RNC-OB
Mic drop. I mean that’s it right there. Yeah, I love that. You say it and you said it first. The studies that you’ve learned about I mean, they found a cause, that was racism.
Torie, RNC-OB
Okay, Yeah. Okay.
Mandy, RNC-OB
So let’s just to add to your discussion people that don’t speak English, people from other cultures that maybe their care providers don’t understand or they’re not from the same culture, people who are not white, people that are African American ,people that are low income, low socioeconomic okay, all of that is true. They have worse outcomes in labor and all three of us have seen them treated markedly differently. It’s whether we notice it or not. It’s whether we talk about it or not. It does happen in everyone’s unit. It does, because it’s our whole country’s numbers. It’s not just one state, one hospital, the teaching hospitals, the community hospitals. It’s not that. But then the studies specifically for African Americans took into account people who have immigrated and then have babies that are black, people who have come from other countries that are Africa, who are dark skin, people who have lived here and then beyond generations…and it is racism and it is systemic. It’s generational trauma, stress. It’s not just one thing for one person, it’s generational it’s in the history of how people are treated and then how we treat people. It’s two sided, so just like laying that out there from that’s a thing and that is…
Torie, RNC-OB
Very well said.So from someone who has seen it, I have seen that happen. I have felt this deep, dark pain of helplessness. If we’ve had racism for ever, how do all of a sudden we have better outcomes in labor and delivery? Just because we know that is right, like it doesn’t come with an answer. It is a lot of good information, but I was a missing like an answer, like what we do I’ve seen this happen and it angers me and it, you know, in rage and lights a fire and I talk about it and I’m like, “Okay, now everyone I know is gonna hear it because when you hear it, you can’t unhear it.” Now go prove me wrong. Go tell me that you work somewhere that doesn’t treat people that are different than whoever treating, treats hem differently on. Go tell me why your numbers are not universal, you know, in the country because they are, we all have the same numbers and it’s staggering. It’s frightening. It’s so much fear. And I teach all you know when we teach parents we’re like, “What are you afraid of? Get it out on the table. Let it out. Let’s work it out. Don’t bring it into labor because that will affect hormones in a no effect where your mind is, it will affect how your baby comes out.” But that’s terrifying to walk into a hospital and not know how you’re gonna be treated and not know if famous rich pro athletes are sicker, then people that are not black or not African American, that’s got to be terrifying. So along the same lines, but different, I think critical critical nurse attention is trauma informed care. I think that incorporates and kind of puts everyone at a even playing leve,l playing field. When you, when you learn trauma informed care, it’s patient centered and focused on individual needs and reinforces that the patient is the expert on their own body, on their own choices, on their own baby and takes pressure off the nurse as well. So I find it to be at least a placeholder for an answer to well, if I know that African Americans are more at risk than I advocate differently. But then what about, what about that 16 year old, you know, homeless mother? Or what about the person who I feel, can’t say no to anyone like that, they’re vulnerable in a way that I don’t have answers for, either. Not to minimize the racism aspect, but I’m hoping to incorporate it together with your latter idea instead of feeling like because I always felt like I was juggling the plates like I don’t know what’s right for this person, and this patient doesn’t know what’s right for this person, but they’re definitely going to be told what to do unless, you know, I can help them come up with their own choice. I think trauma informed care. You can go in with an open slate and, like you said, like people guess people guess someone’s history. If you see the numbers of mistreated or abused people, especially women in the US it’s the majority, the majority of people taking care of people giving birth, it’s the majority of birthing people. So that’s doesn’t matter, how much money you make, doesn’t matter what your partner looks like right now, it doesn’t matter who’s at your bedside like we can’t ever guess those people on when we start to be open to it and hear stories, I think it’s easier to be like, “oh so like I have no idea what might harm this person or trigger this person or hurt this person’s potential to have a healing experience. So I think that it should be Trauma Informed. Foundation should be how nurses learn how to give care, how to do cervical exams, how to get consent, how to do education and at least as a placeholder until we figure out more answers for how to care for everyone the same. It helps me realize that everyone comes with their own experiences, whether you’re 16 or 36 and that’s going to affect how you make decisions, how you feel about me as your nurse. The fears that you bring in and also the like, strengthen and triumphs that each birthing person has.
Torie, RNC-OB
When I was a new nurse, I looked at everyone the same. At that point, I was just so terrified just not to kill somebody at the end of the day. I didn’t care what race you were.
Mandy, RNC-OB
I’m looking at you like you have an amniotic embolism right now because you probably do [laughter].
Torie, RNC-OB
[laughter] I didn’t want to kill you. So that was it. That was my foresight, but I think what kind of woke me up to “oh maybe be this is maybe a problem” was I got a letter from a patient a few weeks later. She gave it to my manager and this letter she thanked me for being nice to her. She said, because some of the other staff, some of the nurses and doctors were not nice to her because she was a drug addict and this, and that she was like, “You were always very nice to me, and you never talk down on me. And you asked about my history, and I told you, you know, like you weren’t scared to ask me, and we be talked about it and you looked like you were concerned. And you held my hand this and that.” I’m like, I’m thinking isn’t that what we’re supposed to do? And that’s when the little light bulb went off, this may be a problem, and then I was think, from that point forward, I was seeing how people were being judged.
Maggie, RNC-OB
Exactly, you can’t stop seeing it. Like how many prenatal visits did that person have before she got you.
Torie, RNC-OB
Right? And she was still being judged along the way, even as being a patient in the hospital. And because once you know, whoever saw in her chart history of you know IVDA, drug use, it was like, “Oh, well, that’s it,” you know. And so, yeah, I think it’s a problem. I think, as humans, we can definitely be biased. And I think you know, that’s a huge problem, particularly, in the medical community, because that’s one time that you cannot be biased because someone’s life is in your hands, literally. What do we do about that? You know, it’s not taught how to be unbiased that, you know, they expect that as a good human being that you just won’t be. But let’s be real, all of us at some point have been. But how do we take that out, as we walk in those front doors of the hospital or birthing center or whatever care they were giving the patient? How do we check that at the door? And we stop that.
Mandy, RNC-OB
I think labor nurses have an incredible potential to do that, but it takes so much time that we really need to be taught specifically and intentionally. But over time, like how many times were you shocked by what happens with your patient or with birth, or how resilient they are, or how brave they are, or how they’re like stone cold, stoic and boom, they have a baby on you.
Torie, RNC-OB
Yup.
Mandy, RNC-OB
Like, oh my God, you were like working, working, working And I had no idea. You’re just always shocked by people’s potential. You would think that labor nurses would be incredible at it, but I think the system just, you know, medicine is just so boxy and square and dare I say…patriarchal and racist forever and ever and ever. It’s very difficult to change. I think it would take every nurse, I would think there’s numbers in nurses…right?
Mandy, RNC-OB
Yeah. Uggh, I appreciate it, you both speaking so openly about that because it is so pervasive and all of the “ism”s that kind of follow us around, it’s really hard, and I agree wholeheartedly with you, I do feel like that’s the most critical thing we can do as nurses is to become champions of our own education. And I think it’s hard because we work long hours and you’re exhausted and there is so much that we have to keep up with constantly, in terms of our certifications and knowing this and doing that on healthstream and keeping up with the new hospital policy. And I think it’s something that, you know, we, as nursing management, absolutely have an opportunity to kind of step in and advocate for the trainings that we provide to our staff, to provide paid time to pursue these trainings, and not just a couple people who get to go to a conference here or there and learn something and come back and share with your friends, which is great and there’s a there’s a place for that. But for these, you know, these big issues that have to do with bias and racism and the way we think about other people and how we truly turn our humanity on as a nurse each and every day, even though it’s the same thing again, even though we’re tired, even though things could be hard for us, how do we leave that at the door? How do we leave those preconceived notions that are, you know, I think so mmuch of it, it really is…it’s the subconscious piece of it. It’s from growing up in a society that allows all of these to persist. All of these beliefs, all these feelings that you know, the systemic racism that exists in our country causes all of us to have racist beliefs, not because we are actively trying to be racist, but it’s one of those things that you have to be actively anti it. You have to be anti racism, you can’t just be passive about it and hope that you’re not doing the wrong thing. You can’t just be like casually, “I don’t think I’m biased.” You have to be anti bias and actively looking, checking yourself when you see something that triggers that like, whether it’s drug use or it’s a new immigrant or its whatever little things pop up in the chart that you see and you think like, it’s her seventh baby, how many new partners is this? Like any of those little things that can pop up and make you start to have a sense of Oh, I understand what this patient is, I know their story, I know all the potential issues that can come from this, like you don’t.
Torie, RNC-OB
Mmmhmm.
Mandy, RNC-OB
You don’t You don’t know that person’s story unless you actually take the time to sit there and ask and actually get to know that individual. And I think that’s hard. But I would love it if all of us as nurses were able to take on a little bit more of that and be really conscious of the way that we approach those who are in our care and really, it’s hard to do it every single day. It’s exhausting in some ways, but I think with training, and I’ll put some things up in shownotes with different trainings available online, you know, for people who are doing work around trauma informed care, including our own Mandy, from people who are actively working to dismantle racism, within nursing, within medicine, particularly with obstetrical care. So people have, like some reliable resources to go to if you’re ready to kind of take next steps along that.
Mandy, RNC-OB
That’s a good point to learn altogether because I never chose breakout sessions in conferences or things that I thought I already heard but didn’t really see. I think it’s, I think every nurse does it and I already said every labor nurse is incredible and we all are learning, so this isn’t like you guys or them or us; we’re all learning. I think learning together is so crucial; when I teach peanut ball education, I’m like, “no I come and I do two classes and I get all this staff, all the stuff.” Because if you don’t teach all the stuff, you’re gonna have champions, which is great. But then you’re gonna have 85% of the people who didn’t want to learn anyway. Don’t know it, haven’t seen it work, and don’t do it. When it’s really probably improving care for everyone and really doesn’t have anything to do with the nurse, has everything to do with outcomes and patients and their experience. And if they want it, and you don’t know how to do it now you’re limiting their experience when they came in because they’ve watched on YouTube about peanut balls like, “Don’t be silly, just learn it.” That has, that’s everything. Like I wouldn’t go to an LGBTQ+ breakout session. Well, what does that have to do with my patients? What does that have to do it like? You just don’t know until you go and then you look for it and then you can’t unsee it and you’re like, “Oh, shoot! I’m like, 10 years behind.”
Maggie, RNC-OB
Yup.
Mandy, RNC-OB
And then you can expand and then you can try to practice it, and then it’s less exhausting the more you know, because there’s a lot of really great information out there. A lot of smart people talking about how we can do better. We shouldn’t just know because we’re nurses, but C-section rate is still 30-33%, birth trauma rates about the same or more. People leave hurt and then racism, and the fact that we have worse outcomes for certain populations is just apalling. It’s not up to one nurse to just figure it out, though. If we can all learn together and peer pressure each other or have like drills. Come on, we have shoulder dystocia drills. Do you guys have drills? Oh, yeah. We need a drill for, like, what happens when you have a young mom, old mom.
Torie, RNC-OB
We have one for everything.
Maggie, RNC-OB
Right, I’m loving your role for you to be able to step up some of that piece of it. I think about, like program development and how you could bring some of that into play.
Torie, RNC-OB
Oh yeah.
Mandy, RNC-OB
Like we’re in our own bubbles. We are in our own rooms individually, separated from everyone else. Except when we do those drills and we’re all looking around like “that’s not how I would do it. That’s what I would say.” But for someone who doesn’t identify his female, there’s a drill.
Torie, RNC-OB
Oh, yeah. There is so much resistance on that from people who might really like “What does that have anything to do with you? Like it has nothing to do with you. Why do you want care?”
Mandy, RNC-OB
Why do you have an emotional response to this?
Torie, RNC-OB
I mean, you know, I have had quite a few lesbian moms and learning how to talk to that type of population where you know I’m including both of them in the in the conversation, I’m calling both of them Mom, you know, it’s, you know, this is your baby too, you know, it’s not just yours, and they really appreciate it. Like I’m like, “are you guys excited? like you guys had a baby.” And, you know, they’re like, yes. And I’m like, God, like why people are so resistant to change. We all know nurses are resistant to change, we know that. The slightest bit of change that we implement in the hospital, it is like, Oh, my God…
Mandy, RNC-OB
Because we had to go to Epic. We haven’t got over that [laughter] We had to go though that upgrade and now we can’t even we can’t even, we’re like “don’t change our script color, we can’t handle it.” [laughter]
Torie, RNC-OB
[laughter] Don’t change the color, please. I mean, you know we are resistant to every little bitty thing…
Mandy, RNC-OB
There’s so much change.
Torie, RNC-OB
And so I make the point, some of the nurses kinda smoking me a little bit, but I’m like guys. You guys are so resistant to this change, right? I said, is it is the best outcome for the patient.? I mean, yeah…they’ll say yeah. Okay. You know, guys, like 30 years ago, you weren’t required to wash your hands. Look where we are; things change. It changes. 30 years ago, when a doctor walked into a room you have to stand up. Back in the day, nurses could smoke like at the nurses station. Things change people, we are not living in the same times. And let’s move on from it. Let’s just move on, you know.
Mandy, RNC-OB
We can do it.
Mandy, RNC-OB
We can, you know, and I think that’s what’s encouraging. We can do this like we can. And just saying all of this feels like overwhelming. And there’s so much to, you know, take it. And when will it happen? But think of the advocates back then who were saying, like I think we should really wash your hands all the time.
Mandy, RNC-OB
That was OB, right?
Maggie, RNC-OB
Yeah, like, you know. So for those people who were and then finally like it caught on, I think we need to feel like, empowered about the fact that, like, yes, there are so many of us nurses.
Torie, RNC-OB
Like maybe we shouldn’t smoke at the nurses station. Maybe we shouldn’t do that…
Mandy, RNC-OB
Now it’s like, we teach our patients not to smoke, so we shouldn’t. Now it’s, we teach our patients how to breastfeed….we should have some pump space, we should have some some time.
Torie, RNC-OB
Absolutely
Maggie, RNC-OB
The same kind of “duh” way.
Maggie, RNC-OB
We need to feel, like, empowered to, like, take these issues and run and know that the change won’t necessarily happen tomorrow, right? Because that’s not how the human condition works, but it does incrementally change. And we can hope that, you know, when the next generation, our children go into healthcare, they look back and they say, “Huh? You guys had an issue with that? Oh, you didn’t do that. Oh…” And we’ll go, “yeah, what a wild time to be alive,” you know, that would be amazing. You know, I would love to see such a 180 you know, in some of the issues that it really seems like. Oh, yeah, that was a whole different world that we lived in. And I do I feel like for all the nurses who are listening to this,. I hope they feel empowered by this to find the issue that they care about. What is the thing on their unit? What is that thing that they see constantly with their population, that they always have, like, had more questions about or haven’t known how to address it, had that, like “OOH” feeling we are in a wonderful time in terms of education. There is so much that is available online all over the world, and especially now, because everything has to be online, but also all the time. You know, there’s a lot more resources that are available to us beyond what’s just on our unit. So if you’re working somewhere, that doesn’t have really supportive staff. If you’re working somewhere that hasn’t gotten on board with new wave obstetrical care that you know there are ways for you to reach out and find resources and I’ll link those, some of those in the show notes that I found helpful and that I’m looking forward to doing myself as everyone is on their journey. Thank you both so much for being here.
Torie, RNC-OB
Thank you so much. So much fun. Nice to meet you, Mandy. Really good.
Mandy, RNC-OB
Nice to meet you too. This is really good. We’re all in different states, and we’re all doing the same thing.
Torie, RNC-OB
This is so awesome. So call me back anytime!
Mandy, RNC-OB
Repeat performance by Torie.
Maggie, RNC-OB
Thanks for tuning in. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. Check out our show notes today for links to trainings, classes, and books that you can check out to gain greater understanding and comfort in your role as an advocate. Happy Nurses Week! Till next time!
014: Being a Doula during a Pandemic
Maggie, RNC-OB 0:04
Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we are honoring the end of International Doula Month, which runs through May. We have a panel of doulas on to share a little bit more about their experiences of providing doula care through a pandemic. I am joined by Chante Perryman, Cat LaPlante, and Rachel Carbonneau, who will share a little bit more about what they’ve learned about work life balance, how they’re pivoting to improve the kind of care that they are able to give clients during this time, and also what they hope to see from a more collaborative care future. On to the show!
So I am so excited to have a wonderful panel of doulas on today to share a little bit more about their experiences, being a doula during a pandemic, something that we have not been able to experience before. So we want to talk about some of the challenges that have come along with that, kind of how they’re growing within that space, what kind of support they can offer to other doulas during this time, and then also what they see as our future as we continue to work towards more collaborative care, and how we want to kind of move on through and past this whole experience with COVID-19. So I’ll start by just letting them quickly go around and introduce themselves a little bit and just share a little bit of their story with you. Rachel, go for it.
Rachel, Doula 1:26
Thank you so much, Maggie, thank you for having us. I’m really excited to be here and be part of this conversation. I am a doula based out of the DC metropolitan area. I have been a doula for 10 years, I run an agency, a team of 12 birth and postpartum doulas, and we are all pivoting right now and sort of re envisioning the support that we provide and how we can better align with other care providers during this pandemic and onwards.
Maggie, RNC-OB 1:52
Awesome. Chante, tell us about yourself.
Chante, Doula 1:54
Hi, Rachel. Hi, Cat. Hi, Maggie. I’m Chante Perryman. I am a doula, childbirth educator, evidence based birth instructor and spinning babies parent class educator here in Lexington, Kentucky. I have been a doula for seven years now, childbirth educator going on five years, I’ve been supporting families in my area for a little while now. Just rolling with everything that’s going on with the pandemic. I know we’re gonna be talking about virtual services, but I’ve been doing virtual services before the pandemic hit so I was kind of already prepared and ready and just like I’m still just flowing with the things so I’m good. Thanks for having me.
Maggie, RNC-OB 2:39
Thank you for being here! And, Cat.
Cat, Doula 2:43
Hey everybody, I’m Cat LaPlante. I am a childbirth educator, a doula, and evidence based birth instructor. I have been doing this work for I’m in my ninth year and it’s been incredible. Like Chante, I was providing doula support virtually, and education virtually before the pandemic, but there was always a way to access people physically if I needed to. And now I don’t have that unless they were in other states, which wasn’t a whole big part of what I did. So this has definitely been an eye opening experience. It was easy to roll into, but I’m hoping that at one point we can get out of it. And it’s gonna be fun talking about the experiences that we’ve had so far, virtually the challenges, but also what what truly it can do and still be able to provide the support that a doula can provide during this time.
Maggie, RNC-OB 3:40
Hey, all right. So let’s just dive right in. So you know, if we, if any of you want to kind of cover first, like just the experience, I think as you know, as birth workers, we are, you know, used to kind of being tied into that feeling of what’s happening in ourselves and then the outside world and how we’re kind of navigating that, and especially with the on call lifestyle, there’s always been a very thin Fail between work and life and how everything rolls out. But I think just so much more technology now. And that being the only way to connect in that continuous on feeling that comes with that. How are you all balancing out time that is rejuvenating for you and let you take care of your needs and your families, while also balancing out the needs of clients and the birth world in general.
Chante, Doula 4:19
I think it’s a little bit easier for me now. And I say that just because like I said, I’ve already been doing this so it’s not something new that I’m having to focus on. Like I was already offering the service. So for me, it’s actually made my life a little bit easier. I only take one client a month. So in that, I don’t have multiple people to keep up with in a month. So I’m still able to like offer classes, still able to do like the family work life balance, and still be able to provide like that one on one attention to the client who’s due that month. That’s a little bit easier for me.
Cat, Doula 5:00
So I think it’s been easier but also a little bit more hectic. So I try to schedule things out. I really like it. Although we know we can’t schedule birth, but I tried to schedule out my day so that I am doing things that are with my family at certain times and then work at certain times because I also work from home. So the pandemic has made it so I have all of my children here and I have four of them, two of them school aged and two of them that are younger. So I am now primary teacher, caregiver, Chef, errand runner for my family while my husband still works out of the home. Plus working from home and now with doula support, being from home as well. It’s gotten a little bit crazy. So one positive is that I have been able to actually take on primary clients again, whereas before, I stopped taking on primary clients about a year and a half ago and I was pregnant with my last child since the pandemic. I’ve actually been able to take on primary clients, which has been fantastic. But then realizing that that also comes with not just birth support, but prenatal visits as part of visits, other things to schedule in my day. And knowing that anyone can put a meeting on my calendar now at the drop of a hat also makes it a little more difficult to keep my schedule in line. Because you just have to go to a computer and log on now, you know, you don’t have to go to a meeting anymore. So it’s been it’s been a work in progress for me and some of the other doulas that that I mentor because they’re like, wow, I know I have more time at home. And I know I don’t have to leave my house and do all that prep work. But now it’s like, I’m just so busy all the time. So I think it is still important that work life balance to be able to schedule, I need to put my phone down, walk away from the computer, not look at it at all after this time and I’ve been doing that for I think pretty well for the past month. It’s been great. Sometimes I get phone calls from clients or from, from colleagues after certain time at night that I’m happy to take but because I know I can very easily say, “Hey, you know, like, this is something we can talk about tomorrow. Let’s schedule another time for that.” It’s been fun to do that, challenges, but still, there’s light at the end of the tunnel every day, every day when I can walk away from my computer and my phone. Yeah.
Rachel, Doula 7:29
It’s been a little bit of a different circumstance for our family. We had a really rough year personally, not having to do with my career, prior to this pandemic, and we were starting to come out of it and regain our footing right about the time the pandemic hit. And we, my husband and I, had a talk about how we were going to communicate this to the children. We have kids ranging from six to 18. We’ve got four kids, and they’re each sort of interpreting the world in this space in different ways, but we instead of calling it the pandemic or talking about the virus, which we figured out was frightening our kids, we started calling it the pause. And we started talking about how we’ve just sort of put a lot of life on pause right now. And in a way, it’s been really great for the kids. I think there were a lot of social anxieties, particularly coming out of this last year for our family and what we’ve had to go through and process and this has been, in a lot of ways a great opportunity to sort of reassess what are our priorities with our day, what are our priorities in our home lifestyle. And so that’s, you know, I think, in a lot of ways been a incredible silver lining. For us personally, it has made things a little more challenging in terms of connection with community in terms of, you know, working with working with clients, but also, you know, connecting with our friends and our family and these sort of things. And one of the things that I’ve noticed has been that where I used to get a series of text messages or a phone call from a client. Now I’m getting a request for a zoom meeting. And I’m finding that zoom meetings are sort of consuming our lives and that I’m spending, I now have 16 hour work days, which I never had before. And a lot of it is just our long zoom calls, that probably, in a lot of cases could be an email. So we’re having to sort of reassess, you know, what our personal boundaries, what our professional boundaries, how are we connecting in meaningful ways that give us that sense of community building and that sense of personal connection and personal outreach, using all the technological tools that are available to us, but doing a little bit better job of picking and choosing which form of technology is right, for different interactions,
Maggie, RNC-OB 9:34
the zoom, the video fatigue, all of that is definitely, obviously as we continue on, but this pause is definitely starting to, you know, wear on on all of us. Something that I was really fighting for, was not having as intense doula “visitor” restrictions, and so I would love to talk a little bit about that. I know you know, when, when all this hit, there’s this whole idea that like we have to obviously try to limit as much as we can, the spread of the virus, flatten the curve, all of that. And you know, and part of that hospitals started doing all these visitor restrictions. And then slowly that morphed and quickly in some areas that morphed from like visitors to doulas being considered a visitor, and not being allowed, you know, to come with families into hospitals. As a nurse looking into the doula world that has been crushing for me to see kind of how that impacts our ways that we work together and really get to collaborate. And I think, you know, it hurts, it hurts our families to have less access to support and it’s hard to have just that much more kind of isolation, thrust onto them during you know, pregnancy and birth. And so I would love for you all to just speak to that a little bit. We’re all around the country…so what’s happening in your community? Have you been pivoting or doing virtual? How are you making that work well for those in your care?
Cat, Doula 10:46
so I think it’s really exposed the the system to a lot of people, and I’m grateful for that because it’s easy to kind of slip things under the rug and policies this way and that way and talk a lot about what could be happening. But if you don’t see it people like that, well, it’s not really there. Now that we’re seeing “essential personnel” not be able to support clients, doulas not be able to support their clients in-person. It’s all of a sudden expose the fact that we weren’t that and considered that in many systems. And also it’s really put, I believe my personal thoughts are that it’s really put a huge barrier for doulas in general. Now that we’re fighting to (and by fighting, I’m not saying like, you know, like with swords, running into places and knocking things down), that we’re really fighting policy and regulation and trying to be seen as an equal part of the team. I don’t know any doulas that have had a career where they have never been disrespected by hospital staff. I’ve definitely been at births where I’ve been part of the team. And it’s been an awesome environment for the client. It’s been an awesome working environment. And I’ve been respected by everybody in the room in my position as the as the support as the doula and then I walk into another room in the same hospital and it’s a whole nother story. So it’s not even hospital to hospital, it’s person to person and if there is any, any wiggle room for people that don’t believe that doulas were essential to the people giving birth, now they’ve found a card like they’re holding it, they’re like, “Well, you know, you couldn’t come in during the pandemic. And weren’t considered essential there. So I mean, right now, like you’re just not.. you’re basically just a service that can be provided and doesn’t need to happen.” And then I’m sitting over here, well, I mean, I havev my Master’s in education, I’ve been doing this for a long time, I’ve had four births of my own where I’ve definitely needed support. And I have have had multiple women that I’ve supported in labor, and they know that they need me and I know that they need me. And it’s a different support that you can give them, we can work together, but it also needs to be a respectful work environment for everybody to provide safety for the mother. So I think it’s, it’s exposed us. It’s exposed our system and shown the inequalities that we have and the biases that a lot of people have about support and how it’s supposed to look and given a lot of fuel to the fire for people that are not supportive of doulas before. So I think we’re going to have a lot of work to do that we already had to do but now it’s a lot more so I hate the doom and gloom of it all, but it’s really I think a sad environment right now for supportive birth.
Rachel, Doula 14:05
I agree with Cat on that scope into the fractured nature and nature of the healthcare system in this country, and this, I don’t think we’d come as new news to anybody that’s involved with health care. But the siloed nature of it has long been a problem for families, particularly for birthing families, has led to a lot of the disparities that we’re seeing in outcomes. You know, one of the examples that I use when I’m talking to my clients is, you know, to explain to them, when they go in for an epidural, for example, they’re going to be administered IV fluid as part of the administration of the epidural. Right, so the to go hand in hand. But there’s the charting that shows how much IV fluid is administered as part of the epidural doesn’t go to the baby’s charts. So when the pediatrician is looking at the baby’s weight loss, there’s no Nexus that shows any relationship between elevated weight at birth from excessive IV fluid administered during the mother’s labor, right? Those become two completely separate charts. And so we get pediatricians, we get lactation consultants that are very, very concerned about baby’s weight loss. But there isn’t anybody taking a retrospective look to the mother’s labor and how much IV fluid might have been administered during that birthing process. And that siloed nature then creates a disparity where we’ve now got a baby that’s losing close to 10% of its weight. And we’re, you know, getting very concerned about weight loss and these sort of things. Maybe we’re pushing formula, maybe we’re looking at other interventions. And in a lot of cases, the the doula is the one person who’s been on both sides of that equation and can sort of piece together the different parts of this puzzle to say, “Okay, well, here’s how your prenatal experience was, here’s what your labor experience was. And then here’s what we’re seeing in the postpartum period for birthing person and baby,” and help to open channels of communication and help to foster that collaborative care among different providers. Right, the midwife or the obstetrician, the nursing staff, the lactation consultants, the pediatrician, and help the client ask targeted questions and get information so that they can make the best choices for their family as they’re getting started. And now we’ve taken yet another piece of the puzzle out right, we’ve taken away that bridging support that’s helping the families navigate the system and navigate this very siloed system where there isn’t always as much communication among providers as we might prefer. In addition, we now are seeing under a pandemic that we’re making a lot of fear based knee jerk reaction type decisions at a high administrative level, where there’s a serious disconnect from what the actual sort of end user experiences of the birthing person in the family and, and then the baby after the birth. And these policies are going into place to protect the the hospital personnel to protect liability considerations to protect, well, you know, we’ve talked about availability of PPE, so there’s a financial consideration, there’s a resource consideration. There’s a lot of considerations going into it. But the voice that isn’t at the table is the voice of the people giving birth themselves. And alongside of that, the doula who helps to advocate for that voice as well. And without that voice in the conversation, we’re losing a significant piece of communication about what the end user experience is and what the needs are. And here in the DC area, you know, as Cat was saying, different hospitals and sometimes different providers are responding differently or interpreting these policies differently. We have a hospital locally where the doula partner, mother, whoever, whoever this individual is, be one support person, but is allowed under current hospital policy isn’t allowed in triage. So the laboring person is going into the hospital and having to make immediate decisions with no support, which is in violation of their patient rights, this state bill of rights for patients. But nevertheless, this is the hospital policy and the patients themselves don’t have the tools to navigate it and certainly not in labor. You know, additionally, we’re seeing at the same hospital support, people are not allowed into the OR. So in the event that a cesarean becomes necessary, that birthing person is again on their own, in what’s often a very emotional, in addition to a very physical experience, these policies, I think, are being made for the protection of hospital staff and resources and financial considerations and all these things. But if we’re making these decisions out of fear and out of immediate response to a crisis, without looking at the long term implications, without looking at the broader implications for the families that are experiencing these without looking at outcomes for the birth itself, but also for the postpartum period for these families, we’re missing a significant piece of the puzzle. We did an informal study within our own clientele, since the pandemic started, we’ve seen a 100% increase in cesareans. Now, it’s not the end of the world for someone to have a cesarean and and it’s certainly life saving in many cases. But that stark an increase in so short a time. I think it’s telling that these policies aren’t protecting the individuals that ultimately are served by these institutions.
Chante, Doula 19:16
For me in my area, when the pandemic started, I followed the pattern of the doulas out of Michigan. And I actually wrote a letter to my governor asking that doulas would still be considered part of the birthing team. Now, of course, my governor is busy so I did not receive a response but at least I like took that as an opportunity to try and reach out to him. But what I have realized is that a lot of the hospitals in my area, except for one, they are still considering doulas as part of that essential team member on the birthing team. So there are three pretty large hospitals here and two of them have that doulas are still permitted to be in the birthing room. Now there are some guidelines with that. But still they can still be there. So like after a baby’s born doulas have to immediately they can’t say postpartum at all, is like literally like 20 minutes and they’re out. They do have to wear a mask. They do have to be screened before they can enter in. Me personally, I’m not attending any births in the hospital just as a personal choice. So I am letting clients and potential clients know that and I’m just offering just virtual doula support and they’re still satisfied with having you there virtually instead of in person.
Maggie, RNC-OB:
Everything you all just touched on, I think there’s there’s definitely, you know, Chante there’s huge discrepancies in terms of what we’re seeing across the country. And I think it was, you know, been unfortunate is the how frequently policies change especially, you know, the first you know, month or so it seemed like literally every day something, you know, new is happening and things have seemed to, in some ways even out a little bit. But there is still just a lot of changes that have occurred. And there’s not always great transparency about what’s going on and who’s making those decisions. I don’t believe hospital administrators, obviously, they’re not evil people. I don’t think it’s a malicious intent. But I do think that they are seeing one slice of the pie, and they don’t have the context to understand how it is impacting everything else. And so certainly, I mean, you know, there’s people who’ve been doing great in the letter writing campaigns and petitions to bring attention to, you know, all these different issues. And I think it’s, you know, it’s unfortunate, obviously, just because of the severe nature of what we’ve all been going through that it has been hard to get traction, necessarily on a lot of those issues because like you said, governors, they’re very busy. They’re dealing with a bajillion people coming at them who need you know, answers to their issue right then. And so it’s been a little bit challenging to get, you know, responses necessarily on those kind of big levels. What I would love to see is that we were able to individually within our own communities, make better collaborative care decisions. I would love to see that doulas who have been you know, they’re active in their community, they’ve been at these hospitals, the people who work at hospitals know them, right. Like I know, as a nurse, I know doulas who frequently come to our units, like we have relationships, you know, how can we all collectively come together to find situations that make sense for our area? Because again, there’s going to be discrepancies and those are going to continue, you know, that we know that it’s not, you know, there’s not it’s not necessarily reasonable if things are gonna be the same all the way across the board. But how can we come up with the things that mutually make us comfortable, you know, during this that everyone has one that everyone’s voices at the table, you know, Your BIRTH Partners, our whole reason for starting was because we really want to see us breaking down the silos because all of these barriers to communication they don’t benefit any of us. We all function best when we are working as a team, our clients or patients have better outcomes when they are fully supported by a diverse array of training and experience and they get the benefit of all that support. And so I feel like by removing doulas in so many places from like the hospital birth experience, you’re taking away this huge chunk, that is something that we cannot replace or replicate, with the resources that we have, you know, in the hospital. You know, as a nurse, I can’t always be there one on one with my patients because of the different clinical tasks I have to take care of and the patient load that day. Some hospitals have made it seem as if like, “Oh, well, that’s okay. Because we can still like do a lot of things that doulas do here. And yes, I personally am comfortable helping, you know, people with comfort measures. I have done a lot of extra reading and education and trainings and have my own personal birth experiences that help to inform my ability to give care like that. However, that is not standard training for labor and delivery nurses. And so many of us are not ready and able to kind of step into that. I feel like it puts everyone at a disadvantage. It obviously primarily puts the client at a disadvantage because they’re not getting the same access to care that they wanted that they need. And that we know is associated with better outcomes like research proven. Again, and again, we know we all support doulas, all of the major organizations from ACOG, and ACNM, and AWHONN. They all have stuff on their website talking about how great doulas are, because we know that and so I think it’s that catch between the fact that we know this and like you said, right, we’ve been saying tools are essential, and they do all these great things. And so then, like, how do we get from where we’ve said that and we have the banners, and we’re all supportive, and we’re all pro doula and then how do we get from that to, like, actually living out that experience in care and putting kind of our actions where our words are? And so I you know, I just would welcome any, you know, kind of particular tips what you guys see do this better and move forward and I don’t think it’s, you know, it’s one of the I think it’s sometimes it’s unfair because it’s not as if like, “Oh, well, doulas, if you want to be like involved in birth, then you should just like, yeah, get involved, like, fix it.” So I don’t want it to come across that way. Because I think obviously, for everyone to be involved, we all have to be picking up, you know, doing the work to make it happen. We’ve certainly talked about the benefits, like virtual support that that’s a bridge, you know, at this point that if and until hospitals are able to change policies, and have all of you know, the resources that they need to feel comfortable, and doulas are also comfortable entering the hospitals, because it’s certainly, you know, give and take relationship there. You know, we can bridge with virtual doula support, and that does a lot, and that’s great, but what can we do kind of as we continue to, you know, move past that and move forward?
Rachel, Doula 25:40
Yeah, and I think there’s a lot of options. I think that we actually are at a very interesting, pivotal moment in history where we have I mean, if we embrace this as this pause this opportunity to reconsider, reevaluate what our journey has been to this point, maybe where we are at this point now, looking at I mean, you know, we’re we’re starting to see some of the brokenness of the system in new and different ways. This gives us an opportunity to reevaluate and come forward in a more intentional way. Right? pick what it is that’s meaningful to us. What are the preferred outcomes? What would we want the maternity healthcare landscape to look like? And then work towards that in a collaborative fashion. And as you’ve said, like a lot of these major organizations are in support of doulas. It’s, it’s not that the way forward has to be central to doulas but the doulas offer a voice that can help to build that collaborative care model, that it’s not only the obstetrical teams making one set of decisions, and then the midwifery teams making another set of decisions and then the nursing team is making another set of decisions. There can be a collaborative conversation, and doulas just because of the nature of the work that we do can help to facilitate that conversation. We actually had a lovely conversation here in the area, and it hasn’t gained as much traction as I had hoped. But I’m remaining optimistic about it, about using outpatient surgical centers for births because instead of bringing birthing people into a hospital and many of them have to walk through the ER to get up to the labor and labor and delivery units. Would it be safer to have them give birth in an outpatient surgical center where we could set up a maternal health care team? You know what I’m thinking, for example, my son had his adenoids removed earlier this year, and was in and out in two hours after general anesthesia. Right. So there there are anesthesia teams that can work in outpatient centers, there are surgical teams that can work in outpatient centers, we offer this for non obstetrical cases, right surgeries that are not maternal health focused. Is that something that we could build? And could we then promote services for lower risk families for whom home birth may not be an option? Right? Are there ways that we can promote safe home birth to hospital transfers, right so that people have the option to birth at home, but also can come into a hospital in a safe way without shame, without stigma, if the transfer is needed, right, all of these are conversations that that do this can help to facilitate because that’s the space in which we’ve resided. Prior to the pandemic, we’re familiar with this landscape we’re used to providing that sort of communication and and open channels of options and exploration before a pandemic, and now during a pandemic. And I think the virtual support is one of those ways that we’ve shown that we as a collective community are eager and willing to pivot and participate in something new and different. My concern with promoting virtual support too heavily is that I don’t want it to become the ultimate solution, where it is only a stopgap until we as a whole maternal health care community can come up with something that’s better and protects the needs of everybody involved. So I think it’s been, you know, one way that we’ve shown our willingness to to change and to grow and to try something new and different. But this is it’s a bandaid it’s not ultimately a solution or a long term response. There there are cases in which I think virtual doula support is wonderful. I think all of us on this call have provided virtual doula support prior to the pandemic, and certainly are happy to continue doing that during a pandemic, but there are families for whom that’s simply not enough. And their voice needs to be honored as well.
Cat, Doula 29:18
I think Rachel put it in a great way and it goes back to how this pandemic has exposed the system. And by exposing the system and now we have this like open wound that we can repair, which is really something if we’re looking at it in a way” Okay, where are we going forward from this?” Now, we know that when…clearly if people are hiring doula still to provide virtual support, that is right there a sign that says people want doulas, right? They see the benefit. They know what the evidence says. They need other people there in the room to help that team atmosphere really shine for the person that is giving birth. So in that way now by exposing the system that we have lived in and all been a part of, for years and years and years and years, we can now repair it. And I think one of the best ways to do so is to start having conversations with each other. So I know that this is not a new concept, right? Like nothing, I tell Chante all the time, nothing is original at this point. Like we’re not, we’re not having to remake anything. What we are doing though, is we can now join committees, right? So we can say this new committee is going to figure out how policies are going to start being shaped and formed, given the fact that we have been living through and will likely continue in some sort of manner through this pandemic, right. So now we can have these policies and these committees that are talking inter professionally, we’ll have you know, the OBs, and the midwives, and the RNs, and the doulas and everyone together maybe even a few parents from the community, about what is important to them so that we can start shaping the future of what this is going to look like. I think it’s really important that all hospital staff when it comes to labor and delivery have some sort of idea what physiological labor looks like, and how it differs from a lot of the ways that routine care is provided. So going to and really making mandatory because the only way that you’re going to get busy people that are stressed out of their own lives and work life balance is to make things mandatory. So make it mandatory, you know, a one hour session a lunch and learn type thing where they can learn virtually from a doula what she does with her clients, so that they can provide that sort of care that that our friends like you provide Maggie right so that have already reached out and done these professional developments that really highlight the different types of care that doulas provide versus what an RN can provide knowing the different barriers that an RN has an a doula has, right? So there’s all these different, like smaller barriers within this large barrier here. So I think we take this exposure that we have had and that we’ve seen through the pandemic. And we can then repair layer by layer as we go to promote better policy as we start reliving in a time that things are changing. And if we go layer by layer, change layer by layer little by little so that the overall end result has less scar tissue and less scarring, then we would normally have if we were to just slap a bandaid on it and see how the body healed. So we do have a great opportunity right now. So my plea to like everyone listening, whoever this is, if you are a champion in your hospital and your hospital system, when it comes to breaking down these silos when it comes to really promoting in your professional development that you reach out to the people in your area. That are doing so or that you make yourself accessible so that they can reach out to you and start the committee. Right start this, start the conversation, start the discussion so that everyone has a voice. And that we come out of this in a much better light than even how we came into it.
Maggie, RNC-OB 33:17
It is frustrating sometimes how hard it is to kind of get together and have spaces where we all are able to talk and have those respectful dialogues where it’s not about sides, you know, it’s not about us versus them. You know, one of the things I have picked up on in, you know, various communities that I’ve been in through this pandemic is that there is this just, there’s this divide that it’s like the hospital and the OB against, you know, the birthing family and the doulas and whoever else is out there in the community. And that just, you know, it just magnifies that feeling of separation and that feeling that we have to fight you know, against each other to preserve what it is that we find is most important. There are so many different really valuable perspectives. And we are not always all going to agree on everything. But I think the hope would be that as we move forward, we are inclusive of each other, you know, as a hospital staff like I think when we are coming up with taskforce when we are coming up with committees to address issues, we don’t think necessarily about involving the people who are out there community. So we’re not necessarily asking for, you know, birthing families or doulas to be on these committees with us just because that’s not how the structure has typically been so it doesn’t even come up, you know, come up with us. It’s not really antagonistic, it’s a lapse in you know, how we think about it. So Your BIRTH Partners, our mission is to improve perinatal healthcare by increasing collaboration and growing community amongst multidisciplinary teams of birth professionals, like that is what we want to do. We want to see ways that we come together. You know, you go to a restaurant, you are getting service from so many different people who are involved in your care. You have whoever you called me to maybe make a reservation, you have the hostess who helped seat you, the server who’s going around and getting orders and bring you things you have, maybe you have a bartender making drinks, you have all of the people back in the kitchen, there’s a bunch of them back there, sure there’s the main chef, but there’s people prepping, they’re the people washing your dishes, there is the pastry chef, you have so many different of these layers of people who are all coming together to provide you with this one great experience. And following that analogy, you know, when you go out to eat, and you have a great experience, it’s because all of those things went together, right? Like you’re really well taken care of. You had great food, the drinks were good, the place was clean, everything meshed together into your own mind. So it’s not about like just one individual part of that that stood out absolutely, that you have just an outstanding server or the food was just out of this world. But most of it, it’s just the way that that all comes together. I want to see that happen in birth. It’s not about one birth bro. People should try to make an impact on each other’s lives, but it shouldn’t be about remembering that like yes, it was the one nurse who made the difference, it was this amazing doula, I couldn’t have been without her, it was my OB who saved my baby’s life. Like, it shouldn’t necessarily be about one individual provider, it should be about the feeling of “I had an amazing birth because I was surrounded by support that covered all of these different levels. I didn’t have to fight because they were all on the same team. They were all working together to help me have this experience.” I feel like we all do well, everything improves when we work together. And I feel like obviously, I say this probably like on every single podcast, and anytime I write anything for Your BIRTH Partners, but I just really would love for us to break down those barriers, get out of our silos, and just come at each other with arms and minds wide open to hear the other people’s perspectives. Because I constantly learn new things from people when I actually just close my mouth and just listen to what people are saying because I have my one view from my lived experience, from my training, from what I’ve seen, but I’ll have a really passionate conversation with a doula and then they’ll say something I’ll realize like “Oh, I was wrong. Okay, well, you know, learn something new….” And I’ll go and talk to a doctor about something. And I realized, “Oh, I actually really wasn’t thinking about that, you know, I’m not considering all the same things that they are.” You know, I would like us to think of ways that each of us can reach out now to people in our community. So if you’re out there listening right now, and you don’t have a diverse community of birth professionals, let’s start making some relationships. And we talked about earlier, everyone’s pretty available right now, right? There’s not quite as much claiming for people’s time. So maybe now is the time a phone call, a zoom call with an OB physician and midwife in your community and just started talking about like, “Hey, I would really like to be more involved. I’d love to, you know, reach out, can we talk about ways to make this work.” You know, if you are a hospital-based professional out there, you know, where are some of the doulas in your community or the lactation consultants, the body workers, the pelvic floor PTs, any of the other people who work out in the community to make this whole experience work. Can you reach out to them and find like, just get their contact information? Can you have referrals to give out to people when you see someone who has an issue, and you you aren’t really trained to help solve it, you know? So how can we kind of start to build more of those bridges so that once we’re all sorted, able to like come together in person, again, we can have really rich, meaningful, complete discussions that cover all of these issues instead of just continuing to kind of tuck into what’s comfortable for us, because it is growth is hard. It hurts sometimes. And you know, healing doesn’t come easily. But I, I just echo everything you all just said about how like, we can really take this. And you know, rise like the Phoenix, we can come out of this better, you know, than how we went into it. And really take stock in what has happened and how we can be more, more inclusive and really just make birth better. We want birth to go well, we want people to have great experiences, we love caring for people during birth, no matter what your role is, you know, as a birth professional. And now that I finished my soliloquy… thank you all so much for joining me on this panel. I really appreciate hearing about your experiences and you’re dealing with this and you know, I hope all of our listeners will kind of tune in and let us know, you know what’s happening in your community. How are you adapting? What are the things that you’re doing that are just going great and are really helpful? And you know, the positives that come out of this? And what are the places that still need growth, where we still can kind of help brainstorm and come up with different ways to, you know, approach the issue. So I thank you all so much for joining us.
Cat, Doula 39:19
Thanks, Maggie. Thanks, everybody.
Rachel, Doula 39:21
Thank you so much.
Chante, Doula 39:22
Thanks!
Margaret Runyon 39:22
Thanks for tuning in. We love to talk birth, and we’d love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter. We’re Your BIRTH Partners on all platforms. We welcome you to check out our show notes where we’ll share more information about doulas and the role that they played during the pandemic. And we want to draw your particular attention to the virtual doula fund that we have set up in response to restrictions during COVID-19. Please go to yourbirthpartners.org/virtual doula. To learn more about how we’re providing funds to help low income families gain access to virtual doula services during their pregnancy, birth and postpartum We appreciate your monetary donations, spreading the word, and all that you do as part of our community. Till next time!
Transcribed by https://otter.ai
Music from https://filmmusic.io
“Gonna Start” by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)
SEASON 2
015: Hope & Partnering Together
Margaret Runyon 0:07
Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today, we are kicking off season two of the podcast. And this year has certainly thrown all of us for several loops. And we took a hiatus over the summer so we could kind of all collect ourselves and, you know, spend time with, you know, our loved ones and focusing on you know, the important work that we all do. And I’m really excited to come back together and start processing a little bit of that more out loud with you all, as we keep working to really improve perinatal health care. And so our vision for this first episode of the season was to bring in some more voices, some people who I consider to be you know, thought leaders within perinatal healthcare, who have really, you know, spoken out and taking action to change the way that we operate. And so I am really excited to bring them on today. And we’re asking the three of them all the same questions. So I have Dr. Neel Shah, who was really one of the first voices as an OB-GYN, as a physician, who I heard really calling out some of the problems within our healthcare system. And then we also have Dr. Mimi Niles, on who I, you know, recently more recently became aware of, you know, her work and her voice within prenatal health care and have just been continually just impressed with the level of nuance that she brings to discussions around birth care and our work as birth professionals. And then our other guest is Krysta Dancy, who is someone who I also met in the last year or so. I love that the framework she brings to discussions around prenatal health care is really based in her background as a therapist, and she brings a really unique perspective to how we, you know, address clients and patients and care for their needs. So, I am so excited to share all of them here with you today. We are going to be asking them questions about hope through the pandemic, and then what they see as the future of really partnering together during birth care. So I am sure you will learn a lot from listening to them and the experiences that they’ve had over the last several months and gain a greater understanding about some of the steps that we hope to see as we move forward. On to the show!
I am so excited to share this conversation with you all with Dr. Mimi Niles. Mimi is a certified nurse midwife. She is a researcher exploring midwifery care models and health equity in our country. She is an assistant professor at NYU, working on their school of nursing. She is on the board of directors for the National Association of Certified Professional Midwives. And she is a parent and an incredible voice for change in our country and in our perinatal health care system. So I’m delighted to have her here to share with us.
With all of this, everything that has happened and these feelings of just unknown and loss that have been running so high through the pandemic, what is you know, what’s the one thing that gives you hope for kind of birth care and continuing on?
Dr Mimi Niles 3:42
I would say…what gives me hope…is Black women.
Margaret Runyon 3:53
Mmmm
Dr Mimi Niles 3:53
All the Black mentors that I have in my life and the black midwives that have been my teachers and my sort of, I don’t know, they give me so much hope because I see in them something that is so it’s sort of spiritually strong and grounded when they have this kind of consciousness around what what the work that needs to happen, you know, and such clarity around that, I think really gets me out of my sort of existential kind of, “I’m just one person, what am I going to do?” And the narrative around the hero, or the American hero, I think is not true. We know that a lot of this work happens in community and it happens in partnership. It happens in sisterhood, and yeah, and I really that that has given I’ve had a lot of dark days during COVID and that has been I have been so blessed to have folks around me who said get yourself up and put your big girl underwear on and get, you know get back to work.
Margaret Runyon 5:04
Yeah. I mean Black women are certainly they are rising out of this and their resilience to continue to, to fight and push and it’s inspiring. And like you said their style of leadership, typically when you’re watching it is so it’s so different from what we’re, we’re used to and so refreshing in just that openness and that collaborative nature.
Dr Mimi Niles 5:27
It’s unapologetic, and I think we, that’s what, we that’s the fire we need.
Margaret Runyon 5:36
Yeah. And so then the last question is, so what is, you know, one thing be it, you know, practice, training, mindset shift, conversation that you believe can help birth professionals partner together to change birth care in the US?
Dr Mimi Niles 5:50
Mmmm. I believe that there needs to be… there has to be an unlearning and a relearning, so there has to be a re-learning about the history of medicine and obstetrics in the US. And there has to be an unlearning of what power looks like in this space. So I yeah, I think there has to be kind of a, that’s how I feel. It almost is like everybody needs to, you know, when you have to turn your computer off completely?
Margaret Runyon 6:32
Yep. Off and back on again? [laughter]
Dr Mimi Niles 6:35
I know there’s a word for that. A reboot or something. Yeah, we need that kind of reboot or rewiring. That needs to deeply happen. And it’s going to take truth telling, and reconciliation and that means everybody’s going to have to be at the table. And it’s going to get super uncomfortable and messy. And people need to know that it’s not personal, you know, that this is about system, and institutions and histories and legacies of colonization and imperialism and American sort of westward Ho. expansionism that has left a lot of us behind. So that I feel like it’s going to take some deep, deep work around not. It’s more than just like, it’s nice to talk about interdisciplinary learning spaces. And I always tease physicians, like, “I know how to work interprofessional game because I’ve had to do it since day one. You all are the ones who don’t know how to work into professionally because you’ve never had to do it. What you says go what you say goes right?” So like those are the conversations I want to be having, you know. And I am, you know, there are physician leaders in the space where I think, why aren’t you talking about midwifery care? You’re a leader in this space. You need to be calling out your physician colleagues and saying “why do we have so many physicians doing physiologic, not doing physiological labor as our C section rates rise, as our induction rates rise, as our epidural rates rise?” Those are all related to health disparities because Black women get more c sections, and Black women get more inductions, and Black women get more epidurals so you need to be, they’re all connected, you know. And so let’s have those conversations. I don’t know how that’s going to happen. Maybe they need to happen in pods or maybe they happen…I don’t know how to operationalize it. But this is aspirational to me there needs to be like serious unlearning and relearning that needs to happen.
Margaret Runyon 8:38
Yes, I cosign that 100%. That is that is what needs to happen. Well, thank you so much, Mimi, for sharing all of this with us today. I really appreciate your insight and clarity around these issues we’re facing.
And next I am going to bring you over to the conversation I got to have with Dr. Neel Shah. All right, well, I am joined here with Neel Shah, who is a physician, a parent, a assistant professor at Harvard University. He is the founder of nonprofits March for Moms and Cost of Care. And really just a huge vocal advocate for talking about our perinatal health care system, and speaking out about ways that we can improve and work to change it. So I’m really excited to have him join us here to give us a couple of answers to these questions.
So Neel, welcome. Thank you so much for being here.
Dr Neel Shah 9:32
Thanks, Maggie.
Margaret Runyon 9:33
So we’ll dive right in. In a time where concerns over the unknown and feelings of loss have run really high. What is giving you hope, as we continue to navigate birth care through the pandemic?
Dr Neel Shah 9:48
A lot honestly, you know, during every humanitarian crisis, which is what this is, maternal health suffers, so whether it’s, you know, warfare or a natural disaster, like a hurricane, or in this case a pandemic, we see that, you know, maternal health suffers. And in many ways maternal health is sort of a bellwether for the well being of all of us. And there are many ways that we’re seeing that now, too. And just to lay it all out, I mean, there’s a pandemic, there’s a deepening economic recession, there’s political upheaval, there’s civil unrest, I mean, that’s a lot existentially for anybody. But what I’m also seeing is all of the seeds of innovation. So you know, there are a number of things that people have been working very hard to change and progress in our maternal health system for a long time, that weren’t really on the table as being possible until now. So whether it’s telehealth, which wasn’t getting reimbursed and wasn’t getting payments. to honestly, if you can get a facility fee, put a tent in a parking lot and care for people in their communities, you should be able to get the facility fee for a birthing center. We’ve had to create new capacity in the healthcare system. So we’re relaxing licensure in ways that allow midwives and other advanced practice nurses to partner in the profession in ways that, you know, were harder to do before the pandemic. But fundamentally, what I’m seeing is that there are a core set of challenges that everybody’s dealing with across the country. And then we’ve got all of these inventive ways of solving them, which are really the seeds of innovation, like we’ve had a 90 year old model of prenatal care that’s been rigid and fixed, and based on nothing. And now we’ve got all of a sudden, like, 1000 experiments on how to do prenatal care. And from that a better way will emerge. I know it.
Margaret Runyon 11:38
Wow. Yeah, absolutely. You touched on so many really important things. And I completely agree with you definitely, you know, necessity is the mother of invention. And this has probably been kind of the catalyst that maybe the system needed to really start addressing some of these issues that have been long standing and this has really shone a light on so that’s great. And then, you know, the other question that we had for you was, you know, what’s the one thing and that could be anything, it’s a practice, a training, a mindset shift, a conversation. What’s the one thing that you think really that birth professionals can, can do can partner together right now to really change birth care in our country?
Dr Neel Shah 12:17
That’s a great question. I mean, I think the existential issue for civil society is the same one that we have as birth professionals, which is trust. At this moment. All of us who work in the professional space at the end of the day to differing degrees are institutional actors. I’m the ultimate one, I’m an obstetrician. I’m a Harvard professor, I’m male. But all of us who have worked on behalf of our professions and institutions have been part of a system that’s left a lot of people out. And among those who have been historically oppressed and marginalized, they have rightfully, not really trust in the system. And at this particular moment, they’re seeing a lot of tough things that are continuing to leave them feel left out. And when you look at who’s being disproportionately affected by the pandemic, or who before the pandemic was being disproportionately affected by inequities in maternal health. So we need to work on being trustworthy, collectively. And that does mean partnering together. And it probably means figuring out ways of using our professional privileges and power and sharing it, in some cases ceding it, maybe in some cases, showing up less as experts and more as learners, you know, less as speakers and more as amplifiers of other voices. And particularly from those voices that don’t have platforms and are being most impacted by what’s going on right now.
Margaret Runyon 13:49
[cut out]….That’s perfect. I think we missed the very end of what you said. And if you want to repeat that, I think you were saying trust and…
Dr Neel Shah 13:53
Yeah, we need we need to work on trust. That’s the point.
Margaret Runyon 13:56
Yes, ok.
Dr Neel Shah 13:57
It’s something we take for granted so it felt worthy of explaining because like people are like “work on trust, what does that mean?”
Margaret Runyon 14:03
Yeah.
Dr Neel Shah 14:03
There’s a deepening divide between health systems and communities that we serve. It’s getting wider. That is what we need to work on.
Margaret Runyon 14:12
Yeah. Yeah, that’s been that. So, you know, our organization starting up was really because we’ve felt like there is this, just this widening gap and this feeling that we don’t people don’t always know how to work together. We don’t know how to find the people who we actually can trust and can partner together because there’s just historically been people doing a lot of untrustworthy stuff. And unfortunately, people haven’t lived up to that [expectation]. And so it’s hard now both for you know, for professionals within care settings, and then also for the people were caring for to know, “okay, when I tell this person, this is an issue, are they going to, are they going to care? Are they going to do the right thing to help to fix it?” And it’s, yeah, it’s been really overwhelming but I there is, I think as we keep working together as we keep doing more trainings together and talking more and just having more, you know, our obviously our whole end is like have more conversations about it talk about the issues, call it out, don’t let it be, you know, the elephant in the room that everyone kind of avoids because it doesn’t, it doesn’t get us, you know, anywhere. Our tagline is like “be, inspired, respected, trusted, heard,” which spells out like for birth, and because we felt like that’s like, that’s what we need, like we need those and we need it on all sides of the table. You know, everyone needs to there needs to be respect and trust going back and forth. And not just kind of this one way relationship that I think as healthcare professionals, we kind of are trained to think we have respect and trust automatically, like earned for us. So, it’s a big one.
Dr Neel Shah 15:33
I love that, Maggie. That’s great.
Margaret Runyon 15:36
Well, Neel, thank you so much for taking the time to share with us today. And, you know, speak into your vision of what you’re hoping the future continues to evolve into. So I really appreciate it.
And now I will be leading us into our last conversation with Krysta Dancy. So it’s my pleasure to introduce to you all today Krysta Dancy. Krysta wears many hats. She is a licensed Marriage and Family Therapist, a certified birth doula. She’s the founder of the Birth and Trauma Support Center. She also co directs the nonprofit, The Place Within Counseling Center. She’s a parent, and she is a just tireless advocate for us tuning into what our clients individually need to support them through birth. So I’m so excited to have her here with you all.
So, Krysta, let’s just dive right in with the heavy question. So in a time where concerns over the unknown and feelings of loss run high, what has given you hope as we continue to navigate birth through the pandemic?
Krysta Dancy 16:40
So not surprisingly, the pandemic has really exposed cracks and flaws in the system, right? We see that anytime there is stress placed on a foundation that has cracks in it. The cracks show and that’s definitely happening. We’re seeing that the pandemic is revealing a lot of systemic issues. Why do I still remain hopeful? Because every time I look deeper to see the professionals who are rising to the occasion, I am inspired. I am seeing mental health providers suddenly become increasingly aware of perinatal mental health traumas of the isolation of new parents. The conversations are being refreshed and renewed and drawing in more eyes than ever before. I am seeing institutions I never thought that would say this suddenly recognising the importance of birthing options. So now I’m seeing institutions to talk about how important it is to have freestanding birth centers, how important it is to support home birth for good candidates. Everybody in my area, who offers birthing alternatives, cannot keep up with the demand. There’s suddenly this increased awareness of how important it is for there to be options. I think that’s going to have a long term positive effect on this conversation. The other thing I’m seeing that’s inspiring me is the way that doulas are coming together nationwide. They are connecting with each other. They are becoming politically active in a way that I’ve not seen happens in such widespread ways. They are petitioning governments to support the rights of birthing people to address issues, like doula bans or racial disparities or income disparities and outcomes. I’m watching them do things like find creative solutions in virtual doulaling, which is not only making sure that doulas will be here to stay, but it’s also making sure that areas of the country and clients who couldn’t probably access this care before suddenly have access to it in a new way, hospitals or facilities that would have never even heard the word doula suddenly have a virtual doula there. I think that the exposure in the long term to all of these things and the ways in which people are rising to the occasion, makes me hopeful that although right now is pretty hard and stressful for everybody involved, the long term is going to become this amazing conversation. That is, if you’ll pardon the pun, there’s this thing being born in this hard time, right? And so the pressure that we’re under is forcing us to be creative and collaborate in ways that we got away with not doing before. So that’s where my hope lies.
Margaret Runyon 19:12
Yes, Krysta, I, you have just highlighted so many incredible things that have come from this pandemic. And I, especially that piece of just this awakening that is happening to issues that have been here for a very long time, that really need our attention collectively and individually to make change. And that does give me tremendous hope as well. And then, you know, the next thing we’re kind of asking everybody is, what do you think is the one thing and be that a mindset shift, a training, a conversation? What is that one thing that needs to happen in order for us to really partner together as well? as professionals and change birth care in the US?
Krysta Dancy 20:04
if I could pick one thing that I think will be revolutionary to the field of perinatal care, it would be cross disciplinary learning. I come from a mental health background, I moved into birthing background after. What has always been amazing to me is the ways that no matter how well educated you are, no matter how prestigious the institution or how well mentored you were, or how much work you’ve done to learn, we have all received lenses from our institutions that are often specific to our professional role and we don’t even realize it. And as soon as you get people from other disciplines in the room together, talking about the same problem together, all offering their different lens and being able to connect with and empathize with the different lenses looking at 360 degrees of the same picture. magical things happen. It’s incredible. When we have you know experts in the room on psychology psychosocial models, racism, health disparities, medical care, midwifery, hospital administration, the list goes on when we get these people who are generally very siloed as they are in the birth world, and we put them in the room together in a collaborative model, we suddenly come up with something we could have never thought of the sum is greater than the parts, right? And so that for me, cross disciplinary training is the future. It is where growth happens, and I’m very excited every time I get to take part of it.
Margaret Runyon 21:36
Krysta, I can attest to that power of collaboration. Having taken your courses before I too have been struck by really just the the new ways that we can think about things when we share perspectives. And obviously so much of that is what we hope to have happen here through this podcast. You know, we look forward to more challenging discourses about what is happening in perinatal care? And how do we actually take that and come together with all of the different perspectives we bring, and our experiences and really create something that is better than any of us can, you know, imagine on our own. So thank you so much for contributing and sharing your thoughts with us.
Thanks for tuning in. We love to talk birth, and would love to talk about it with you. So, please join the conversation by finding us on Facebook, Instagram or Twitter, we’re your birth partners on all platforms. And you know this episode, we were blessed to hear from, again, people who I really consider to be you know, thought leaders and great vocal advocates for change. But even you know, more important than those couple of voices are hearing from all of you. And so I would love for you to, you know, come and find us, the posts that we’re sharing this week on social media, and comment and let us know about your experiences, share what is going on in your world, in your profession, in your community, and how you are finding hope through this pandemic and what you want to see as next steps as we all try to collectively move forward to something better. So we look forward to hearing from you. If you want more resources about the guests we had on the show today and anything we talked about, you can check out our show notes on our blog at yourbirthpartners.org and we will look forward to hearing more from you. Till next time!
State & Future of Birth Care
Margaret Runyon 0:06
Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so glad we’re here to learn together. This week, I have the pleasure of continuing a conversation with Dr. Mimi Niles. For those of you caught our last episode, you have already had a glimpse into the clarity and brilliance that Mimi brings to talking about issues surrounding perinatal healthcare. So I am really excited to share more with you about this conversation; we talked about so much of what is impacting really the state of prenatal health care. We talked about respecting individual choices and what that looks like with the language we use and how do we advocate for those who are in our care. We talked about birth pro education, where we are missing the mark and some steps we need to do to move forward as those of us who are experienced birth pros and those who are just starting out. And we talked about really trying to change the landscape, recognizing the racism that’s been inherent in our system, and actively taking steps forward to create a system that actually has equity at its base. So I am just delighted to share this whole conversation with you. And because I am human, unfortunately, we did have a little bit of a technical snafu. And so Mimi was very gracious to allow us to kind of restart the interview after missing the first 10 minutes or so. So very grateful for for her for catching that we weren’t recording and letting us start over so you’ll catch that at the beginning of the episode. Thanks so much for being here. Onto the show!
Now that we’ve been chatting forever, let me formally introduce you.
Dr Mimi Niles 1:48
Okay, great.
Margaret Runyon 1:50
So I am super excited to have Dr. Mimi Niles on here to chat with us about birth care and advocacy and what it looks like for her in her practice as a midwife, as you know, a researcher with the birthplace lab as a, you know, nursing school professor, and really as a voice for midwives, and for birthing people to really kind of step into what they want for their birth and for all of us to be a little bit more aware of it. So I have been following Dr. Niles work for, you know, this year and just really been blown away by the nuance that she brings to healthcare and to thinking about birth, and the way that we provide prenatal health care. And so I am super excited to have her on here to chat with us.
Dr Mimi Niles 2:40
Oh, thanks, Maggie. We’ve been chatting but didn’t capture everything.
Margaret Runyon 2:44
Yeah, so we’ve been chatting and had a technical difficulty, as well happen. And so we’ll loop you all into the conversation now that we’re all recording. Yeah. So Mimi and I were talking about, you know, really how we provide care to people and you know what that looks like? And how do we see what’s happening in someone else’s world and really kind of step into that in a place of from respect and a place of humility to really be receptive to what they need. So I’ll let you take it from from there.
Dr Mimi Niles 3:17
Yeah, I mean, I was we were just talking about something I’ve changed. I mean, it’s just to truly jump into this over the changed in my practice. I’ve been practicing for going on 11 years and attended hundreds and hundreds of births. You know, I mean, that you know, as midwives we call it, the catch and catching a baby and have been really conscious lately of, you know, as that human emerges, just having the first hands at that child feels, wanting them to be the laboring parents’ hands or the support parents’ hands or the support grandma or whoever it is, that is wanting to be in that role. I’ve been really trying to consciously support that and really sort of advocate for that because i think it’s more than just a moment of like a really cool thing to do, you know, but I think it’s a symbolic gesture of that we there in the labor room, the professionals in the labor room are really just kind of guardians of the process, the actual labor and the work happening is is in that laboring parent’s, that laboring mother, and I-it’s so important, you know, like when people say to me, oh, you delivered my child or if another provider says, I delivered 500 babies or something like that. It really is like a screech moment for me because I think even that language of taking away that work that’s being done is really super problematic, and it’s our language matters, you know, and I think that’s why midwives have claimed this kind of like we catch babies or we attend births or really trying to be conscious around this like delivery idea or doing deliveries. You know, my cousin had a baby and it was very precipitous. So his partner ended up having the baby at home. And so he texted me and he said, you’d be so proud of me because I delivered the baby, you know, and I thought, No, you didn’t know your wife did all the work.
Margaret Runyon 5:22
[laughter] I support you, but… That language is really important as someone who you know, most of my training has been in hospital settings. Obviously, delivery is part of you know, the vernacular, but it’s something that over the last couple years, I’ve really tried to, it slips in sometimes, but I really tried to take it out of the vocabulary, especially when, you know, we’re talking to to birthing parents about what they’re doing because absolutely, they are the only people who deliver their baby into the world no matter how they come out. And I do think returning that, really just that power to them, and I think you know, something that you could we touched on earlier is that, that feeling of like, respect for the family, and how do you want to speak just a little bit to like that background that you have in kind of like community family nursing and how that plays into it?
Dr Mimi Niles 6:16
Sure, sure. So I was telling Maggie that I went into nursing as a pathway to midwifery. So I always knew that I wanted to be a midwife. And if you’re in the birth world, you know that there are multiple paths, pathways to midwifery in the US, which could be a whole other episode, but so my pathway was the CNM pathway. And when I graduated nursing school, I remember everybody was telling me you have to do med surg, you have to do med surg, and I thought, God willing, I will avoid med surg at all because I knew that I wanted to do ultimately do birth work. And so it felt like what would give me the skills that would sort of build towards that dream of being a birth worker and the first job that I got offered was visiting nurse, Community Health Nurse here in New York City. And everybody told me I was crazy that I, you know, I would be in homes alone, and I wouldn’t know what I was doing. Because there’s no one; there’s no one to ask, right when you’re trying to figure something out.
Margaret Runyon 7:20
A different safety net…
Dr Mimi Niles 7:21
Yeah, yeah. And you know, you might call your nursing director and they might not be on the phone, or you might call the physician and you might not hear for them for for more, you know, for days when you need an immediate, immediate answer. But it was the most humbling, most enriching even now, like professional work training experience I’ve ever had because it sort of create this really deep sense of humility because you’re entering somebody’s home. You’re kind of getting entree into their family unit and into their culture that’s just like you knock on the door, the door opens in this just this whole world that you have to very quickly assess and understand comes into your view. And then you have to, I think a good visiting nurse or a good community health nurse or any good nurse provider, like finds a way to humble themselves really, really, really quickly. But nothing will do that, like home care, because you don’t know really what you’re entering. It could be so many scenarios that could happen. But I think those are the skills that I wanted as a midwife, because even though I’ve worked for 11 years in a very, very big hospital system, I still open that door of that labor room, and that is the same sort of spirit or energy I bring in sort of a complete humility of, I don’t know, this family system, I don’t know their history, I mean, you know, their clinical history, but that’s very different than as you know, like you don’t know the internal family dynamics or, you know, the very personal intimate histories and I think that’s what I struggle with as a birth provider is that we’ve, we’ve like, we have thrown all of that out already. We expect all of that to be thrown out of the birth experience. But really, if you really just watch your birth happens, all of those things are really magnified in the birth experience all the the love and the tensions and the histories of families and partnerships and parents and grandparents and sisters and auntie’s, and it’s all like, it’s just all there. You know, if you’re in the like the rawness of the birth experience. Yeah. I don’t understand how women let us have let us get away with this as institution based providers of saying, telling them that none of this matters, you know, your blood pressure matters, your diagnostics matter. Your FH matters, your contraction pattern matters, but we don’t really care if you don’t have such a good relationship with your mom and she’s in the room with you. And to me that that is like another vital sign that that absolutely matters, you know, or that you have, you know, you’re a single mom now or you’re not with the father of the child or the other parent of the child anymore, that matters, right? That matters to me.
Margaret Runyon 10:06
Yeah, I mean, so much. Oh, yeah, in health any time, but especially going through the transfermation that birth brings with it and welcoming a new soul into your family. What, who is your family? You know, I think we obviously in the US, we’ve, you know, we’ve created this whatever this you know, box of this, you know, happily married, you know, cisgender white heterosexual couple, and regrettably, that has dictated so much of how we based care off of, and while that might be a reality for many birthing people in our country, it is not the reality for all of them. And I think in our big institutions, we just have a really hard time moving past that and really accepting that like there is validity in all of the different ways that families come together, but it also means we need to change what we’re doing. Like, we can’t just say like, “Oh, that’s cool, you’re doing a different way, I’m gonna keep doing it the same way, I always do it for everyone.” There’s a huge disconnect there. And I do think the, that background that you have in, in home nursing probably really helped to solidify that piece of it for you. And I was saying, you know, I wish, I wish all of us in any healthcare field, no matter what you’re going into, as you know, as a nurse, as a physician, as a midwife, that we have that chance to have time in community, time where we really see that the job we have is one piece of this bigger puzzle going on in someone’s life and really respect and kind of be humbled to that because I think part of the, you know, so many advocates for birth, speak to, you know, homebirth is kind of this, like, almost this pinnacle, you know, kind of piece of it. And I think the reason that that happens is because of kind of traditional homebrew midwifery model really is person centered and you are in their in their space. So you can’t help but tune into all of that and encourage them to just be themselves more. I think there is a piece of it that when we people come to the hospital to give birth to their babies, they come into our turf, and we lose sight of who is still, like you said, when you open the door that is still this is their space, it is their body. They’re the ones who are giving birth. And, you know, I don’t think that home birth midwifery is is you know, right for everyone. But I do feel like obviously, that what we what is brought into that model of care is what we need to bring more of into hospital based birth care, because it has to still be there space, it has to still be there has to be all that attention to what makes them themselves.
Dr Mimi Niles 12:48
Yeah, yeah.
Margaret Runyon 12:49
Not what I want to do because I did that way my birth or is the way I’ve done it 100 times before.
Dr Mimi Niles 12:54
Right, right. I mean, I think the issue though is that people who choose homebirth. And even providers who choose to be homebirth providers are saying this institution does not serve us and it does not serve our needs. So we’re stepping out of the institution. And I know people that say we need to bring that model to institutional care. But I think the, the way institutions were designed, and I know this is hard for people to listen to, it was designed actually to exclude the person centered model, and it was designed to exclude sort of shaping your care to match what the person needs. It was designed in sort of a factory model type ways so that everybody gets the same thing. Right. And so we have fetal heart rate monitors. Everybody’s on a fetal heart rate monitors so that a nurse can watch multiple people at the same time, right and so what you’ve done is a lot that technology has actually doesn’t allow for us to return to a person centered model, because now the technology has sort of surpassed sort of the human capacity in a way. And if like, if a nurse comes up to me and says, Well, you know, I just, I don’t feel right, about something or a little bit too much bleeding or a little bit, you know, something, you know, it’s not picking it up on the monitor, but I’m hearing these little dips, and you know, like, things like that, that matters to me more than, like, I’m not just going to look at the tracing and say, “well, I’ll don’t see anything on the tracing.” I think the tracing also was designed to provide legal protections, all these other types of things. So I don’t have as much faith in the institution, as maybe other people do, because I took an institutional job thinking I was going to be sort of a, you know, I was going to do midwifery from the inside. And it’s really hard, you know, and I’m, it’s really disruptive to one’s sort of spiritual grounding in the work. And that’s where I am now with my research is sort of looking at how do midwives within the system, how and what do they do or not do to kind of preserve what we call the ethos of their model, like what do you do to preserve the ethos model of midwifery when a homebirth midwife might see four people tops in a four or five people tops in a clinic day, or their clinic visit day? I’m seeing 25 to, you know, sometimes I’ve 31 people my template. So what can I do with this model? To preserve some of that ethos because it’s, if it’s just about time, I’m not gonna be able to do it, right because I might I have like 10 minute blocks or 15 minute block. But my theory is there’s got to be more than time, there is something about how we relate to the people that we take care of. And that whether midwives within a system because a lot of us do, 98% of us work in a hospital system. What are we doing to? Are we able to translate anything of our model which was more designed to be delivered in homes and birth centers? What can, what are we doing in the institution because I suspect two things I suspect, we are just functioning as physicians in a way without the surgical skills, although some do first assist, or we are really struggling in that system, and we’re getting burnt out and torn up and because we’re, we’re fighting, like we said earlier, other sort of ideologies of nursing ideology or physician ideology, and there’s not a lot of alignment. You know, I can tell you how many nurses I meet in nursing school or my students who have never heard of midwifery. You know, I think if a nurse hasn’t heard of midwifery, then we have we’re failing right here, totally failing.
Margaret Runyon 17:05
How is anyone else who wants to know that it’s even an option? Right? Yeah, that is such an important distinction. Because Yeah. As someone who’s worked predominantly in, like, in hospitals and health care institutions, I totally went into it in that same feeling of like, right. “So this is how you change things, right? Because you get in there, and you’re just going to be able to like, kind of change things from the inside out.” It’s, it is so much more complicated than that. And like you made such a good point about just the fact that like, they, they were intentionally designed to do the opposite. And so that is something that as you know, as providers and you know, birth professionals who work within hospital settings, I think it’s that’s just a really important reminder to keep kind of like bringing to the forefront when we’re interacting with institutional policies when we’re having these back and forth, is to have context for that. And I also think, like you just did and saying that out loud, like you’re having issues on your unit, you’re discussing a policy just saying like, “hey, timeout, do we realize where this is stemming from? And is that how we still want to keep going? Is that the path we want to continue on? Or are we actually ready to do something very different?” And I think often the answer is, “no, we’re not ready.”
Dr Mimi Niles 18:14
Yeah. Yeah.
Margaret Runyon 18:15
But, uh, you know, I think as we continue to have this conversation, it does get, you know, it gets closer to having that I think we know what I was saying earlier, you’re the article that you and you know, some of your colleagues had really written about the pandemic. And because obviously, this has just been, like, everything under the magnifying glass in terms of issues that are present in our society at large, in healthcare in particular, and really in birth care, and how do we really actually view the rights of birthing people and who is in charge of their care, who gets to dictate it? And you know, you all had written really beautifully about kind of balancing out these concerns for birthing people and for birth professionals and really took a just a nuanced look at What it means to provide ethical care that is equitable in any in a good day, and then also in really, really hard days when things are challenging. And so I don’t know, if you want to, you know, to speak to how has, you know, working through this pandemic, especially like, what do you feel like you’ve kind of gained, particularly during this time? And it doesn’t have to, it doesn’t have to be positive. It might be a deep sense of sadness about the system. And that’s very understandable. But, you know…
Dr Mimi Niles 19:33
Yeah, there’s a lot. Yeah, there’s a lot I think, I think I’m still processing it. Because I’m in New York City. We were the epicenter of the pandemic and the hospital where I service was one of the, like, worst hit communities to have this experience. And, you know, New York City experienced a few maternal deaths during COVID as well and so it’s really been a lot have self reflection, I think, as a midwife, as a New Yorker, as a researcher and just stepping into a role where I don’t want to be just to the ivory tower researcher, I really want my work to be feed into advocacy spaces and feed into sort of activist agendas. Otherwise, I feel like you know, it’s been made clear to me that my work, I want to be on my deathbed and to think I helped to change midwifery, maternity care, perinatal care, at least in my little maybe Brooklyn neighborhood but in in America, because it’s not working for anybody. And that was sort of the goal of that paper to say this system actually is failing all of us. It’s not just, I mean, mostly failing Black families and Black women and Black mothers that is clear, if COVID has not made that clear then that should be crystal clear, and it’s failing the systems that predominantly take care of Black families because that’s the system that I work in and and really what I’m beginning to understand that I can be as loving and kind and compassionate and humble and educated and woke or whatever you know as I can try to be and, but the system is going to, it’s not designed to be loving. The system is never going to love you, yoou know, it’s really there to get paid. And, you know, this kind of like base commitment of doing no harm to me is not enough. You know, it just not enough. I mean, to me, I, you know, we talk a lot about physicians doing no harm. And I think if that’s the bar, like that’s the lowest bar itcould be, right? It’s basically saying, we’re not gonna hurt you, we’re not going to kill you. But we’re not even doing a good job of that. Right?
Margaret Runyon 22:13
We’re not even meeting that bar very often, and it’s a very low bar.
Dr Mimi Niles 22:16
Yeah, so I want the bar even higher. I want the bar to be, you’re gonna walk out of our system and you’re going to feel like a more full person, you’re going to feel more whole, you’re going to feel more healed, instead of like, at least, you know, I don’t want people to walk out of my care and say, I feel more broken, I feel more hurt, I feel more harmed. I can do that on my one to one interactions. But if the system is forcing me to see 30 people a day, and the system is forcing the person getting care to only have my time for 10 to 15 minutes. Because it’s a medicare/medicaid predominant system. And yeah, those systems are really, really struggling with being defunded, or being chronically underfunded. You know, it’s very complex. So it’s, it’s more, I don’t want to minimize maternal death. I just want to say that, it with the systems we have in place, I don’t see improvements without a radical shift in how those systems function in communities that have been underfunded in every single part of their lives. In terms of their ability to access safe, affordable, stable housing and food sources for their children and great schools for their kids and things that I take for granted for my own kids, you know, and clean water, you know, that we don’t like there’s still plenty of communities and we have dirty water, you know, and so if we can’t guarantee those things to the people we take care of, and then we think that when they’re in the hospital bed, none of that matters is really I think something that nurses and midwives and physicians, we’re getting duped in schools now, I feel because we think that if they have a good clinical care episode, it’ll somehow magically resolve their health problems. And that is, that is just, it’s bullshit. It’s not true. You know, they’re walking in with the whole generations on their shoulders. We all are. And they’re walking out with that, too, you know, and so, yes, the healthcare experience is important, but it’s not everything, you know? And are you talking to your families about like, what kind of home are you going back to? Do you have the kind of support that you need? Do you? You know, do you have clean water? Do you have employment or have you been unemployed? What does this kind of what does being a new parent gonna look like for you? Because just because you walk out of there and you have a baby in your arms and you didn’t die. Again, to me, that’s the lowest bar that you can get.
Margaret Runyon 25:04
Right? Absolutely. I mean, I think and we’ve talked, you know, before on the show, like post partum, that whole entire period is so just ignored, like, just flat out ignored. And I think as, you know, as as a nurse, like even when you’re, you’re going through it, and you’re very focused on the birth and right and even if you meet that really low bar of like, yes, you and the baby are both alive, and I’m sending you home. Like we don’t have enough; there’s not enough training, there’s not enough practice and how to skillfully really assess how is that going to go and provide resources and support in a way that doesn’t demean or criminalize parents for not perhaps having every single duck in a row when they showed up to the hospital. And that’s a huge, a huge missing piece and a huge piece of why, you know, the high rate of, you know, maternal death in that first year postpartum due to mental health issues because we’re not looking into that. We’re not actually assessing what people are really going through. And that’s and like you said, that’s if they actually even make it, you know, out of the hospital. So there’s just there’s so many layers to where we need to increase the support we give and a huge piece of that comes into us as birth professionals, as healthcare providers, being willing to, like have those conversations and learn how to how to talk to someone about their home environment in ways that are comfortable and are not judgmental. And that do not have this, you know, I think, unfortunately, so many times when people are in difficult situations, there’s just always this threat, the you know, the CPS threat, the threat of who else is going to have to get involved, instead of being able to provide resources in a way that really feel congruent to what the person wants, and that is a huge issue.
Dr Mimi Niles 26:51
Yeah, it’s such a big issue. And I think, you know, I mean, the other thing that makes me that COVID has made me realize are deeper is that the hospital systems have not put in the effort, for the most part, I’m sure there are exceptions to this. But have we become part of the community? Have we truly become a community member, a community stakeholder? Or are we just an institution or a building that has been plopped into the middle of a community? That doesn’t that’s not enough work to call yourself a community member? Right. So the bridges between what the community needs and what the hospital can offer? They haven’t really we haven’t invested in the time or research or thinking around that how many of us work in the communities that we serve? I don’t know. I wonder about that. How many nurses and physicians and midwives and admins and everything do you actually work in those neighborhoods? Mt guess is depending on where you are in the pay scale, the lower you are on that pay scale, yes, you probably are of that community. And the higher you are, you may or may not be known depending on I’m talking about the community, you know, sort of the underfunded public health communities.
Margaret Runyon 28:04
I would imagine, like in urban environments…
Dr Mimi Niles 28:07
Yeah. And I think that’s really problematic. I mean, I we have to talk about the fact that midwifery is, you know, over 90%, a white work woman workforce. That is what it is. And that has some deeply racist, complicated racist roots. You know, nursing is the same, you know, I don’t think I don’t know how much nursing talks about it. Yeah, I’m just more tuned into the midwifery conversation, but like, we have a very deeply racist history.
Margaret Runyon 28:35
Yeah. I think ufortunately, at least in my experience, it is very, not acknowledged. I think, I think it started I am definitely seeing changes in you know, the educators I know who I’m talking to, especially in light of just everything that’s happened this year. I think there has been a a way late wake up call that we really need to change the way we are, you know, conducting nursing education, but that is not crossing all of these boundaries. And not everyone; there are plenty people who still don’t want to acknowledge that because I think they feel if we just if you don’t say it, it doesn’t, you don’t acknowledge it, it’s not real, it’s not happening. And I think it’s very easy, and I say this as a white woman, it’s very easy to fall into the idea of just like, yep, ignore the negative just keep, keep going along and just have this very narrow view of what it looks like and what it what it meant to you to become a nurse. And this, this idea of like, right, you know, Florence Nightingale, the only nurse who’s ever talked about kind of a thing, and there are so many more complicated parts of our history, and, you know, tons in terms of health research and how we’ve carried ourselves out and, and the way that we have always applied policies, and how, you know, bias both implicit and very explicit, has impacted care and, you know, racism has been has been rife throughout healthcare. Yeah. Because it has been rife throughout our throughout our country, because it is how our systems have been made.
Dr Mimi Niles 30:00
Right. Right.
Margaret Runyon 30:01
And so I think, you know, absolutely as you know, as birth professionals, we need to be really tuned into that and and like and like that we’d have to keep, we have to keep talking about it and then putting action in place. It’s not enough to just acknowledge that it happens. And I think that’s what unfortunately, we saw so much and kind of the fear over the summer is that a lot of places I saw acknowledge, I did see lots of schools of nursing and you know, midwifery organizations and doula groups and you know, physicians saying like, “yes, racism is wrong. We need to do you know, something about this,” but then…there’s the void of what that actually means. And so I think it’s, you know, it’s obviously we need to keep continuing to work through and being really conscious of each of the interactions we have with everyone.
Dr Mimi Niles 30:42
Because it I think it needs this is the root of all the evils I think, is the real power of redistribution. And who is willing to do that? You know, I like I struggle lot with the fact that only 10% of the maternity care workforce are midwives in the US. When you compare us to other sort of high income, high resource countries, that pyramid is reversed, right? Where most of their primary maternity care providers are midwives. And the physicians are really thought of as the specialists. And we have flipped that proportion. So that OBs who are surgical technicians in my mind, you have become sort of the generalist or the laborist and it doesn’t make sense because they don’t view birth in general as sort of a normal physiologic process. They’re trained to, to discover pathology and to specialize, and to do surgery and to look for what’s wrong, versus midwives who are actually deeply trained and to look at the physiology of birth. And in that training, we learn when it’s not going, you know, right. We’re like, oh, something’s not right. Something’s going off here because for most of humanity, the human body has been able to birth people. Doesn’t matter where you are, there’s not we know there’s no biologic difference right? Between birthing bodies, so what’s happening here and what’s happening in Bangladesh should be that it’s there’s really no difference right? And so I think we need to really there has to be a reckoning and a truth telling and a reckoning around how is powered distributed in health care, both internally and externally. And we know that power and health care is physicians on top, and everything else on the bottom and until that power paradigm shifts. I, you know, I don’t mean to be a pessimist, but I don’t see a lot changing in maternity care because the power paradigm has to shift and we have to say “most people will have bormal physiologic process if we if we support them, and if we create the right environment. Most people will do that. And for those that don’t, how do we continue to support a process even if some pathology gets introduced? I’m of the mindset is you can still keep it normal. Yeah. I mean, yeah, I’m still it can still be special and sacred, you could still have family-centered cesarean, I mean, there’s, there’s things that we can do to make this process loving and humane and compassionate…even if you have preeclampsia, even if you have diabetes, even if you you know, whatever other comorbid condition rises up. We can still we can and still should be doing it, and I challenge nurses and midwives and physicians, particularly female identified of us, that being nice is that is not the end goal either. To me, that’s the bar, the bottom of the bar. And I said I’ve met a lot of nurses and midwives who are just like, “well, I treat all my patients the same and I’m really, really nice to my patients,” and it’s just “It’s okay. And?” you know?
Margaret Runyon 30:43
It’s just not enough.
Dr Mimi Niles 32:16
Yeah, yeah.
Margaret Runyon 34:10
Yeah, I think we’ve been, you know, especially in this country just because people think we’re a wealthy nation, we theoretically have access to all these brilliant minds. We’ve kind of skated on our laurels about that, like, of course, we have great healthcare, like, of course, birth care is going well here. No, it has not, it has gotten, you know, worse. It’s twice as bad as when my mother had me; the maternal mortality rate has doubled, you know, since then in those, you know, 30 odd years from that’s not and that’s not okay. And we have hidden that from view. In the way that then people feel like that there is just this, this baseline is like, well, if you’re just like, keep doing your job, right, and that’s fine. Well, no, it hasn’t been working. It’s not fine. It’s not okay. And there is a huge, you know, shift. I had the chance to talk briefly with Dr. Neel Shah, about this topic as well. And one of the things he said is that, you know, as a physician, he is really trying to be increasingly mindful of where there are those opportunities to cede power, you know, whether that’s in, in the birth room and in, in speaking engagements in, you know, passing the mic to other people to share those other voices that haven’t had a chance that, you know, who hasn’t been able to really dominate the conversation in the same way. And I do think that’s, that is gonna have to happen, but like you said, it’s hard because it means that people who have power have to give it up, and that’s, that’s challenging for anyone’s ego, to let go of something that you had. But you know, it’s a process.
Dr Mimi Niles 35:36
And it’s just super, it’s, it’s, I mean, I, I get uncomfortable about it, too, especially as a woman of color. I feel like a little bit of power. I have the thought of kind of, that I’ve worked so hard for whenever that power is I don’t even think I can put it in a box. But, you know, just the fact that you’ve contacted me, to me, it feels like there’s a power in that right.
Margaret Runyon 35:59
Yeah, yeah.
Dr Mimi Niles 36:00
So what am I going to do to use that? And I do think that what I’m learning too, and I want to speak directly into it, whether you use it or not, is that there’s something about how black women lead, that I am learning from, that I am in, in absolute reverence of because despite everything that this American system and world keeps telling them, they continue to sort of push through in this space and say, “Listen, if you make it better for the most marginalized,” right, this is Black Feminism 101, “If you make it better for the most marginalized, it will get better for everybody.”
Margaret Runyon 36:37
Every one rises.
Dr Mimi Niles 36:37
Yeah, because what we don’t talk about with with maternal health, is that it’s it is yes, it’s getting worse. But the reason it’s getting worse is because the gap is getting bigger. That means white women are doing so much better. And they’ve left people who are marginalized are still doing poorly, right? So it’s not just just they’re doing poorly and everybody is. It’s that the white women are doing so so much better. So we know that it’s possible.
Margaret Runyon 37:03
It’s an even bigger divide.
Dr Mimi Niles 37:05
Yeah, we know that we can we have the capacity to do it.
Margaret Runyon 37:09
So it’s not that childbirth is so inherently dangerous that we can’t do better.
Dr Mimi Niles 37:13
Right. Right. And it’s it is a gap, it’s a widening gap. It’s not just one side, the marginal side is falling away from the center; it’s that the privilege side is is moving way past the center to. And so we think we need to talk about it. White women need to talk about that, like we are doing so much better. What are we going to do for our Black and brown sisters to make it better for them? Because now we have that privilege resource we are, you know, we have that resource. What are we going to do with it? You know, I think that’s, I don’t I don’t know if enough white women or white nurses or white midwives are having that conversation and say, what are we going to do it? Yes, power ceding is important. But also what are we going to do with this resource that we have to kind of draw people back into into the center who’ve reallly falling away. And I’m not, I’m not asking for white people to do that for me, but I’m just curious as to, are White women talking about that?
Margaret Runyon 38:06
No, it’s necessary. I mean, I will say, with relative confidence that not enough of us are talking about it, because if enough of us were talking about it and taking action, we wouldn’t be right here, you know? And so I do think it’s something that it’s something that I again, as a white woman, like I am trying to stay just increasingly conscious of it and having those conversations with with different people, people from different walks of my different places that my my path crosses with people. Because again, it’s there is that the comfort when you don’t experience something that you can just turn a blind eye to it and ignore it. And especially in like you said, in, in birth care, that is literally causing only more and more and more harm to everyone who is not White. And that’s unacceptable, on a human on an ethical level, to let that continue.
Dr Mimi Niles 38:57
At the same time, right because it’s never to me, either/or. Is that the principles of reproductive justice apply to White women to right? Because if your autonomy is being stripped, your capacity to choose things for yourself is being stripped, and you’re blindly following whatever your provider tells you. Your justice, where is your sense of justice about what’s happening in your own body? And your own the sovereignty of your body? Right? Yes. I think that’s also simultaneously happening where that’s, you know, I’ve taken care of, I’ve talked to people in the city, you know, people are like, “Oh, can you talk to my friend, you know, your midwife? Can you help them?” and they’re, like, some executive at Google. And you ask them about their birth experience, and they’re like, “Oh, my God, I don’t know. It just, you know, just, I just use the person who is giving me my pap smears.” I didn’t really research who the provider was going to be of this immensely intimate experience. But I’ve spent two hours researching strollers, you know what I mean? So it’s sort of like, what are we all doing here? We’re all in this sort of physical process is happening, and how have we all? How have we let this conversations fall so far out of sort of feminist discourse and like radical feminist discourse that we’ve been left in the dust? You know, we’ve really been left in the dust in terms of like, no, this is my body, my body mind choice. Like that’s, that’s the same. The abortion slogan should apply to us to my body. My choice, you know?
Margaret Runyon 40:25
Yeah, I mean, obviously, all of like, reproductive justice. It is it is all of it. And I do think again, I think we saw it unfortunately; we saw it when white women were working to get the right to vote for them and not for all women. We saw it when you know, really, you know, in the 60s,70s. As you know, regret rates really hit off and again, it was very focused on the experience that you know, white women wanted from it that we are not being inclusive. And we’re not, we’re not seeing often enough the experiences of people outside of our own, whatever that little microscopic part of our world is to see what people need. It absolutely leaves all of this behind. No one of us, all of us, you know, it really is. And like you said, I mean it is it’s Black Feminism 101. And it’s, it’s hard that that’s not just like, being human one on one that like if we’re all doing, we’re all doing well.
Dr Mimi Niles 41:14
And shouldn’t we be taught that in nursing school to me. Yes. Like that’s to me semester one. You need to be doing like, like, social theory and critical race theory, health disparities and health equity. And we’re not learning about those things. We’re really we’re like they’re reinforcing. Like the stupid stuff from cultural competencies still being reinforced. And it’s so frustrating to be in front of a group of 19 year olds or 20 year olds who are like, “I want to help people,” which is so beautiful, to be 20. And to know that about yourself is a beautiful thing. And then to fail them when you ask them what’s a risk factor for preeclampsia and they say “being Black,” and there’s absolutely no, no other kind of critical thinking around that. I want to cry every time it happens, I feel like a failure. And I feel like I want to cry because that means whoever taught them before did not teach them what it means to be in America living in a Black body. It’s not about you being Black in the color phenotype of your skin. It’s about everything that comes with the history, and the current reality of being Black in America means you can still get choked to death, Black people are overrepresented in the prison system and under represented in the legislative system, and the educational system, and the healthcare system. And you know, like all those things that I want my students, I want them to be able to, you know, their hope to have their PhD in it, but to be intelligently be able to say, the experience of racism, anti black racism is what the risk factor is for preeclampsia. Yeah; I’d be much more happy with that response.
Margaret Runyon 42:56
Yes, I think, you know, the conversations that’s been happening and you know, “Racism, not race” that I feel like, you know, Dr. Joia Crear-Perry, she’s said over and over again and you know, several webinars and things that I’ve heard, like, that distinction is huge. And I’m so glad that we’re stating it so explicitly now, so that it can hopefully help. Because I know, I’m speaking for myself, I went to, theoretically an excellent nursing program, and I learned a ton there, and I’m very grateful the experience I had, but I was a years into practice as a nurse before I really understood health equity as a concept; why is that? That should not have been that way that absolutely should be covered in those first couple years in nursing school when you’re just getting a baseline for how that works. Like we just didn’t have that context; it wasn’t there. And, you know, obviously we all grow and you know, deepen & mature in our practice as well. So no, none of us come out as experts; are we ever experts even? But no, you know, there is that piece of at least having a baseline knowledge and understanding and some of those concepts & terms we’ll use and to apply when you come across a situation that you realize like “whoop, hang on.” Like, the red light is flashing something is up here. And you’re able to then look into that a little bit more and ask questions and figure out plans and have that knowledge and that language around it to discuss when other people. That’s a big difference. I can certainly look back at times in my career where I did not have the knowledge or the language to say like, “Oh, actually the issue right now, I think, yes, is that we’re being racist,” and it would have been really helpful if I had had the confidence, or, you know, or just know how to realize like, “hey, actually, maybe if I could just call out that like, actually, guys, that’s the issue right now that I think we’re really viewing this from the wrong context.”
Dr Mimi Niles 44:35
Yeah.
Margaret Runyon 44:36
And how many lives that could have potentially changed or at least that situation could have changed? If all of us were more educated on that.
Yeah. I mean, to me, that goes directly back to the power of conversation. Can a nursing student, some will, you’ll have the outliers, can they really do that? Or can you be in a conversation with a physician in in a debrief or case review and be that person as like a first year midwife, you know, it would be really, really hard compared to who I am now, when I say “I’m Dr. Mimi Niles and this is what I know.” But it took a lot of work for me to, to to get there and it does; it shouldn’t be that way. That’s how I feel. And I know we got to wrap it up, but I feel like doing this work, it should always feel like a privilege. It should always feel like a privilege. I mean, you know, my, my midwifery director always says like, she’s very, very raw, very, very explicit, and says, like, “people are looking at your vagina, who do you want to look at your vagina?”, you know, like, that is such an intimate experience. And we have stripped like I said in the beginning, we have stripped it of all of its intimacy, and all of its sanctity and all of its humility, right? So we go in there and we lift the sheets and we, you know, all the bullshit stuff that we do is about power. It is totally about power to me. I mean, that’s the fundamental pulsing heart of what happens in every single not just a labor room. But the labor floor and the unit and the hospital and the you know, so it, you know, I really want people to be thinking about sort of the ecology of nursing. That it’s not just, because we think it is it is interpersonal and the relational aspect of our work is so important, it’s the beating heart of our work, but it’s an ecology, right? So there’s the interpersonal, and then there’s the institution, and then there’s the community, and then there’s the town you live in, and then there’s the state you live in, in the country, in the world. I mean, so you have to keep expanding out your consciousness around what does your work mean, as an interdependent work in a complex, multi layered multifaceted system, that it’s not just you be nice to somebody who’s going to, you know, I don’t know cure all the ills of racism. No. But do you, can you bring that consciousness to your interaction with someone you know, and know like you said, it is going to be a muscle that you, it’s like going to the gym, you’re gonna have to keep working out, it’s never going to be a done deal. And it is going to require people with power, historical power to do more work. And are they willing to do it? I don’t know. I don’t think so. But that’s, you know, what is the system going to demand of them? I know as a professor, I’m going to demand something else with my students. Yes. You know, I don’t care. I mean, I want you to pass your NCLEX but I also want you to be able to critically engage, what racist health care looks like because that’s the kind of health care we have right now.
Oh, my gosh, yeah. I mean, there’s so much in just how we do nursing and midwifery and medical education that is so, ike so much of education in this country. That’s so built on a test that we’re hoping is measurement we think it is, and it, it’s not, it’s not doing, it’s not doing the job we need it to do.
Dr Mimi Niles 47:49
And it’s going to reinforce people who have resource right because you can get a tutor and you can take take Kaplan and you can, you know, maybe your parents are professors and they can you know, like when I’m helping my teenagers I have to really tell them you guys are, you know, this is such a privilege for you that you have a mother who has a PhD, who can read your essay and say, “Okay, let’s change this around this, you know, I suggest this right?” That’s so different than I grew up with an immigrant mom, who was a nurse’s aide, she couldn’t do that for me, you know what I mean? And so to bring that consciousness around, it’s not just the test, or the grade or the getting into Harvard or whatever it is, because you come from an ecology, you come from a system that’s either going to that you’ve beat the, you know, you’ve beat the odds, which is very few, or you’ve come with, again, generations of privilege and power and resource that’s going to just keep…you know I think of the Kennedy family often because that’s just like, that’s like blue blood in America, you know?
Margaret Runyon 48:47
Yeah, yeah.
Dr Mimi Niles 48:49
We have to think about things that way and even teach our children that you know, like this isn’t you’re not it’s not use your DNA but you’re come people are coming with a lot of stuff that you don’t have access to, you know?
Margaret Runyon 49:02
Yeah, I think that constant just, you know, that weighing of our resources of our privilege, and being conscious of it, and then again, leveraging that is the, you know, the next step of it to realizing what you have that other people haven’t had access to. And how do you move beyond that, then how do you how do you there’s ways you can share that? Are there ways that you can, you know, redistribute it? And then all that…
Dr Mimi Niles 49:22
Equity, right? Yes, but equity is right, that sort of I don’t know either is like they just throw out the term equity. And equity means it’s the distribution of resource is designed around who has historically not had that resource, you know?
Margaret Runyon 49:37
Equity vs equality.
Dr Mimi Niles 49:38
You don’t give a community? Yeah, you don’t give all community same thing and say, go all knock yourselves out. You know, you can’t; like look at what happened in Katrina, look at what’s happening in Flint, look at what’s happening in Newark. I mean, you have to redistribute resources equitably with justice in your mind, in your heart and in your action. You know, same for nursing, same for midwifery, that’s how I feel. We need to recruit more nurses of color, we need to recruit more midwives of color, and physicians of color to make the pipeline stronger. So that when you walk into a classroom, you have a professor like me, or you have a professor like Dr. Monica McLemore. You know, like, those are the kind of professors that we need to be; that’s what students need to see, I think…so powerful.
Margaret Runyon 50:23
and we can, you know, we need we do we need more voices to speak to the non-, what has been the dominant narrative. Because it’s, that’s not it’s not serving all of us, but oh, my gosh, well, Mimi, I feel like we could probably talk, I could talk to you all afternoon, and like, you know, pick your brain about a million things.
Dr Mimi Niles 50:37
Oh, I love talking to you.
Margaret Runyon 50:38
Well, you thank you so much for taking the time to talk today and share your wisdom with us. I really, really appreciate it. I look forward to connecting more.Yeah,
Dr Mimi Niles 50:46
Yeah, thanks, Maggie. I hope we stay in each other’s orbit.
Margaret Runyon 50:49
Absolutely.
Dr Mimi Niles 50:51
Okay. Bye. Bye.
Margaret Runyon 50:53
Thanks for tuning in to Your BIRTH Partners. We love to talk birth and we’d love to talk about it with you. Please join the conversation by finding us on social media, we’re Your BIRTH Partners on all platforms, we would really love to hear from you; what inspired you about this episode? What really caught your attention? What are the topics you think we need to delve into more? And what are you doing in your community to change the state of perinatal health care to create a better future? Till next time!
017: Moving Beyond Burnout
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today I am joined by our own Angela Mike, Certified Nurse Midwife, and Pansay Tayo, doula, we are going to be digging into burnout. And this is such a an issue throughout healthcare, it’s magnified in the birth professional community, and this pandemic is just pushing it to new heights. And so we wanted to take an opportunity to dig a little bit deeper into what it has meant for us to, you know, operate as birth pros in different environments, places where we felt supported, places where we haven’t, and what are some of the steps that we’ve taken to make it so that when we serve in our capacity, as professionals, when we get that opportunity to care for other people, that we’re doing it well, that we’re doing it from a place in ourselves where we are able to really pour into others. And we are able to provide boundaries and balance to our lives, and to model that for our clients. So that we can all move through birth in ways that feel genuine to us and honor all of our different roles. So I’m really excited to share this conversation with you all. On to the show!
So Angela, I would love it, if you would just kind of start us off and share a little bit more about what kind of brought this topic up close to your heart and why you wanted to speak to it now.
Angela, CNM 2:06
I think that, you know, we always talk about, you know, how can we improve health care for women? How can we improve health care for mothers and babies, I feel like it is often that we are expected as birth workers to do more, and give more of ourselves and not take a break, and be okay with being exhausted and be okay. And like we are supposed to accept that this is a part of the work. And we are shamed. And we are discouraged from taking time to ourselves and for ourselves. And if we want to leave or do something with our families, there is like this, almost there’s this like social punishment for doing that. And this I don’t know, I felt like we needed to take a different direction with one of our podcasts because we always talk about us giving to women, and serving women, but no one’s serving us.
Pansay, Doula 3:12
So true. So true.
Angela, CNM 3:15
Yeah.
Margaret Runyon 3:19
It kinda harkens back to like that very first episode we did on the podcast was talking about, you know, kind of some of these themes. And I think now, you know, several months later, having lived through/living through a pandemic, the stakes are that much higher, and everyone is being pulled in like that many different directions all the time.
Pansay, Doula 3:40
This is a very intense and needed conversation. And I think it’s so difficult for us to address and, or it runs so frequently within the birth community. Because it’s a very, you know, well known challenge with women, period, right? Even in my own life and childhood, when you look back at our cultures and our upbringings, because I really think that’s where a lot of these things start that you’re not strong enough. If you take a break. Mm hmm. You know, that it’s, you know, work, work, work, work, work. And that signifies how powerful we are. If we get sick, how fast can we heal, to get back to work to get back to tending to, you know, the children. I myself being raised by a male, I think I got an extra dose of that, you know, it wasn’t any, you know, I could remember, come from out of a tonsillectomy surgery and maybe, you know, gave me a week and a half and it’s like, okay, let’s go get the bathroom clean. You know? So with with most women, a lot of women, I do know that to be the background, did we see self care growing up?/ You know, just being able to do it all signifies your strong woman, even more so with black women, “you’re a strong black woman” taking that into our birth work, because I know I experienced it myself, we, we want, we want to help and we want to nurture, and we want to make, you know, bring change, and we want to, you know, help save and empower, you know, our women that we forget that the things that we need to teach will help guide them, that we need to show that we are, you know, operating within those boundaries, you know, ourselves. But you know, you’re excited about the new career, about the knowledge and just being able to help and it’s like, you know, I’ll take all the phone call, all the emails out, you know, do a consultation for two hours. You know, you just want to do do do. Right, what point are you showing healthy boundaries, which big thing that we need to teach our pregnant moms right now expecting mothers about boundaries, and how how to take that time to heal, and show and teach people how you need to be treated and care for, you know, doing these precious and sacred, you know, moments, but we’re not doing them, ourselves. So, I guess starting that, from the beginning of all of our trainings, wherever the birth work training is taking place, I believe it should begin there. That how can we care for our women? How can we care for, for our community, if we drained, right? Well, we’re not working at our highest, you know, in our best potential, if we’re tired, you know, if our brain is foggy, you know, if we’re burnt out, right. So even now, you know, my change, come with my mentees, you know, and to teach them even though you’re excited, it’s a beautiful thing to want, you know, to help our mothers and to guide them. But you can’t have you know, like a mom that’s like, call, you know, no contract, and she’s, you know, calling you every day and texting you every day and want you to drop, you know, drop everything to, you know, attend to them, it’s a business, it is a business, right, and we have to set healthy boundaries for ourselves. And also, it’s a good thing for our clients to see that we have to take time for ourselves. So we are operating and our focus and highest potential.
Angela, CNM 7:58
I could not agree with that more as a women in general, it is a part of our nature to nurture. It is just a part of who we are. We want to care for those around us. We care for complete strangers, whether it is in a clinical setting or in our neighborhoods, we care for random children that come across this is just who we are. And so it is ingrained in us to be yes with servants. Yes. And then there are of us that go into this field of helping people of serving people. And absolutely do you get lost you the guilt of not being able to be all the things to the clients, to their families, to your co workers or colleagues. It is all encompassing sometimes. And then there’s the guilt of not being present in your home, not being a present mother, not being a present partner to our spouses. And certainly there is no such thing as being present for yourself. Like at the end of the day, you can’t there’s nothing else to give of yourself. And, it’s just, I find it intriguing that we are in this culture where the expectation is that we give, give give and we’re expected to suck it up, you know, and not complain and we’re expected to have more energy on top of the energy we don’t already have because we completely burnt out our use and I will say as much as I love birth and pregnancy, it is exhausting. It is exhausting. Yeah, I’ve been, unfortunately, you know, a part of many births where I was faking it till I made it, I was so done mentally. But on the outside, I was being an actress, because I knew how important it was to be there for that family. And, gosh, and I knew, I think the part of it that, you know, continues to drain you with that, you know, at the end of this birth, and it’ll be beautiful, and it will be worth it, because it is worth it every single time. But then you have to go home to your family who have not seen you and they expect you to function at 100% as well. Yeah, and be completely present. We’re put in positions where there was no leeway to say, Hey, I’m human, I need someone to allow me to take care of myself, I don’t even need someone to take care of me just I need time to take care of myself. Can that be granted to me?
Pansay, Doula 11:11
Yes.
Angela, CNM 11:12
And that is why? I mean, I thought about it for years and years and years, I always knew in my heart that I wanted to be a home birth midwife, or work in a birth center. But you know, after 15 years and in birth, I know I realized I cannot do that. I can’t do that. I don’t, I never get a break. And I’ll be compassion fatigued, and that is when you start making mistakes. That is, as healthcare providers, that is when you miss things, or you get laid off, because you don’t want to do something, you know, because you’re tired.
Maggie, RNC-OB 11:55
Yeah, it is. I mean, I think that we underestimate the just the level of burnout that happens across I mean, I think it’s obviously it’s throughout all health care professions, because then that giver piece of as people who pursue that, sure people all have their own motivations, but so many of us do go into it, because we have that that draw to, you know, care and provide. And that makes a lot of times that lines up with personalities, who aren’t good at boundaries, who aren’t good at serving our own needs. And I know when I was looking over at, you know, some stats for this, and you know, there were several studies done, you know, in the 2010s. And, you know, the rates of burnout across the board for midwives, OB-GYNs, nurses, you know, anyone touching birth, they all range between, like, 40 to like 58% of birth pros were feeling burnt out.
Pansay, Doula 12:48
Yeah,
Angela, CNM 12:49
I got a new job. Unfortunately, I did. I switched my job because I was burnt out. I was I was so burnt out, I just needed a break. I needed a break. Yeah.
Maggie, RNC-OB 13:04
And you do, you deserve a break. And there’s all the cliches around self care, you know, you can’t pour forth from an empty cup and all that. But it’s true there, you just literally we can’t, we cannot just constantly give and give. And like I said, I think that’s part of this whole bizarre world we’re living in right now where we’re going through a global pandemic, and we’re just supposed to keep acting like maybe we’re not, and we can still do everything I used to do otherwise, just, there’s like an Nth level of insanity on top of everything. And so I feel like even like, it’s just more so now. And then we’re so concerned because things keep changing. And we’re concerned about the health of those in our care. We’re concerned about our family’s health, and navigating all of this. And it’s not easy, I think, you know, you were talking Ang like, in this new job, what are you feeling is like the difference maker, like what are things that we can search for as birth pros that like, people who can make decisions can kind of provide to, you know, those that they’re working with to help?
Angela, CNM 14:02
What my initial assessment is; we can’t be greedy. I cannot let money be the driving force. Because it is greed, that makes it acceptable for us to work without the appropriate amount of resources or personnel to do our job effectively. When we take shortcuts in that arena, that’s where I ran into issues. During my first week of orientation, the first day excuse me of orientation, for this new organization I work with the speaker had us all go around the space and introduce ourselves and what our job titles were. And I remember hearing I am not lying, not lying. I remember hearing about five or six different descriptions of jobs were assigned to one person “I was hired solely to do this.” And that kept going on. And I was like in awe, because at my last position, I was like, well, I did all of those jobs, those were all my job titles, plus being a healthcare provider, plus being the supervisor to all of the nurses in our clinic and all of the nurse midwives in our clinic, plus being in charge of scheduling plus, plus, plus plus. And all I could think was how is this that’s why I was so done. I, like wasn’t sleeping, I was constantly stressed, I cried a lot. I felt like I could never keep up, I felt like, I would see my schedule. And I’m like “I don’t want to see this type of patient today. I don’t want to do this, oh, they put an induction in on my my call day,” I just, I get phone calls that someone is being triaged for labor and I am feeling sick because I don’t want to go in because I’m so tired. I just want to sleep in my bed and be home with my family. And I realized now very quickly after now seeing patients in this, this clinic for the last two weeks that it is because I was doing way too many jobs and still expected to function like I was doing one still expected to function like nothing else matter. Like my happiness and well-being didn’t matter, my family didn’t matter. All that matters was me doing the job that I had been tempted to do effectively. And now with this new position, I have my own team, I have my own nurse, and I have my own medical assistant. And they do everything for me. So that all I have to focus on is seeing my patients and doing patient careful. I can see 25 patients and see them without rushing and take care of their need. And complete all my documentation and go home, like at the end of the day, and not end up staying over. That never happened. At my last job ever. I would have charts that were well overdue that needed to be completed and signed off. But I just didn’t have the energy. Because I was so bombard about all my additional duties and tasks. And now that I’m here I I enjoy it. I’m like so happy. Wow. I am so happy to see my patients. I even took two walk in patients yesterday. I’m like, absolutely bring her in because they make it easy for me to do my job and to do it effectively. And they spare no money at ensuring that we have what we need.
Pansay, Doula 18:08
What brought on the shift into the into the new position? The new job? What was the was it that were you did you just start looking for another job? Or what particularly happened to make it, to make the shift?
Angela, CNM 18:21
It wasn’t one thing in general, it was several things over three plus years, three plus years of working in that particular job, but I worked it to other private practices before. And I just knew something has to change. Something needs to be better. It has to be different. I am not happy. And I know that my calling in life is to care for women, I know that this is where I’m supposed to be. But when I am feeling anxiety as I drive into work, and feeling sad when I’m looking at my schedule, and sad when I see all of the additional tasks and duties that I have to do or when I check my work email, and there it is filled with things that I need to do. I hate like I literally, I stopped caring. I was like I just don’t care. I just don’t care. I’m just not going to do this one thing. I can’t; things were being turned in late or subpar because I just couldn’t keep up. And I mean, I would be in with appointments with patients. And I would feel myself thinking, “Oh, God, problem focused. I can’t deal with all these things.” That’s how I felt. That’s certainly not how I treated the women are cared for. But that’s how I felt like “oh, this is taking too long. Oh my god. Like I don’t want to deal with this right now.” You know, and I never used to feel that way, I never used to feel that way. You know, that when you have no time and you’re exhausted and you are just beat down, you just don’t care, you’re not happy. So that is what caused the shift, I’d like something has to change. I was like, either, I am not meant to do this work for women, which I did not believe, or need to change my work environment, and I need to find something different. That’s what I did.
Maggie, RNC-OB 20:34
And I love that you had that self awareness to realize that and if you’re not then depriving the world of you, and you as as a midwife, because that has been such an important role for you. It really reminds me of the Audre Lorde quote, where I think I’ve seen it a lot on social media lately, and it just rings really true that “I’ve come to believe that caring for myself is not self-indulgent, caring for myself is an act of survival.” And, you know, especially as a black lesbian woman, obviously she, you know, shouted that message that like it is okay. To care for yourself. And it’s not just, you know, I think so many of us we do we have that you feel selfish, or that you’re, you know, taking something away from someone else. But it’s necessary for you to then show up in any of the other roles that you have in your life. Yeah, what do you feel like, Pansay? How do you? How do you feel you’re, you’re finding balance? How are you helping, you know, your mentees as you’re guiding them through this? Because it’s not, not everyone can get a different job? You know, right, there’s only so many opportunities, etc.
Pansay, Doula 21:39
Yeah, Mm hmm. And look, you know, as we, as we’re teaching and you know, guiding women into finding their voice and birth, right, finding your voice with your experience, you know, taking back birth, this is your experience. And here it is, we have to find our own voice that said, “Okay, this is too much. Well, this is enough, you know, no, I can’t take this on.” Yeah, but I definitely feel that one, one part of that, within the community, that I’ve experienced is to not charge your worth for the client, so that way, you’re trying to get all of these clients to make rent, right? So you need all you know, tons and tons of clients to feed your family, tons and tons of clients. And with that, your time is shot. Right. Because as much as you you know, you’d love to work in you know, you love to help the financial component of it, you know, if there is, if I do not have another job, and my doula work is, you know, my sole financial source, then I need multiple clients to keep the rent paid to, you know, and even I, they, you know, you will get guilt, you don’t guilt it from the community, or you’re charging this amount for doula work. I mean, like, really, and it took me, you know, it took some talking to, from from elders, you know, in, within the community that you charge, you have to charge what you’re worth, and you can’t feel guilty about that the amount of time and effort that you are putting, you know, into these, these wemos, prenatal visits and going to the, you know, doctors with them, and, and all of that, and that that right, there was a shift for me, because it allowed me to then relax, okay, so I do not have to fill a month schedule, to try to, you know, keep things going. So I feel like more of that need to be talked about within, you know, community that, you know, yes, yes, to leave a slot or two, you know, within your schedule of the year to help, you know, sliding scale to help women that are in need. Right. But that, you know, just to work yourself in the ground should not be what we’re doing month to month, you know, right to, you know, to fulfill our our passion.
Maggie, RNC-OB 24:09
Mmm no.
Pansay, Doula 24:10
Mm hmm.
Angela, CNM 24:12
That’s such a good point. Is this culture, what is this culture that we have created? That makes it okay to work ourselves into the ground? Like, what is it about it? Like, I mean, and really up until this pandemic, you call in sick for work, your colleagues, your leadership, your boss, they are pissed. They want an excuse. They want a doctor’s note? They it’s unreal, your kids are sick. Y’all, shamefully I have dragged my sick children to work with me. One of my kids I was so grateful that I was on call because I’m like “well he can just sleep in the call room with me.” And my baby had the flu and strep, I had no idea. And the next day I was gonna go to work with him. And he was like beet red, his eyes are red. He’s like, Mommy, “I can’t get up, my whole body hurts.” And I am like “what is this? Why is this acceptable to me to just keep going to work and keep pushing and putting my family’s health at the back burner?” At the back burner. And so, unfortunately, because he physically could not move, and I looked at him, I’m like, Oh, my God, and then I felt the need to take pictures to send to my colleagues, and they would know, I wasn’t faking it. I wasn’t trying to get out of work. My kid is sick, you know? In my head, but I, I’m sorry, I’m gonna cry. I’m so mad that I have done that so many times, to my children, to my family. I’ve sent my kids to school with sprained ankles, and just wrapped their ankles up and gave them motion and Tylenol, and wrote notes to their teachers saying they’re fine. Don’t [worry] I need to go to work? I’m like, why is acceptable? Why is that acceptable?
Maggie, RNC-OB 26:22
Assistant, we created it as like, there’s no margins, right? You know, so like, one thing gets thrown off. And, and that’s it. And it’s obviously like, that’s not real, it’s a construct, we’ve, we’ve created that because of how we design systems, because there’s not enough to go around because you know, especially when you’re working with other people, like there’s not enough staff. So if one person calls out, well, then like that was the whole thing. So now, it’s gonna be a miserable day for everyone. And that’s, that’s the system, you know, that’s not just, that’s not you. And it’s…
Angela, CNM 26:52
Yeah.
Maggie, RNC-OB 26:53
And it’s heartbreaking. I think like, as we’re sort of thinking of this, and like going forward, I get when I was looking at it, like Shafia Monroe is a consultant, she does a lot of trainings around birth and taking care of yourself. And she had this this article about, like, steps to self care. She had these four steps that like, self-care’s a mindset and that the first was that like, believe that you deserve be cared for? Yes. Which it’s still like, that’s step one. And I’m sure there are a lot of people who would listen to be like, Oh, I’m not sure that is. I don’t know if I really believe that. And then, you know, she goes on, like, believes that the world will continue safely as you rest.
It will, it will.
Pansay, Doula 27:29
Yes.
Maggie, RNC-OB 27:30
And then the next one that you’re like, Okay, sure. I believe we cared for him, then you’re like, oh, but will it because there’s so much.
It will.
But it does, it does continue to turn.
Angela, CNM 27:39
Yeah.
Maggie, RNC-OB 27:40
Certainly you need to take care of the people in your immediate circle your family, your you know, the people you care more sure, but they can be cared for by someone else. There are other people who can step in, and do that too. So that you can ever like have a moment when you know, she goes on just like and then believing that you are more important than your job.
Angela, CNM 27:58
Yes. It’s so funny. That that was what pushed me and I actually shared a quote on social media fan that same thing, because I’m like, if I died today, you know, a lot of people are gonna be sad, or be devastated. My job. My colleagues, yes, it’ll be a sad thing. Oh, it sucks. Angela died. But guess what? The show goes on saying no one else can come and feel my spot. Yeah, it does not matter if I am there or not. And that is what gave me the push. I was like, “you know what, my life is important. And I deserve to be happy. And I am no longer going to put myself second, I’m no longer going to send my children to school with injuries, and drag them to work sick, because I’m concerned about how others are going to feel,” so to speak, and not that I don’t care about others, but that’s not going to be the priority when other things are more important.
Pansay, Doula 29:06
When you think about how we can make the shift to change this, right, you know, when I look at my daughter, and I look at my you know, my granddaughter, it’s like, okay, they mimic us, right? They just do what we do. And I you know, I recall finding, you know, finding my daughter just you know running out the house, right? She’s running out the house, like “did you brush your hair? Did you do this?” And you know, not taking time, right for herself just to groom herself or you know, you can take a bath slowly, you know?
Maggie, RNC-OB 29:38
Yeah.
Pansay, Doula 29:38
And when I started to see that I said, “oh, look what you’re doing?
Angela, CNM 29:44
Mm hmm. Rolling out of the house, yeah.
Pansay, Doula 29:48
Yeah, I’m teaching her to not take time for yourself. That put everything before simplistic things as brushing your teeth, grooming yourself, taking a bath. I’m like, “Okay, this this, this is not good. This is no.” So making that shift so that I know moving forward, this will not be their story. You know, and that was major in my household major that made me like, “Okay, if I have to do work for me, I have to do it for me, at least, you know, for them.” So this does not continue. So that’s been the greatest eye opener and reward for me, especially as female. You know, that’s, that’s something that we should love doing. You know, we are caring for ourselves. And we again, we better care for others, when we’re cared for, when we’re okay.
Angela, CNM 30:43
Yeah>
Maggie, RNC-OB 30:43
It does. It ripples…
Angela, CNM 30:46
Right. So, gosh, I mean, you, you hit the nail on the head and say, rushing out the house, doing all these things. It just shows that we put other things first. And we should have, we should have, why don’t you have time to slow down and just take a bath? Or just put your makeup on? If that makes you feel good?
You know, like this? Yes.
Maggie, RNC-OB 31:12
Yeah.
Pansay, Doula 31:15
Yes.
I’m so happy that you’ve made this change. Thank you for yourself. Yes. You deserve it. You deserve it. We all deserve it.
Angela, CNM 31:26
Yes, we do. We all deserve it. Yes.
Pansay, Doula 31:29
And you do and you deserve. You know, there’s there are seasons in life. Right. So I think that’s where, you know, you’ve tuned in that right now, in this season, like this was the shift you need to make. Wow. And that that’s Yeah, that’s good. That’s good things, you know, ebb and flow. And we can’t be expected to just be doing 150% forever, it’s not sustainable at all. And we have to have grace when when we need to step back or, or transition, move to the side, find a different way, a different way, to care a different way to, to serve and love and you know, to live out our gifts. There are a lot of ways to do that in birth work. Mmm. Yes.
Maggie, RNC-OB 32:12
Thanks for tuning in. We love to talk birth, and we’d love to talk about it with you. Please join the conversation by finding us on social media, we’re Your BIRTH Partners on all platforms.
We would really love to connect more on this topic. So we know burnout is prevalent and compassion fatigue, and that we all have hard days and moments that make us question if we’re finding a balance and how can we keep doing this work that’s really meaningful to us, while also caring for everything else that matters in our lives. So please share with us strategies that have worked for you, ways that you found community, that you found job roles that give you satisfaction and also let you find some peace. Till next time!
B.I.R.T.H.-Be, Inspired
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. So today, we’re taking a moment to reflect on where we have come from in the last year. It was about a year ago that I first started talking to a few friends and colleagues about the idea of this podcast. And what we wanted to, we wanted to discuss, what we hoped to bring to the birth world through these conversations. And so as I’ve been reflecting over everything that’s happened in the past year, one of the things that I wanted to focus in a little more is the motto that we had chosen for our organization. And so our kind of motto or tagline is BIRTH spelled out. So it’s be, inspired, respected, trusted, heard, these are the values, that we hope everyone is bringing into birth these the way we want people to feel as they’re giving birth their babies, these are the things we hope birth professionals are embodying. So I wanted to take this opportunity to talk through a little bit of that, and see, see how we’re feeling see, how we’re actualizing these in our practice. So I am excited to welcome you into this conversation with Pansay Tayo and Angela Mike.
So let’s just dig right in. And, you know, talk about what, what this has been like how you’ve been reflecting on this time, this experience of living the pandemic, how that is shaping and changing your practice. And kind of where, where we’re going from here.
Pansay, Doula 2:06
I definitely feel that as you know some not-so-good things have happened with this pandemic, one thing that it has brought, for me, and that I see for quite a few people, right? It gave us the permission that we’ve been all waiting for to just BE. You know, I think we’ve all was like silently praying. Like when when can we stop? When can I pause? When can somebody say okay, you can just just just don’t get up for a couple days, you don’t have to go to work you don’t, you know. So it’s like a collective [audible sigh]. Wow. And I don’t want to go back. That is what I’m manifesting that this, how reliving now, this is how I want to continue to live, and this is how I am keeping it moving forward. Right? Because this is living now. And I feel like I’m living.
Angela, CNM 3:00
Yes. This is crazy. I was so happy when they said, “Okay, we’re no longer seeing patients in the clinic. We’re going to work from home,” I was like, “Oh my God, to not have to get up, hustle and bustle all day, and take the commute. And try to figure out how in the world am I going to get out of here on time, so I can be across town to pick up my kids? And yes, all the things.” Yes. So happy to just pause… Yes.
Maggie, RNC-OB 3:36
You know, I think it’s, it’s funny to like how much of this this feeling we all have this constant push and push and push how that flows into how we treat birth?
Pansay, Doula 3:49
Mm hmm.
Maggie, RNC-OB 3:49
You know, because we do we have that it’s constant, everyone’s got something else to do and people you got, you’ve got other patients to see, you’ve got other clients to get to, and so you’re looking for things. And, you know, we were talking about earlier, like, I wanted to dig into kind of our, you know, our motto or slogan, you know, for our organization like that first, you know, it’s be inspired, respected, trusted, heard. And that first one is BE like when do, how, and when are we allowed to just exist
Pansay, Doula 4:21
Just be.
Maggie, RNC-OB 4:22
Just be and so much in birth, obviously, especially in like, the medical industrial complex, it’s a factory, we got to get people in, and get people out. And that mentality has completely dictated the way we’ve you know, yes, how we care for people, particularly in the hospital. And I think it bleeds out then into community work too sometimes, though, where because of the pace, because you’ve got so much to do, because you’ve got to make that money. You’re operating in this different realm. That doesn’t respect just being.
Pansay, Doula 4:56
Yes, yes.
Maggie, RNC-OB 4:53
You know, I don’t know if you all when we all are feeling this way? This just this push and you have to do something else? Like what are the ways that you’ve done it? Because I, I know from from attending birth with you, from talking to you about birth, like you are able to bring a different, you’re able to hold space for birth to be. So like, what are the ways you feel like you’ve been able to do that? Because I think it is an intentional process. And I know, you know, Angela you’ve touched on it, sometimes it’s not just that, some people certainly are very ethereal, and they just exist here all the time, and they’re just on that vibe, and that’s beautiful, too. But for a lot of us, we have to like, [audible exhale]
Pansay, Doula 4:56
Yes, yes.
Maggie, RNC-OB 5:01
consciously step into that. So can you speak to some of the ways that you’ve been able to do that and bring that into your practice, when the world does not work that way.
Angela, CNM 5:46
For me, birth is the space that I protect. Honestly, it’s kind of evolved into this natural process for me, because I’ve worked in birth for so long that I truly just trust the process. I trust a woman’s body, I trust that our higher power has perfectly designed her body to carry, grow birth, and nurse and grow a baby outside of her body. And so when I’m in those spaces, I always think about this midwife that was one of our instructors at frontier. And she always said, “be the knitting midwife” and we were like “what?” like, when you’re knitting, you are still, when you are knitting, you are quiet, and when you’re knitting, you are not touching other things, like be the knitting midwife sit in the corner, be silent, and watch, watch. And it doesn’t always require you doing something. She’s like, “your job is to watch and intervene when necessary.” And I would always like I take that to heart, every part of my training I took to heart I’m like, this is the evidence, this is what they’re saying this is this makes sense, I am going to do that thing. And that is what I would do, I would just pause in the birth and I would keep my hands completely off. And I just allow things to happen spontaneously and only touch if I needed to. I only did things if I needed to. And it creates this peace in the space.
Maggie, RNC-OB 7:38
Yes.
Angela, CNM 7:40
Remember, you know, I recall working so hard on doing that creating this peace in the space for a birth. And I certainly was not creating that peace for myself. And so a part of what I programmed myself to do in birth. I’ve been working on doing that for myself. Creating that peace, creating that space, creating boundaries, saying no, and not feeling like I need to explain why I’m saying no.
Pansay, Doula 8:12
Yes. Wow.
Maggie, RNC-OB 8:19
Mmmm. Pansay, you know, as a doula obviously, for many people that role is very hands on. You know a lot of people want a doula to be actively with them and you know, providing some physical comfort measures or being there. How do you feel like you’re able to both do that when that’s wanted, obviously, desired or but not feel that pressure that like it’s on you to make birth happen, you know, that like that you have to be the one to to fix it or to try to get it to that next step instead of just letting it be?
Angela, CNM 8:54
Gosh, that is so perfectly said “to make birth happen.”
Pansay, Doula 8:58
Yeah. Mmhmm. I think, I think that when I think about, you know, training, doula trainings, that quite a bit of it is focused on just doing right, that the doula should be doing. And I think I learned otherwise having you know, attended a multitude of home births. Right. That’s that’s the eye opener for us. Yes. That really holding space does not necessarily mean touching.
Angela, CNM 9:37
Yes.
Pansay, Doula 9:38
And after experiencing that, it changed how I attended women and doula women in the hospital setting two-fold because I no longer rush to get to the hospital. So okay, let’s let’s labor at home and really guiding and teaching the couples that I’m just there to hold space, you have everything right here, especially, you know, we’ve done childbirth education, you’re educated, which takes the fear and the anger out of them, right, because they know what the body is doing. So no need to be anxious. And I’m here to watch and just hold space for you and to guide you, if needed. Once we need to move to the hospital setting, you know, that was a question in my mind for years, how can I change how birth is just up, you know, happening in the hospital, you know, the nurses come in, and everybody’s just, you know, hustling and bustling. And here it is, I know. Then we need peaceful sacred space. Right? So I figured, okay, I need to show them that we’re different. That yes, it’s a lot of pregnant women on this floor. But this room is different. So I started creating signs in very bright colors that I put on the hospital door that says this is the sacred birth of such and such beautiful parents to be in the names and this is this is I am the doula but beyond these doors, you will witness you know, holistic modalities, aroma therapy, you know, we ask that you respect the sacred space you know, use low tone voices and went on and on, right. And it worked, right? I could always hear the hospital door, you know coming into the room the door open, but it’s slow. It’s like, what is this and I can feel them, like what is this and by the time they read it and then open and see that I’ve created space, I’ve covered the furniture, furniture with you know, tapestries, and there’s lights and, you know, Goddess figures and you know, all this beautiful serene atmosphere, it usually just brings them down, like, Okay, this is different. We’ve never witnessed this before. So that to get the staff on the same page that we need peace in here, we need to provide stillness for her body to do majority of the time, you know, the nurses and everybody aligns, sometimes I get, you know, what is this, you know, and have somebody you know, energy coming against what we are, you know, trying to create. But because because the world is, you know, for the most part, telling our clients to just go and have this baby, nobody is saying it’s sacred, nobody, it’s focusing that the environment should be as such that your body is relaxed and open. And that it can do it that taking drastic measures to ensure that my client has as much of that as possible, but has has probably been the driving force of Sacred Butterfly Births, right. Because they’re so connected, if she does not have that, then the body is closed and the body is afraid and doesn’t want to open and then we have interventions and all these you know things so it’s very big with within my work for me to hold the space to make sure I’m not bringing baggage from home. Right I teach the mentees that you know weeks leading up to the birth is time for you to start if it’s meditating more, just slowing your pace, your pace down releasing some things, ensuring that the daycare is set up properly. So, you know, once you leave you’re not, you’re not worried and calling in. Yes, you know, our moms are very much connected to energy, you know, during pregnancy. So if you’re bringing all that, you’re mad with husband and you’re fussing when you touch her, she’s going to feel what you’re feeling. So the importance of knowing how you’re, you know, that your energy is aligned, so that when you touch her, she feels peace, she feels safety, she feels serenity, and she feels a mothering. It’s, it’s crucial. It’s crucial.
Maggie, RNC-OB 14:12
Yeah, I think that’s a good point for you know, for us hospital providers when we’re going you know, in and out of these rooms and the the advantage to working you know, in those spaces that you have a lot of exposure to birth, right, there’s a lot of people coming in, and that is can be beautiful, and helpful and invigorating. But it is also a job right? And so peopl, and we’ve all done it, like you can lose sight of [the goal] it’s not my birthing day, I’m not about to have my baby. So you are, you’re thinking about the stuff going on at home, yes and about how you had to pick up extra hours to get overtime so you have enough money for whatever cuz it’s it is still work, sacred work, but it’s work. So I do think that ability to like poof, again, just keep taking those pauses, take that exhale, when you leave whatever you were talking about, outside the room, your concerns, your, whatever it is, and then be able to kind of take that moment like that is such a, that’s a beautiful practice to be able to keep building on and really kind of, not that we need to compartmentalize too much, but being able to step into that space with that, that energy that is protected for birth and also allowing it to be, despite a timeline we’ve predetermine, you know, that we thought would work. Because “I have another patient coming in and I need to take care of them. It’s actually be really great if you could deliver like now.”
Pansay, Doula 15:35
Yeah…
Angela, CNM 15:37
Yup [laughter]
Maggie, RNC-OB 15:37
Instead of like, “Oh, right. We’re not delivering pizza. So, they don’t have to go right now instead: Oh, cool, so I’m gonna have to figure that out. Because that’s my deal. Because it’s my job. But for you, I’m waiting to see when your body and your baby decides to be born. Like it’s a big shift. And I think that, you know, that other piece of it that you know, birth can be so inspiring. Yeah, and, and we have all ridden a birth high, right, where you’ve just been a part of just this completely beautiful moment. How do we keep our expectations for birth, and for what we’re hoping it to be? And kind of also not let it get I guess, too much. I had the opportunity to do a doula training over the summer, which has been really great and wonderful. And I’ve definitely learned a lot through that. And one of the things we talked about was, you know, with so many people offering virtual services, because that’s, you know, what’s been happening and a lot of doula work and connecting, like, you know, a lot of us as birth pros, like, there is something about physically being in the room, kind of like soaking up some of that energy that we all love so much, right. And then to it’s been hard and difficult for people to not be there experiencing all of that, but also that that this opportunity to really like check into what the client needs, what support do they need? How do you still hold space when it isn’t that that physicality piece of it? And how do we kind of temper our expectations, because I think, I have totally caught myself before realizing like, “Oh, I care more about this, than the person who’s actually birthing does” whatever it is, like, this position that, you know, whatever, and, and realizing that you really want that power to completely rest, you know, with that birth, with that birthing person you want them to have that inspiration coming, yes, you know, it’s for them, it’s for what makes them feel good, and not what would make you feel good, not what would allow you to redo your own birth or to yeah, again, to fix what happened wrong in that last birth, it could have made the difference like that there’s this constant push and pull on us.
Angela, CNM 17:54
It’s so important, I think, to be able to create those those balances, not only, you know, inside of the birth space, but in our work environments, and our personal lives as well. And it takes a you know, an awful lot of humility, and unfortunately, just growth in time, you know, aging because we become wiser and age and we are less selfish, to realize that it is not about us at all, nothing that we do, to serve people is about us. And I think that’s where our power to be able to humbly step back and do that comes from time, wisdom, growth, and not being selfish. Not being selfish in that space, especially…
Maggie, RNC-OB 18:49
Yeah.
Angela, CNM 18:50
Which, which, unfortunately, sometimes it makes room for us to not care for ourselves. So finding that balance, I think can be challenging, can be really challenging.
Pansay, Doula 19:08
Thinking about this, again, takes me back to training and I think some of us leave doula training with just wanting to fix it. Just wanting to fix her. Right? Um, fix the C sections, you know, no c sections, no pitocin…
Angela, CNM 19:26
That’s why we all go into it.
Pansay, Doula 19:27
Yeah, yeah, yeah. You know, but if we don’t find a way to bring change, right? I mean, we can’t go in and just say, okay, you’re not getting an epidural today. That’s not gonna work, right? How can we put forth effort that will hopefully shift and make the change? Because just just thinking that that we can change it. It leaves us depressed and sad. When we go and our client has a C section we feel like we fail I’ve been there, and it’s like, “oh, wow, I failed.” Okay, so what is it, that we can do that helps change to come? And I feel like that’s the education piece, doing everything within your power, did you do everything within your power to help this client or guide this client to make decisions for themselves? You know? And when I was able to answer that, yes, that I have done everything, then when the outcome wasn’t what I would have hoped I had peace with outcome.
Angela, CNM 20:41
Yeah.
Pansay, Doula 20:42
Right? Yeah. So that’s the best, that’s what I feel, you know, with that, where I’m not, I’m not trying to fix it. I’m just coming to bring education and to guide you, you know, to give you the tools to be able to have the best birth possible. When I look at what earlier in my career, was I giving all that I could? No, no, I was not. So are you are you fully bringing and committing to giving your client all the tools even if that means extra, you know, extra prenatals? Or maybe, or maybe doing childbirth, you know, education, you know, a more consistent basis as far as the classes, you know, it takes a little bit more effort. But I can release it at the end, because I know, I have done the best that I could.
Angela, CNM 21:36
I think you know, a big part of that lesson for me, PSA was also being accepting of the family, the woman’s person. Yes. Yes. That was always a really challenging part for me, not understanding why somebody would prefer to just have a repeat c section when they’re a good candidate for a trial of labor, or wanting to have an unnecessary, not medically indicated induction of labor, or wanting to immediately have an epidural to numb things before they even started. Even breastfeeding. Like, I could not wrap my mind on my why would you not just want to watch me for three years? Like why would you want to do that? I always feel like I was able to be a good actress during some of that, but I am sure, I am sure, you know, of my cockiness, my, that the people, the women I serve, they were aware that I probably felt differently. It took me a very long time to be accepting of those things. And thankfully, I am at a point where it is not just me saying okay, well, you need to accept these things. But truly feeling genuinely feeling like it is whatever she wants to do, whatever her choices are, and I 100% support it wholeheartedly and I will fight for her to get what she wants. And I will fight for her if she is so terrified of having a vaginal birth that she wants a primary c section, as long as she knows what all of those risks are. And guess what I will first assist in a C section and I will be there with her through the end of it. And it is taken me, you know, it’s probably only in the last year where I have not felt like I have failed as a as a midwife, when the birth does not go the way we all anticipated and hoped for. Because I realized that I do not have control. All I can do is my very best. The universe has a plan. And there’s a reason why things happen the way they do they didn’t win. I don’t like it. And I no longer feel guilty about those things. It has only been in the last year that I have been like you know what, “no, Angela, how dare I even feel that I can control the thing that happened? How dare I?” All I can do is my very best with the knowledge I have and with the information that’s in front of me.
Margaret Runyon 24:33
Thanks for tuning in. We love to talk birth, and we’d love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. We hope you enjoyed this conversation and we would love to hear from you about how you are tempering your expectations around birth, how you are letting birth just be and how you continue to inspire and be inspired by the act of birth. Till next time!
National Midwifery Week
Maggie, RNC-OB 0:05
Welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today we are celebrating National Midwifery Week, we had the chance to bring together some of the wonderful midwives who work here with Your BIRTH Partners, to spread more information, more awareness and to share their experiences about what it means to be a midwife now in the year 2020, in the US. So you’ll learn a little bit more about their experiences, how they chose their path into midwifery, what they wish they learned in school, and they didn’t, what their ways are to cope with difficult births, and they’re going to touch on the ways that they really embody the slogan for this year’s National Midwifery Week is “midwives for equity.” And I am so honored to share this conversation with you because it reflects so much of what we hope to see in the future, as midwifery continues to grow to be more inclusive, more accepting of all people, regardless of gender, of race, of socioeconomic status of any of the things that have held us back, and that have stopped people from having equity, in their health care, and in their birth care; everyone deserves a midwife. We hope you gain greater understanding about what’s brought them into this work, and that you feel inspired as you go on in your own. Onto the show!
So yay. So I am just so excited to have some of my favorite midwives here to chat about just everything that is going on for you all and then you know, I feel like I’m always celebrating national midwifery time, but especially here during the national midwifery week, just to kind of check in with you all and talk about midwifery, we had a couple questions that came in earlier in the week that we wanted to kind of address and then whatever else you guys want to kind of throw out there and we’ll see if anyone else who joins us has any other questions. So welcome, welcome. If you guys just want to go around and say who you are, what your shtick is for anyone who’s listening who doesn’t know.
Angela, CNM 2:25
I am Angela Mike. I am a Certified Nurse Midwife. I also hold a doctorate in nursing practice. I have been in women’s health for almost 15 years. And I am currently here in the Las Vegas area, working in a private practice where I do outpatient only women’s health care right now. I have four children and a husband and yeah, that’s about it.
Meredith, Doula, CPM-student 2:54
I’ll go next; I’m Meredith Strayhorn. I am a student midwife and a birth doula. I just started school in August and so newer to the game, but I absolutely have been loving my experience so far. I am in Northern Kentucky, right near Cincinnati. I have been in birth work for about three years now. But I have loved all things birth for as long as I can remember. So really glad to be here.
Ray, CPM 3:23
I’m Ray Rachlin, I’m a Certified Professional Midwife, Licensed Midwife, and Lactation Counselor. Based in Philadelphia, Pennsylvania, I have my own home birth practice refuge when we’re free, and I kind of serve Billy, South Jersey, Southeast Pennsylvania suburbs. And I also do IUI and queer Fertility Care. and educating providers is also a really big part of my practice. And my pronouns are she and they.
Maggie, RNC-OB 3:50
Thank you. So we’ll kick off with the first question is just kind of what does midwifery mean to you? And you can answer that in any way that it kind of fits for you. And I think there’s a couple of different kind of like the definitions we all like here and think of all the time but I’ve seen a lot of posts this week that people have really been diving into like, you know, obviously midwifery is more than like, just, you know, birth and all these things. So I’d love for you to share with us what what midwifery means to you.
Angela, CNM 4:17
Midwifery is about being present, listening to women, listening to families, it’s about choice. It is about validation, and it is about support and empowerment. My primary purpose for going into midwifery was because I wanted to protect and serve women in a way that empowered them enough to take charge over their personal health care.
Ray, CPM 4:51
Ditto. For me, midwifery is about the restoration of choice. And it’s the restoration of choice through slower care, through relationship based care, through building trust with the families that we serve, listening to them, believing them, and then working in partnership to help have healthy outcomes and also to guide people through unexpected scenarios and their reproductive lifetimes. And I started attending births 11 years ago as a doula and ultimately decided I needed to become a midwife. And I needed to become a home birth midwife, because what I saw in the hospitals, I was attending person in New York City was the absence of choice and agency. And when I first saw my first home birth, and I saw what was possible, and what birth could look like when pregnant people weren’t fussed with and didn’t have to comply to arbitrary rules and systems was that it looks really different. And I wanted to create competition, so hospitals could have to behave better, that if they were that if home birth and community midwifery was a viable, robust option in this country, hospitals would treat people better, and then we would have better outcomes across the board.
Meredith, Doula, CPM-student 6:03
I love that. Both ditto to both of you, you know, for me, midwifery is also about advocacy. So ensuring that they have choice that they that they’re they are empowered to, to really truly choose the experience that they wish to have and not be forced, or, you know, we there’s so many times that we hear that word allow in the maternity care system, and I absolutely hate that. I agree. It’s about listening, it’s about choice, it’s about supporting and offering that guidance and education, and I’m really big on education, I’m trained as an educator as well. So making sure that not only do they know what choices they have, but also understanding those choices, and then being able to impact the entire system, my goal is to turn it on its on its side and, and change these negative outcomes that we have. And for me, especially in the black community,
Maggie, RNC-OB 7:01
Absolutely, there is certainly a lot of change that needs to happen. And midwives have always been really pushing and leading for that change. And, you know, to your point, Meredith, obviously, the Black midwifery community is really, you know, pulling forward and, and claiming that very loudly that we need to, we need to make a change, and that we need to have to have more equity, and we need to have better representation so that everyone is receiving care that resonates with them, that comes from people who share their life experiences. And you know, and I say this as like a straight white woman, a lot of our perinatal health care system has been set up to support people like me, but I do not represent all of the people who come in to birth. And so many of our hospital systems are really set up by very, very narrow minded people. And for people who, who aren’t straight, who aren’t White, who aren’t having a super planned pregnancy, for all sorts of different factors that come into our lives, we need to we just need to do better in terms of supporting everyone and providing what they actually want and need. So another question we had was, What do you wish you had learned in school, but didn’t? Like, is there something when you are going through midwifery school that you realize now like that would have been the difference maker?
Meredith, Doula, CPM-student 8:32
I’m just gonna say I’m all ears for this one. Since I’m still in school, I would love to know, what are some things that y’all did not learn that I can maybe, you know, push for, and figure out how we can get it into these programs?
Ray, CPM 8:46
I think the short answer is how to care for people that aren’t straight white women. You know, I thought training as a Certified Professional Midwife and training outside the larger healthcare system that I would learn how to do better care for people who are not being served by our current, you know, patriarchal system. And that wasn’t true. I just learned different ways to care for straight white women. And my, you know, majority white women midwifery class was not adequately given you know training on like cultural competency, or humility. I was not trained to care for my community of like queer and transgender people. It took a lot of work and a lot like searching outside of my program to start learning the skills to serve people that are, to serve, like women of color, to serve queer people, to serve transgender families. And I mean, it’s still a lifelong learning process. Like I’m never never going to get good at it. But yeah, obstetrics and midwifery center, straight white bodies, and as long as that’s the basis of normal, you know, like, women of color are going to continue to die like they needs to be a huge shift about what bodies are normal, what bodies are centered in our training.
Meredith, Doula, CPM-student 10:01
So something that I have heard, I haven’t experienced it yet, but I have also heard that the NARM exam is written that way, it is centered around serving white women. And that was like the trick, if you will, that I’ve been told when I’m ready for my norm, just pretend like I’m answering it as a white woman, which isn’t fair, because I’m not and my clients are probably not going to be either. So.
Ray, CPM 10:30
Yeah, I think that’s true, I think. Yeah…
Angela, CNM 10:32
Yeah. You know, it’s so interesting that you guys have, you know, pointed out the lack of culture diversity in your training, I think what stands out to me most is, you know, certainly, being a black woman, this is my baseline, you know, this is my norm, I am adjusted to nothing being, the standard not being created based on me. So, it’s interesting, like, when I think about, you know, like, “Oh, did I get that sort of training and midwifery school or nursing school?” or, you know, and I remember having cultural diversity classes. But for me, it did not stand out. Because I already knew that these are things that I needed to do. So I don’t know that I felt like I was lacking that stuff. Um, I was always grateful for those cultural diversity classes, because I would be like, yes, people who don’t look like me need to hear this. Yes, I hope they are taking this and I hope they are absorbing it. But it is more than just taking a class or two, it is more than just, you know, I’m talking about how we impact change to decrease the gap in health when it comes to race disparities. It is about social change is about things that have been ingrained in our system. Since the beginning of time, it is about forcing people to recognize their privilege, and forcing people somehow to see things that they take for granted, are the things that Black and Brown people are dealing with on a regular basis. So as far as like, you know, lacking you know, that aspect of my education, I would say, I probably wasn’t as present as it should have been. But in general, like, oh, gosh, man, y’all I went to Frontier Nursing University. They have a phenomenal midwifery program like I did not, I felt so complete there. I felt so whole and I felt so validated. And it was like I suddenly was not alone in the way that I thought women should be treated in the way out thought births should happen. It was no longer this crazy nurse I was no, that is you are smart. And that is what we shouldn’t be doing person.
Margaret Runyon 13:10
So as a nurse, obviously, there is like, especially working in mostly hospital systems, there is that that kind of that othering thing that happens if you’re working outside of that system? And so it’s interesting how you know, within midwifery, then that started to feel like that was that there’s a shift happening that that is more normal, that what the expectations around birth, that they are, you know, they are different than obviously the medical model. I wonder, so Mere, you just have started, you know, your CPM program, what led you to choose that route? What led you choose the school you’re going with?
Meredith, Doula, CPM-student 13:45
So that’s a that’s a really great question. My original plan was to become a CNM. Then I had some conversations with some friends, some other birth worker, friend, one in particular, who is planning to become a CPM, she and I just kind of talked through some different things, and I had to I just the track that I’m on and kind of what I think I really want to do is homebirth as well. And so I felt like if I were to go the CNM route, that I may have to do some training, and that I just I wanted to kind of get into practicing and not really have to untrain my brain with the medical model. And that may not be true. This was just where I was in my thinking, but I really wanted to just go straight into the like community based midwife homebirth mid midwifery care. And that’s, I don’t know, I guess that’s just sort of the it felt more right for me. But I can also say that I absolutely love and appreciate our nurse midwives as well, because I’ve worked with several in the hospital as as a doula and you know, there is a need for every type of midwife. And so I’m grateful that you know that that path is available for people to choose what’s going to fit best with how they want to practice And the clientele that they want to serve? Absolutely. So, you know, my hope is that as a home birth midwife, if we do have to transfer then I can find somebody to transfer to that appreciates midwifery care that understands midwifery care, and is operating out of that model as well. That was, I guess that’s probably the best way to describe my path to it is just doing the research and then seeing what felt right for me.
Maggie, RNC-OB 15:25
Yeah, I know, for a lot of people, and I know a couple of nurses who chose not to go CNM path, even though they already had a nursing degree, and they chose to be CPMs. Because they wanted to have that kind of that experience of providing more community based, you know, home birth care, which can certainly happen, and there are, you know, nurse midwives who do that as well, just the different, you know, training piece of it that goes into it. And I love it for obviously, collaboration like that is, you know, that’s our whole game. That’s what we want to see more of. So absolutely. We need more, we need more midwives going down any path to be all over the healthcare system.
Meredith, Doula, CPM-student 15:56
Yeah. So that they’re not to say, that’s not to say that at some point in time in the future, that I don’t end up with a nursing degree or, you know, advanced practice, depending on what, you know, what depends on what the future holds. I don’t know what that is. And so I have some really big goals and big plans. And so they open up different avenues for me, but to legally be able to do the things that I’m trying to do. So we’ll just have to see.
Maggie, RNC-OB 16:22
Yeah, the legalities certainly keep getting getting in the way. And that’s, uh, hopefully we’re gonna keep pushing through on that issue as well. I don’t know if you want to speak to that a little bit, just while we’re mentioning it like so in terms of pandemic changes. So one thing I’ve seen is obviously a bigger push for midwives to have access and for CPMs, to be able to practice. Ray, an you speak to that? Or any of you all about kind of, like, have you actually seen much traction really happened with any of that kind of permanent changes?
Ray, CPM 16:53
Yeah, so the there is a number of so maybe a little bit of context. So Certified Professional Midwives are currently licensed in 33 states, right, Meredith? That might be 35. Right now, it’s a qualification that’s existed since the early 90s. And it’s direct entry midwives. And there are other states like Pennsylvania, where I practice, where there’s like a statute saying that we should be regulated and regulated us, there’s places that it’s illegal and midwives get prosecuted. And at the beginning of the pandemic, there was this very intense and profound surge towards folks wanting to leave the hospital and have a home birth, whether it is because of fear of COVID, or new hospital restrictions or the risk benefit between home and hospital changing. And you know, like, myself, and every other midwife, I know, those phones are like ringing off the hook, and I was on the phone for like hours a day. And yeah, had more interviews in like a two week period than I had like that year. And we tried to manage the volume. And also we’re trying to figure out how we can just create better access. So New York is the only place that actually got a bill through. So there was an emergency order that CPMs who had licenses in other states could practice in New York, and then it got extended. And that’s currently in place. And Pennsylvania, we also tried to do the same thing, but it did not go through. So we are still the same legal stature that we are, which means we can’t bill Medicaid, which means the ability to leave the hospital system has been yet is limited to people who have the funds to cover the cost of a home birth. So what then ended up happening in Pennsylvania is that myself, Asasiya Muhammad, and a few other midwives decided to organize a birth fund to just do births of at our cost, and then give grants to people who are black women on Medicaid to be able to access homebirth. And our fund was really successful. We raised $50,000 in from you know, the last like four months, we’re able to give 22 people grants for home birth. And this also got other funds started. So there’s at least 12 funds now that I know of throughout the country that are also granting, like black women on Medicaid the funds to partially or fully cover the cost of a home birth care so they can leave the hospital during the pandemic. So that’s been a really interesting, cool community response to have that like and also like, a band aid, it’s not systemic change that increases access.
Maggie, RNC-OB 19:17
So cool. Here’s a next good one. So what’s your favorite thing to help folks with other than birth?
Meredith, Doula, CPM-student 19:24
For me, it’s education. It doesn’t matter. It doesn’t have to be about birth. It’s just like I said, I’m an educator at heart. And so I just like to learn new things. And so anything that anybody wants to learn about, I’m like, Yeah, let’s go find out more information about that. I’m all for it. So just helping figure things out whether that’s, you know, something that’s just personal or if it is, you know, more on like that like business level or within their profession, or even just like fun, fun facts just exploring different topics.
Maggie, RNC-OB 20:00
That’s great.
Angela, CNM 20:01
My 100% most favorite thing is girl talk in the clinic. Let me tell you hands down those GYN or antepartum visits like I love having women come into the office, and chit chat about whatever it is like whether she is concerned about this weird discharge, or her itchy vagina, something on her boob, her period being all over the place, or I haven’t had a period in a year or two or three or five, I’ve seen that. Um, I love it. I love when I get, you know, my eighty year old patients coming in who want to have sex talk with me. I like it just brings me complete joy. And it is one of those things where, because I love birth so much. You know, I started off as an l&d nurse, and I love birth so much. I just thought how am I ever going to do this thing in the clinic, but I’m a talker. And so women talk and they come in and we have girl talk for nine hours pretty much. And so that is the most most favorite thing that I love to do. I love it so much. And I also love being able to tell women, that their bodies are normal, and to not be ashamed of their bodies. And I love being able to counsel them about ways to make themselves better, whatever that means for them, you know, and by better I mean, health wise, you know, that? Yeah, it’s the girl talk in the clinic. That’s my favorite. Where you get to know people, you know, and establish those relationships and that trust.
Maggie, RNC-OB 21:48
Yeah, that relational piece is awesome.
Ray, CPM 21:51
I think my non baby catching favorite thing is helping people get pregnant. I do IUI, intrauterine inseminations in people’s homes, and it’s like this really sweet, nervous, intimate experience. And, you know, I love that I can help queer families and single parents by choice, like get pregnant in their own bed. And that feels really important. And then also, like, really cool to like, get texts and photos of like, babies that Yeah, I like I was I was a part of helping. Yeah, great. Yeah.
Maggie, RNC-OB 22:25
That’s beautiful. I love that that is, can you speak to you a little bit not to get like too into details, but you know, how many, it’s not that it has a quantity but like, do you see pushes towards that in terms of more like home based outside of the fertility clinics? Like I know you do that work, I don’t know that many other people who do that, who offer that it is that growing more?
Ray, CPM 22:48
I think it’s kind of growing as a movement with like home birth midwives or midwives or small practices that are doing this for folks. You know, IUI is a very simple procedure. And the thing that we’re doing to help facilitate home IUI is fertility awareness counseling. And it’s just like, an extra level of doing fertility awareness counseling, because you need really good timing, because sperm is really expensive. But yeah, I think it’s like happening and more and more cities, but like, my practice is the only one who’s doing it kind of like in you know, like, 100 mile radius, at least if not over, which is Yeah, not okay. There’s just not enough options and fertility clinics are designed around the needs of straight people. And so, where people often are single parents wind up getting like more tests and more intervention than they necessarily need or desire. Because if the system is not set up for our bodies and our families and so it’s like nice to provide an alternative for folks that want a less medicalized experience to conception.
Maggie, RNC-OB 23:46
Just thinking in my head about like, what are the, you know, like, what are the steps that can get put into place like do you, is that something did you train like specifically for that? Like, is that something that any, you know, any CPM or any, you know, nurse, midwife homecare provider could could step into?
Ray, CPM 24:01
I think so. I mean, I think queer competency is like, first and foremost. And if you’re not a part of the community, or being a part of the queer community is not competency. There’s still more to learn. And then, you know, the actual actual logistics of IUI are incredibly simple. I was so fortunate to train in a birth center that had a queer midwife who started an IUI program and to also do an apprenticeship with a transgender midwife, who’s also a naturopath who’s doing some work and that kind of gave me the foundation I needed to be able to start this part of my practice. But preconception is absolutely in the midwife scope of practice, you know, and if you can do a pap smear, you can do an IU. I just, I think 90% of yeah, fertility and IUI care is being really good at fertility awareness and answering questions about sperm.
Maggie, RNC-OB 24:54
Yeah, awesome.
Angela, CNM 24:56
I’m a little bit jealous. I want to do that.
Ray, CPM 25:01
Before the pandemic, I was working on creating an IUI for midwives class, and then the pandemic happened. And that plan kind of went somewhere and it’s like in the background, I’m like, I’m gonna come back and do this and make this happen. So like, everyone can have a midwife who can like get them pregnant in their home, or just have access to like the midwifery model of care for this intimate life experience.
Meredith, Doula, CPM-student 25:22
So that leads to one of those things like the legalities in Kentucky, that’s not something that we have in our scope of practice right now. So there’s still more work to be done to be able to really broaden what we can do as far as well woman care, and then, you know, being able to offer a service like that is amazing.
Angela, CNM 25:47
Incredible. I did want to just kind of backtrack a little bit, because I wanted to put a spotlight on something Meredith said when she was talking about reflecting about which route to take in midwifery, and being concerned about man, the possibility of becoming over medicalized as a midwife. And what I want to say to you and hopefully to any other woman who is out there listening, is that midwifery is in your heart. It is, it’s who you are, it is in your heart, and you will 100% be able to make the distinction between when I need to intervene. And when I do not, it will tell you, I never had those thoughts and those challenges or those concerns. And I know plenty of nurse midwives who do homebirths, I am a crunchy hippie midwife, oh my goodness. But if I need to practice medicine, I am serious about it. Like I had my last baby at home with a CPM. Like because I love and believe in what we do. I love it so much. And I trust birth, I trust birth. And so I think a lot of the physicians that I’ve worked with even midwives that I work with, when they find out that I had a home birth with a CP and they’re like, like, what? That does not determine competency. I know so many Certified Nurse Midwives and physicians who should not be practicing medicine at all. And it is about what you know, it’s about what you trust, it’s about your heart. And it’s about what your intentions are. So if at any time in your life, you decide, you know what, I want to become a nurse midwife, I want to get my doctor’s, whatever it is, it doesn’t mean that you have to let go of the core at all, it does not mean that I would probably say even in my clinical practice 90% of what I do to treat people or intervene is counseling and education. It is rare that I am writing a prescription for anything. It is even rare that I am writing referrals because I meant it. And most of the time, it’s just really going through their history and saying, “Hey, you know what, these are all the things that are probably contributed to that. So let’s try this first, you know.” So yeah, what’s in here will never change. Doesn’t matter how many letters behind your name.
Meredith, Doula, CPM-student 28:25
Thank you so much for that. And I hope there are others listening because that’s I think that’s really key. Yeah, absolutely. Thank you.
Maggie, RNC-OB 28:34
All right. So I have another question for you kind of switching gears. So do you have a routine/practice something you do after a birth? That helps you kind of like process or review it? And does that change if you’re dealing with like a difficult birth or difficult outcome?
Ray, CPM 28:52
I mean, I now have all these COVID protocols. You know, like when I’m leaving a birth, I have to like, wipe down everything. I like I touch, like, yeah, like every alcohol swab gets wiped down before it goes in my bag. Then I have to wipe down all my bags, like right as I leave the house, I’m putting them in my car, and I’m like sitting on a towel in my car that like now is my car. So then I can get home, take off everything that I’ve been wearing sani-wipe my phone and my keys and immediately take a hot shower. And then I get to touch things in my house or eat something. And so that’s a new, that’s a new routine. Yeah, I think before this, you know, like, try I yeah, I think there are times that I’d like just kind of, you know, go to a birth and be like, okay, it’s 11am like go to your appointments and then you get to go take care of yourself and other times where I got to be like slow and sleepy and just let the experience degrade a little Yes. Which is, you know, a solo practice and sometimes, you know, you just have to work until you’re done. Yeah, and I think with like harder challenging births, I’m really feel so fortunate to have a bit of free community both close and far, you know, I, you know, call midwives all of the time, I’m on the phone with midwives and processing my experiences and learning from theirs. And you know, in our midwifery community peer review is a part of the standard of care, which means like I, when I have a complication or someone transfers out of care, I go through the chart with like a group of midwives, where we’ve all signed, you know, a confidentiality agreement and like, go through my chart from start to finish on what I did, and then learn from others, I can get feedback about what I could have done better or experiences other people have had. And so yeah, every challenging experience can also be an opportunity to learn and be a better midwife.
Angela, CNM 30:46
Probably one thing that I do, excuse me is reflect Frontier University, let me tell you guys for four and a half years, all they made us do is reflect I was reflected out, we it was just in, they had to be deep, thoughtful reflections. And I now realize that the purpose behind that was to ensure that I stayed honest, to increase my self awareness. And to grow and learn from it’s easy to reflect on those beautiful experiences, it’s so easy, we just want to bask in that glow, that energy because it feels you it is what feeds your soul to keep you going to the next birth and the next experience. It’s the ones that are really traumatic, that we don’t want to think about, we try to put out of our minds. So after every, every birth experience, I always reflect and certainly on the ones were that were traumatic, and there’s lots of crying, lots of self doubt, lots of regrets, all the what ifs, maybe I should have done this, maybe if I had done that. And we also go through a very intensive peer review process. We did something called morbidity and mortality meetings, once a month, and during those meetings, whatever, if you there are certain criteria for things that had to be discussed. And so whenever your, you had an experience that met those criteria, you had to present the case in front of a group of your peers, this would be midwives, PA students, Family Medicine physicians, Obstetricians, and then you review the literature on it, you reflect on the things that did not go well, how those things could have been dealt with better. And if it is a sentinel event, then it goes to a medical panel review board to determine whether or not you met the standard of care, and you practice within evidence, and if those things that you did, contributed directly to that or could have been prevented at all. And so it is definitely a humbling experience. I’ve had to present one really serious case on my behalf and it still haunts me, even though I was found not to be negligent, I did all the things, right. But it is a reminder that you are not in control. And you do not have the power to make everything right. But you have to be you have to be watchful, you have to be watchful, and you have to be confident and competent enough to know that this is no longer normal. This is becoming a-typical, even though we’re still safe, this isn’t right anymore. Now you need to be medically managed. Because when a mom loses her life, when a baby loses its life, you can’t come back from that. Like it stays with you forever. It stays with you forever and ever and ever. Even if you did everything right.
Meredith, Doula, CPM-student 34:08
So for me, just having that safe group to be able to talk things through. And just really being able to process is really helpful. And then outside of that something that I do for my own self care is just finding a nice place to hike I love nature I love finding different views and in being able to just really experience everything that God has created. And so that is another way that helps me process so if there’s something that is pretty challenging or difficult that I’ve experienced then trying to use nature therapy to cleanse my my mind.
Maggie, RNC-OB 34:51
Yeah, those are all good idea. I think obviously having that, that community that support that you can let you look in and reflect and like you did to learn and to grow, because none of us ever, we’ve never arrived, you know, we’re always keep learning and thinking of different ways that we can just keep pushing forward. And then so the last question, and we’ve had a chance to touch on this a little bit. So for National Midwifery Week, the slogan for this year is “midwives for equity.” And so I just kind of wanted to see like, you know, what does that that mean for you? How do you feel like you’re, you’re going to kind of living that out as you kind of work through your day to day and as you’re kind of doing your, your bigger kind of planning for what comes next?
Ray, CPM 35:37
I definitely think a lot about how, you know, while home birth has traditionally been in the hands of midwives of color, the modern home birth movement in the United States has been white, or majority white, and if I’m not challenging, the kind of current paradigm of how care is delivered, and who gets to access these like sweet, lovely waterbirth and creating other avenues to access midwifery care whether it’s financial or social or otherwise, then I’m reinforcing the same systems of oppression. And yeah, it’s, it’s not easy. And I don’t think I necessarily, you know, do a great job every day. But I think I’m really excited to be in a midwifery community that like prioritizes, lifting up Black and Brown birthing people and lifting up queer birthing people and transgender people, and trying to like, find a way forward. And I think those are kind of the voices I want to continue to listen to and like, work towards.
Meredith, Doula, CPM-student 36:47
That’s awesome. For me, part of me being in midwifery school, and becoming a midwife, I think, is part of that contribution. For me, I not only want to be a part of this community, but then, you know, once I have more experience, and I feel confident in doing so, being able to educate others, and kind of, you know, being a preceptor being an educator, and, and being able to train up the future generations of midwives and being able to bring awareness back to the roots of midwifery, I think is really important. You know, like you said, it’s right now home birth is pretty typically white. And that’s, that’s not where history comes from. So just getting back in touch and bringing awareness so that again, when we talk about equity, that everyone who seeks out this system of care has access, I think access is extremely important. It’s crucial that no matter your socioeconomic status, your race, your you know, how you identify, none of those things should matter. We are all people, and we deserve to be treated as such. And we deserve the kind of quality care that we’re seeking.
Angela, CNM 38:07
For me, this year has been so pivotal in regards to decreasing disparity, and improving equity amongst all individuals. And for me, it is ensuring that I am vocal when I need to be, and silent when I need to be. And I make it a point in my practice to always tell women when we open the space and I introduce myself, I tell every last one of them, this is a safe space. I’m so glad that you are here. Thank you for letting me offer to serve you. You can tell me and share anything with me there is absolutely zero judgment in this space. And I flat out say depending on what it is that therefore I’m like, I don’t care who you’re sleeping with, I don’t care what STI you have, I am not here to judge you at all. This is girl talk, I am here to serve you. And I want you to be honest so that I can protect you and help you. And so that is that is you know, that is how I ensure equity. You know, I put my families know that do not care where you come from. None of those things matter. What matters is my ability to serve you in a way that is respectful and that is meaningful, and in a way that you feel empowered and validated. Period. And I have zero tolerance for it when it comes to other people misbehaving. So those are the times where I talk about speaking up. I have zero tolerance for people who treat other people poorly and I will call you out directly Not mean about it, but I will be direct, and let you know, that’s not acceptable, I’m not comfortable with you speaking that way, in my presence or around the people that are in my space.
Maggie, RNC-OB 40:12
Mmm. That’s all so good. Oh, I just I am just, there is obviously there’s just so much inequity in our system right now. And I am so excited for everything that is happening in terms of just the the greater awareness that is coming. Obviously, this is not like a new issue. But I’m glad that it’s receiving at least more, more play in the the bigger world out there, I’m glad the bigger institutions are talking about it, that it’s that, you know, equity is getting onto the hashtag scene, and that it’s, you know, at least there is more discourse happening around that as we work on the, you know, both individual issues that we all can address, you know, in our lives, in our communities, and then obviously, these bigger systemic structural issues that, you know, are behind so much of it. And, you know, midwives are, they’re there to be with people, whatever they need, whatever, you know, whatever their background is, whatever their gender is, whatever their race is, in all the ways that you know, all the ways we identify as these complex human beings that cannot be just put into a little box. And so I am, I’m really excited to see what, what keeps pushing forward for. And I’m really grateful for the work that all of you do every day to keep pushing for that and striving to do better in your own practice and helping everyone else in theirs to also grow and keep making birth better. So thank you all so much for like sharing your time with us today and sharing of yourselves. Is there anything else you guys wanted to add before we close out?
Meredith, Doula, CPM-student 41:52
I would just like to say I would love to stay connected with both of you. I would love to learn from each of you. You are phenomenal people and I know that I could benefit greatly and that can impact those that I serve as well.
Angela, CNM 42:06
All about collaboration, Ray said earlier how she talks with midwives every single day. Literally every single day, y’all I just got a text from one of my girlfriends, she’s actually a family nurse practitioner, she’s like, I need to do a phone consult with you about you know, an OB patient. And like, this is what it is like we are so much better when we are together. And we can learn so much from each other because we all offer something that is so important, so powerful. And I am an advocate for all midwives and advocate for anybody who is practicing medicine, practicing safely, offering incredible support to women and families. Like that is what I love. And so to be surrounded by women who all heightened for that same thing. It’s magic. It’s just magic.
Ray, CPM 43:03
Yeah. And Meredith, I’m so excited that you’re joining the CPM community, like we need you as a midwife, we need more black midwives, we need more black cpms who are like leading the home birth movement, where it should go. And you know, like we cannot do this work without nurse midwives and awesome labor and delivery nurses. You know, if I didn’t have nurse midwives in the hospital that I could text and consult with and really trust that when I transfer my clients, I’m transferring them into good hands like I couldn’t do my job and or even just the times where I’ve gotten to the hospital after a super long birth and I see a nurse friend that I know who like greets me and my client and like gives us the energy to like get through it it. You know this? Yeah, this work should happen and community and collaboration and that’s what leads to good outcomes. And I’m so excited to get be here with all of you celebrating National Midwifery Week and for everything that’s going to come in the future as we work to change birth in the US.
Angela, CNM 44:05
I just want to say one more thing. I’m sorry, I like start talking about birth and midwifery and I just get all in my feelings that I remember like when I was when I was planning my home birth, it was a few CNMs I worked with and they all referred me to the CPM practice because that is the home birth practice that all of the midwives used in Atlanta. And I will tell you, I learned so much more. Because I thought I was granola. I had some issues. And I learned so much more about practice, and the pause, and being still, and being patient and just listening. My appointments were an hour long and probably we spent 45 minutes with me just laying on the couch and her talking to me, and humanizing me and she made me feel feel so empowered about my ability? Like I, it was all the things that I want it but I did not have birth fear. Like I was not afraid to birth my fourth baby at home, without an IV, GPS positive, no antibiotics. No, you know no pitocin I was not afraid of any of that, you know, she just reminded me, it was just like “Angela, look at the evidence, think about it, look at the evidence, you decide.” And I was like I trust you. And that was it. And I had a beautiful birth with no issues. And it was everything that I wanted. And she reminded me to always be that way in birth, even in the hospital. Okay, I’m done. [laughter]
Margaret Runyon 45:50
Well, I could sit here and talk to y’all all day because I do I value so much of the just the spirit and a passion that you bring to to all of this and the way that we connect with each other and connect with those in our care. So I really appreciate you all. Thank you Happy National Midwifery Week. Enjoy your celebration with whatever would feel good!
Meredith, Doula, CPM-student 46:12
Bye. Bye. Thank you so much.
Margaret Runyon 46:20
Thanks for tuning in. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. You can check out our show notes this week for information if you’re interested in becoming a midwife and wanting to understand education pathways, we’ll be sharing some resources about finding a midwife in your area that meets your needs. And we’d really love to hear from you what struck you during this conversation? What was something that you learned or that made you think a little bit harder. We’d love to hear about your experiences as a midwife for accessing midwifery care, as we all work to grow and make birth better. Till next time
B.I.R.T.H.-Respected, Trusted, Heard
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, we are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. So today, we are continuing the conversation, breaking down our motto. So what does it mean to be respected, trusted and heard through the birthing process? And the thing that was really important to me as we were creating this organization, and getting a sense of our values, and what was important to us, and what we thought needed to change to create a better perinatal health care system. So we’ll be diving into how we see this playing out in our practices now. And I’m also going to have a chance to explain to you a little bit more about the perspective I’ve had as a birth nurse working in the hospital, and some of the barriers that come up for us in terms of actually living out these ideals. So I look forward to share this conversation with you. On to the show!
So we had a chance to discuss what it means to us to let birth be exist without trying to put so many constraints and expectations on it. And we’ve also talked about what it is to be inspired by birth in part 1. Now I want to just kind of move on to that next piece of it, which I think is sometimes a little bit harder to put into practice, that respect that you have for the person you’re caring for.
Angela, CNM 1:52
Yeah.
Maggie, RNC-OB 1:53
It’s their story. And even when we want it to be totally different. Like they don’t all, for a number things that are, like you said, just completely out of our control that are beyond you know, what anyone can do, but also things that are just not, you know, everyone is on their own journey. And we have to kind of accommodate for that I you know, those last couple things of our motto is that I think they really go hand in hand in that respect and trust and heard. So like, do people during birth…do they actually feel that way? Because I think like you said, when we can answer yes. Like, yes, this person was respected for what they wanted in that moment, which is allowed to change, it’s allowed to be different than it is a couple minutes ago, from three weeks ago. You know, and do we just trust? Do we? Do we trust people with their own bodies with their birth? Do we do trust them to? That it’s theirs, that it’s their life? And that’s Yeah, yeah. And that’s, you know, we expect that like, I think so, you know, a lot of in like, especially in the medical model, like we expect that trust from us, right. Like, we expect people to respect our opinions. We have people around us and what we bring to the table with our experience, our education absolutely matters, you know, but we expect that. And then when someone comes in, and they and they don’t agree, right? What we’ve said there is that that piece of all of our you know, that ego that just is like, ooh, ah, you know, I’ve done this a couple of times and, you know, and like it has to be, it has to be two ways. And yes, and if it’s only gonna be one way, it has to just be from us, to the person we’re caring from, like, we have to respect them, and we have to trust them. Even if it doesn’t feel like that’s coming back to us. That doesn’t matter. That’s another time. But that’s like, that is not what has to happen. Yeah, right there. And I feel like that I was listening to do really powerful stories, mothers grandmothers were sharing from, some women, black women in our country who have died, you know, recently, and they were hosting this really incredible panel talking about the experiences that their daughters had, as they went through birth, and then afterwards trying to get a care. And the theme throughout all of them was that they did not have them. People just flat out did not hear them. Right, their provider just they couldn’t get anyone, no one would see them, they wouldn’t return a call. They just wouldn’t see you know, they went to seek care. And they were pretty much told like you’re fine, and they were not, you know, and that there was just there was no respect for what they knew about their own body. There was no trust in them as again as a fully autonomous person that we all are in at every stage of our life. And especially when we’re pregnant and bringing another life into it that does not magically go away. And I just have a feeling like, constantly we trample on people’s right.
Angela, CNM 5:04
We just, we do. We dismiss them, because we treat them as if they have no clue. I will tell you one thing. I mean, this was the driving force of me becoming a midwife I always knew. Like, even as a teenager, I mean, 14-15 years old, didn’t know I wanted to be a midwife. But I knew that women mattered. And I knew that I needed to be with women, I needed to work with women. And I didn’t even know in what capacity but I just knew, like, I’d always felt that way. And being a labor and delivery nurse for such a long time, seeing all the things that needed to be changed, like, I need to become a midwife, because I need to fix this, at least for some women. And the one thing that I drive home with all of my patients out there, who they are, that you are your best advocate, thank you for trusting me, thank you for coming to see me to allow me to care for you. And this is even for my GYN patients. But I remind them, and I empower them, I tell them, the moment you think something is off, you can see me because I don’t know unless you tell me and I will listen to you, because I trust that, you know, this is the first time I’ve ever laid eyes on your body. This is the first time I’ve ever touched your body, I am relying on you to tell me what is going on. So that we can work together to figure it out, you know, like, I just and I do my teenagers the same thing. And right now I work with a population that is pretty high risk. I can’t tell you how many STI s i can daily. And I empower those women, and I tell them you do not feel ashamed, you are going to learn from this experience, I’m going to give you the tools, so that now you can go out and be better. Like I am not judging you. This is a safe space, you are allowed to do whatever you want to do with your body, but I want to teach you how to do it safely. And I want you to know doing these things are going to increase your risk, right? But there is no judgement here because I want you to tell me everything. And until we like 100% feel that way about every single person we care for women are going to continue to death. And so it’s like, Yeah, when babies are going to continue to die, senselessly these things are going to continue to occur, and nothing’s going to change until we start treating people like they are human beings, like they are freely thinking and even if they don’t have a ninth grade education, they know their bodies because they are the experts of them.
Pansay, Doula 7:53
That’s right.
Angela, CNM 7:54
I know their bodies and maybe they can’t articulate what’s going on. But they know something is just not right.
Pansay, Doula 8:00
Yes. Yes. Yes. That’s it’s such a challenge you know, in the hospital setting that we have to deal with it’s like an air you know about them that that that labor delivery nurses have? Yes. Like this. This is my area. This is my I’m an expert here and you’re just coming in, you know, to help have this baby. My last birth I could. My mom was laboring on the toilet and the toilet, and I could hear that. Oh, yeah, we had only been there two and a half three hours. I said okay, well, I will rather not the baby coming a toilet let me go get me go get somebody.
Angela, CNM 8:44
Yes. Don’t you love that sound, when you know it’s time.
Unknown Speaker 8:49
That point she had travelled; she was reaching for baby. Come on. And the nurse I said just come take a listen. It’s time. She said Oh no. I’ve been doing this a long time. She’s only been here two hours. It’s in a way the baby is coming.
Margaret Runyon 9:04
That arrogance.
Pansay, Doula 9:06
Oh, wow. Okay, so I found the midwife and the midwife came in and just stood she didn’t go in a bathroom. I was so impressed. She just stood there and listened. She said “Oh get the bed ready. It’s time.”
Angela, CNM 9:18
Ooh! That gives me chills.
Pansay, Doula 9:20
Oh, yeah. Okay, I was so shocked. You could hear now you know if it was mom saying okay, you know baby’s coming or you know if someone would came baby would have came in, came in a toilet but for them to release this air and treat every mother as a mother as a person. Yes. individual person and not at you know, you’re the expert. You’re not, like you said, you’re not an expert at this one. This body. This particular. Yes. Bith. Yes. It’s so important, soo important.
Angela, CNM 10:03
Every woman sounds the same when it’s time.
Pansay, Doula 10:06
Yes indeed-y. Yes!!
Angela, CNM 10:09
Yeah, you can hear it. It’s like that mon was different that gets different a shift is taking place.
Margaret Runyon 10:16
Yeah. I think it’s funny that like, I don’t think everyone hears it.
Angela, CNM 10:21
Oh, they don’t,
Maggie, RNC-OB 10:22
Like they don’t want to know, because I think they’re in another realm. Right? They’re trapped in how contraction looked on the monitor.
Angela, CNM 10:30
Yes.
Maggie, RNC-OB 10:31
Was it time? Or any factors, right? Yeah. Right. And we get this snippet into, you know, clinical factors. He was like, Oh, this mom was the first baby, or because she’s got history like, and there’s no way she’s ever going to have a vaginal birth. So I’m not even looking for that. I’m just waiting for enough time to pass and we’re finally going to call it. Yeah. Like, it’s a completely different view on what birth is what it means. That’s why people like what what it is, as my sweater to say, says birth matters. But it does, like it matters on this so many other levels. It’s not just a day, it’s not just a moment. But I think for us, and it’s not it’s not any one individual person’s fault. Obviously, it’s the culture we’ve created around it, particularly, you know, in hospital birth, and it makes it hard sometimes for us to tune into that. Because, you know, we’ve been told so many other things. That’s not what birth means about what this looks like.
Pansay, Doula 11:34
Uh huh. Mm hm. Which takes us back to, you know, the beginning. And the, you know, the core of it before we had all these doodads and machines and all that. What, what, what was birth? Yes. And and if we just hold space and listen and watch, and that it happens? It happens. Yes.
Margaret Runyon 11:59
The beauty expertise is that like, right, when we can be there to support it, if something does go off course….
Pansay, Doula 12:05
That’s right. Mm hmm.
Margaret Runyon 12:07
That’s when then we need to be able to pull in that. Yes. That know how right, you know, like, it’s, and that has been happening again, forever. Right. For millennia, there have been people who had a lot of experience, who were there midwifing. And who were providing those, you know, those services that support they were the ones who had seen tons of babies before, and they could know they could hear the difference? They would say, Oh, right. Oh, maybe didn’t hear a little funky. We need something to help baby. Oh, hey, you’re bleeding too much. Yes, we do next, like we’ve always had different ways of balancing it with things are not going perfect. But that’s when it’s needed, not just because, you know, we could
Pansay, Doula 12:51
Right, right?
Maggie, RNC-OB 12:56
I’m really grateful for these conversations to to center and kind of to just think more intentionally about the work that we get, that we get this honor to do and to be a part of and to think about how do we bring different energies into that space? And she?
Pansay, Doula 13:15
And with your part, how do you see change coming about in the hospital setting, with with your coworkers? And because I’m sure it, it has gotten difficult for you, as someone that trusts birth? And seeing nurses or doctors handling things? Probably not so good manner? How has that journey been for you?
Maggie, RNC-OB 13:43
Yeah, so I think it’s it is interesting, I as a, you know, a more whatever, holistically minded, like labor nurse, I often feel like I’m, you know, straddling these two parts of life. I, you know, I pursued nursing very much, you know, like Angela saying, I knew I wanted to be involved in birth. And then nursing was the path to get there kind of a thing. So I think I went into it with a different vision for what birth was gonna look like. And then that is obviously above, just like, you know, Angela was saying, you know, before, I can certainly look back on conversations I had with people, the way I taught a class, you know, 5-10 years ago, and you look back with that little bit of cringe that like, mmm yeah, I was just, I was in a way, right, then I was feeling the way in my head about how this work. And this was the right way. You know, I think just getting that kind of just that, that passion that comes okay with youthful exuberance, that you feel like both that you can change things and like, this is what has to happen if we just did this, what happened? And so I think that as I’ve worked and I’ve had the privilege of working in, you know, several different hospital settings. And so, you know, in all of those I found the people who probably have a similar viewpoint on what it means to provide and that’s always really helpful just for both changing the skills you know, and increasing my knowledge. About what things can look like, you know, and I’ve also, obviously, I’ve always had colleagues who have a different take, right? on birth. And I think it has been obviously, certainly there are hard moments sometimes where you see something happening, you think it’s just really not the way I want this to play out, this is not the call I want to be making. And sometimes that comes down to a provider preference, you know? I am a nurse; I’m there to, to help and support the process and take care of all these things. I don’t always, I’m not the one who gets you know, the final say, yes, on how you know how a birth is progressing. And just like you said, sometimes that can be really disheartening, when you want it to be different, when you thought something else could be the outcome.
And so at the same time, I also think it’s, you know, it’s those opportunities for grace, and just reminders that like, you know, we aren’t in control, and that we are all keep learning and growing. Yeah, as we go. And so absolutely, it is easy to sit there and judge or be frustrated with how someone else has handled the situation. But without having walked that mile in their shoes without knowing the background without knowing what how did that last birth they attended go? What happened there did something happened that we transfer, we bring that on? And so I think as I’ve gotten older, and practice more, I’ve been able to have more a more nuanced view of it. I think earlier on, it was really, it was probably more frustrating to me, I think now I get less frustrated about individual differences in care, and more about the system. Like I feel my that is now what bothers because I feel like what has driven those individual behaviors. Most of the time is not an individual who just hates birth or hates women or people’s experiences. Unfortunately, those people might exist, but that’s not who I’ve met. I’ve met people who have had been a part of really bad experiences, okay, because the way we do birth, right, that scares them, and it scars them. And it makes them not trust birth. It makes them not trust people were caring for right, sorry, you know what I mean? Because I think we’ve set up care, so there’s too many to balance, you’re in charge of too many people’s care. Yeah. So they don’t all get great care. So then mistakes happen, bad things happen, because we didn’t give people the attention they needed, you know. And so then I think when people are part of a system like that for again, decades, yes, it beats down on your soul. Does, you know, and so then you get jaded, like, you know, like we talked about, you get burnt out on what it means to care for people. And so you start just accepting that like, Man, it’s not going well. And I could do that extra stuff. But it feels extra. Right? It doesn’t feel like baseline, it feels like, Ah, that’s gonna be a whole lot of effort. Is it even going to matter? Because I’m doing this with you know, like it? Yeah, it changes the way you view. You view birth, and you’d be what your role is within it. It disempowers you, you know, I think when you keep seeing that this is how birth operates.
Again, that whole you know, I had the chance when I was talking to Dr. Mimi Niles a couple episodes ago, and she’s a midwife. And she talked about that piece of it in particular, where, you know, we set up hospitals as factories. Right? So we made it. assembly line. Yeah, we tried to create it as much as we could get you come in, you pop on the monitor, you do this, we get to this and check, check, check. Yeah, to make it easy for us to manage an influx without increasing the stack we provide Midtown, you know, like Angela talked about with burnout without changing Who else is there to help? We just said like, Okay, cool. So now you’re also responsible for this, and this, and this, and this, and this, right, and everyone has capacity. So eventually, people, they have to let go of something, whether it’s just to literally get through the day, or it’s to just to get, you know, to tap any mental energy for themselves. They just start saying, Well, I’m not going to do this part of it. That’s, that’s too much for for me to do. And so again, I’m there. Certainly, some people can be lazy or selfish or whatever. But I don’t think that’s most people. And I don’t think that’s most people again, who go into like caring professions, I don’t think they go into it.
Because they want to just do the bare minimum, I think they go into it thinking that they’re gonna be helping people. Okay, and that they’re gonna be a part of it. And then, you know, the system comes along and says, No, I’m not gonna let you do that easily. Nope, I’m gonna penalize you, because you were in that person’s room forever helping them do birth, and so then you weren’t taking care of the rest of your assignment…. So now, other people had to pick up the slack and you’re actually kind of like, people are irritated at you because they didn’t have that energy. But everyone has, you know what I mean And not enough, not, not a bad way. Not necessarily, I guess like, but that there’s just You know, they are feeling like, “Oh, well, you weren’t there to do it. So I had to do it, which means that I couldn’t do the thing I needed to,” and it it ripples, right? You know. So I think people end up, you end up creating systems where people realize, like, “Oh, I can’t be in that person’s room, helping them change position, helping them come up with different whatever’s, you know, taking them off the fetal monitor, and, you know, just auscultate, if that’s indicated, and you know, and appropriate, so that they can have more freedom of movement.” Because I don’t, I have to also do these other things. Right? I know. And so that just makes it so it’s really, I think it’s not all the time, every day is different, right? Because some days, sure you do you’ve only have one person, you’re caring for you like, Yes, I can give it my all and I’m fresh. And I had myself care yesterday. So I’m like ready to hit this is my first shipment of three. But by that third shift, you know, and you’ve been at, you know, this is your fourth 12 hour shift in a row…
Pansay, Doula 20:51
Wow. Wow.
Maggie, RNC-OB 20:53
It’s really hard to bring that same energy, even for someone who loves birth, and really wants to see it be that personal. And so I think it’s always just that like, yeah, so it’s I don’t know, there’s this balance, but it’s like that. I mean, again, sometimes we all can make individual…people still having down choices and the ability to change. But so often we we try to make these big changes, we want to see happen. There’s all these other issues that are holding you back from doing it that are that are, unfortunately beyond our control. And that’s why we just we need to change the way we train people. We need to change the way we staff.
Pansay, Doula 21:27
Yes, yes.
Maggie, RNC-OB 21:28
And people don’t want to do that. Because again, it’s the almighty dollar. Yeah, it’s more money. Yeah. So then people are, you know, getting less than that is that they can’t change, you know, yes, yeah. Wow. And so I still Yeah, I think it’s just it’s a lot to be a part of a system that doesn’t always feel like it’s honoring…
Pansay, Doula 21:48
Yeah. Yeah. First…
Margaret Runyon 21:51
where people are and again, that doesn’t always feel good. It matches up with your, what you’re bringing value. You know, it’s hard to be a part of a system. And so you do you make all these you try, you know, and and try. Yeah, didn’t didn’t work. I heard you know, Jennie Joseph was saying on the Evidence Based Birth podcast, you know, a couple, maybe weeks months ago. But she, you know, said about this, like, this is generational work, like the changes that we’re trying to make, to birth care, right. It’s taken us under a year, you know, to get here, you know, 19 hundred’s to now birth is completely 180. You know, we’re in such a different place. Right. And it will take time. Yeah. To get back there. And so, you know, I try to focus on the things that I individually can do each day, each time I’m taking care of someone, how do I do that? And then we just keep, we keep chipping away, we keep talking about this stuff. We keep holding on these issues. And we keep giving, you know, for selves race to make Yes, to make the change that we can. Yes, in our bubble. And then to just keep you know, we keep pushing, we keep taking it. Like, I feel like it’s my you know, my new life slogan, but it’s one day at a time, right? You just yeah.
Pansay, Doula 22:56
Yeah. Mm hmm. One mama at a time, one patient at a time.
Margaret Runyon 23:02
It’s one birth at a time, right? Yeah. And we have a chance to have that one. Yeah, no, it’s that whole. What’s the quote about you know, if you, you know, if you change one person’s life, you know, like, if each of us in our lives, if we get that chance to touch and change one person’s life, like what a gift that is, and if it’s more than that one person, and that number keeps growing like, yeah, even better.
Pansay, Doula 23:28
yeah.
Maggie, RNC-OB 23:29
But there’s, there’s lots of work to do.
Pansay, Doula 23:31
it is, you know,
Margaret Runyon 23:33
We can all do that work individually. And then we all have to just keep we have to keep reaching out and pushing for it to be beyond beyond us. Because we deserve more; our system does not have to be this way because it is serving no one. You know, it’s not serving, it’s not serving people who are operating within it. We’re trying to provide care. It’s certainly not serving the people who are receiving the care.
Pansay, Doula 23:58
Yes, yes, absolutely. Absolutely. Keep pushing, we’re doing it. Thank you!
Margaret Runyon 24:08
Thanks for tuning in. We love to talk birth, and we’d love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. You can check out our show notes for a full transcript of this episode. And a few links that we hope will help you as you grow in your practice. We’d love to hear from you about what struck you about this conversation, something you’ve learned something you’re considering as you keep working to make birth better. Till next time!
021: Birth Professionals & Liability
Maggie, RNC-OB 0:05
Welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you, no matter what your background is, and are so excited to learn together. So today we are digging into a really heavy and complicated topic, we are talking about the role that liability and malpractice play into the decisions that birth professionals and birth providers make when they are taking care of people. You’ll learn more about some best practice strategies that you put into place to help there be clarity around difficult situations, difficult outcomes, we’re going to talk through some of the tools that providers need to work on in terms of communication and follow up with those in their care. And to help you gain a greater understanding of this topic, we have a special guest on today, Irnise Williams is both a nurse and an attorney and a mother. And she’ll be sharing some insight into the way she has seen these play out. And we’ll also be joined by our own Dr. Abby Dennis! Onto the show.
All right, so I am really excited about this conversation. I feel like the issue of liability and how that impacts the way we relate to people in our care is honestly at times really overwhelming. And it’s really hard for us to get a sense of how to balance out our concerns for, you know, the patient’s well being and what’s happening. And then also thinking about, you know, ourselves and our livelihood, and how all of these things kind of mesh together in the very just litigious society that we live in right now. And so I am really excited with the two people I have on today to talk about this. So if you all just want to introduce yourself briefly to our podcast audience, and then we’ll get into some good questions.
Irnise, JD, RN 1:56
So my name is Irnise Williams, I am a nurse, I’ve been a nurse for about 12 years, I’ve been an attorney for six years, I practice health law, business law, and I help healthcare providers protect their license and reduce liability.
Maggie, RNC-OB 2:12
That’s amazing.
Abby, MD 2:15
I’m Abby Dennis. I am an OB GYN practicing in Baltimore City, which is one of the areas where malpractice really drives practice very heavily. And so this is something that’s an issue pretty close to my heart. I’ve been on the podcast before, what else do you want to hear about? I’m a doctor and a mama. And I’m excited to be here. I’ve had a little break and being on these.
Maggie, RNC-OB 2:40
Hey, I’m really glad to have you back. So yeah, so I think one of the things we want to talk about first is kind of where do we feel like the how do we feel like the fear of liability, especially for birth professionals, when we’re dealing with, you know, to at least two lives, you know, are under our care, kind of that fear of liability play into our practice? And how do you see it playing in you know, for you Irnise in different, you know, outside of the birth professional thing? Does it feel like an extra layer, it often feels like an extra layer for us, you know, even more kind of weight on it?
Irnise, JD, RN 3:15
Yeah, I guess Dr. Dennis, did you want to start?
Abby, MD 3:18
I think the fear of liability unfortunately, drives a lot of practice. And you’re talking about ob gyn. It’s something that I wish I didn’t think about at all. But I think all of us think about a lot in ob gyn, there’s, you know, we are in a position where we really need to have perfect outcomes all the time in terms of moms and babies. That’s partly because I think we’re dealing with a young and healthy population. I mean, most of the time when somebody is pregnant, they have a baby, and everything turns out, right? when things start going wrong, that can happen very quickly. And often, decisions need to be made in the heat of the moment. And those decisions need to take into play, you know, medical outcomes, and also somebodies personal sort of outcomes and expectations for their birth. And that can be it can be a lot.
Irnise, JD, RN 4:14
Yeah, so I think for me, I’ve never been an OB nurse, but I’ve had two babies and they’re two very different scenarios. first child was born at Howard Hospital in DC. I was a student, I was a law student then but still a student. And, you know, I think my experience there was more of a family oriented, very loving, nurturing environment. I did feel like I had a lot of say in what was going on because when I was ready to have a C section because I’ve been birthing for too long, I just didn’t feel like we were progressing and I was in pain. It was just a lot going on. The doctor really did come and listen and will leave was like okay, well, this is what you want. These are your options and kind of explained everything to me. My second birth was a Planned C section, but it was at Hopkins. And although you know, it’s a very amazing place. That was where I started my career, I felt like it was very sterile. I didn’t feel like people were very warm, were very trained and didn’t explain things to me. So even when, like I knew because I was a nurse, I’ve worked in the OR that something was going on, because everyone’s so quiet. Like, no. Like, I was like, This isn’t normal. And I think I didn’t get the reassurance that I got when I had my first C-section, where everything’s okay, this is where we are with things, this is what I’m doing. And I think that plays a lot into how people react to their birthing experiences. I know Maryland is just an extremely litigious state, that’s where I’m barred. And a lot of the cases that come out out there are just extreme in they get so much media attention. And you don’t really get the full story, like you get the sensational part of whatever the attorney puts out, or whatever is kind of being litigated, but you never really get the other side, you never really get what happens, you don’t really get to see the details of how preventative care could have played a role in it. And what I tried to explain to both patients and to providers is that a lot of people sue because they’re angry, and not usually because of just something happened. Like I think people we all know that life isn’t perfect that we’re human, that even our bodies don’t necessarily react perfectly in certain scenarios. And there are some things that are extremely avoidable. But I think how people are treated in that situation really plays a role in how the like the person’s outcome. So I, you know, had clients come to me, and they’re like, this is what’s my outcome, I felt that this wasn’t a good outcome. And if it’s a serious case, I do kind of explain, like, even if we do pursue at the point, when I was doing some med-mal work with some other attorneys, you know, nobody’s perfect. And things happen, like, let’s review the chart and see what decisions were made. Because people there could have been conversations that were happening that maybe the patient wasn’t privy to. And sometimes patients are in a situation where they feel like people are making decisions for them. Because they just don’t have that relationship, right. Like maybe the provider who they built a relationship isn’t on that weekend. And so someone else’s there in that relationship where you know, that doctor would have told them, this is where we at this is where things are going. And maybe they, you know, the patient would have made a different decision just didn’t happen because they didn’t have that relationship. And so I think Maryland is a very unique place. And the way they allowed things to kind of go and they’ve they like, I think it’s just gotten to a point where it’s gotten so out of control that everything feels wrong, right, the patient feels like they’ve been wronged and the providers feel like they’re in a very position where they can never be wrong. And so there is some, like, congressional work that needs to be done to really even out the playing field, and to really educate and to support both the patient but also the provider because we don’t want to lose our OB-GYNs, right? There are a lot of places that don’t have OB-GYN because of those reasons. So I think that’s a layered conversation and so much work to do on both sides.
Abby, MD 8:11
I’ve had so many thoughts as you’re talking because there are many layers. I mean, I think your point about communication is absolutely on key. I mean, that’s, that’s the heart of this. And when something happens quickly, and there’s not time to explain, sitting down with a patient after the fact and really making sure they walk away from their birth, knowing why you did what you did. Is is so important. And I think that piece is lost a lot. And I think the trust piece also could be it just needs to be done in a different and a better way. Again, Maryland is a unique environment, it’s very plaintiff friendly, there have been a couple very large obstetric cases that have really changed the climate of practice here. They’ve sent some precedents that are pretty scary for those of us who do this on the OB side, and I think have shaped OB-GYNs out to sort of be the bad guys in a lot of people’s eyes. I think the reality is all of us who go into this field are doing this because we want to take care of women and we love what we do. I think women’s health in this country has been sort of under represented & under reimbursed. I mean, there are some major issues there that trickle down and then affect the way that we we practice. And I think that there are a lot of little pieces that need to be fixed if you want to if you want to fully address this.
Maggie, RNC-OB 9:38
And that’s really hard. I feel like obviously that communication piece. In some ways, it seems easy, right? Like if we just right, we respect the people who are in our care, and we have these conversations, if that could be enough to kind of get through difficult situations and difficult outcomes that are not wanted by obviously anyone and I wonder where where does it we think we fall off on that, like, is it that providers aren’t comfortable or trained about how to have those conversations? Is it that they’re already kind of worried and they’re their guard is up? Or is it is it like the just the paternalistic nature of health care that a lot of times people are just kind of making a decision that they think “I would make that for myself” or “I would make that for my daughter.” So I’m gonna make it for you. Where do you think that piece of it falls off?
Abby, MD 10:25
I think it’s a lot of those things. I know, you’ve heard me say, you know, it’s I don’t want to be paternalistic, or materialistic or whatever, you know, I have been doing this long enough, though, that, you know, at the end of this healthy baby is in a healthy mom are of the utmost importance. So it’s, it’s hard as a provider, when you see something happening that you know, is not, the patient’s not on board as a plan that’s going to lead to that, things become really challenging. But I think all the trust and all the communication and all the decisions that you make in the moment, are one piece of this. And I think the other piece of this is that as we walk away from from birth, particularly birth, where you have a child who’s had some injury, families walk away from that and process it in different ways. And you know, is, even if I’ve explained why something happened to a family, they may have a very different take on that five years in, particularly if they’re five years in, and they have a disabled child with, you know, health care costs and physical therapy appointments, occupational therapy appointments and home care needs, that becomes challenging. And I think sometimes stories change. And in that sort of setting, because I’m sure families become, you know, stressed and angry, and all sorts of emotions come out after the fact.
Irnise, JD, RN 11:54
Yeah, I mean, I think that no health care provider is trained to have difficult conversations, that wasn’t a part of my nursing training in school, I think the only thing that even kind of opened my eyes to what happens outside of the health care world where it gets into the legal world as when I first started nursing, they had the, one of the attorneys work for the hospital come and do a training, and basically scream at us and say, “Do not write this in the chart that you called the doctor five times and he didn’t respond.” Like, it just stuck in my head. And I was like, he’s crazy. But like it stuck in my head. So like, even if I was having a very emotional day, and I didn’t like the doctor I was working with, I still reminded myself like, it doesn’t go on the chart, just send an email to your supervisor, right. And I think sometimes nurses or other health care providers, write things or put things on the chart, because they’re trying to protect themselves without understanding, you have to protect the entire team. It’s not necessarily just about you, as an individual, your license, it’s about ensuring that what’s happening is very clear. And everybody, everyone may not be privy to what’s happening in the background. So if a doctor is not responding, and doesn’t mean that they’re not, you know, listening or hearing what you’re saying, they may be stuck in another emergency, they may be having a meeting or meeting with a different provider to make a decision. And that may not go into the chart, but that’s something that goes into, you know, their decision making process. And so I think that that part of that education of what goes into the chart, how to document and even training on how to have difficult conversations, because we don’t know what goes on outside, I think, for me, because I have that attorney, and he would come to the OR every year like, like to have these comments with us. And because that’s where it was really big for us, our OR there. I mean, people would sue. I mean, even though the doctor explained all of the risk, and the anesthesiologist explained, I’m like, it doesn’t matter, right? Like if someone didn’t survive their surgery, they want to see their their chart, they want to, you know, take it to an attorney. And so he would just be so just clear about what should go on the chart, and what should it and that has kind of followed me through my entire career, and is a lot of the education I provide to other health care providers, especially nurses, because nursing can even though I think very few nurses are sued, and very few nurses lose their license, in their minds, they feel that the world is against them, that the doctors are against them, that the patient that the Board of Nursing is going to come after them if they don’t do everything right, even though you see very few nurses in in, you know, in litigation cases. And so I think what I try to explain to the nurses that I work with in our training that I have discussions with and I have opportunities to reach out to is like we are a team and we have to all be on this together. And so I’ve seen cases where and not just OB cases but a case where like someone have fall which is a “never” event, that should never happen. But when you look at the chart, they did everything right like The note was “patient had a fall.” period. Right? Like it was like it was very clear. The doctor was paged, the doctor showed up, the doctor wrote a note, like it was like, boom, boom ends, but that daughter who was there when that fall happened, like, that’s not what happened. And I’m like, I can only go off of the chart, and I can’t sue a hospital because of your mother slipped and kind of fell when someone was helping her up when there were two people there helping her, right. And so if we follow the protocols that we have in place, which sometimes people don’t, which leads to issues, and if we communicate effectively with each other and work together as a team, the health care system in itself can kind of protect itself from some of the things that happen, never everything. You know, there’s some times where people make mistakes. And that’s just it, and you have to pay for those mistakes. But there are times where it’s just confusion in the chart. And if there’s confusion in the chart, it opens up the door for attorneys to basically make their own case, right? They can’t make their own case, unless there’s basically just not enough information in the chart, or there’s conflicting information in the chart. And so I think more healthcare providers, one needs to learn how to have difficult conversations about the process. What could potentially happen, like I think nobody ever told me about, like, potentially having a C section. Nobody ever prepared me mentally for that. It was like, I was young, I was 25, I was healthy. I was going to have a baby. That was it. Like nobody really discussed the options, what that would look like what that would feel like the feeling of not being able to birth a baby. For some people, it’s not a big deal. But for me what it was a big deal, and I felt very lost. And that was no one’s fault. That was you know, but I, as a nurse, I still never have that expected outcome. And that wasn’t necessarily a negative outcome. I had a health I want a healthy baby. But even that moment, that gap made me for a long time feel like, this isn’t what I wanted, right? And so I think in healthcare in general, if we start guess, from the greatest thing that could happen to the potential risks that could happen and how we work together to prevent those things, I think maybe it would soften the landing when things don’t come out as people expect. And we’ll never stop every case from being pursued. But I think some of the smaller cases that come about that people end up just the hospitals end up paying out because they don’t want the fire could lessen if we were just, you know, starting from the beginning and have those conversations and then just working together as a team.
Maggie, RNC-OB 17:29
Mmmm. It’s interesting like, as a nurse, I can resonate with what I think some of us have been through, like you said, that was like the training courses where someone comes and like pretty much tells you like, you’re gonna lose your license, it’s inevitable, it’s happening if you don’t do XYZ, and they tend to be like, very, very intimidating, and I’ve seen it a couple different places. You know, when we’re charting, I think, especially in high emotion situations, when there is a bad outcome when something is not going to plan. People have a hard time separating that piece, you know, the facts from the emotion and a lot of us feel a lot of responsibility, right for what’s going on, which is good. But I do think it can make it challenging to have transparency and what is going on because obviously we’re not trying to like, you know, try to omit something, you know? I think that’s one of the things that when I’ve talked to people who work, you know, who are outside [the system] when I talk to clients, and you know, doulas, people who aren’t involved in charting and the whole medical management of care, I think they’re often surprised, unaware of that whole dynamic, and I think they perhaps desire more transparency like that, if there’s just if there was just like a video running the entire time that you got to see what was going on that like, that would be the answer, right? Like if it was real play, you know, what’s going on that that would help to process it. And so I feel like sometimes it feels like you’re caught in the middle, right, between kind of what what we know and are taught is like, “best practice,” from an organization standpoint, you know, for us for our license, which does matter, you know, it is people’s livelihood. And at times, it feels like it it creates this “us versus them” piece where it feels like if we do that if we’re charting in just this way and we’re doing all that like that we are protecting only us as an organization as a health care system and that we’re not working with you know, the client and I…
Abby, MD 19:40
That’s the goal, right?
Maggie, RNC-OB 19:41
Right.
Abby, MD 19:41
…Is for the entire unit including the patient to be satisfied with the care provided, to have good care. I was just talking to one of my partners the other day about the idea of a head cam like how much I would love to just wear a head cam around when I’m on call. So it recorded everything, recorded all the conversations, all the care. So all those nuances of care would be completely transparent should there be an outcome that at the end of the day is seen very differently by myself and by a patient. And I sometimes wonder if that would make me see things differently? I’m sure it would. And I think it would also just sort of help in situations where outcomes aren’t as expected. That’s never gonna happen, I know.
Irnise, JD, RN 20:26
Yeah. I think we all want that perfect scenario of, you know, either someone completely wants a complete video, or even even having the ability to have the conversation how you say, sometimes the story changes, I’m like, I could see that like, where people say they understand you explain, they understand, they say they understand. And then they say, no one ever told me that right. Like, I think there is no perfect situation to kind of avoid all liability. But I do think that the validity of some people’s voices not being heard is what drives to me a lot of what happens in the Baltimore area. What I’ve seen in Baltimore, is that people feel like they are not heard and some of the underserved communities feel as if they’ve been taken advantage of, then no one cared about them. And it may not necessarily be that direct interaction with the provider that took care of them that day. I think it’s just systemic, right. So much of what drives people in underserved communities is the systemic oppression and the heaviness that they carry, to then deal with another blow of their child or having to do the odd who’s injured until that anger then kind of just gets funneled towards something where they can actually have a, where they think as a positive outcome is at least being able to recuperate some type of money. And that’s a to me a very Baltimore thing, like, there’s no place that I’ve ever lived, where I’ve heard people talk about suing anybody, like just not even healthcare, but just anyone, like, it’s a running joke amongst me and my friends. And a few of my friends are like, from Baltimore, they’re like, Oh, that’s how people live, like, just get a case, like that’s how it is. And it’s and so I think, as a health care system, in order to prevent those things, you have to even go above and beyond, right, like, because you’re in that unique place, I think all providers have the responsibility to have those conversations. But in a place like Baltimore with that, in the back of people’s heads, like if this doesn’t come out, right, like they already have a plan, they already know who they’re going to call, they have a name and a number. And when you lead with that, it to me, sometimes it opens the door for negative outcomes, right? Because that’s your expectation is an underserved, “I’m from this underserved community, they don’t care about me anyways. And so if this happens, or if it doesn’t come up the way I expected, then I already have a plan in place.” And that’s something that’s way bigger than health care, or that’s something that’s so much bigger than we can control. And if we focus on trying to either we can focus on trying to fix that, which is impossible, or we can say there’s no way I’m fixing that, and then just kind of leave people to figure it out. But I think there’s a middle ground where there are layers of support and education, where we noticed people who aren’t just understanding what’s happening. So I’ve seen some patients who just can’t grasp what you’re saying. And the doctor can only spend so much time with the patient. But someone has to follow back up with the patient, if it’s a nurse, if it’s a community, educator, someone has to be that layer to ensure that what is happening in that education is being provided. And I feel like in Baltimore, they’ve lost so much resource, so many resources, so much support, that they just lacked that, you know, they don’t have the ability to have that extra layer, there’s no one in the community educating. My friend used to be community educator, a small organization, and they closed and that was it, like she did not care about the money, she did not care about the the location. She loved what she did, and she provided so much education to new moms, expecting moms gave that support, you know, and it closed. And so it’s like when you lose something in a community that’s already underserved. And then you send them into a huge hospital system, which can be extremely overwhelming. No matter what the doctor says, no matter how much time the provider spends with them, they’re not getting it. And I think that’s the bigger issue is like how you’re saying it’s under, you know, women’s health is just under how what when we are literally the beginning of life and the continuance of life, why would we not support that industry and ensure that they have all the resources that they need for every level? And I think that’s to me is what happens in Baltimore where I see there’s a huge disconnect from the end result of getting to the hospital and kind of the beginning of where they’re seeking care.
Abby, MD 24:53
Between, you know, reimbursement, which is interesting when you look across the board of medicine, I mean, the global sort of reimbursement for 46 weeks of maternity care. Last time I looked, we get less for that, as physicians, than anesthesiologists do for placing somebody’s epidural in labor. OB has been deemed a primary care specialty. And in general, when you look at surgeries performed specifically on women and you look at reimbursement, maybe compared to like the same procedure in a urology setting performed normally on men. Or if you look at other surgical subspecialties were predominantly men are the providers, reimbursement is extremely different. OB-GYN is probably the most, it’s one of the most, litigious branches of medicine. And one of the least compensated, that combination is really hard. Particularly when you take this to underserved community, communities in the inner city, the reimbursement for a Medicaid patient is a fraction of what private paying patients get reimbursed for that 46 week period of care that we provide. And what that means is OB-GYNs are seeing far too many patients, too many patients to build appropriate relationships, right. And then we’re in the situation where we don’t have those appropriate relationships, we haven’t built trust, and we have to make life or death decisions, not knowing how a patient sees us or, or sort of what their perception of the whole situation is. And it’s a tricky situation to be in. A lot of OB-GYNs just stop providing the obstetric part of care at some point in their career. And a lot of people just leave practice environments like Baltimore City where, unless you’re in academics, it’s just really tricky to survive. And those malpractice cases takes such a toll on doctors, like I don’t think people understand like, I deliver babies because I love that I love that more than anything else in the entire world. So for somebody to then accuse me of trying to hurt them or hurt their baby. I mean, that’s from the doctor standpoint what these malpractice cases become and they take so much away from you. And then I think about the patient side of things that you’re explaining Irnisee. And it’s a tricky, it’s a tricky situation. I feel like we need to do more things to help maternity care providers and patients be on on the same page and and understand that we’re all going into this together as a team.
Irnise, JD, RN 27:34
Yeah, I think that’s that’s definitely key. And it’s sad to hear, you know, I think nobody ever talks about the toll that it has on everyone involved. Like, you know, I saw one time a nurse, she’d been a nurse like 50 years been in so long, and she got like a phone call about a deposition from like, 10 years prior. And she was like, why, like, it gave her so much anxiety. And so I can, nobody ever really discusses that part of it and the stress that goes into having a deposition and for the you know, from the legal perspective, I understand in order to effectively win a case in any environment, you have to go what I say like go hard, like you have to hit at every point, or the court is going to find that in your favor and not in your clients favor. And so you know, yes, I think people look at attorneys and they’re disgusting, they’re terrible people. But in some instances, like that’s the way it’s been. That’s the way the situation is treated. Like that’s the way the justice system has been created. Like there is no in between. I mean, if I think in Maryland, you go to arbitration. So it’s not as bad you don’t essentially have to go to court. And if you are with a good arbitrator who is balanced and fair, it doesn’t get nasty, it’s does stick to facts and what really happened and and people are able to express themselves appropriately. But I think that’s where like I have seen amazing arbitrators who they don’t allow it to get personal, they didn’t allow it to they really just sticks to what happened in the facts in the chart and, and then kind of at the end, they allow people to kind of express their feelings. And I think that’s effective, right? I think people’s feelings and emotions are valid. But that’s the place for it isn’t necessarily in the litigation, right? Like the facts really should be the only thing that’s coming up in litigation, and discussing the standard of care if it was met or if it was not met, because that’s just what it is. But I think emotions and media and all of that kind of drives those conversations within pushes the two parties further apart. And they really aren’t able to have the appropriate conversation or reconciliation. And even that when it’s all said and done, that trauma is still laying there for the patient and the mother or the mother or the family. And then the provider is left to figure it out on their own. Like that’s it right like however it is in their favor or not. There’s no care for the provider on the other side of that so I think they I don’t either I don’t know what Maryland to do, I think there are a lot of conversations and a lot of requests of things that they should do. But I think as providers, being able to request from whomever you guys are working with, for more support, like there has to be more, there has to be someone in the office to answer the questions, to answer the phone calls to be able to, you know, get the people to the end, without it overwhelming the provider who’s trying to close their notes, and see as many patients as required, and then also on call, so they’re ripping and running from the office to the hospital, and also have a family and a life. Like, we’re asking this one person to be so many things. And I think that that becomes unfair to to everyone involved. But, you know, there’s only but so much we can change, I think shining light on these kind of kind of conversations, really helps open up ideas of how we can get better. I think tech is improving a lot of things and a lot of areas, but I don’t really see them focusing on OB-GYN care, like as much, you know, I think it’s like primary care, they’re receiving a lot of support, that like specialties like diabetes, and IBS, and all these other specialties are receiving a lot of tech, you know, innovation, but I don’t really see people having that same conversation about here, you know, bringing that to the tech world and saying, this is the problem that we have, who’s willing to solve it and let people figure it out. Like that’s, you know, not our job is to necessarily figure it out. But there’s a whole world out there are people who are figuring out problems and creating solutions. And I think letting people know, the problems that we’re having in this industry will kind of help foster some ideas that maybe some innovative ways that we can kind of help patients get to better outcomes.
Maggie, RNC-OB 31:45
Yeah. And I do think that’s what’s so hard. It’s like, because, again, because of that whole “us vs them” thing, I think so often, it seems like that the providers, the birth pros, like don’t necessarily care about the outcomes. That either way, you’re just kind of getting through and like, sure you want good things, but it doesn’t I don’t think it’s apparent how like crushing that piece of it is. So Abby, I really appreciate you, just speaking to that piece of it so vulnerably and sharing with us and Irnise, thank you for just unloading all this wisdom that you have as a nurse and as an attorney, and helping us to see just some of the other dimensions to this issue. Thank you both so much for sharing all this with us.
Thanks for tuning in. We love to talk birth and would love to talk about with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, where your birth partners on all platforms. We’re going to put more information on our show notes about some resources you can look into if you’re interested in learning a little bit more about malpractice climate and how it relates to obstetrics and how birth professionals are helping to navigate issues of liability while still providing truly patient centered care. We look forward to hearing from you and your experience and how you are navigating this complex issue as professional. Till next time!
Relating and Caring: Birth Pros & Clients
Maggie, RNC-OB 0:05
Welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. So today, we will be continuing on conversation from last week’s episode. So last week, we had the pleasure of Irnise Williams being on the podcast with myself and Dr. Abby Dennis, and Irnise is a lawyer, a nurse, a mother, she wears many hats well, and we had such a great conversation, we started off by talking about liability, and the impact that that has on birth professionals and their actions. And then we continue that conversation, and we’ll hear today is us really diving into how we relate to those who are in our care. So, you know, part of the issue that we see when we talk about the relationship between care providers, and patients and clients is that there’s can be this power imbalance, there’s difficulty because of the way that our healthcare system is set up in terms of how much time we have to develop relationships. And there are other you know, issues that come up between how we see our patients, what we understand about their life story, there are racial implications about how we relate to those in our care. And we’re going to dig into all of that today. And so I welcome you on to that conversation. On to the show!
Maggie, RNC-OB 1:36
One of things, we’ve touched on this before is that, what do we do, as birth professionals, as providers, when someone wants to make a decision for their care, that we really don’t feel comfortable, that isn’t recommended, like we had a whole episode earlier about, like shared decision making. And again, I think it’s hard, that is certainly like the, the beacon that we all want to be shooting for is that we’re having these conversations back and forth. And we’re providing education, and we’re building on that, obviously, you know, ideally, pregnancy is several months of time to hopefully have better resources, have more education. But then when we get so often in that, like the heat of the moment, and not everything, you know, allows for as much time and if we’re really recommending something, and the person or care does not want that, you know, what happens? You can’t just trample on people’s autonomy, you know, because they’re in our care. But it is a really, it’s really heavy line. And I think we see it a lot in, particularly in like, hospital based birth, when someone’s wanting less intervention. You know, a lot of times we have a lot of policies that dictate how things are supposed to go and that we’ve put into place, not always, they’re not always the most well thought out, but they’re generally put into place with the idea that this is promoting safety and helping us to manage, you know, everyone is in our care. And so I just wonder, like how, you know, what do we do when we really don’t agree when someone wants to do something that’s different from us, I think, unfortunately, one of the things that I see happen, and I’ve seen it happen several times is that, you know, someone’s wanting to do something different with their care, when baby is either inside of their body, or especially, you know, afterwards, if someone you know, if they’re taking care of someone, you know, has a newborn who has an issue, and the parent doesn’t agree on the recommended course of treatment, that then we started having like issues of kind of the threats that perhaps Child Protective Services has to get involved. And then we start kind of adding in a lot of different elements to it. How do we provide care still does it doesn’t agree with necessarily what we would do?
Abby, MD 3:48
We’re all moms, right? So I do, I think the general principle of like in motherhood, in my household, if I start making threats, if you don’t do this, then I’ve lost, right like we’re not in a good place in our house, and we probably aren’t going to accomplish what we need to accomplish. I sort of see it the same way. And again, that sounds we’ve used the terms paternalistic and maternalistic a lot in this episode already, that sounds that way. But I mean, I, my job is never to threaten somebody, if I’m threatening somebody, then we’ve gotten to a point in discourse where we’ve gone too far, we’re not seeing an issue, and where I need to stop, back up and start over again. The concept of goal oriented medicine meeting a patient where they’re at is a really important one. And I try to carry those principles with me to obstetrics even though that does get much harder when there’s a baby involved, whether it’s still inside somebody’s belly or on the outside. But I do think the moment you start “your baby’s going to die”… I mean those kinds of conversations are never productive, right? They just aren’t leading us down. They aren’t helping me create a bond with a patient that’s going to help with their care in the long run. That being said, I think patients need to understand that when we’re making hard decisions or deciding whether we need to be more interventional in an OB situation, it’s because we have taken on some risk. So although I should never as an OB, say, your baby’s gonna die if blah, blah, blah. I do think that people need to understand when we’re making decisions about whether we need to do a C section or whether it’s time to induce labor and meet a baby, usually, we are making those decisions based on stillbirth rates, what is the likelihood if I leave this situation, that somebody is going to have a live baby in a week? And I feel like finding ways to have that conversation without it being threatening can be challenging.
Irnise, JD, RN 5:55
I think yeah, I think this definitely comes into play with about education from the beginning. You know, the worst time to try to make someone to make a very emotional decision is when they’re in labor and birth or when they’re a new mom, I think so much of what happens in obstetrics doesn’t ever come across people’s, you know, plate, like, you know, if either there’s, they’re googling things, and God knows what combination of words that they’re using and go, very extreme things could come up. So like, No, I don’t want to do this, because I heard that if I do this, this is what’s going to happen. To me, that’s like one of the scariest. The scariest things that I’m starting to hear with patients is Google’s god, I’m like, you can come argue with me about Google. Right? I mean, in a lot of situations, I’m starting to hear like, Oh, this is what I heard in my family members and medical provider, and I’m just like, okay, here, you know, how do we reel it back in. Um, but I do think that so much of the education has to start before we even get to the hospital. You know, for me, because I was a nurse, I knew, like, I had some idea of some things that could potentially happen in some outcomes. And so when the doctor was suggesting I do this, or just that I do that, I was okay with it. Because I had an idea. It wasn’t foreign to me. And then when the doctor left, the nurse would come in and be like, are you okay? Did they answer your questions like that extra layer of support, I was able to have that second conversation where I was like, I really didn’t, wasn’t comfortable with what he was saying, I really think that he should take this baby now. And they’re just like, Well, you know, give it a few more minutes. And like, kind of work with me and my emotions, instead of really making me suppress what I feel. I think that’s hard. Like, when do you tell someone that they could potentially have all of these negative outcomes? Like, I don’t think there’s ever an appropriate time to say what could potentially happen on labor. And when I remember when I was going through in the beginning, I think I was three months. My husband’s like, why are you freaking out about what could potentially happen? I’m like, because all of these things could like, do you either get the patient who’s like me, who is just like trying to control everything, because I know a little bit of something even though I wasn’t an OB nurse, or you get someone like my husband, who was like, just let the people do their job, like it’s fine. And then when we get to the scary point where I have to get rolled back, he’s like, Whoa, what’s happening? Like, how did we get here, right, like, but he never had an opportunity even to be educated about the potential things that could happen. And so I don’t know where we interject in that conversation. If it’s at the six month mark, the seven month mark, to tell people what could potentially happen. If I tell you this, you guys don’t think I’m absolutely crazy… I had my first son. on a Monday my C section, they discharged me on Friday, I was in law school, and there was no virtual option. And they told me if I did not come back to school on that Monday, that they were going to kick me out. Literally, I put on big girl panties, literally, and went to school that Monday after being discharged from the hospital on Friday. Like, even though I knew I could literally die from being outside, not even resting being away from my baby who was one week old. Like, but that’s the society that we have created, where there’s so much pressure from all of these different people and places and decisions that people have to make because of that. And I think some things we can’t control. But I think there is somewhere that there has to be some education, about when we get to these hard decisions. You have to trust the provider. Right? Either you’re going to trust me and instill in me the ability to tell you and you make that decision. Or, you know, let’s talk about what your options are. But I don’t know you know what, that I think that’s a organizational thing or industry thing where people have to decide when and where we talk about these things, because all people see is baby showers and babies right like in pictures of babies at home. You don’t see any of the ugly in between. You don’t see, you know, you don’t see the data and the stats. Like I have friends who never knew that people, that miscarriage was common for every person that I have, like personal friend that I have, who’s had a miscarriage has literally disappeared off the face of the earth, came back months later and was like, I had a miscarriage. And I felt very alone. And I felt very shy. And I’m just like, I’m embarrassed. Why would you never reach out to me? Like, I’m a mom, why would Why would I not embrace you? But I think they didn’t know that one in four women have miscarriages. Like, it’s just not talked about, right? And that’s no one. So I’m like, this is like, no, but where do we have that education? Where do people get that information, so that they know like, what could potentially happen and how to make those decisions. I think a lot of people like critical thinking, if you don’t have the ability to go through the options that the doctor is giving you. All you’re going to go off is instinct, which is most a lot of our patients are just going off instinct, or what you know, or what you’ve heard, everyone’s birth birthing experience is very different. But even when I want to go into my birth, I was like, I need to have a natural birth because all of my friends are having natural birth, they were looking at me like are you crazy, like it took me two days to get an epidural. When I get an epidural. I was like, Oh, my God was I thinking, but there was no one telling me like, you don’t have to sit there and be in pain, like you don’t have to endure, there’s no award on the other side of having a natural birth. Like you can take the epidural if you feel like you can get I don’t know when that happens. I just feel like there’s such a lack of education and information. And then when people do seek that information, it comes from inappropriate resources and sources. And so I think that’s what’s missing. And I think it all then all gets put on the provider to figure it out. And it’s not their responsibility to necessarily educate someone from beginning to end in an emergency.
So yeah, and I feel like I think so much of it comes down to like our, our society, like we’re very focused on success, achievement, good things that have happening in a way that I think sometimes we really just completely disregard a lot of the hard things of life and especially, I think, obviously, social media hasn’t helped that because it feels like everyone’s just living their highlight reel, right? So a lot of we miss a lot of the other…
Abby, MD 12:13
I am. Yeah. [laughter]
Maggie, RNC-OB 12:14
I absolutely agree with you. I think that piece of it in terms of being pregnant and you know, you’re picturing like, great, glowing, and you’ve got the bump, and you know, you’re bonding with a partner, and you know, you’re doing all of these things, and, you know, growing this family, that we’re just just woefully underprepared for how to deal with difficult things that come up, and who to talk to, and where to look for support? And absolutely, I think that, that plays into our mindset, as we’re going into it. And then I think, you know, the flip side of that is it for us, as you know, as providers and, you know, as, as a nurse, like, part of my job is to help people gain some perspective and clarity around that in ways that are appropriate for where they’re at. You know, like, I, I do think that sometimes, for tons of birth stories that I’ve heard, and friends I’ve talked to, and family members, and you know, especially for a lot of people who had an unexpected, right, they’re planning on a vaginal birth. And that’s not how it goes, like so many of them, you know, their stories that just finally a doctor comes in and pretty much drops that you baby’s gonna die if we don’t do this. And I think that it’s especially I think it is so effective. Because in our society, like, we just want to be focused on the happy thing, and you know, the end, right. And I think that it lets people get to that, like, I don’t know, that weird sense that like that they can’t have like that they can’t have a hard conversation there or a hard moment and that we’re not prepared to do that with people and talk through nuance and talk about stuff other than just trying to make it like, if you just do this, then you’ll be happy. If we just do this, the baby will be great. And it you know, I think it created that really harmful like, healthy mom healthy baby rhetoric, which absolutely matters. And again, like if, if you’re only getting one thing, that’s it, but I think we tried to make it like very simplistic, just that we were saying like healthy mom and baby healthy birthing parent and baby just means that you both walked out alive, which, you know, low threshold, right, surviving versus thriving. And I do I think that obviously, we’ve seen like our, you know, our maternal mortality rate is incredibly skewed. You know, it’s much, much, much higher in the black population in the indigenous population in you know, in people color. And I just wonder how quick we are, to jump there and to try to use that as a manipulative tool, instead of an actual conversation that’s hard. You know, like, it’s hard for us to like, I think a lot of people and I and I’ve worked with obviously I’ve worked with excellent physicians and midwives who really take tons of time and they really do try to you know, swing this out, but I I think I would just I wonder how that ties in that, like, if so many of us just want to get to the end part like, this is hard for me right now. And I don’t want things to be hard. And so I just want to say like, this is the answer, you take this, and then we get to their side, and I just get to show you like, and here’s your baby. And like that, we fix it like that. It’s not a bad thing. I think we have that drive to care for people and we want we’re responsible for we want to fix it. We can’t always and I think we see that then, like the birth trauma that comes from that, like, we didn’t necessarily fixed it, we fix this one piece of it, but we didn’t necessarily fix the situation. You know, I don’t know…
Abby, MD 15:36
I think sometimes that dialogue is coming out of a place of provider anxiety. I mean, I, I find myself sometimes involved in deliveries that aren’t going as I wish they would either I don’t have the relationship I want with a patient, or, you know, you have a baby that you know, is probably okay, but you’re even watching a bad strip for a long time. And you’re just not 100%. Sure. And do you think we sometimes get at this moment? where like, crap, have I pushed this too far? Like, Did I make a mistake, am I in a place where I’m now going to deliver a baby who isn’t going to be healthy. And I do think as providers, sometimes when that cycle happens, lose control of what’s coming out or know that maybe like, that’s when you see providers, and it’s important to remember that those of us who are delivering babies are just carrying a lot. The more you do this, the less actually physically anxious you feel when you’re doing it. But there is always this backstory of I hope I don’t make a mistake. And I do sometimes think when you see providers that are suddenly using language and like that they’ve spiraled into a place as providers where they’re worried that they have or they’re about to make a mistake. And suddenly, it’s like, all important that, you know, you say whatever you need to to get somebody delivered and not explaining very well. But I think that’s sometimes is coming from…
Irnise, JD, RN 16:56
I understand that I think I’ve seen the healthcare system that I work in now that when it comes to difficult conversations, a lot of patients complain that the doctors like shut down, and they become very angry, very like in they’re like, Who is this person because this isn’t like we had all the optimism in the world. And they just don’t know how to explain what it is they’re trying to get across in an empathetic way. And time is short, like it’s hard to get someone understand difficult things and a very short period of time. And then you also have the pressure of what are all the other things that you have to do on the all the other patients you have to treat. I you know, I don’t think it’s anyone’s fault. And it’s, it’s how people cope with those things, I think can also be very difficult because some people just hold it all in. And then when they get to that patient who really isn’t listening, it’s like then they explode, right? Like they’re just so built up. Um, but when we talk about like mortality, and the racial disparities, and all those things that come into this, I feel like we’ve talked about the problem for so long, we know that the problem exists. And I feel like we’ve had fewer conversations about solutions and how we get there, how we help providers have those civil conversations, how we help providers to build quick, you know, relationships in a short period of time when that’s not their patient, but they’re on call and they’re in between multiple births. And people are calling you know, how we do that. I think those are the tools and those are the conversation, I hope that we start to happen the next years, where we begin to teach people from, you know, the beginning of their residency how to do that. So that it’s a practice, that when they go out on their own their bedside manner, the practices that they have, are not something new to them, you know, and I think every healthcare system, every hospital has their own rules. And they’re all its detriments when away, you go some places, and they do extremely well. And then you go some places, and you’re just like, you know, left out to dry. And then that’s when all of a sudden the nurses sitting at the bedside, like what the doctor tells you. They’re like, I don’t know. And you’re like, well, I wasn’t in the room, he told me that. The doctors didn’t tell me anything. And you know, and so it’s like, I think we all have to come to a better place of either seeking the tools, creating the tools, having those conversations of how do we do this and make this better? For me, I know that when I hear a lot of black women, even educated black women talk about their birthing experience, no matter what their education or socio economic statuses, they say that they didn’t feel like they were listened to they didn’t feel like they were respected, that it didn’t matter that they you know, had all degrees, it didn’t matter that they had a husband or partner warmer birth experiences. And people don’t know sometimes how to actively listen like what it looks like. Like even though the provider can be listening. Sometimes, the look of actively listening isn’t there. And so even if they’re listening, they’re taking in what someone is saying their reaction to what maybe is being said or what conversation is happening, leaves the other person to think that they’re not listening. And so some of those tools I don’t think are something that are costly. That’s conversations. That’s education. That’s grand rounds. You know, those are the things that we should be talking about is how do we make this practice better so that we are fair and respectful to everyone across the board? I think, you know, when I, when I started to read the articles about maternal mortality, I was like, This is crazy. Like, I just couldn’t understand how someone who had everything who did everything, right, could have such a negative outcome who, you know, is coming in and saying, I’m having symptoms of a blood clot and everyone’s acting like, it’s not a big deal. Like, somebody had to say something like, was it were they ignored? Like, you know, I think the story that is told is that the person was ignored. But I don’t believe that, like, I don’t believe that there wasn’t someone who said something. And figuring that part out, I think, is a layer that’s missing. So we keep putting out data and we keep putting out articles about, you know, the last, but we’re not really figuring out what really happened like, Is it the EMR system, like we have a new EMR system where I’m at? nobody’s listening to anybody, all these people are like, this is crazy, like, so you think? Like, is it that this happened during a transition period where something there was change? Did this happen? You know, as we were getting new residents, new providers, were providers covering a service that they weren’t normally provide, like, all of those things have to come into play to figure out because there’s no way that you can tell me that someone who was articulate enough to express their need, speaking with a provider, who they built relationship is now happening in a negative outcome just because of their race. Like, that’s very hard for me to understand. And so there has to be something else that is happening. Under all of this, whether it’s assumption whether, you know, whatever, to fix it, like not legit like, my thing is, like we’ve talked about, we know this is a problem. And it’s only getting worse to me, which is absolutely crazy. But I’m like, What are the solutions? How do we get to a better place? How do we make black women feel comfortable going in to see a provider who may not look like them, but knowing like, you have my best interest in mind, like how to rebuild that and figure it out to make it better, because I think for me, for a provider, it puts a lot of pressure on the provider, because if you won’t gain and you see like, the data is in the back of your head, your reactions may not be the same where someone who you’re like, Okay, I know this woman probably don’t have a good outcome because she’s white, because she’s, you know, educated because she has, you know, it comes from a good socio economic status per turn, the likelihood of her losing her baby is very, a lot lower than a black woman. So if that maybe that’s some people’s reaction is like, I know the data, I know the stats and like you start reacting in a way, that isn’t your norm, right? When I’ve done some anti racist work with an organization that I was with, and the provider pool been provided for 30 years worked in inner city, basically said to me, like, I don’t know how, I can talk to a black patient, who I’ve been seeing for a long time who comes from this community, but I can’t talk to like, you, like talking about me. And I’m sitting next to him. And I’m like, Oh, hello, how are you? Like, do I speak a foreign language? Like, what is it, but there was, he literally said that to me, like without missing a step, there’s something that’s going on in our minds in people’s hearts and people’s opinions, that is causing a barrier that they don’t even realize is there. And I feel like until we figure that out, then we’ll be talking about the negative outcome, and not really figuring out how do we eradicate that and save people’s lives and save people’s babies and have a better experience for everybody? Because no provider wants that on their plate and no patient wants that on them.
Abby, MD 23:44
I was just gonna say I think your points of teaching medical providers to really communicate effectively, I think that is a little piece of, of one of the things we can do. I mean, I agree in medical education, we’re not giving our young doctors and nurses enough tools to work with at the bedside, I remember. You know, somebody really smart saying me, to me once like nobody’s coming to the hospital three in the morning, you know, because they lost their mucus plug. Because there isn’t something in their head that they’re really worried even like nobody’s coming hospital three o’clock in the morning. Because of something that’s not really important to them. And your job is to figure out what’s important to them. Is it really that they were scared about their mucous plug? Is it that they think something bigger is going on is that there’s something else that they’re scared about? Like, you need to sit and you need to be present enough with that person that you figure out why they’re there, and you need to make damn well sure that when they leave the hospital, they’re on the same page you are that they’re safe enough to leave. And I think it’s hard to teach those skills and I think all of us need continuing not just in medical and nursing. schools but we need sort of continuing education and reflection, we need people to watch us and how we interact with patients. I think we need third party people giving feedback on how interactions have gone. I think we sometimes need to talk to our, you know, really hear from our patients after we’ve communicated about what they’re, you know, what they think the message was. And I don’t see that happening, happening Well, at all.
Maggie, RNC-OB: 25:30
No, I don’t think we could we’ve put good systems in place, you know, for that, because I and I, I mean, yeah, I think most of us, I mean, sure, some people have a terrible bedside manner. Some people just are awful communicators. And some people own that, and they don’t care. All right, fine. They’re outliers. Sure. But the vast majority of us, we are intending to go into a conversation, make a connection, develop a rapport, understand what that person is going through. But I do think, I mean, to what you were saying, Irnise, systemic racism, it is so pervasive in our medical and nursing education. And, you know, unfortunately, there are still so many of those textbooks. I mean, they’re literally being published 2020, that still have those, you know, god awful, cultural competency, a chart, you know, this little box, it’s supposed to tell you like, so if you’re, if you’re talking to someone, it looks like this, these are things they care about, and that those are still being published right now. So people are still, you know, they’re not getting, they’re getting very narrow views of what is meant to represent or help them to dialogue and have a conversation with people. And then so many of us like, we’re not bothering to do more education, to find out more paths to realize like, Well, of course, that doesn’t make sense. Like, of course, that wouldn’t be how I figure out to relate to be blunt, Dr. Joia Crear-Perry is an OB GYN, and she founded the National Birth Equity Collaborative organization. So it’s all completely focused on this, you know, bringing equity to it. And one of the things that she has just said over and over and every like webinar talk I’ve been able to have her to listen to from her is the you know, it’s “it’s racism, not race.” So often when we’ve looked at this stuff, and we’ve had the conversations, and we’ve done the research, and like you said, we’ve talked it to death, like this is happening. This is happening this it’s Yeah, agreed it’s happening. But people have wanted to pretend that it’s just about like that there’s something right here, if we could just figure out what it is about it, instead of recognizing that like, no, every time we look at it, like it’s not education, it’s not socioeconomic status, it’s not anything else to do with their health history. It is because of these racist tropes that continue to follow us through. And one of the things that I think will be really helpful for understanding this and kind of tying back to that idea of like, how are we actually perceived by the people in our care? Because that’s what matters what you know, impact over intent, like if we think we’re being warm and fuzzy, and we’re doing this and we’re actually making people feel like crap, well, then, doesn’t matter what we thought, Dr. Karen Scott is doing a so that’s a Sacred Birth Study. And so they’re doing this whole study looking into all of these, they’re doing it all over the place. She’s based in California, but looking particularly into what are the experience of black birthing people, when they interact with their health care providers to understand what’s going on there. And to get a better sense of both like the the clinical interactions that they’re having, and like, the greater social context around that, to get a sense, and it’s like they are, they put all the different scales together to really get one that really valid is looking at all of this, these different contexts to try to actually get more to the bottom of like, this is what it is, this is what happened here, the examples and then eventually, it’ll be and here are the action steps that we’re going to take. And so I am like, I’m so excited to have people who are really, because obviously, people have been working on that for decades, but not getting attention, not getting enough funding, not getting anyone to give them you know, I see it on social media where people say like, Oh, yeah, those are and then they come back with like, you know, the recommendation is do another study on it. No! Sure, once we validate something that’s necessary, but then actually change it. Like we don’t need to just keep saying it’s happening.
Irnise, JD, RN:
Yeah, so I think that one of the things I think I learned early in my career is that I had my own implicit biases. And I think, you know, it’s a loaded conversation because people kind of think, implicit bias and racism, which is not necessarily true, because as a black person, I can be implicitly bias against another black person, like it doesn’t, you know, it’s not necessarily race related. And I noticed, like, what all of my triggers were very early one because I had a professor who was I took care of a patient on my maternal health clinicals, who was like, 13. And she had a baby and I was like, I cannot take care of her. She thought he was like, I was like, she can’t say the word vagina. She was like talking about like, the word she was describing. I was asking her about her Peri care, and she just could not even say the word vagina, and I was like, I can’t take care of her and she was like, excuse me, like you are in there. This is what she just gathered me up. You’re right. To put my feelings of how I felt about this young girl having sex to have a child yet having a child and not being able to say vagina, and like, suppress that, to provide her proper care, but I can tell you for the first two hours I had her, I don’t even know what was happening because I was just looking at her like, how did we came here, let you out the house at 13, like I was, in my own mind, just confused at the fact that the 13 year old had a baby. And so my instructor gathering me up, always reminded me when I go into a situation where I have these thoughts, that they can block how I engage with them, they can block how I could not tell you, he said for those first few hours, because I was just I was through. And every time I go into a situation to care for a patient, and I noticed that kind of, you know, feeling flaring up regardless of why I may be having a bias or I’m able to check myself, I think that that’s the issue is that people have implicit biases, they don’t realize that they do a barrier then comes up, and you really may not be hearing the person who’s sitting in front of you. But you can’t ever check yourself because you’ve never been checked, you’ve never had anyone teach you how to check yourself. You’ve never had anyone teach you of how to recognize when you’re having these implicit biases. And I think sometimes people take certain people’s reactions to something personal or just in a way that they just wouldn’t agree with. And then a barrier immediately comes up. Like I think with, I remember when the provider came and sat at my bedside and I was like, Listen, this is what we’re gonna do. And I’m not gonna take anything else. And he just laughed at me was like, okay, girl, and then he went out and told the nurses, and the nurses are like, Oh, she’s a nurse. She was at Howard. He was like, came back with, why didn’t you tell me you were a nurse. And I was like, because that’s none of your business. But he was he wasn’t, you know, I wasn’t I was able to have that conversation and that connection with him and feel comfortable with him. Even though we’re as some people would have took it that I was nasty. I had an attitude. I was rude, right? And would have been treated me differently because of that reaction, where he just understood I was frustrated. My husband was sleeping, and everyone’s eating and I was hungry, like you recognize all of those things about I think that and other situations where I had my second baby, and they were just they could not understand why they want to get a blood transfusion. Why wasn’t willing to do that. So like, every time they would tell something, I was like, I don’t really want to do that. They would they just couldn’t understand because maybe I missed the the one thing that I asked for when I had my second baby was I wanted a lactation consultant to come. Because I struggled the first time and when I was at my first hospital, I had my first son, it took them a couple days. But she came she helped me Everything was perfect. They couldn’t get someone to come. And I was like, there’s no reason for me to stay here. I don’t care if I die, I’m there. I cannot they for five days you can’t get elected and a nurse who is certified to come help me breastfeed. And I had trouble breastfeeding for four months. Right? Even when I came back to the house, volunteer lactation consultant classes, I did all of these things. We struggled for four. And he nobody cared that the only thing that was important to them were my labs. And I’m telling them breastfeeding is not it’s like that was the barrier. Right? And so I think people don’t realize that, that whatever your focus may be, may not be with the patient focus, maybe, right? Like if the patient is literally fixated on this one thing, sometimes you just got to figure it out how to either give it to them or explain why you can’t get it. I mean,
Abby, MD 33:43
You almost need to be patient. And I’m thinking a lot about like provider tools to get through these conversations that are difficult. But I think sometimes also giving patient tool patients tools, ways to just say, Look, I don’t feel like you’re listening to me, this is what I need right now. And then on the flip side of that we need to be doing those kinds of things to or calling out awkward conversations and situations. I feel like, you know, it’s often extremely helpful in a conversation where things aren’t going well to just stop and be like, I sensed that you’re really angry. And I need to know why that is and what I can do to fix this, like I think sometimes really, like calling it out when when a communication barrier exists is important. And I think on both sides that can be improved.
Irnise, JD, RN 34:29
Yeah, I don’t think…I do think there are times where patients don’t feel empowered. I’ve been in situations the patient where I didn’t feel empowered to question the doctor or to ask more questions, and then the doctor leaves and, you know, I’m sitting there feeling more lost, like I know and I think people may feel like that, you know where they The doctor is God even though you may not agree with what they’re saying, and then they’re leaves, you know, there. That’s why I think the room for error happens where the doctor has said something you seemingly agreed because you didn’t say Anything or, you know, protest, basically. And then the doctor assumes that you agree with the plan, and then the plan goes in. And if the outcome is not what they wanted, they said, Well, that’s not what I wanted anyway, you’re like, but you didn’t say that. And then like, I didn’t even know that I needed to say that. Right.
Abby, MD 35:25
Yeah. I think sometimes just a quick like, I need you to tell me, like your understanding of our conversation, you need to tell me what what your understanding of your options are, and where we need to go from here.
Maggie, RNC-OB 35:37
Yeah, I feel like so much of it just comes down to like, it comes back to like that time, which is precious, and we don’t always have enough of it. You know, beyond our control that like, if we just had enough time to constantly just sit, pull up a chair. Okay, let’s get into it. What do we actually need to go and like, have a conversation instead of trying to go because I’ve totally done it to where you would love to just like, go into the room? Get this? Yes. And then I go into the next thing, because you’re just we’re busy. Yep.
Irnise, JD, RN
The home, I think, for me, the optimism that I have is that we’ve overcome some very difficult things and that we can get through this, like we can figure it out, it may take some time, it may take some tools, it may take training, it may take money, but we have to figure it out. And even if that means that as an as an industry, that we have to advocate for ourselves more, you know, go to the legislators ourselves, and not just lobbyists for the hospitals. For us, then maybe, you know, as an industry as providers, as you know, doctors who are have been harmed in this situation can speak for themselves. Because if you put a lobbyist at the front of that to speak for you, your outcome is not going to be what it is. But if each individual provider actually spoke off about their situation to their congressional representatives on the state side, and then nationally, I think the conversation will move a lot faster and push forward instead of sitting in committee where nothing is being is figured out. So I hope that we can become better advocates, as you’ve seen how they treat health care providers in 2020. At its own needed Yeah.
Maggie, RNC-OB:
Well, thank you both so much for this I honestly, if we could just keep talking about this. Like it’s such a, there’s so many layers to this conversation and just getting the whole big picture about what actually needs to change and respecting the feelings and the difficulties that are there on all all sides of situation.
Irnise, JD, RN
Yeah. So much for having me. pleasure meeting you, Dr. Dennis.
Abby, MD 37:46
Oh, it’s Abby. I hope we get to talk again, at some point. Yes.
Maggie, RNC-OB 37:50
Thank you both. I appreciate it.
Thanks for tuning in. We love to talk BIRTH and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. So we would love to hear from you. What has been your experience with relating to, you know, whether you’re a pregnant person, someone who’s given birth in the past? How did you find good connection? What helped you to relate to your care providers, whether that was physicians, midwives, nurses, doulas, anyone else who helped you to feel comfortable along your pregnancy birth postpartum journey. And we’d love to hear from our professionals out there in terms of what you have done to bridge this gap and make it so it’s easier for you to have difficult conversations to relate to those in your care. Till next time!
023: Perinatal Mental Health & COVID-19
Maggie, RNC-OB 0:05
Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. So today we are digging into a topic, perinatal mental health. And this is one that I think has often been just ignored or kind of push the side within birth care. And that is never Okay. And then adding in all of the complexities that 2020 has brought into our lives and brought to the forefront of our attention. We felt like it was the time to dive into this topic a little bit deeper. And to get an understanding of what we can do now as birth pros, to mitigate a little bit of the stresses that those in our care are feeling and to learn better tools that we can share, to ease some of this and make sure that we are tuning into mental health and well being just as much as we are turning into physical health. I’m really excited to welcome Emily Souder onto the podcast to dive into this topic with us, and to share some of her experience and recommendations. Onto the show!
Wonderful. Well, Emily, I am so glad you could join us on the podcast to talk about all this. And we would just love to introduce you to our listeners a little bit if you can just tell us about yourself.
Emily, PMH-C 1:39
Sure, absolutely. My name is Emily Souder, and I am a licensed clinical social worker, I work as a licensed therapist. I’m certified in perinatal mental health. And in my other business, I’m also an intuitive guide and Reiki Master practitioner. So I have sort of these things going on at the same time. And I do a lot of time writing as well. But most of my time has been spent in the perinatal mental health space this year.
Maggie, RNC-OB 2:05
Yeah, yeah, well, and I, obviously, there’s, there’s just so much happening right now that I’m sure that there is just a wealth of need for all those different services that you’re providing. And I love how you stepped into them. I’d like to just kind of set the stage first by talking about kind of mental health as it fits into the perinatal scope. So in my background as a labor delivery nurse, and working most frequently in like hospital based practices, mental health often is best thought or kind of a bonus, even when we actually are really able to address it beyond kind of the role like getting report or reading someone’s chart and seeing “Oh, they have a history of you know, mental health issue.” It rarely, rarely, like comes up beyond that. And so I’d love to talk, if you want to speak to that idea of where do you think-Or why do you think that there is kind of this disconnect between the physical health of someone and then their, you know, emotional or mental well being?
Emily, PMH-C 3:01
Yeah, I think that a lot of times, we still as providers have almost this idea that the mental wellness, wellness and the mental life of somebody has cut off sort of from the rest of their health and the rest of that picture of what wellness looks like for someone. And it’s almost as though people have forgotten that all of those things are connected. And all of those things are worthwhile, because they all impact the other, you know, somebody’s physical wellness can very easily impact their mental health and vice versa. So there’s this loop that we forget, and we just sort of like cut off that connection. And it’s a huge missed opportunity to be able to see people as a whole, you know, not only as themselves, but in the system and in the environment in which they exist. And that’s just something that I think has a lot to do with the lens that I don’t know, you know, perhaps training and perhaps the larger culture in which we find ourselves that there’s not this. It’s sort of like this forgotten idea that we are all these whole beings and that the mental health is part of that. And it’s not a taboo thing to discuss. It’s a really important and rich part of being well and healthy.
Maggie, RNC-OB 4:27
Yeah, I do think obviously that taboo and the stigma, you know, certainly plays into it, I and I know, I myself can look back at times where I’ve been informed of someone who’s in my care of, you know, a mental health issue that they’ve had in the past and I haven’t really known how to broach the subject with them in a way that feels that you know, demonstrates my authentic, caring about wanting to make sure that all of them is well and not that I’m trying to pick apart their story or Ask them to share more of themselves than they actually want to and I think, at times, you know, during birth, there are so many different, you know, factors at play. And it can be really helpful to kind of understand as many of the different lenses that the person in our care kind of has. But we’re also weighing that with this, obviously respect of their privacy, I am, for all other intents & purposes, a stranger, you know, to them. And so I do think it’s sometimes it’s kind of hard to want to respect their privacy and not pry, but also want to demonstrate that, like, I just really want to understand what is going on how you are actually doing in this moment really, like, not a fake, “I’m fine” answer. So that I can actually be, you know, supportive and caring and aware of that. And I don’t know, if you have any kind of tips to share about navigating that within that kind of like a, it’s a quick rapport building, not months and months of care.
Emily, PMH-C 5:56
Right, exactly. And, and the truth is that, it will be easier to connect with some people and others. And that’s because we’re all bringing our own stuff into the space or the room with us, that’s just, you know, how it is with human interaction, you know, and I think that if we find ourselves in a really warm place of curiosity, you know, just getting curious about the things that kind of make this person who they are in the room with you like, what they are looking to accomplish, and the things that matter to them, and the things that they either are able to do or not able to do based on how they’re feeling really being a non judgmental space, and kind of even saying, you know, like, sometimes, you know, after having a baby, or sometimes when they’re pregnant women have thoughts of for instance, as an example, scary thoughts, you know, of falling down the stairs with their baby, or seeing themselves seeing something awful happening. And if we normalize some of that meaning that give you know that we give people an opening to see that they’re not the only ones who might be having some of these things come up. And that helps to make us a safe place to because a lot of times, you know, people don’t want to be seen as crazy. They don’t want to be seen as unfit to be with their kiddos, or like they don’t, you know, they’ve just, they’re not used to getting vulnerable in that way. So, kind of opening, setting the stage and saying, you know, it’s something that a lot of people experience during, or after pregnancy, to, you know, have anxious feelings or have depressed feelings, and you won’t feel like that forever. But it also sounds like, you know, you’re really having a rough time or, you know, just really being an open space. I think open and non judgmental are the biggest two words and warm, you know, some people not in a fake warm way, but just like this open curiosity. I’m just thinking about so Karen Kleiman is a woman who she’s a therapist who is in Philadelphia, and she started the Postpartum Stress Center, a really big pioneer in perinatal mental health. And I was just like answering this question. I’m thinking of her book. It’s called The Art of Holding in Therapy. And it talks about how, you know, as, as therapists in particular, we hold space, but therapists aren’t the only people to do that, you know, especially in the birth world. But we need to do it in a way that there’s patience and non judgment. And just, yeah, I keep coming back to openness.
Maggie, RNC-OB 8:46
Mm hmm. That’s great. I’ll have to I haven’t heard of that book. I’ll look into it. And I’ll link it in the show notes for everyone listening so you can find easily. I do you think that that idea of like holding space is not something necessarily that our culture has valued, or that’s something that we necessarily learn, I think we’re just so often in a rush. And we kind of can be very, you know, solution oriented. And it’s very hard for me, myself included, to pause and just be like, open and hearing and doing the act of listening without trying to jump ahead already to like, fixing it. I do feel like certainly for me, sometimes that hesitation to like start the conversation to get into it. It’s because we don’t have a solution to offer. And so we feel uncomfortable, if someone is open back to us and unloads all of these things that are going on for them that are that are really heavy, and that are not something we can just like, oh, let me go get you an ice pack…
Emily, PMH-C 9:41
We can’t we can’t even fix it all the time.
Maggie, RNC-OB 9:44
Like I think that I think that stops us from doing anything because we then don’t want to have that sense of being unhelpful, more not able to, you know, to take care of someone.
Emily, PMH-C 9:55
Yeah.
Maggie, RNC-OB 9:56
You know, one of the ways that we can as provider Just get more comfortable with that piece of not having the answer or the solution and just being there to hold space and, and then obviously, as appropriate giving referrals, you know, to therapists to people who can then help process it down the line.
Emily, PMH-C 10:14
Absolutely. But a lot of it is practice. And some of us I’d say a lot of us aren’t comfortable with pauses in speech or conversation, or, you know, even the idea of not being able to fix something not being able to have a specific, a specific idea, or a specific skill to teach or something like that, that can be so hard because like you said, we want to feel effective. We wanted like, that’s our little like, I’m doing my job, I did this thing, I shared this skill, I taught this, you know, coping technique, and sometimes the value is just in the relationship. Sometimes the value that we offer is just in sitting with someone these days, virtually, or otherwise, to be able to hear their story, and not run away and hear the entirety of it in all of the stuff that some people will kind of, you know, just kind of dismiss, like, Oh, you know, but yeah, you had this, this upsetting thing happened during your birth experience, but you have a healthy baby. So, you know, who really cares? You know, we like being the person being the space to sit with the person, as they really say, and I feel traumatized. You know, yes, I have a healthy baby. And I feel traumatized, you know, like, so that we are, so there’s value in that, that is still doing a job, you know,
Maggie, RNC-OB 11:45
and that’s a great point. Yeah, I do. I think we, again, we’re just very quick to, to throw that like button on there and try to like wrap it up in a bow and just say like, but it’s also fine. When the answer is often that like, it’s not…
Emily, PMH-C 11:58
Exactly.
Maggie, RNC-OB 11:59
But it will be eventually. And there’s things that you can do to work through that. That’s really important, like distinction. And exactly, that is helpful, too, just to recognize that as, as its own gift that you can give someone is that just openness and accepting, and not trying to rush and make it make it right or force into processing. They’re not ready to. So and then I I feel like this this time that we are existing in and we also are happened to be recording this on November 3. So it’s Election Day here. And you know, there are just so many complicated dynamics at play this year, I think I mean, I feel like for almost anyone I’ve talked to of any age 2020 is certainly showing up to be just a year to try all yours. And so, you know, if you could speak a little bit to, to that and what you’re seeing, you know, going on, and how we’re kind of how we can kind of balance all those different layers of just stress and anxiety that’s hitting everyone to different degrees.
Emily, PMH-C 13:02
Yeah, and I will, I’ll start by saying I don’t have the one answer, because this is still so unprecedented. I think there’s still so many things we’re figuring out. And I will also speak to things that could be helpful. But just to start, you know, even baseline pre pandemic pre racial injustice, and recently I was in a presentation to that added on the third part about climate change and environmental injustice, as being a third aspect of things that are really going on right now. Bu pre-, pre all of these things are, you know, not that they just started, right, but pre pandemic, pregnancy and postpartum were things that could be challenging, they were things that can be challenging. Anyway, you know, because of because even pre pandemic, you know, our expectations don’t always, you know, happen, parenting looks different than we thought it would, birth looks different than we thought it would. So they’re already these things to grapple with. So that stuff is still coming up, that hasn’t stopped. But there’s it’s two different degrees, because one of the things that’s being really impacted is what our social support looks like, and how people are able to be supported in the postpartum period. So I would say that for the first couple months, so we think back to like mid March, when things started kind of shutting down and everybody was sort of in survival mode. Now, we’re still in survival mode, but a lot of us are kind of like I’m in survival mode. And I’ve also recognized I need this sort of support. So things were relatively quiet in my therapy practice for the first couple months of, of people being, you know, social distancing and everything. And then it was like at the end of mid May, it was, when I started offering the group therapy group for people who have given birth during the pandemic. That was when people started, it was like something started picking up, there was this energy behind it. And almost like people were waking up out of that initial survival period and realizing, “Oh, my gosh, I’m feeling really hurt and upset by how things didn’t go.” And not only that, but I’m seeing ways I can connect with people, whether it’s a therapist, or like a support group or something like that. And I apologize, because my kids are making all sorts of noise. This is just typical.
Maggie, RNC-OB 15:44
Yeah, this is real, real live zoom life. Here we go.
Emily, PMH-C 15:48
And I forgot to mention in the beginning, that I’m also a mother of a three year old and a newly today six year old, so
Maggie, RNC-OB 15:55
and a happy birthday to them!
Emily, PMH-C 15:57
so that’s going on as well. But, you know, there was really just people had ideas about meeting up for, you know, coffee with their other new mom friend or their other new parent friend, and they had ideas of what that would look like, and what playdates would look like, or even just being able to, like chat over coffee, while their babies just, you know, played next to each other on a blanket or whatever, and, or their mom coming into town. And all of those things have been disrupted. So it’s like, all of these little things coming together, and the not so little things, you know, several parents that I work with have had NICU stays, which looked, you know, again, baseline and NICU stay will be very upsetting. And now we’re only one parent was able to be there at a time. And at least in the beginning. I think now, maybe there might be some different fields to correct me on that. But
Maggie, RNC-OB 16:53
Yeah, obviously still, you know, place to place dependent, but I do, I’m hearing a lot more of kind of loosening back to kind of previous expectations around that now that there’s just more, I think, more rapid testing, and yeah, better access to PPE and all those things that, you know, it’s kind of give hospitals reassurance about working their way back to a more full visitation. Right.
Emily, PMH-C 17:13
Yeah. But back, yeah, back in March and April and May, and like, there was just, you know, people weren’t able to have the support that they envisioned that they thought they would have they planned for, because people might have really planned Well, for their support after, you know, that’s one of the things we talked about, you know, when possible, you know, during pregnancy, thinking about who’s going to be able to help with the logistical things, who’s going to be able to help with the emotional support. And you could have done the best job with all of that, and then COVID happens. So. So there’s there more layers of, you know, challenge and even trauma, because some of these things can occur to some of us is traumatic trauma is extremely relative. And I’ve definitely worked with several people who have had that sort of experience from all of this. And so what can we do with that? Well, you know, one of the things that I think is really important, is connecting in ways that we can finding if there is an online support or therapy group, because there’s something about being in this cohort of other parents who are going through birthing and newborn and infant stage right now, there’s something being with other people going through that that can be really powerful, even if it is a virtual connection. So you know, having having that interaction, you know, having distance movie nights with your sister, if she’s around, you’re able to do that having, you know, still signing up for things like meal trains, and having people do contactless drop off at your porch, if that’s something that you’re comfortable with. And, you know, having, if you have a partner that’s helping you, you know, really finding ways to connect with them and be on the same page, you know, at least like a sort of, like weekly check in. I have one client who does a daily every morning with her husband, they have like a check in. But yeah, having something like that, too, can really help.
Maggie, RNC-OB 19:18
Yeah, I think that that check integrated, because I do think there’s something about, especially at the beginning, again, because this has been for such a long time that we’ve gone through all these different phases. But I do think it’s easy, you feel like you’re you’re physically with people all the time. So you get that sense that they must understand what you’re going through, because you’re with them so much. And then, but there’s still so much that gets lost and like you said, everyone’s experiencing things in, you know, in different ways. And I think that’s often you know, there’s also a difference because of just hormones and experience, you know, between the birthing parent and you know, another partner and how they’re perceiving everything that’s happening and all these transitions, that definitely can you know, complicate that dynamic. And then I think when you are I’ve heard from a couple of people who, you know, had babies during this time that then there’s just there’s been a lot of extra pressure put on the non birthing parent to try to help meet all these needs that there is sometimes just because of, you know, personal comfort and safety, just there’s physically no one else there to do it. That that’s been a big strain on a lot of those relationships, you know, obviously, because then there’s just that many more expectations that can’t, can’t be met by one other person.
Emily, PMH-C 20:29
Exactly, yeah. And that’s not sustainable, that’s not sustainable, sustainable for them. Because even the non birthing partner has, you know, the wellness needs that they need to meet, you know, whether they, they need some time on their own, if they’re an introvert, or just some time to breathe or get some movement in. And I think, you know, some things that people have done to kind of solve that is to be able to well either first of all, like bubble up with a family that they feel safe with, or make, take some risks that on balance. You know, for instance, like having a mom fly in from out of state, for instance, there’s some risk involved, right. And when you balance it against the other stuff that’s going on, when we’re talking about mental health, and functioning and all of that, that stuff’s really important too. So finding a balance that works for any given family, about how, you know, they can be best supported, because that’s really important, too.
Maggie, RNC-OB 21:40
Yeah. And again, I feel like back to you, when we first started talking about that, I think, for us, as you know, birth pros, and when we’re talking to you about this, so much of our, our experience in our training is very focused on that physical health piece of it. So it’s easier for us to talk about, like, right safe hand washing and masks and taking care of all these things, you know, safety wise, related to our physical health around COVID. But we can sometimes kind of put those at a higher place, and they should be in comparison to our whole relative health. And so I do think it’s important just to remember that like, right, there isn’t this, you know, it’s not a one size fits all, for each, you know, in each individual, each family, and that we can be comfortable speaking to some of those nuances, you know, with those that are in our care, instead of trying to have some, you know, hard party line, absolutely, you know, that public health wise versus individual health in the person we’re taking care of, and what they actually need.
Emily, PMH-C 22:35
Absolutely, yeah. And that, like I said, that’s going to look different for everybody. And, you know, it doesn’t have to be like, oh, we’re gonna, you know, just throw out all the boundaries and throw it out all the you know, but, but finding, you know, I guess the ways that you can meet your needs, well, while taking on minimal risk, but ways to really, like have the biggest impact on the the mental health or the, the part of you that needs to be hugged by your mom, or your dad, or, you know, whoever, whatever, family member, whatever, friend, if it’s a friend like that’s like family, yeah, stuff really matters, you know, because we don’t want it’s not, you know, having a having a parent who has untreated depression or anxiety, etc. After baby’s born impacts, how, how baby develops, and that relationship, so that’s really important, too. So yeah, always thinking about it, like relative risk, and what is the balance here? And what? How can we make this work? Hmm. Yeah.
Maggie, RNC-OB 23:42
I think the other piece of it that, you know, goes along, because there’s just so many factors at play right now. I think in some ways, they’re a piece of it felt like we’re all going through the same things, you know, together. But then there’s also huge differences in our lived experience, and you know, all these myriad of things that just differentiate how we can respond that based on our, our history and our relative resources. And so I think sometimes as, you know, birth pros on the side where we want to help someone out and relate to them. But we also don’t want to minimize the differences in our experience or try to equate our experience to theirs. Can you speak to that a little bit and kind of how do we go through just all of these The, the try pandemics that are you know, happening right now?
Emily, PMH-C 24:35
Yeah, yeah, absolutely. You know, I think, listening and validating and sort of, no matter what thing I hear you, and I believe you, you know, about somebody who’s experienced not trying to talk them out of it, or, you know, put you know, look at the bright side, just like kind of thing I hear you and I believe you and I see what you’re experiencing? At least, you know, I see what you’re telling me. And really allowing them to just candidly, just authentically express that, without even putting yourself in it at first, you know, without even, you know, depending on the conversation, you know, if it’s a back and forth, then, you know, maybe eventually get to you. But first focus on the person’s experience, if somebody’s sharing with you, somebody’s telling you, like, really, like, ask them questions about it, you know, ask them questions about how they feel about this, or the things that they might be doing already to, to address it or just not even ask questions, but just to listen. And one of the things that I’ve seen people do, that I think is important to avoid is sort of competing, you know, about like, Oh, well, you have this going on, I have this going on. So you know, and just sort of this, like struggling enough, or whatever thing. Yeah, like, like one upping and saying, you know, and, and just really, before you even share about your own experience, making sure that what you say, honors the other person’s experience first, and you might not understand it, but believing them that their story is true and valid, even if you don’t know anything about it. You know, even if your history, your background, your upbringing, has given you nothing to relate to it, you can still relate to another human by hearing them. Yeah.
Maggie, RNC-OB 26:42
And as I feel like we’re all creating that kind of like authentic connection. And I do well, I do think that it is, it’s great that there are so many, you know, different virtual experiences that are coming up. I do wonder sometimes just about like that, it’s harder to get that sense that you’re really like, tuned in, and that the person who you’re talking to isn’t distracted, just by again, just by everything else that’s happening, kind of outside the screen. But it obviously seems like so much of our life will continue in these kind of virtual spaces. Predominantly, for now, do you have any kind of tips that you can give in terms of kind of like that, just that like kind of the zoom, just zoom fatigue, and that feeling of like not, it’s feeling almost harder to engage that way, even though that might be what you really desperately need. I don’t know, if you’ve seen kind of, or ways that what people can help to kind of create communities that actually allow for that kind of authentic sharing even within this.
Emily, PMH-C 27:39
So, you know, I will note and just to completely, you know, hear what you’re saying around like the zoom fatigue, because, you know, when I first started seeing like I even pre pandemic, I was seeing clients virtually not as much I was seeing some clients in their home. And and, you know, honestly, I probably will stay with this for the foreseeable future. There is there’s something there’s something depleting in a different way, about, about having the virtual presence now. I think part of it comes from, you know, sometimes a lot of the time I spend time looking at my webcam versus the other person, I go back and forth. But like, if I’m talking to somebody, like I’m talking to you right now, I’m looking at my webcam so that it looks like I’m looking like, I want you to feel like I’m looking at you. Right, right. And that, I mean, how often do we for an hour, so like my therapy sessions with clients are usually 60 minutes? How often do we spend 60 minutes or most of 60 minutes looking at one single point, like, on a and so that’s just like thinking about physical strain when it comes to the other stuff. You know, I think that there’s a whole range of what a lot of us need based on whether it’s our love languages, or whether we identify as highly sensitive. As a highly sensitive person, sometimes it helps me to have better energetic boundaries in the virtual space. Because, well, for the, for the simple reason that there you know, we’re not in the same physical space together. And sometimes that helps with the energy transfer. Um, and with that said, sometimes there can be what feels like a lack of warmth, or something like that. So for people who, for people who, who experienced that, I think one thing that I found that helps me and it seems to be I’ve seen some of my clients do it too, or like I’ll ask them to do it is like putting your hand on your heart while we’re talking or something like that, because that really allows you to connect in with your body. Hmm. And, you know, feeling your physical body and connecting with your physical body during conversations is a way to, I think anything grounding is really helpful. Because there’s something detached, right? There’s something attached about this type of this way of interacting. And so I think that even though we might not be connecting with the other person in the same way, like whether it’s a grounding visualization, which I do with my clients a lot, or it’s this, like, you know, physical touch with your body, it can really help to sort of bring you back into your body from like, this virtual space.
Maggie, RNC-OB 30:51
Now, that’s really powerful. Obviously, I’ve been doing it here now as you’d like, set it in it is there is something about that, that it is it’s grounding. And it does ground…
Emily, PMH-C 30:58
It’s so interesting.
Maggie, RNC-OB 31:01
that energy and that sense of where you are, yes, exactly in space. That’s great. And then, you know, as we’re kind of wrapping up here, are there any particular resources that we can share with birthing folks if they are looking for, you know, whether it’s therapists groups that, you know, places we can send people where they can find something like this? I know, some of these researchers still kind of new and it’s hard to they’re not as global as right, as some things.
Emily, PMH-C 31:29
Right? Absolutely. The biggest one, without a doubt is Postpartum Support International, and that is postpartum.net I believe. They have so many online support groups, I mean for almost anything you can imagine. They also have managed speaking options as well. They also have, so there’s a listing of therapists there. And you can check with whether they’re certified in perinatal mental health or whatever whether they have experienced I mean, I’m assuming if they’re listed on there at all, they have experience, right. And each state has at least one coordinator. I’m trying to I’m just thinking like word searching here. I think it’s like, Support Coordinator or something, but it’s the type of coordinator…
Maggie, RNC-OB 32:13
I do think they’re called support coordinators, right? Yeah. Okay.
Emily, PMH-C 32:16
Right. And so you can reach out to them, and they can start to get you connected with resources in your area. The great thing about the virtual, the more virtual support that we’re offering now is that there you know, many areas in different states where there aren’t people who specialize in perinatal mental health and so well, now you have access to these people. Because you know, even if you’re I think Southern Maryland is one that might not have a time of perinatal mental health therapists, they’re in that way, distance doesn’t matter. Right. You know, you can work with somebody. So that’s been really nice as far as increasing access. So Postpartum Support International. Not to give a plug for in another podcast, like I don’t I certainly don’t want to say
Maggie, RNC-OB 33:01
Oh, no, absolutely!
Emily, PMH-C 33:02
So it’s Mom & Mind is another podcast that’s really wonderful talking about all sorts of topics when it comes to the perinatal period and mental wellness. I’m trying to think of others. I mean, I feel like I’m going to be thinking later, like, “Oh, I should have mentioned this.”
Maggie, RNC-OB 33:24
That’s ok, Emily, you could email me later, and I’ll add them into the shownotes if anything else comes up?
Emily, PMH-C 33:30
Oh, and also, the Loveland foundation is Rachel Cargle’s organization. And do you know of it? Yes. Yeah. Yes. And they do therapy for black women and girls. And that’s the organization that my therapy practice donates to, like, that’s what we specifically give to. And, you know, so that’s a really good resource. But I’ll think I know that there are others, but PSI is a really, really great place to start.
Maggie, RNC-OB 33:59
Okay, great place to start. That is, that’s perfect. That’s great. I’ll link all of that, you know, look around for some other resources to kind of help people, as we’re just all, you know, navigating all this. Is there anything else you’d like to kind of share with our audience on this, anything I didn’t get a chance to touch on?
Emily, PMH-C 34:18
The only thing I think I’ll say, and I’m always a big advocate for birth story, reflection, but I feel like even now more than ever, that taking the time to do that is is really valuable. I think that having that space to think about particularly the work that I do with clients, when I use the guide that I wrote is around like, your inner experience of your birth experience. So I think that that’s particularly important right now and can be really healing.
Maggie, RNC-OB 34:54
That’s beautiful. And we’ll link to where people can get access to the guide so that they can work through that too. That’s great.
Emily, PMH-C 34:59
Great.
Maggie, RNC-OB 35:00
Well, thank you, Emily so much. I really appreciate you just sharing all of your experience with us and helping us to think through how we can all kind of get through this time with just a little bit more health.
Emily, PMH-C 35:12
Thank you so much for having me. It’s been really fun to connect. really enjoy talking with you. Thank you.
Maggie, RNC-OB 35:20
Thanks for tuning in. We love to talk birth, and we’d love to talk about with you. Please join the conversation by finding us on Facebook, Instagram or Twitter. We’re Your BIRTH Partners across social media. And as always, we welcome your feedback. We would love to hear what is working for you as you navigate these really difficult times with those in your care. And we’d love to help you as you gain more resources around this issue. So don’t forget to check out our show notes for information about organizations that truly support mental health during the perinatal period. We’ll be sharing links to Emily’s work around birth story processing, and a couple of other little tidbits in there for you. Wishing you all good health. Till next time!
024: “A Womb of Their Own” Q&A: Trans & Non-binary Birthcare
Maggie, RNC-OB 0:05
Welcome to Your BIRTH Partners, we are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today we are sharing a conversation, a Q&A that we recently had during Trans Awareness Week around the film “A Womb of Their Own,” we were blessed to have the filmmaker Cyn Lubow and our own Ray Rachlin midwife of Refuge Midwifery, who came together to answer questions from our audience about what it means to navigate pregnancy and birth as a trans or non variant person, and how we as birth professionals can best contribute to safer and inclusive birth care practices that help everyone in our care to be more comfortable as they navigate this journey. So I am very excited to share that conversation with you. On to the show!
Welcome, everyone. I am Maggie Runyon. I am a birth nurse and educator advocate, and the founder of Your BIRTH Partners. So I’m just really excited to have this conversation today and following up from the film. So our our whole goal at Your BIRTH Partners is to bring professionals together to step out of our silos and create better, more inclusive, equitable care for folks who are pregnant and have babies. So I am really glad to have you here. So Cyn and Ray, if you want to just introduce yourselves a little bit and give a little context for why you’re here. Cyn, go for it, you’re our special guest!
Cyn, Filmmaker 1:39
Okay, well, I made this film, as I said, between 2013 2016 I just wanted to explore the diversity of gender. And I thought a good way to capture people’s attention and and to break down people’s assumptions and people’s ideas about gender that are that we tend to cling to rigidly I would pair masculine-identified people with pregnancy. And then people would be forced to question the assumptions. And then once I had done that, if I could then keep doing that throughout the film, that they could come out with a more inclusive, more fluid understanding of what gender could and couldn’t be. And I’m happy to answer any questions anybody has about film or anybody in it for me,
Maggie, RNC-OB 2:30
Thank you so much for being here.
Cyn, Filmmaker 2:32
Thank you for doing this.
Ray, CPM 2:33
So I’m Ray Rachlin, I’m a certified professional midwife and lactation counselor in Philadelphia, serving kind of like Philly and South Jersey, my practice is refuge midwifery. And I got really involved in kind of promoting affirmative reproductive care for trans people, especially in the childbearing year, about like five years ago now. And part of my practice, pre pandemic was like educating healthcare providers on trans inclusive birth care. And in my own practice, about 10% of my clients are trans and non binary. So it’s community that I’m a part of, and is like a really big part of my heart, and that I get to kind of serve in a couple of different ways.
Maggie, RNC-OB 3:12
Wonderful, getting to partner with you on all of this. So yes, we have our first question coming in from Christine: “I wonder if you could explore with me, during the film, one person observed that being pregnant take strength, and that they found they were able to lean into their masculinity in this regard, can you please share some thoughts on the concept of strength and gender?”
Cyn, Filmmaker 3:33
I mean, I find whatever I tried to talk about gender, I get caught up in the archetypes of male and female that there are pros and cons to ascribing to but try to talk about, about male and female and breaking down our rigid ideas of it. It’s inherent in the process of trying to talk about male and female that we can’t talk about it without rigid ideas about it. So you know, archetypally, we think of strength as being associated with men. And obviously, we, you know, we want women to be associated with strength as much as we as men being associated with strength. So, it just makes it very difficult to even talk about what what is gender, what is male and female, anyway, and how do we how do we talk about it? Obviously, men have strengths, women have strengths. All men don’t have the same strengths necessarily all women don’t have the same strengths necessarily. But we do associate pregnancy with a certain vulnerability, a certain you know, need for protection and rest and things that we think of as sort of weaker things. And I was one of the people I wasn’t the only one but I was one of the subjects who who said that I experience pregnancy is also as a strength, as a strong thing. And I didn’t want to be, you know, a wilting flower, or whatever you would say about the traditional image of well, of a pregnant woman, nor do I think that it fits because being pregnant is not for the weak or faint of heart. It’s, it’s, it takes, you know, everything you got to do it. So it was, you know, I was speaking to wanting to transform, that association of pregnancy with weakness. You know, we associate traditionally femininity with weakness as well. So pregnancy and femininity, weakness, all have traditionally gone together. And for those of us who are trying to disrupt those associations, I think it’s important to remember that whenever they, whenever there is some attempt to show man what it’s like to be pregnant, you know, people pretty much all agree “Oh, wow, that, you know, I don’t know too many men who could stand that” as, as Robin Williams, just to say, out, try to pass a bowling ball through your penis, and then you’ll know what it’s like to be pregnant, and to deliver babies. That’s just one of the concepts that I wanted to completely disrupt. And I, even at the time, you know, this was a long time ago, obviously, that’s why I enjoyed so much. Taking pictures of me, you know, when big pregnant belly lifting weights, you know, I’m showing muscles, because that was my version of disrupting. Did that answer the question? I’m not sure…
Ray, CPM 6:51
it does. And also, I think I really appreciated that like the documentary brought that into the narrative, because anyone who’s like in the birth world knows that like pregnancy and birth, really, possibly the most gendered experiences we have in our culture. And there’s this like, a lot of assumptions about gender and bodies and how like people experience thing and that like, also the strength that people may be experienced has to do with femininity, or like, you know, motherhood, where in fact, you know, the body, or the reproductive organs you have and like your experience of gender, like don’t actually have much to do with each other. They do for some people and not for others. And pregnancy can be a really like, you know, empowering masculine experience for some and a disempowering masculine experience for others or feminine, you know, there’s just no, you know, I think we just like really have lots of opportunity to, like, start challenging the assumptions we have around who gets pregnant and like how they experience their bodies. Because the truth is, like, you know, pregnancy can be dysphoric for folks of all genders. But if we make assumptions about where strength comes from, or how people are experiencing it, we like lose the opportunity to actually support them.
Maggie, RNC-OB 8:01
Yeah, I think that’s a good point. I know, you know, AK Summers, commented about, you know, just that idea of, I’m just gonna have to settle in for like a hard nine months here and just kind of muscled through it at that. So absolutely, for some people, it is going to be a way to find strength in whatever, you know, kind of energy you’re pulling from and that for some people, it’s going to remain hard and something that you’re kind of settling into. We have a question coming in here. Layla: “Do you have any advice for prepubescent trans kids about fertility preservation before starting hormone therapy, so they may have the opportunity for a biologic parenthood in the future?”
Ray, CPM 8:39
I can answer that one. So, for those who don’t know the only life transforming hormone therapies that permanently impact fertility is puberty suppression, and then hormone use. So if gametes don’t have a chance to mature, then they aren’t really able to be used in the future. And there is like some technology, trying to harvest immature gametes to bank and then use later and it’s pretty experimental success rates are fairly low. It’s also extremely invasive to like, do procedures on like, maybe a 13 year old girl’s testicles. So I think first and foremost, like hormone therapy saves lives. And the priority always should be on like doing life saving hormonal therapy during therapy. And we can do some informed choice on the current available options, but like they aren’t great. And oftentimes, like hormone affirming therapy is much more of a priority than having a genetically related child. And that’s kind of what I think sometimes genetically related children is something that parents of trans children feel really strongly about and in like, how much suicidality there is among trans teens. For me, it’s not as much of a priority. And I don’t know because fertility preservation for very young people like not a priority and like, you know, fertility technologies, I’m not really sure when they’re going to improve, but success rates are definitely like under 20%.
Maggie, RNC-OB 10:03
Thank you for speaking to that. And another follow up to that: “Ray, your work showcasing how to show up. For QT birthing folks, as a midwife has really inspired folks to think outside the binary in our work. Can you talk about some basic steps that you encourage birth workers to show up for the needs of trans and non binary birthing folks and community?”
Ray, CPM 10:23
Yes, I think first and foremost is use gender inclusive language when talking about pregnancy, birth parenting, with everybody get used to taking gender, the gender experience of pregnancy, like out of it, and just like talking about pregnant people, instead of like pregnant women. And in doing that, you create more space to like recognize, you know, the person you’re caring for as an individual. And not there’s like this weird, like loss of self identity, when we call people Mama, that we’re trying to, like, help bring personhood back and like doing gender inclusive cares about benefiting anyone who’s sitting in front of you, not just trans clients, or patients. And also, if you’re using gender inclusive language all the time, you won’t mess up. The next thing is having that, you know, like working with whatever health system that you’re in to, like have like gender inclusive language and gender inclusive trainings, like, you know, so having like forums having websites, informed choice documents, images. If queer people and non binary people and trans people don’t see themselves in your healthcare setting, they’re not going to know that as well. Same with like, on your website, or a page. And you know, if you haven’t gotten training and have done an experience working with trans people, like there is a lot of like, available trainings, you can definitely pay trans birth workers to really teach you how to be more inclusive. And then when it comes to actually the opportunity to care for someone who’s trans or non binary, be really explicit about what you do and don’t know, like, when it comes to trans health, like most things we don’t know, you know, because, you know, the research is mostly qualitative. It’s done on like, you know, a good study of like, in trans health is often like 40 people, and they’re mostly white and middle class. So there really doesn’t tell us a ton of information about the people who are most at risk of experiencing harm in our system. And like self reported data is like not like it is a part of like understanding like Health and Science, but it’s not, we don’t have good ability to do evidence based care. So just being really explicit about what we do and don’t know where points of tension might come up. Like if you have an Electronic Health Record system that doesn’t offer trans inclusive options, you know, or pronouns, like the like, like mentioning where that might come up as issues and also trying to be a bridge as an advocate to like, you know, do more procedures in house, or facilitate like doing a soft handoff to other providers to reduce incidence of discrimination, and generally also, like, continuity, and like reducing how many people a trans person sees like, improves the chance of like not experiencing discrimination. So for healthcare providers, it’s doing more things in house and like writing plans for continuity. And for doulas, it’s really vetting your referrals and like, helping them come up with plans with their providers to like have more continuity to protect wellbeing.
Cyn, Filmmaker 13:08
In addition to the rounds on electronic records, it’s also really important to notice if the person’s you know legal name is is what follows them on their electronic records and is not what it says for them their dead name and is not the name it that they go by. So it’s really important to if there’s not a way of managing that on the electronic file to be sure that you use the right name.
Maggie, RNC-OB 13:37
Erica has a good follow up to that: “As a medical student, I find the healthcare aspect of this room especially fascinating. Can you talk a little bit about the healthcare experience of those in the film had? Did you find that their health care providers were affirming of their identities? Or were their negative experiences?”
Cyn, Filmmaker 13:51
Yeah, you know, if I had known how, how useful important the film would be for people in birth care, I probably would have probed that more, but as it happened with the people that I ended up working with as subjects there, there wasn’t a lot of, certainly not trauma there. There weren’t a lot of problems that they report, I did ask them about it. And I didn’t get a lot of juicy stuff from them. And I don’t think that’s representative of the field in general. Less so now, but at the time so I you know, some of them were in the Bay Area, and they worked with educated trans inclusive midwives at home or, or even, you know, in institutions where, where they did better some of them. Morgan, I think talked about, I think it was a friend of theirs who made signs and put them up around the birthing room saying, This is my gender. This is my name. This is my partner. My partner and I call each other… with instructions just posted right there, so that anybody who came in and out had the information they needed. But yeah, didn’t hear any horror stories. Ray, I imagine you have.
Ray, CPM 15:05
I mean, I’m in this like, interesting subset of doing home birth where like, what we know from like research is that trans people upon birth set rates far greater than the general population. So, for example, for instance, you know, general population, like 9% of people are using midwives 1.36% are having home birth or birth center birth. And for trans non binary people in the literature, we have like 45 to 50% are using midwives and 20% are happening out of hospital. So, birth center and home birth. So you know, we’re, we’re seeing this because people are in part trying to protect themselves, you know, and like, I think like, you know, queer understandings of bodies and like midwifery care, like have a lot in common and also, when you have a known provider, and you know, who’s gonna be in your environment for your birth, like, you are more protected from discrimination. And also, like, homebirth is definitely not right for everybody or appropriate for everybody, either. There’s like some pretty awful stuff in the literature, I haven’t had like, bad experiences, and like, you know, transferring trans and unlearning books to the hospital. But I’ve also like been able to set up a really good co care situation, and like there are, you know, good hospital providers that can do serve trans people well, during birth, and also like, I’m in a large city that has a larger population. And they’re going to be places that it’s safer to just, you know, like, not be like not disclose that you’re trans or non binary and just kind of go under the radar. And they’re also people that don’t have those options and may experience a lot of discrimination may not. So it’s a really wide gamut.
Cyn, Filmmaker 16:44
Yeah, heartened by the the midwifery schools that have contacted me that are very serious about booting all this in their in their training seems like there’s really a very concerted national, maybe international effort to update people.
Maggie, RNC-OB 17:02
Yeah, absolutely. circling back around…. Susanna had asked about, you know, “how do we increase the number of trans affirming providers, hospital doctors, and to follow up with that. So most of my experiences as a birth nurse in the hospital setting, and that there’s sometimes this kind of tension between not having a very long time to establish a relationship with people that are all of a sudden in our care, compared to, you know, working with a midwife in the community or a doula. So you know, if you can speak either, you know, for your personal experience, your professional experience, what are the ways that we can kind of bridge that gap when people are suddenly, you know, in our care, and we don’t have as long of a time to develop relationship? Essentially, how do we get to know them and support them without prying unnecessarily into details about their gender?
Ray, CPM 17:50
I think the first thing is that like, you know, you can ask, like, have your pronouns like really like explicitly on your badge, like, introduce yourself by name and pronoun every single time. And that gives people the opportunity to say their pronouns. And you just ask what people’s pronouns are, they don’t tell you and you ask what parenting terms they’re going to use, and what their baby’s name is, what they’re calling their baby. Like, there’s lots of ways to, like create connection in a short period of time without being like, Are you having a boy or a girl, or I think like, Mama is really a shorthand for, like, don’t remember your name, or I’m trying to create connection, when in fact, like, take the time to write their name, but I think it’s just like asking, and then using the terms that they use, and not asking any invasive questions about their gender or body, like, you know, there’s, you know, like stuff with, like, you know, why? Why do you want to be pregnant, if you think you’re a man, like, that really doesn’t matter, it absolutely doesn’t matter. So, like, don’t ask it just like, you know, like, trans cares, trauma informed care, assume that the person is like, not had a positive experience in their body, and you’re going to find a little bit more gently, you know, like, ask for consent before touching, like, ask about preferences for procedures that involve the chest or genitals, like if maybe they don’t want a resident doing cervical checks, you know, and that should also be true for everyone that we care for, as well. But just like kind of taking, taking the time to like, slow down and like not make as many assumptions like really makes a really big difference, asking open ended questions about how or they’re going to feed their baby or who’s going to be supporting them afterwards. And then, like, you know, oftentimes, like the advocacy of like one or two providers on the labor floor, like does get like trans inclusive training to happen with like, EHR with like, intake questions. So even if like, not everyone on the floor is competent, there’s at least like one or two people each shift. So if someone who’s like trans or non binary comes in, I’ve definitely had this experience where like, I got to the hospital, I’m like “hi, I’m transfering with a trans patient” and like, they send us a nurse with blue hair, and it’s amazing, you know, like so even if not every one of the floors, they’re able to provide trans care, like there’s been some baseline training and some people are really there and ready to do the advocacy and they can continue to work to bring the rest of the labor for their
Cyn, Filmmaker 20:00
Right, I’m guessing that you also either use general gender neutral terms for body parts. Or ask them what what words they use for body parts, like birth canal instead of vagina or something.
Ray, CPM 20:17
Yeah, cervical checks instead of vaginal exams. Sometimes I’ll just call things a front hole. Yeah, chest instead of breast or interchanging or saying feeding at the nipple.
Maggie, RNC-OB 20:28
Oh, and then Claire has a question: “I work with an organization who supports pregnant people in new parents experiencing postpartum depression anxiety. in British Columbia, Canada, we’re working hard to create more inclusive care, we finally have a 2SLGBTQ plus support group ran by queer facilitator, yay. Can you speak a bit about the mental health impacts of trans non binary parenting, and how, as Mozi says, women, we can better meet the needs of our clients, it’s not always possible to hook them up with a career counselor right away. And we’re really mindful that our one career counselors carry huge emotional weight.”
Cyn, Filmmaker 20:59
Wow, maybe do some trainings for the staff. I’m not sure if this is volunteer. I mean, I think, as with many on many topics, queer people, you know, when they’re going to be that vulnerable, it’s really helpful to be seeing somebody who’s, who’s actually queer. It’s very hard to fake that. And it depends on how much being queer is a mental health issue for them for. For the majority of queer people, being queer is not their issue. And they don’t necessarily need any treatment any different than anybody else. But it is still important to use the right language to use our pronouns, to use the right name, to not make any assumptions, which, you know, good mental health counselors, I’m going to make assumptions anyway. But a certain level of education just in familiarity. One of the reasons I wanted to do the film was that and the way said it’s being useful is that I wanted people who didn’t have access to experiences with trans and non binary queer people to get of the experience just by watching the film on a flyball. What are these people look like? What do they talk like? What do they sound like? What you know, what, what, what’s their experience from their mouths? What What was it feel like to be around, you know, somebody like this, if you’ve never been around, something like that, and we know from all kinds of discrimination, with all kinds of communities that the more experience one on one experience that you have with, with people, the less discriminatory thoughts and feelings that you know, the more they go down, or dissipate. So, since there are people that just don’t run into anybody who’s trans, I mean, that’s less and less true, because now people see people on TV, and, you know, they’re, they’re famous people have come out as trans and, and so on. But having starting out, not experimenting on actual people, but by having a little bit of exposure, without having to have somebody be or exposure, I was hoping that would make some inroads so that when people did encounter actual trans people, or non binary people, they would have some precedent in their minds for like, Oh, yeah, yeah, I’ve seen that before. And that’s, that’s not like, blowing my mind right now. So I my point was, I guess, to, to get as much exposure as possible, and, and at least some things against education, and to try to get more queer therapists.
Maggie, RNC-OB 23:48
I mean, that absolutely came through for me, you know, watching the film is someone not, you know, part of the queer community, a huge exposure just to different, you know, just the fluidity of gender and I think you were able to really effectively show a lot more of the nuance that goes through it really pushing way beyond that binary that so many of us have kind of had ingrained through society. We have another question coming in.
Ray, CPM 24:16
I am looking through and I see a question about educating other birth workers. Yes. And I know for me like I like to have like different opportunities like this do when a trans inclusive birth worker education and I do that a lot of my Instagram and also a really big fan of paying trans people for this labor and paying them really well. There’s a couple folks that are doing this. There is king yaa, there’s moss the doula, there’s love over fear wellness, are like Tristen just started Trans fertility and family equality council like there are like places to go to like get this screening and I think people who are cis should be paying trans people for this information?
Maggie, RNC-OB 25:02
Absolutely, absolutely. And we’ll, we’ll send out a link to some of the other resources for everyone when we kind of like follow up from doing the training. So that sounds great. And then, you know, going to going from there, Susanna had asked “Furthermore, what do you think is like the crucial kind of pivot points for organizing for change on a bigger level within healthcare society, at large?”
Cyn, Filmmaker 25:28
Personally, I think exposure is a big part of it, I really felt feel like what people see on TV and in social media now to his influences a lot of what they think about the world. And I think that marriage equality came out of, you know, what I was talking about before, more and more and more people being exposed through television, to queer people. I mean, we know that people always been surrounded by queer people, but but it wasn’t safe to come out. So they didn’t know it. But Ellen came out. And we got more and more representation everywhere. People just got more comfortable with like, “oh, they’re just people like they are no, no big deal.” And, and I think that, that breaks through that. Obviously, there’s, there are things to learn, but that breaks through the resistance to learning them.
Ray, CPM 26:27
This question feels huge, and I think I’m also in a very pessimistic moment, and feeling like trans health has gone back a bit and the pandemic, in terms of rights and options, you know, I do think exposure to our stories, that our families is a big part of it, like normalizing this, but also it kind of takes like advocacy and organizing at every level, you know, it takes it, I see my role, you know, as a home birth midwife, both and like, raising up the families that I serve, and then also trying to like support there being other trans competent providers and birth workers around me that I can refer to and have a robust support system for, like transporting people in Philadelphia. And we need more of those folks also in the hospital, doing advocacy in the hospital and in clinics, doing advocacy with front desk staff, and at like acupuncture offices, because like, you know, in, like in this area, like there’s not a pregnancy chiropractor, I could send trans people into, there’s just all these places that, you know, even though like we’re it’s becoming more visible, and our stories are like being shared more, there’s still like, there’s just so many gaps in so many layers, and now like within the limitations on people and support people, that puts trans folks at higher risk of experiencing discrimination, because there’s not like a support person or buffer advocate who could like go to an ultrasound. So, and I don’t, I haven’t seen ways around that yet. I don’t know, I think by birth is definitely like the most gendered experience we have in our society. So changing it to be inclusive of queer and trans and non binary and like non normative families is going to take a ton of work and possibly a generation to shift the mindset.
Cyn, Filmmaker 28:11
For sure, seems like, you know, point taken that that part of the training for not just midwives, and doulas and childbirth educators, but chiropractors and acupuncturist and doctors, and, you know, anybody who comes in contact with somebody around health and bodies and mental health should have that as a required part of work and how we get there. That’s not my area.
Maggie, RNC-OB 28:39
Yeah, absolutely. I would say that it takes takes time. And, you know, I’m grateful for you for making this film. And it’s an option for people to get exposure, and I’m seeing, you know, a lot of the comments that people have, you know, here at the showing and wanting to bring it back and share that. And it does seem like there’s, you know, changing there, I know, Kristen was commenting on the generational differences in the perception, acceptance of transgender may suggest empowering, you know, the medical, nursing, pa, physician students, you know, to change the healthcare system that you know, starting with younger people who are just getting out there and haven’t been, you know, broke down by the system quite as much already that that’s definitely an inroad there. And then, I know one of things we had talked about Cyn, if you want to speak to it a little bit, it’s kinda like the representation within the film in terms of what we kind of want to see next as we keep talking about trans and non binary folks.
Cyn, Filmmaker 29:34
I wanted as much diversity as I could access and afford, I had no budget. So I wanted diversity and where the person was around the pregnancy process, age, location, geographical location, race, class, education, you know, experience of gender where they were on the spectrum or if there is a spectrum even in terms of gender identity, I didn’t know any of the subjects other than myself, of course, before starting this project. So I was amazed I found any. And I spent two years trying to find as much diversity as I could, as I could find. And I kept hitting my head against the wall trying to get racial diversity. And it was the, it’s my, you know, biggest regret that I was at, I totally failed at that. I got close. And then, you know, things didn’t work out. I talked to a bunch of people about why I was having so much trouble. And of course, that opens up a whole new, whole area about racism and white supremacy and the forces in our world. But I would still like to see a more racially inclusive version of my objectives done. And I don’t know whether that’ll ever happen for me or someone else will do it. Because I think it’s really important different cultures and different races and different different perspectives and experiences are really important to this topic.
Maggie, RNC-OB 31:07
Ray, do you know of any other resources that that would speak to a broader?
Ray, CPM 31:13
I think a lot of the resources are happening in community. So you know, the kind of, like trans birthing community is on Facebook, it’s on Instagram, it’s on like, tiktok, which makes me feel old. But you know, like, I think, because their resources aren’t set up for us, like it’s happening, kind of like in informal networks, and like people who are building like, you know, support and power, there’s a really large Facebook group called birthing, breastfeeding trans people and allies has a trans only birthing group. There are some groups around like, non binary folks who are trying to get pregnant right now. And they get pregnant. Like, there’s, yeah, the community is like happening online.
Cyn, Filmmaker 31:55
And that’s new. I mean, that’s exploding. As far as I can tell, even, you know, whatever that was six, seven years ago, when I started this, I found people on YouTube, and I begged them to be part of my film. And but you know, tiktok wasn’t around and trans families and allies, I always forget the name of their that group, but they, they they weren’t around yet. It’s great. What, how much the support is spreading?
Ray, CPM 32:25
Yeah, there’s like a lot more online community. But definitely the stories that get lifted up are typically like white middle class stories, for sure. So I think probably, you know, as a white person, you know, the stories that we don’t see are the ones that are like not being told to us.
Cyn, Filmmaker 32:39
Yeah. And and, understandably, though, don’t want to be told to us.
Maggie, RNC-OB 32:45
Well, I think we’ve covered all of the questions, if anyone has anything else burning questions that they wanted to throw out there. I’ll give a couple more minutes for that.
Cyn, Filmmaker 32:55
Or does anybody want to be unmuted? So you can ask?
Maggie, RNC-OB 32:59
Yeah, if anyone wants to come off there and come on to the mic if they want to, or share anything about, you know, resources, you find helpful, any of your experience that kind of speaks this topic, we would welcome more voices on here. Let’s see, let me find you.
Missy, CNM 33:12
I was just gonna say one thing that happened, I’m a certified nurse midwife, I work in a private practice. I’m in Oak Park, Illinois, which is just west of Chicago, but we serve the Chicagoland area. And one of the best things that happened to us is having our first trans birthing patient a couple of years ago. So one of the things I would say to the other providers that are on the call is that one thing that was helpful is like we had all of our literature that we usually give to people and unfortunately for him, he had to do a lot of the educating, which is part of why I was like amen to paying people for their labor, because we need to be acknowledging that trans folks aren’t the only people that need to be educating and, you know, sometimes they just want to be a patient, which is fine, but we went through the folder and he essentially like he pointed out a lot of things to us that we didn’t even look at even though like my lens as a queer midwife was there. I’m also assist fam like, you know, person, so I’m not it’s it’s looking at all the lenses like, doesn’t matter so much that I’m a queer midwife, but I also was not as sensitive to trans inclusive care as I needed to be. So like, for instance, our TDAP vaccine had a bunch of stuff about pregnant women on it, and I didn’t even look at that she, you know, maybe, but we just handed out with our patient education. So I think that like, it’s helped me take a closer look. And so I just wanted to comment on that. In that, you know, I guess the point being translation shouldn’t always be our teachers, but sometimes, like, I think that this particular patient was very receptive to us and chose us particularly because we are a practice that supports physiologic birth and kind of birthing in your own terms and we are in hospital. The last thing I’ll say, you know, it’s unfortunate like part of what I did to protect him as a provider was to self select all the nurses that would be a part of his care. You And it’s really sad that that’s what I had to do. But when I knew he was coming in, I was the midwife on call. So I talked to the charge nurse and kind of figured out who it was, that would not be an asshole to him. And you know, that’s the world we live in. And I think that in the last four years in this administration, it’s been much worse. I’m hopeful that it will maybe get better. But I’m hoping that we get to a point, I’m really proud that a lot of the providers that I work with Hi, Morgan, Hi, Dr. Bratman, other people are on this call and are invested. And I think that that’s a gift. So I’m just grateful to be a part of this.
Ray, CPM 35:38
Thank you spoke to a couple of things that like just that went well, though, you know, like you like protecting your patient in the hospital choosing like nurses that were like going to be a do a better job, keeping them safe. Something I didn’t mention is, when it’s your first time caring for a trans person, it can be great to just acknowledge that you don’t know things and that, like, they’re gonna educate you because like the research and like the national transgender discrimination survey is like almost all trans people are educating their providers about their health care needs. So if you just like start with that shared understanding, and like, you know, ask them like, do you want me to read anything to make better understand how I can serve you or like, this is like, I tell people at the beginning of care, like, if I do something that doesn’t work for you, I respond well to direct feedback, or you can shoot me an email, you know, like, let them know, like how to call you out. And kind of just builds trust to create more opportunities for like, both learning and like you change your practice. So the next person doesn’t have to teach you these lessons. Yeah, for sure.
Missy, CNM 36:31
I agree. And yeah, I think that that was the gift too, is that he felt space, or he felt safe in our space to be like, hey, Missy, like this. sheet is not cool. Let’s talk about how to change it. Thanks for letting me share.
Maggie, RNC-OB 36:45
Thank you, Missy. Appreciate sharing. Would anyone else like to come on and share?
Cyn, Filmmaker 36:50
Also, if people don’t have questions? I would be interested to know if anybody wants to respond. What surprised you in the film? And or was there any, is there anything that you will do differently now that you’ve seen the film?
Maggie, RNC-OB 37:04
Aaliyah, I am going to find you.
Aaliyah, doula 37:07
I am very new to the birth world. I come from a culinary background and got into the both worlds June or July of this year. I’m going through a full spectrum doula training with birthing advocacy, doula training right now, and I identify as queer, but I, I come from a background that’s open with like, religion and spirituality, but very, like, aggressively strict when it comes to gender roles. And I’m a twin and my twin identifies as trans. And so I have been part of his journey of learning about himself, which has taught me so much about myself and changing my labels, and how I want to be viewed in the world. And this film was so enlightening for me and so beautiful. And I feel so much sadness and disappointment for the world we live in, because our trans siblings have to educate us on how to best serve them, and how they have to fight to just be seen as valid people and how they want to be viewed in the world, and how they feel most comfortable in their bodies. And this film was so beautiful to me, because it was just, let’s sit down and talk to some folks about their life and their experience. And it’s not a lot of times that I’m learning about a marginalized community. It’s very much a cis white view of this community and the things you need to know about them and the things you they’ll they’ll mention some things that are very important, but just gloss over the general topic. And I like how laid back and comfortable this film came across as it came across is a very respectful conversation that I would have with some folks that I know who are open with how they identify and move through the world and are willing to share that with other people. And the way you approached this project, and the information you shared with us in a way you shared it with us was so beautiful to me, and just how simple and straightforward it was. And I just wanted to express gratitude in that. And this is something that I’m really sad to say is new to me. It’s something I’m still learning about. And trans rights a trans justice is something that I regularly fight for on top With the anti racism work that I’m doing on top of the queer inclusion work that I’m doing, it’s just another layer of equity work for me. And the fact that something like this is so big and important in my eyes is disappointing, but also really awesome. And I just wanted to express gratitude to both of you, because I follow you Ray on a lot of the things that you do and blows my mind and how just amazing and wonderful both of you seem as people, and just the work you’re doing in the world is awesome. So thank you for that. And I’m super excited to see where we are at as a community in 10 years and the strides we can make with just the what I see is little things that like, the little everyday things that we do, that can turn into projects like this that can shift so many perspectives and share so much knowledge with the more mainstream world. So thank you.
Cyn, Filmmaker 41:10
Thank you for the work you do.
Ray, CPM 41:12
Yeah, thank you. Also, that reminds me I should plan something myself and another queer midwife are working on a project called Queer Conception Stories. And right now we’re seeking submissions of LGBTQ folks who created families through some form of help, you know, whether it’s donor sperm, donor eggs, donor uteruses, and just kind of how they made their decisions and created their families to be a guidebook for other queer and trans people who are earlier on in this process. So I’m going to put that in the chat. Please share it widely. The deadline for submitting your stories the end of February.
Maggie, RNC-OB 41:45
Wonderful. Would anyone else like to share? Karen…
Karen, birthworker 41:49
Hey, everyone. So I am a new birth worker. I just started my labor doula postpartum child brush, lactation, infant massage, you name it, I’m doing it. As a straight white woman. I am taking king yaa’s birthing beyond that binary, I have one transgender friend, and a grand niece, she hasn’t come out as transgender. But it seems that she’s heading in that direction. So I want it to be able to take these courses and watch this movie to help better understand so that when because it’s going to come out is that I’m going to come I’m going to come across someone who is transgender, and being a birthing person. And I want to be able to be educated, and not use the wrong pronouns, but be able to treat them with the respect that they deserve, just like every other birthing person. So I just wanted to say thank you so much for letting me be part of this. letting me be able to see this video, when I first started the birthing beyond binary class, they had talked about it and Lorenzo happened to be speaking at our very first class. So I was like, Oh, my God, how can I get my hands? Can I get a DVD, you know, to watch this. And then when I saw this, that it was being offered to watch and screen I was like, Oh my god, I gotta get in on it. I got to see it. So thank you very much. It was very insightful. It was just amazing. It really was.
Cyn, Filmmaker 43:28
Thank you.
Maggie, RNC-OB 43:29
Yes, thank you. And Karen. I’m also doing king yaa’s birthing beyond the binary course. And I know someone else was just, Gloria shared their information in the comments. But yeah, I believe they might still be accepting registration, if you want to kind of roll into it and get a little bit more information there. Or hopefully this will be the first of many times that they’re offering this but yeah, you can only find them on you know, Instagram, Facebook, and I can look up their website to to link to that, because it’s a great resource.
Karen, birthworker 43:58
Definitely.
Maggie, RNC-OB 43:59
Great class so far. Someone else wanted to share… Leila.
Leila, med student 44:03
Thanks so much. I just wanted to share with you all a glimmer of hope in that. We’ve had a lot of hope with the conversation so far. But some people may seem pessimistic about where we’re headed and the resources that are currently available. And I just wanted to share that I’m a medical student at Case Western in Cleveland. And in two of our courses, one of our courses, they’re elective, so not everybody is taking them but a lot of students are and one of them is LGBT health elective where there’s a section on queer family building and educating medical students that sometimes families aren’t even just two people and consist of multiple people who’ve contributed to a birth into a pregnancy and we’re gonna rear that child and also in our breastfeeding elective there’s a section on breast and breast feeding and lactation care for trans patients. So I just wanted to share that it is making It’s way also into the medical curriculum and people are learning a lot more about it and are engaged in it.
Cyn, Filmmaker 45:07
Yay! Thank you for sharing that. That’s very wonderful to hear. Yeah, that’s awesome. My, my younger son is in his first year of medical school, and it hasn’t happened yet. But we’ll see.
Maggie, RNC-OB 45:20
Yeah, I mean, it’s heartening to hear that it is just getting more and more into the medical training and that we’re having more access to it.
Cyn, Filmmaker 45:30
I’ve wondered about that for for transmen, who are birth caregivers as well, whether they get discriminated against for masculine gender? What, what? Whether a man or or a trans?
Ray, CPM 45:45
Oh, definitely, definitely, yeah, I’m a non binary midwife. And I think I experienced the most discrimination from other birth workers than like anywhere else in my life. Wow.
Cyn, Filmmaker 45:55
Wow. That sucks.
Ray, CPM 46:00
Maggie, can I do one more plug?
Absolutely, yes, please. Sorry, Shosh was just on the zoom just reminded me. I teach a class called Beyond the Baster, which is for if you have queer trans folks in your life, who were trying to get pregnant and don’t know how to, or how to create a family as a workshop just don’t like, and you know, the DIY side of building a family. And we’re going to do the next one in January. It’s been traditionally open to birth workers. We’re going to do a separate one for birth workers a little bit later in 2021. But you can be follow me on Instagram we’re about to, that’s where information about it will be.
Maggie, RNC-OB 46:34
Yes. And I have taken that course it is excellent. So I will I will second that. So definitely check it out. Thank you, Ray. Well, we will wrap up then. Just want to say thank you so much. I really appreciate Cyn, thank you for creating this film and this opportunity to have these conversations and dig deeper. Ray, thank you for joining us and letting us all of your personal and professional experience on this topic. I really appreciate you both.
Thanks for tuning in. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners on all platforms. We also welcome you to join our new community Facebook group. So there we’ll have a chance to talk more as we navigate these issues together as birth pros who see the future as collaborative, inclusive, and equitable. We look forward to growing that community with you. You can also check out our show notes if you want links to the research that was shared today. And we’ll be highlighting some other trainings and birth workers who specialize in helping birth professionals to create inclusive and safer practice environments for everyone in their care. We look forward to hearing from you about what struck you about the film, what other questions you had, what you loved about the QA and what you want to see next from us as we keep pushing out more educational offerings. Till next time!
025: Trauma-Informed Birth Care
Maggie, RNC-OB 0:05
Welcome to Your BIRTH Partners, we’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. So today, we have the whole original podcast crew on to talk about something that’s really important, trauma informed care. And this is so important, and so deep, that we certainly are not going to hit on all of the elements of it in this 30 minute podcast. However, we thought it was worthwhile, that we speak a little bit about how becoming trauma informed has impacted our practice, both in the you know, individual moments that we have with those in our care, how we approach certain situations, and also how it has changed our outlook on what has up till now dominated a typical birth care, especially in the hospital. And so we really want to see a moving away from a standard of care that makes birth in some ways seem matter of fact, and something that has to just be rushed and pushed up along. And that we don’t actually have time to address and care for the person who is in our care. And that is something that absolutely needs to change. So I welcome you into this conversation. On to the show!
We are going to dive into another big topic here. And that is trauma informed care. And this really, as we were talking about, you know, different ideas for topics, these last few episodes of the season, Abby had mentioned how like this is, you know, we could spend hours talking about this. And I think one of the things that sometimes gets in our way is that, you know, perfection being the enemy of the good. So trauma informed care is it’s big it is, you know, it’s immense. And I think one of the things that I have realized is that when I was going through nursing school and learning more about birth care, I was kind of coming up as this idea that like some people are, you know, going to have trauma in their backgrounds, we need to be extra sensitive to that. But the impression that I was given or that I received was that this is like a small portion of the population that we need to be like more sensitive to. And I think what I have seen, and as I’ve, you know, gone through my practice is that, like, trauma affects almost everyone. And it lives in the body. And then as we are making our way through pregnancy and birth, and just this really intense period in our lives like it is going to come up and it’s sometimes unexpectedly for everyone involved. And so I want us to just have a chance to kind of dig into when did you all pick up on the idea of really having like trauma informed care as part of what you do.
Ray, CPM 2:57
I think one of the main reasons I chose to train as a CPM outside the hospital system was because of trauma I witnessed in the hospital setting. And I couldn’t imagine becoming the midwife they wanted to be in, in that environment. Yeah, with training, kind of maybe without autonomy, or with a lot of norms that felt really uncomfortable to me, just assumptions about consent isn’t a given in the hospital setting, and I was like I needed to train outside of that system in order to be the kind of care provider I wanted. And I’d seen some really hard and scary things as a doula that made me feel like it would be impossible to be in a hospital setting. And I think when I was like, when I was doing my training, it was really, like, very difficult for me to realize that I was going to cause harm as a provider, you know, I was like, I’m going to do this big thing in the most perfect possible way, and then everyone’s going to be safe and happy. And that’s not true. You know, I like to kind of sometimes tell people like I have like a toolbox of like, really shitty skills, you know, that are like incredibly painful and life saving. And don’t involve, like a ton of consent. Like, we’re like, there’s a consent in this relationship, like you’ve chosen to hire me to keep you safe. But like, does that mean you hired me to do a manual removal? Yes. But will it be awful in the moment like, yes. And I think realizing the negative impact I could have on people and how powerless I was over that was really devastating to me. And, you know, I’ve been in practice now for like four years and have a lot more quoting than I did when I first started and feel less scared of that than when I first started. But it’s, it’s challenging. I mean, I think like, I really like that within you know, home birth midwifery care, like consent, and like informed decision making is the foundation so there’s a lot in the model that prevents harm, you know, in that, like I ask before I touch people every single time I do it. Informed consent for, like things that happen during birth, like in pregnancy. You know, there’s, people really get very clear and like how I like learn and how I provide care before it comes to birth. So a lot of things are in Yeah, aren’t surprised. And also, like when I talk about, like, how I manage complications and how I transfer, you know, so even if, like, they’re not like, these are not necessary scenarios people expect, there’s like a lot of trust in the relationship and how I’m keeping people safe. And I like to think that it’s protective, but it’s not always, you know, I think my partner…I feel like I’m going off topic, but I went to birth, you know, yesterday, and, you know, I got to my client’s home, and like, I can’t do this, this is awful. And I was like, “Ah, yes, looks good.” And you know, had a baby two hours later. And my partner when I got home was just like, “how do you know when someone’s saying that, and, like, it’s okay,” and I was just like, “it just sounds different.” But, you know, that’s like an assumption that, I make that like, I’m just like, “there’s like normal labor sounds, and then there’s like suffering and they sound different.” But, you know, that doesn’t mean that like, I’m gonna make assumptions about how, you know, like, what people want and how they’re going to be cared for, and like, I’m going to get it wrong sometimes. And that can be really traumatic.
Pansay, Doula 6:15
I do remember very well, at the early stages of my doula work, and being in the hospital setting. And at that time, really feeling that it really wasn’t, you know, that this is the way it was going to be done. Right, you know, here. But once I was able to experience and participate in several, you know, home births, and look at it, you know, being untouched and, you know, respected and honored, celebrate all those things, it’s very hard for me to hold back to the hospital, because that just became, it just felt barbaric, you know, to me, but it was at that time that I knew that I had to change, you know, and make make a difference in my practice, as far as informing the client of what happens, what really happens when you are there, and how to prepare and fight, you know, for their rights and protect themselves. So that was the shift I often really believed, like, all doulas should support just the one homebirth just, you know, just one, because it, it really connects what we hear about as far as the naturalness, you know, of birth, and how the client is really in control, really honored, really respected here, so that that’s when the shift took place for me.
Abby, MD 7:39
In thinking about trauma and birth. You know, it’s interesting there, it’s a big category, there are a lot of different categories, you know, things that one thinks about my background, before medicine was as a rape and sexual assault counselor, like that’s what I did first. And I feel like there’s always been a subset of patients that are coming into birth, with actual traumatic experiences, or traumatic medical experiences that are really going to shape the way that they do when they when they have their baby. And then there are the traumatic births, which were the unexpected births. You know, we have the births, where things are supposed to be going right. And then suddenly, very quickly, they aren’t. I think the more nuanced thing is the whole middle spectrum of that. And it’s been interesting being in a hospital setting my whole career and seeing in the past couple years, a real attention suddenly towards consent in birthing trauma informed birthing like these are these are terms that I feel like ob gyn hadn’t heard a couple years ago. And it’s funny because now I’m seeing on some of the OB GYN sort of like social media that I follow and the like people using these terms and thinking about this and thinking about consent and birthing. It’s interesting, because I think what’s spearheaded a lot of this, unfortunately, is this phenomenon where as a society, we’ve created this thing where people want perfect birth, and have expectations about their birth. And then when that isn’t what happens, there’s a lot of disappointment and people walk away from that really upset. For me, though, that can be problematic. But the movement of really making sure that nothing is done in a hospital setting without consent, and without sort of a partnered relationship between the provider and the patient and without sort of compassionate delivery of information. That that’s the part of this that I think a we can be doing better, but we are starting to do better.
Angela, CNM 9:36
I was reading an article just a few days ago, and it was talking about how we respect women, when we are providing care for them. And the one thing that stood out to me and actually I remember just learning this being told this when I was in nursing school, I was 19 years old and one of the instructors always said, :whenever you are, you know, greeting a patient, do not greet them for the first time undressed” and that always stayed with me. And I was like, “well, yeah, that makes sense.” You know? Like, she doesn’t know me, why would I make her be undress before she ever even gets to move me. What a vulnerable and uncomfortable thing for her. And then, you know, a week ago, here’s 20 years later, I’m reading this article about how we should assume trauma. As providers, as clinicians, we should assume trauma in every single patient. And it does not matter even now I see 30 patients in my outpatient clinic some days, not a single one of them is undress before I go into the room, not a single one of them, I do not like it, it’s a very vulnerable thing to ask a woman that you’ve never met before, to sit on your exam table, covered in pieces of paper, while you talk to her, and try to get into her history and get to know her before the exam. And so I think that is me certainly is hard to move from that, you know, you know, my physician counterparts, they sometimes have 35 patients in their clinic, and they have 10 minute appointments, and it’s double booked. And unfortunately, the business of women’s health care of medicine in general, does not accommodate for us, always delivering trauma informed care, and assume and trauma in people it is around, getting the patients in now. generate those RV use, otherwise your pay is impacted. And it’s unfortunate, but it’s still we have to make it a priority. We have to make it a priority. To be consciously aware of those things and knowing that we do not know anyone’s background. And I even go as far as always asking the women if they would like a chaperone in the space with me because I just I refuse to assume I refuse to assume that she’s going to be 100% comfortable with it just being me and her because I don’t know what her story is or her history,
Ray, CPM 12:28
I guess in home birth that’s really one of the benefits of being like outside the insurance system like a lot a lot of drawbacks, but because I’m not I don’t have to meet the same numbers like slowing down is a given you know when, like yes to never meeting someone without clothes on. But also like if someone is due for a pap smear when I start caring for them, like I just defer until the second appointment, because four weeks or eight weeks with a pap smear is like not the end of the world and having more relationship before I’m like in someone genitals is a big deal. And I can like have a conversation about how have you dealt with speculum exams? Like, is there anything that makes them better? You know the last few IUIs I did, I’m like, “do you want to insert the speculum yourself or me?” People are perfectly capable of inserting a speculum themself. And it’s just trying to, you know, there’s like, even I think with things that have to go quicker. There’s always ways to build in consent an agency, I think what I have to interact with larger health systems, I’m just always aware of just that it’s like not a part of like, it’s not central to training. So then it’s like something that’s often learned after the fact versus like, in community with midwifery care, like consent is really central. And it just assumes that trauma history. I think, for me, like trauma informed care is like really parallel to trans care. It’s just not assuming people are doing okay in their body. And if that’s the case, like how do you slow down to create safety, even, you know, like, I can’t control if someone has a trauma history, and it comes up, but it can, you know, be consistently respectful. And that does make a big difference.
Abby, MD 14:01
I think in addition to slowing down to make sure the consent process happens, and important part of this, to me too, is just creating a situation where the patient has a sense of control, because I think that as long as we’re partners in whatever’s about to happen next, and as long as the patient feels like they’re in control, I think that changes the dynamic in a healthier, healthier way. I struggle with how to provide, you know, efficient care and also feel like I’m always you know, asking for consent, allowing a patient to feel in control, providing compassionate care. But I think there are just very little subtle tweaks that you can do that completely changed a patient’s perception and experience and change the dynamic.
Maggie, RNC-OB 14:47
I totally agree with you. I think it’s sad. It’s such an indictment of our healthcare system that you know, as Ray and Pansay were talking about this feeling that you need to be outside of the hospital environment to be able to get that like that is problem with the system in which we’re operating that it is so hard to get enough time to, to actually ask someone for consent to let the person and care actually dictate what goes on. Right now, you know, the research shows that about one in three people feel like their birth was traumatic, which is devastating. And at the same time, I was having conversation with someone who is not in the birth field and has not given birth earlier this week and talking about this about how just kind of some of the stats around where our perinatal healthcare system is at. And they responded when I said, you know, one of three people think their birth is traumatic, and they just were like, “Well, of course, birth is traumatic, like you’re having you’re going through this like experience, and there’s like a baby coming out of your body and you don’t get to you don’t get it, you don’t know what’s going to happen. Like you’re totally out of control, like how would it not be traumatic for everyone?” And I just thought, like, how, how sad that is that as a society, we have normalized, that idea that birth is that it is just going to be hard and traumatic. Think that, like we said, assuming trauma, assuming that everyone has a history, whether they have disclosed it or not, I think especially in my role, as you know, as labor delivery nurse, I often, you know, compared to you all, who luckily get to hopefully see people in clinic beforehand, you developed a relationship with them before it’s time for birth, I’m usually meeting people for the first time unless I’ve seen them, you know, for a triage visit, like, “oh, you’re here to have the baby, let’s do it.” So there’s a very, very small window in which to really establish a rapport and to get to know understand people. And it is very hard, especially someone comes I’m in labor, to then go through this whole history with them and sort of dive into all of these issues. And so I really have found that for, for me, what has been helpful is just assuming, if it is not been disclosed to me in their chart, or by them, I am assuming that they have a history of trauma, I am assuming that they are not comfortable with random people, me just coming in and putting my hand inside of them like I am assuming that all of those are going to be really difficult feelings for them and then navigating it as such. And that’s been something that I feel like change. I think when I first started out as a labor and delivery nurse, I was kind of taught the idea that like you just kind of you roll in and you say like, “Hey, this is what we’re doing. Let’s get to it, doot doot doot doot doot.” And I look back on those. And I just realize like, Oh, my gosh, I am certain that I made people really uncomfortable. And that I did cause harm doing that, because I wasn’t being aware enough. You know, around cervical checks. I’ve really changed my practice around that. And I also think I’ve changed my mindset about how important that piece of information is to care that if it’s not, you know, if it’s not going smoothly, if there is discomfort or pain that there is always time to great, we’re not going to do this right now. Let’s circle back around. Let’s think if this does this really matter right now, like do we even really need this information? That that is one thing that like I had a light bulb moment about, but I’m wondering like, what are some of the things that you’ve realized I know, they’re relatively easy steps that you’ve taken to kind of create space for trauma informed care?
Angela, CNM 18:15
I will say some of the things and I don’t know, I’ve always done this. But I’m even more conscientious of it now. I mean, I literally ask permission. Before I do everything, I go into space and my patient is clothed, I go through a history and i ask “is it okay? If we do a breast exam? Is it okay, if we do a pelvic exam? Your pap smear is due.” like I ask permission before we do the exam and I talk about what those things means and what’s going to happen and I, especially my young women who’ve never had a pelvic exam before we talk to those things. And it goes I mean, even though I’ve gone through that process when I come into the room, asking if it’s okay for me to enter, I ask them or let them know “Hey, now I’m going to lower the drape. Now I’m going to touch you you feel my hand touch you now I’m gonna make room insert my speculum, please let me know if this is uncomfortable” and I am constantly making sure that they’re okay. And if at any time, they are jumpy or uncomfortable, we just stopped the exam. I cover them up, we take a moment to breathe. Like it takes no additional time. Like you know, I’m talking through all the steps that I go through. But it’s not like it prolongs my clinic appointments. You know, I’m still in and out of there as quickly as I need to be. And I never leave work past the time I’m supposed to I’m always added their own time. It’s just taking the moment to just listen, listen and be conscious and be aware because we all know what it’s like to meet a complete stranger and have to be naked. And, you know, God forbid, have to put our legs or feet in stirrups. No offense to anybody who uses stirrups, I just do not like them at all. It’s a vulnerable thing. You’re so insecure and self conscious. And so you just have to ask, even in a hospital setting, I was always Okay. Is it okay? If I do a cervical exam? Are you okay? If I do this, and I never ever, ever, like pull the sheets up, because I can’t see in there anyway, it is just lift the sheets just enough so I can put my fingers where they need to go so that I can complete the exam. That is it.
Abby, MD 19:07
I think all of those things are things I try to do in practice. I also I really like the question, “What are you expecting to happen today? Like what was you know, what was your expectation of what we were doing at today’s visit?” And I also always, before I do an exam, I always say if you’re uncomfortable, please let me know if you need me to adjust if you need me to stop if you need a moment. And then beyond that, I think the other really important thing is just watching somebody’s body language and paying attention and watch my residents check somebody’s cervix and not look at their face, you should always be looking and paying attention to body language and picking up on on the subtle cues that patients give if they’re uncomfortable. And if you notice that, it’s never the easy thing to do, especially if we are rushed, you need to stop and you need to address it and make sure that patients Okay. None of these things that you just mentioned, or that I mentioned, take a lot of time.
Pansay, Doula 21:31
Let me say, the first thing when I think about trauma, you know, especially with myself and a lot of my clients, black women, our trauma is so deep. And a lot of it is generational. When you think about how mothers are going to birth, the stories that we hear is not give us the easy transition when we start having our own children. So I consider every client, just like you all said that their traumas probably similar to mine, and seeing how OBs and midwife at home and hospital, yes, home birth, you do have more time, you know, with them. But it’s a different setting to really be able to dig deep for them to uncover and you know, really get into the past trauma, and how they feel now about this sacred, beautiful experience that has been just covered with fear about what’s going to happen. So with every client, I feel that it’s my job to provide a safe, sacred space to help them kind of strip down the layers and look at what happened. how, you know, how can we help. And that opens a gateway for what’s to come if we’re in this, what’s happening now. And I find that with every woman that if you deal with trauma, it makes them stronger, and help them be able to find their voice to speak up. You know, to watch what’s going on now to be able to say I don’t feel comfortable. Now, can we talk about this? Let me talk to my husband about it. But we would go into our pregnancies, feeling defeat questions, and we kind of just let things happen thinking that it has to be that with pregnancy. It’s a it’s a mind body and spiritual experience. So what it has to be dealt with as a whole going to the hospital as two separate things. So I’ve seen a complete shift that you know, dealing with clients, tending to the mind, spirit, I mean spending, sometimes it a consultation or a prenatal visit, supposed to be an hour and three hours have gone by where they are just talking and releasing; it happens so much my birth outcome has been significant. How we built their confidence, you know, to talk to the providers. “I don’t feel comfortable, you know, with this, no, I don’t want to do with you do this. Let me try. Let me find a waiver. Because this is not what I want to do.” But it has to start, you know, taking taking care of the whole woman. It cannot be separated, dealing with the trauma of the past trauma from previous births, whether or not childhood, you know, trauma, trauma that’s embedded in our DNA generationally. Right it has us feeling so defeated. With Sacred Butterfly Births, we deal with the whole woman, one woman at a time, and help her to release and heal from that trauma, which helps her to be stronger. And to walk into this pregnancy, I can’t speak up and say that this is uncomfortable. This is not you know, what I want to happen, but really helping them find their voice. That that’s my part. And because I feel like though I don’t have too much, you know, control in a hospital setting about what what’s waiting for us, right? So what what what I do have control and what what kind of what I can help with, is with the client and helping her find her voice and knowing that, yes, she has a choice. And yes, you have say so. And yes, you can decline anything and you should be respected. It’s your right. And that you’re not just the number that you will person. And this is a spiritual experience that should be honored and respected.
Ray, CPM 26:04
I so agree with everything that everyone has said. And I think the thing that keeps coming to mind for me is like preventing birth trauma has also has to do with prenatal and postpartum care. You know, like prenatal care, for me is about helping people like teach people how to parent by teaching, like by through informed consent, you know, by actually, you know, like, let’s say with something like group beta strep or GBS, like talking about what the risk of a GBS infection is on a baby, what how that would be dealt with the risk of death and a newborn, if you decline antibiotics. And then if someone chooses to decline, let’s say screening or antibiotics, talking about like, this is how I’m going to manage things differently. These are all the ways I’m more likely to transfer your baby, are we on the same page that you still want to decline this, okay. And then just respecting that choice, and then carrying out different management, if I you know, can’t rule out a GBS infection, or the water has been broken for a certain period of time, you know, all of that. So there’s like a part of like, informed consent and refusal and respecting that. And then, you know, in the birth process, I think, you know, I’ve definitely, like, have been through a lot of intense situations with people that you know, and that could be traumatic, and a lot of ways and sometimes are, but there’s a really big difference if you understand what’s happening to your body, and like, feel a part of the decision making during it. So like, when I’ve had clients that, let’s say, transferred for, like a baby that’s in a stuck position, and, you know, labor’s not progressing, and we go through a lot of interventions in the hospital, and they don’t work. You know, before COVID, I would go with folks and like, could help with decision making and help under, like, you know, from a trusted source being like, this is what I’m thinking, like, this is why I think pitocin is your best shot, or like these other tools we have left, but we’re running out of tools, you know, so even if like the opposite, you know, of the plan, like a C section happens, they’re like, yeah, that made the most sense for this birth, even if I’m like sad or angry or disappointed, like knowing what’s happening in your body and feeling like you have a care partnership, maybe makes a really big difference during the birth of love. The other part is the postpartum like having, you know, a very different experience than what you expect to happen in your body having like, big, you know, trauma stuff comes up during birth, because that stuff. And it could be simple as someone touching your leg, you know, it doesn’t have to be like these invasive things that we also do. But having somebody like, you know, for me, it’s like, you know, being able to process the birth and then having adequate support to like, get through a lot of the early postpartum transitions, which, you know, like having a baby is a little bit like getting hit by a truck. So, you know, like, if someone’s like they’re in like in your corner, both for processing and then to help you get out of pain and like get your body more healed and like help adjust to baby, then you’re not like left with this raw experience with like, no support. And so, you know, like in the US are really failing for family postpartum care. And, you know, I wonder if these numbers would look different if like, we had like visiting nurses going to people’s houses twice a week, the first like three or four weeks, you know, in Germany, a midwife comes to your house every day for the first month and I was once hired by someone who was working from Germany and they were like, what I need to cover a lot because they’re insurance from Germany cover that I was like, I literally don’t even know what it would do every day when someone’s you know, house like how, like, but how well do they set people up for like success when they just having support and hearing someone to answer your questions and or troubleshoot your hemorrhoids is just a part of it.
Abby, MD 29:31
I don’t mean to change this up to I’m listening to this conversation and thinking about how as a hospital provider, who is part of this history of providers who have provided sometimes very unacceptable, dangerous dramatic care to patients, how can I be coming from that history? And how can I become a person that patients can trust You know, I’m grateful for the skills I have when birth really does become traumatic. And you know, I’m the one that ends up doing the C section when things are really wrong or dealing with a postpartum hemorrhage or dealing with these really quick emergent situations, how can I provide that care, but also distance myself from a history of physicians who have done harm to women? And get patients to trust me? I don’t know that there’s an easy answer. I feel like there are a lot of themes, what you were talking about with postpartum, you know, education and Pansay, what you were talking about with the education and empowering women during birth, that needs to happen. I feel like in a busy practice, we don’t always have time to do that. So we need to use our resources, we need to use our, you know, support people, our doulas, our educators, and really come up with a system where we can all help really get patients to their best possible place, going into a birth with the best set of expectations about what that birth may or may not look like. And then help them walk away from that feeling like they were in control and cared for while and treated, you know, safely and compassionately.
Maggie, RNC-OB 31:16
I mean, obviously this is my vision. And that’s like, why I love having these conversations with all of you, and all the different roles and life experiences that we represent. Because I feel like that is that is what we need, like, our system needs a whole reboot, so that we can actually have people best supported in the way they need by the people who have spent their life learning how to give that care. Well, like we all can’t do that, necessarily. We all care for people very differently. And that’s great, because people need us all to be very different kinds of providers and different situations. And, you know, just like Pansay was saying about, you know, the intergenerational trauma that is part of our world here in the US because of systemic racism, that is something that I can be aware of in a more more academic level, or, you know, a more mental level, but it is not something that I have experienced as a white woman. And so I am going to connect with those people differently. And so I think with all of this is that moment, again, for us to balance out what are the systemic responsibilities, and the things we can change on that bigger level? And where do we find the personal responsibility for our individual actions and how we can change the tide, one person at a time. In particular, there are some wonderful birth professionals out there who offer trainings around trauma informed care. In particular, the Birth and Trauma Support Center run by Krysta Dancy has a wealth of information on this topic for how you can, you know, change your practice to be more in tune to the way trauma affects all of us. And as we’ve highlighted in this episode, in different ways, because it’s not the same trauma for each person, it’s not going to have the same, you know, impact on their birth and on their experience, but it’s all things that we need to be more aware of. So I’ve taken some wonderful training through there that have really helped open my eyes. I particularly enjoyed trainings from Dr. Sayida Peprah, who is a psychologist and a doula and does a lot of work around intergenerational trauma in the Black community. I have really enjoyed trainings from Mandy Irby who speaks particularly to nurses and other birth pros about how to prevent trauma in hospital setting. I also had the pleasure of doing one recently with Eri GuajardaoJohnson, about trauma informed care for survivors of sexual assault, and that was very powerful, and I’ll link all of these folks and their trainings in the show notes, so you can find them easily. But I do feel like this is our opportunity to, you know, reflect on our own practices and what we’re doing now. And take a moment to see how we can model for everyone else in the system, ways to change the cycle of trauma being so prevalent in birth, and create a different future for it. So, thank you all so much for having this challenging conversation with me. I appreciate you.
Thanks for tuning in. We love to talk birth and would love to talk with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, we’re Your BIRTH Partners on all platforms. And we welcome you especially to join our new Facebook group, so there we are Your BIRTH Partners community. And there we have an opportunity to dig more deeply into these conversations we have on the podcast and learn more from each other as we apply these out there into the real world of birth care. So we look forward to seeing you there. You’ll be able to find on our show notes, links to some of the trainings that I mentioned that have been really helpful for me growing as a trauma informed professional, and we look forward to hearing from you about what has helped you on this journey. Till next time!
Cultural Humility in Birth Care
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners. We’re here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today we are discussing cultural humility in birth care. We are going to dive into some of the differences between cultural competence and cultural humility. And we’re going to talk about what it looks like to create culturally competent care spaces and to elevate our own practices so that we can cause less harm as we’re taking care of everyone. So I welcome you on to this conversation with Dr. Angela Mike, Certified Nurse Midwife, Ray Rachlin, Certified Professional Midwife, Pansay Tayo, doula, and Dr. Abby Dennis, MD. Onto the show!
You know, cultural humility, and how do we show up for people recognizing all of the different systems of power and oppression, and the roles that we have, the power that we have to, you know, kind of two weild for, you know, good or for evil. And I think that’s one of the things too, that I think when, because of the way our like, academic medicine, and you know, nursing and midwifery, and a lot of the trainings I’ve done, try to break down into like, connecting with people who aren’t like you into, like, it’s a box, it’s a chart, you know, on the page that just says, like, oh, if the person looks like this, here’s the way they’re gonna feel about it, if they’ve got this ethnic background is how they’re gonna respond. Which is just it’s so incredibly off base, it’s, it’s remarkable, you say it out loud. And it just sounds insane. And it’s insane that these are still like the way textbooks are being printed now for medical and nursing education, you know, I think there’s that whole piece we’ve talked about about like, how do we go from cultural competence, this idea that somehow magically, I as one person, am going to understand the culture of everyone who comes in front of me and be able to care for it appropriately, versus cultural humility, where I am open to the fact that I don’t know anything, I don’t know plenty about each of your cultures, whether we look the same, or we’ve lived in the same areas, and we’ve had some of the same experiences, like, I can still learn so much more about that. And so I wonder if we could speak a little bit to, you know, how do we kind of get past some of those barriers and create in ourselves that ability to be open to people who look like us who don’t look like us who have some major experiences, who have no shared experiences, and still be able to provide care for them?
Angela, CNM 2:45
I think I mean, you said it, Maggie, it’s just being humble, you know, ourselves. And acknowledging, you know, I don’t know. But being genuinely open without judgment, and not tolerating, but accepting people for who they are, where they come from, and what they believe in their philosophies. Because at the end of the day, I’m here to provide a service, and they chose me. And I need to be respect that respect needs to be parallel, you know, and I think that as long as we just remain open to differences in make ourselves aware in each individual’s space, then that helps to create that balance. Because you’re right, there’s no way I can be culturally competent. When everyone’s situation, I don’t know, your background, I don’t know your story. It’s different from mine. Even if we do look alike, it’s different than mine. And you just have to be willing, willing, and just 100% open without judgment.
Ray, CPM 4:03
Yes, to all of that. And I think something I learned in like doing trans health care that’s been really helpful and like, serving people with different backgrounds and me, is giving people opportunities, like how to correct me, you know, like at the beginning of care asking, like, both for, like, “Are there things like you know, culturally, religiously, that you think is important for you to know about caring for your family,” and that, you know, I’m not a perfect midwife. And if I’d say or do anything that doesn’t work for you, like I’m a New York Jew, so I respond really well, to direct communication. So you can like, tell me up front that like, I messed up and also, if that is totally uncomfortable to you, shoot me an email and I’m happy to like, address any ways that like, I’m wrong. Like in trans healthcare, a lot of what we know is that trans people typically have to educate their health care providers about their own needs. And you know, when I’m caring for someone who’s like black or brown, you know, although like over the years, I’m getting more experience, I’m like, still, like, I’m never going to understand. So acknowledging that that exists and that they’re going to be my teacher and like, some of my trans clients have been like after things like you want me to, like, read or learn about to better care for you, please let me know. And it kind of goes, you know, there’s different ways to ask that question to be like, “how can I like learn to be a good care provider for you?” and acknowledging that that power dynamic exists goes a little bit towards building trust?
Maggie, RNC-OB 5:29
Yeah, I love that. Just that reminder that we don’t know everything, I think so much of how like medicine was set up is that that feeling that we all have that we’re supposed to write that if we admit that we don’t know something, it you know, if we open that up, that it opens up this idea that maybe we’re not a good provider, maybe we don’t know enough to keep someone safe. And so I think sometimes our ego prevents us from wanting to engage on that, and admit that we, you know, we don’t know something and I do, I just, I love that idea of really like starting that just opening up with like, “Hey, I don’t everything about you, but I would like to know more about you so that we can be in this relationship together. And you know, we can do this.” And just having that moment of just like authentic connection and breaking down role walls that we put up, you know, that keeps this bizarre power, dynamic at play.
Abby, MD 6:24
There’s something really beautiful at birth, when you do really get to that point where you feel like you, as a provider, and a patient are just like, completely present, and you’re communicating well, and you’re doing your best to get one another. It’s one of the moments for being in a healing profession, it can feel really magical and wonderful and right. But it’s, it’s hard. We’re all learning, like you said, we’re all learning and we’re trying to be better.
Angela, CNM 6:55
I think there are parts of medicine, too, that just does not allow you as a professional, you know, as a profession historically, anyway, to admit that you don’t know. Maggie, I can’t even tell you how many times in my young career as a, as a nurse, I was just so afraid of like being wrong or my ego, would just be in the way. So often, it prevented me from being able to learn and grow my practice. And thank goodness now I’ve become more of my own person where I have zero problem saying, you know, what, “I just don’t know, I’ve not experienced that before. I don’t know what that is, let me get one of my colleagues to come look, I have no clue.” You know, and, and being okay with that, you know, I’m really good at a lot of things. And sometimes I just don’t know, and I think in medicine, gosh, we need to give each other permission to not know to not have all the answers so that we can protect our clients and do what is absolutely best for them. You know, we’re just human, you know, we’re just human. Several brains work way better together than one sometimes. We need to, to allow for that, and I think that would break down. So many barriers that we’ve already discussed today. Specifically, when it comes to trauma and birth, and cultural awareness, all of those things, even when it comes down to like the different professions within the birth community. You know, that would be at least the beginning portion, in my opinion of healing, and making things better.
Abby, MD 8:58
We’ve focused so much on gaining people’s trust that we’ve I think tend to that whole phenomenon of not being able to be like I need help, I don’t know. People, there must be some maybe subconscious thing that we’re doing. We tend to repress I don’t know if it’s ego, or if it’s just feeling like that’s a barrier to gaining anybody’s trust, which is so important.
Maggie, RNC-OB 9:23
Pansay, I feel like you do that so beautifully. And I’ve watched you do it in circles with people. And I don’t know how much of that you have… I don’t know how much that is just because you’re an incredible person. And that comes naturally for you or if that’s something that you would really, you know, kind of cultivated, but I’ve watched you really I don’t know if you can speak to the way that you engage with people and both acknowledging their experience and then being able to offer yours in just a really, like genuine and heartfelt way.
Pansay, Doula 10:00
I approach all women, you know, and especially in, you know, when we’re in circle or even a client, I’m looking at my past, right? And how I was treated and things that happen, the amount of judgment that was put on me for what, whatever reason, and or why did I feel blocked out of certain groups or, you know, situations. So, a person, no, no judgment, no assumption, just the person. And when I create sacred spaces for that, there are some things that I know for sure that this is a haven being having a spiritual experience. And I want to provide a space for this being to feel safe to be able to let the walls fall, and just connect to source. And when I do that, they feel at all all they all they fill is love, and support and safety. So I’m not assuming from the color of your skin, or you know, how you dress, or whatever. But you’re human being in spiritual experience, like we all are. And that’s that, that will be my hope, that how we treat it when we go into any of these facilities, any doctor that we see if that we had treated and respected is just that.
Maggie, RNC-OB 11:30
I feel like that’s another one of those things, you know, that it feels like, that should be human nature. Right? It’s just so sad that that is something that needs to be fully said, It’s sad that that is that is not what happens, for way, way too many people way too many professionals, birth workers who they’re not prepared to, to see the whole person. And, you know, to get past some of those assumptions, I think it’s one of the things I know when, when we talk about like, cultural competence, it feels like it’s often just being broken down into again, we’re just we’re trying to put people in, in boxes, and rely on those stereotypes about what we’ve assumed, or the last person we cared for, who looked or seemed similar about this person, but you know, on based on, you know, race or class, or any of the ways that we kind of can quickly assess people. It’s just incredible how much we miss doing that, and how much we miss it, what we bring, you know, as ourselves to, you know, when we just tried to be in this, you know, false professionalism piece that, you know, that is that is driven by white supremacy, and what you know, what the expectations are around how we are all supposed to behave in these situations. And we’ve completely created this, you know, false dichotomy where people feel like they can’t connect from a human being to another human being, and that we have to put on all of these, these airs around who we are so that we can establish credibility, what a different world it would be if we really were able to do that, everyone.
Ray, CPM 13:09
Yeah, I think both in this and in the trauma-informed care conversation we had, you know, the thing that prevents us from having a healthcare system that centers, the needs of like marginalized people is profit, you know, in capitalism. And as long as we have a health care system that is for profit, you know, people are going to continue to die and suffer and be treated badly. You know, and because I think, you know, that idea that, like experts know, everything, and it’s top down and power over versus power with, and like, is a product of healthcare being a for profit system. I so wonder, like folks in other healthcare settings had the ability to practice slower, and have more relationships and have more conversations about the nuances of care and like what we do and don’t know, or like, getting to know the person in front of them, and like learning the skills to do that, instead of learning the skills to code to go to let your you know, to be able to keep seeing more people? What things would look like, and I don’t, you know, I don’t think there’s any easy answer. I do think, you know, with, like, the black maternal health conversation and like, you know, the fact that people are dying from racism in this country, the answer often comes back to midwives. And like, it’s not midwifery is not the answer to all of it. But having longer appointments with a provider that you know, and have a relationship with and is more likely to act as an advocate for you is a big part of the answer. And having more providers that look like you and prioritizing that is a big part of the answer. All of this, but as long as we’re in for profit health care systems, like we’re we’re going to continue to fail and like in all these different ways.
Maggie, RNC-OB 14:51
Yeah, absolutely. I think I mean, I was just looking at some of the stats about kind of the some of the racial breakdown around you know, who provides care, who receives care and, you know, the recent census data was showing that from, you know, for our youth, so zero to 16, so that people that will be childbearing in the next couple decades, you know, we have in our country now like about 50%, identify as non white. And then our, the breakdown of our care providers. midwifery is about 90%, white. OB-GYNs are about 75 to 80%, white, you know, nursing is somewhere in that range as well, you know, and so we are going to keep running into these issues. If we don’t, you know, both for people like me, who, you know, are white, and have been ensconced in kind of this completely unearned power and privilege, to not care about someone else’s culture, because ours has been the dominant one, we are just going to see more trauma, and more harm, and continue to see excessively high deaths for black and indigenous, and you know, all people of color, if we’re not able to let go of that there needs to not be a dominant culture, there needs to be an acceptance of all of these different cultural backgrounds everyone’s coming from. And I think so many of us in, you know, in healthcare, because our health care providers professionals remain so white, it is hard to drop some of those things that come along with white supremacy culture, and to step out of that, and to let go of some of this, you know, the excessive the professionalism piece, the needing to be right, and being the expert, and some of these things that all come along with it, so that we can actually engage with the people in our care. And I’m saying this as a white person who, obviously I don’t have the answers for exactly how that looks. But, you know, I will certainly link in the show notes, some trainings that I’ve taken around, you know, cultural humility and understanding how our role can play into that. I think those are, you know, that’s really helpful.
Pansay, Doula 17:15
Is there ever like a, Maggie I can ask you, within your trainings that you’ve taken, you know, in the hospital, do they ever have classes for you all, as far as cultural humility? Feels like me, wait, it’s a part of, like, any type of any type of training or you know, anything dealing with birth, pregnancy, anything like that? No.
Maggie, RNC-OB 17:37
So I think there are some health systems who are probably a little bit more, you know, whatever you want to call it forward thinking progressive, who are recognizing this as something that needs to start from us in, you know, that we, as the birth professionals need to change the way we’re interacting, I would say, the trainings that I’ve taken, you know, over that have definitely been outside of, you know, hospital setting that I’ve done some, you know, there’s some organizations who, you know, who could have done it more within the system in terms of being able to, you know, earn the CEUs, continue education credits that we need to like, renew your license and stuff like that. So they’re, you know, some of them are kind of within that space. I’ve seen a way more about it in like doula trainings, I’ve done, you know, as of late and way more in kind of like community offerings, I’m sure it is like regional and some places are, you know, doing more than that. But I would say most of the kind of like formal from, you know, nursing education and health care settings, systems that I’ve worked in, most of that comes more in the kind of like, check the block cultural competence. This is what you need to know about people who look like this…have not dive more deeply into the work that we do internally. But Abby, I don’t know if you’ve seen more?
Abby, MD 18:43
I’ve seen some of this working curriculums at medical schools, which I think is really great. I know, as somebody who’s several years out of training, the place that I’ve seen this coming the most is the National Organization of Family Physicians, where I feel like I’ve seen a couple things on training courses for cultural humility and sort of ways to communicate with patients and, and just be a better provider. We’re not doing it well enough yet, obviously. But I feel like there is at least a movement to be better.
Pansay, Doula 19:13
A lot of work that needs to be done. And, you know, when you look out at the numbers, the statistics, you know, we could could feel a little, you know, overwhelmed and you know, is this going to end, but I see light, just one woman at a time, tons of education, you know, tons of healing spaces for us to do the best that we can in positions that we have in a community, knowing that if we’re caring for them properly, she’s going to tell our children about this wonderful care. She’s going to tell you know, her daughter, her sons, how she was respected, how she was honored because beautiful experiences are setting the tone for the next generation. So for every woman that I’ve got in journey through, you know, pregnancy and birth, and they, you know, they hear that healthy baby have, you know, they’ve had a magnificent experience. This is now my prayer, my hope and you know, warm, so this family and the generations to come. So woman at a time,
Ray, CPM 20:22
I do feel like I have hope and like the newer organizations in the birth worlds, like the National Association of Certified Professional Midwives has made children ability and racial justice a priority and a forefront, they have a formal scholarship program for midwives of color. You know, I think the older guard organizations are not making those same, like choices and changes that we need. But I feel like I have some hope in like midwifery futures, I think I have less hope and like how we’re actually going to create, like, shifts the healthcare system to one that’s going to, like be able to adequately provide and also, like, who’s going to get trained and who’s going to run these systems, you know.
Maggie, RNC-OB 21:06
There is. There is hope in you know, the future. And it you know, and I hope us all in, in having these conversations and, you know, working through these, that it’s something all of us can kind of dive more deeply into the roles that we can work in, in creating the birth care world that we want to see that we want to be there for, you know, for future generations, and that we’re, you know, we’re continuing to work at one birth at a time.
Pansay, Doula 21:28
Well, I thank you all for the work that you have done and are doing it for, you know, all the women that you care for. And for even, you know, coming here to this platform, and giving us insight, you know, in your position, and in your roles for us to learn more about, you know, your process in caring for women. And I appreciate it, and I learned so much.
Abby, MD 21:52
The feeling is very mutual. I feel like this is this is a subject that I feel like right now my job is to be a little bit quiet and learn because I realize I’ve been doing a lot of things really wrong for a long time. And I appreciate this forum to do that.
Maggie, RNC-OB 22:10
Yeah, absolutely. Grateful to grow and learn alongside all of you.
027: Professionalism, Activism, & Politics in Birth Care
Maggie, RNC-OB 0:00
Welcome to Your BIRTH Partners. I’m your host, Maggie Runyon, birth nurse, educator and advocate. And I invite you to join us as we break down barriers and cultivate community, discussing issues that impact pregnancy, birth and postpartum. We welcome you, no matter what your background is, and are so excited to learn together. And today we’re going to talk about activism. And what does it mean to be an activist as a birth professional, we’re going to touch on issues of professionalism, what our history is with that word, and what it means, how it limits us and our beliefs around our role within first and healthcare, and society at large. We’re going to discuss some of the particular issues that are really relevant right now, both in our political landscape. And as we work for better birth care for all birthing people. We have a special guest joining us today, Katy Cecen, will be telling us more about her work as a nurse and a midwife, turned whistleblower, activist and community organizer, she’ll share some of her personal journey with us and how she got there. She’ll be serving up some tough love and encouragement, as we all work to examine our practices, and find the ways we can truly lead as birth professionals dedicated to improving the health of all those around us. Onto the show!
All right. Well, welcome Katy. I am so excited to have you here on the podcast to chat with us today. And I’d love it if you want to just start out by introducing yourself to our audience and tell us a little about yourself and your work.
Katy, Midwife & Activist 1:39
Sure. I name is Katie CSUN. I am a midwife, former NICU nurse, a community doula and a full time organizer and activist working on issues around medical racism and reproductive justice here in Brooklyn, New York.
Maggie, RNC-OB 1:54
Yay. Awesome. Well, I am really excited to have you on here. We wanted to do this episode to talk about a couple of different things primarily, where does our role as birth professionals, birth workers fall within kind of the greater conversation about reproductive justice and health care legislature and all of these things, because I think some of us feel that, you know, one of our roles have to be kind of like a political, you know, as a health care provider. So I invited Katie to join us all today, because of her current work as a community organizer and activist, but particularly because I wanted her to be able to speak to what she saw out as a birth professional working in the field that really prompted her to take action in this bigger way. And Katie suggested that we share a testimony that she gave to the New York State Senate. And she delivered this in October of 2019, reflecting on preventable maternal deaths, at our workplace in 2017. And I invite you to listen to her testimony here to gain greater context about what is happening right now in birth care in our country, and why we feel it is so important for all of us to be more active as we work to change it.
NY State Senate 3:15
We have Katie McFadden, midwife from Brooklyn, New York. Thank you for joining us. One sec. And you swear affirm that the testimony you’re about to give is true.
Katy, Midwife & Activist 3:25
I do. Okay. Chairman Rivera, Chairman Godfrey, members of the Senate and Assembly health committees. Thank you for taking the time to listen to our testimony today. My name is Katie McFadden. I am a midwife and a registered nurse certified in neonatal intensive care. I recently resigned from my position as an as a staff nurse in the neonatal intensive care unit at SUNY Downstate Medical Center in East Flatbush Brooklyn, where over 90% of our patients are black.
On August 9 2017, I emailed my supervisor to ask when we could expect more nurses describing unsafe patient care conditions in the unit caused by understaffing. There seems to be a lot of consequences for a nurse who doesn’t do everything she should in a shift and no consequences for the administration that asks us to do more than we ever could. I wrote 20 hours later that Echo florman a mother of six who had just given birth to her twins, who are being cared for in our neonatal intensive care unit died of preventable staffing related complications. In the months following Mrs. Foreman’s death, I sent four more emails to increasingly higher levels of the hospital administration, trying to raise the alarm of of the imminent peril our patients faced due to understaffing, including the warning It is only a matter of time before another serious event occurs. On November 28 2017, four months later, another black mother Tunisia Walker died of preventable causes shortly after giving birth to her first child at SUNY Downstate. What I was too busy and traumatized to put together at this time, were the headlines in the news published the same weeks, I was sending frantic emails, detailing how Governor Cuomo chose to unlawfully withhold disproportionate share hospital payments, huge sums of federal financing to reimburse hospitals for services they had already provided, which sends public hospitals into hiring freezes. The mechanisms to improve safety and prevent another maternal deaths were obvious to us in the fall of 2017. But the resources needed to implement those improvements had been intentionally with been withheld from us by the governor of this state from the hospital, the state runs in the neighborhood the state itself segregated black breathing people are 12 times more likely than white breathing people to die of pregnancy related causes in New York City. Research shows us that that disparity would drop by 47.7% if black women gave birth at the same hospitals as white women in this city. In other words, half of the black white disparities in maternal outcomes is due to the lower quality of care provided at a concentrated set of quote unquote minority serving hospitals, many of which are public, therefore run by the state run by the government and systematically disadvantaged by our separate and unequal system of health financing. Quality is worse at these hospitals because staff and services are missing. Staff and services are missing because we cannot afford them. We cannot afford them because reimbursements from public insurance are considerably less than the true cost of care. And we care for a disproportionate amount of patients on public insurance because of historic and ongoing racial segregation and economic disenfranchisement. Funds intended to compensate for the inevitable budget for shortfalls at institutions serving a disproportionate number of patients on public insurance, instead, go to private, disproportionately white serving facilities because of laws passed by this predominantly white legislative body and upheld by our white governor. Even in neighborhoods with better funded and safer private hospitals. Widespread insurance discrimination causes de facto racial segregation. And while insurance discrimination is illegal, then Attorney General Cuomo refused to prosecute the last case that was brought against it to challenge this practice. Racial health disparities have existed since race itself was created as a tool for socio economic socio economic domination during chattel slavery. In 1850, our constitution counted most black people as three fifths of person and the white black infant mortality was one to 1.5 in 2019, the public insurance covering the majority of black birthing people pays half as much as for obstetric care as the private insurance covering the majority of white birthing. Yes, please. And the white black infant mortality rate is worse at one to two to three, private and public insurance represents a separate and unequal system. And their disparate reimbursement rates reflect the hierarchy of human value our society has pathologically carried with us since slavery ended. We’ve never stopped having racial disparities and health because we’ve never started valuing the lives of all people equally. A single payer system eliminates the funding disparities that drive racial health disparities in New York, for this and for all of the reasons presented before you today. I urge you to pass the New York, New York Health Act. Thank you for your time.
Unknown Speaker 9:34
Thank you, Miss McFadden.
Maggie, RNC-OB 9:36
So Katie, we have just played the recording from your testimony in front of the Senate. And I want to go from there into one of the first questions when I reached out to you was the idea of professionalism and where is that rub between “is it professional to speak up and challenge the system that we are a part of” and what are the steps we have to take to get into that mindset?
Katy, Midwife & Activist 10:05
When I hear that question, and I first want to really break down a couple of the components of, of what we’re talking about, because I think like if we really understand kind of the premise of the question that answers itself. So the first like the first concept I want to introduce to help us understand this is the idea of the afterlife of slavery. And that is a framework that was developed by Dr. Saidiya Hartman, to describe the continuing presence of racialized violence in American society, that is an unbroken chain from slavery until today, and essentially posits that the way that racial violence and racism have manifested itself has changed significantly since chattel slavery was the law of the land until today, but what hasn’t changed is the underlying white supremacy and anti black racism that causes for there to be hugely on equitable landscapes for black and white Americans today. And I think it’s really important. So I want to answer the question like, essentially, is it unprofessional for healthcare professionals to be political, with the understanding that we are currently living in the afterlife of slavery? And so when we, when you ask that question, we have to think about American history and ask like, well, who made politics who determined what professionalism is, and who created the American health care professions? Because the like, we know that, like, we know that those things developed in politics is a, you know, we have 400 years of political history, professionalism is culture that has been developed over 100 or 200 years since the Industrial Revolution. And so to zoom in and answer that question today, as if the policies have not been created by white supremacists, as if professionalism has not been created to support and uphold white supremacy. And as if segregation and medical racism, were not foundational to the establishment of the American health professions. So like, who determined what is professional, white men who explicitly wanted to hold on to power and keep other people from obtaining that power, the white men who had power normalized the things like their culture as being the professional culture, and then as more explicit racism starts to fade in American society, you we don’t say you have to be white to work here anymore. But we do say you have to be professional to work here. And all of the standards of what makes you professional, are predicated on those eight men with power, who were creating that culture to exclude people and hold on to power. The, you know, the policies like is it okay to get involved with politics or to talk about politics at work? Well, those you know, it used to be legal to, to own other humans in America, like that was an American policy, like you would have been you, you know, and then like the same people who created lot like the same constitution that upheld slavery is the constitution we are living under today. Our founding documents wrote in that, that most black people were three fifths worth of a human. Lastly, healthcare professions, a lot of what makes a profession a profession is the ability to exclude other people from doing the things that you do. So the profession of nurses, you know, we put in IVs we put in catheters and like, that’s something we do you know, that’s a nurses aides don’t do that and those skill differentials by holding on to those skills. That’s what helps us establish as a distinct profession of nursing. And where we do learn those skills, but school and then if and thinking again, to American history, you know, it was legal to racially segregated schools up until the mid 1960s. In America, we create healthcare professionals. So there’s an in and an out, we create schools so that people can get to the end. But we say you can’t come to that school if you’re black. So like we explicitly made these professions predicated on whiteness on white supremacy on the actual exclusion of black people and other indigenous people and people of color.
So I mean, so I suppose in some ways, it is the most professional thing to not discuss politics as an American health care worker, because it’s been set up to benefit us conforming to those professional expectations there for allows that white supremacy system to continue on, on challenged, I became a nurse, not because I wanted to uphold an established the honorable profession of nursing, nursing, because I wanted to help people and I wanted to help take care of people. And so you know, to phrase it differently, if, like me, you got into health care, because you primarily wanted to help people in people that you want it want to help is anyone who needs help, regardless of skin color, then there is essentially no other option than to become political than to push back on established professional norms. Because we know the status quo as is, is killing people, and is hurting people and is a system of violence. And so if the if the true goal as a healthcare professional, or as a health care provider is to promote health and well being, then the only way that we can do that is by deeply questioning the the harmful practices that we have inherited politics now is the creation of 400 years of mostly white domination and oppression. But politics, like the word in the dictionary is essentially collective power, fundamentally change what policy and politics looks like in America so that it no longer continues to uphold the racialized violence that started in slavery. That is only if we become incredibly involved in the politics and policies surrounding us. really consider the amount of privilege you must hold to right now 10 months in to an out of control pandemic, not see the need to fight for policy change to save your own life. So like so many Americans, you know, so many of my friends and neighbors in central Brooklyn, need to get involved in politics, because they’re about to get evicted. And that’s the only, you know, the only avenue of recourse is to work with other people towards systemic change. So if you are somebody who not only is not in already involved in movements or actions like that, but didn’t even see the need to, I would really encourage that person to check themselves and examine the ways that they are upholding those harmful systems, that that you may not have realized, because the concept of the afterlife of slavery is something we teach in school. And because we, you know, we’ve been actively taught to consider current American history as if we’re the greatest nation in the world that like made a Whoopsie on race, but that that we fixed in the 60s and not as a country that essentially found different ways to continue the same forms of racism that benefited those with power does indifferent and easier to hide forms.
Maggie, RNC-OB 18:23
Yeah, absolutely. I mean, that that exceptionalism piece, it absolutely does, can you kind of hurt us, and probably the way we the way we position ourselves in the world, the way we position our collective moral compass. And I just wanted, I really appreciate you like spelling all of that out, because I do think…I’m sure for many of our listeners, like those are things that they’ve thought about, they’ve maybe like, put some of those pieces together. And some of them were like, absolutely just nodding along with you, because they know all of that. But I think for like you said for many of us who’ve had a lot of privilege in this life, it’s easy to just not pay attention, right, because it hasn’t been pushed in front of you. And I think sometimes too, within the birth world, we get in these bubbles of kind of what are what is our role? What is our place? What are we actually doing? And another theme that has come up as we have, you know, several conversations on the podcast this year, is when are the times that people step forward and take action. doulas see themselves as as advocates, you know, are they able or should they be stepping up for people who don’t have a voice in the situation? And that’s one of those things that we have talked about? Because, you know, our belief is obviously that we all need to be collaborating together to create more inclusive equitable care spaces where everyone’s opinions are respected. And so by necessity, yes, sometimes you do have to step up because absolutely, not everyone is treated equally based on race based on class based on 8 million others ways that we categorize and other people. So, you know, okay, one of the things that I think people feel like they just don’t even know where to go from here. So you know you’re a birth pro, you’re in that the grind of day to day, how did you know maybe you can share a little bit about your own story how you transition from, you know from a nurse at the bedside midwife and then now you’re you know, full time organizing activist and that’s where you’re really seeing your purpose.
Katy, Midwife & Activist 20:25
So like the punchy answer I have to the question of, of why I’m doing the work that I’m doing now in the way that I’m doing it is because I’m not a sociopath. You know, in the in the testimony that I presented, I talked about how like I emailed, I emailed my bosses 24 hours before a woman died of preventable causes. I escalated up the entire chain of command at the hospital to say that there were safety issues and what could we do about it, and no one responded and things did not get better. And we had another preventable maternal death. I spoke to the press about the ways that understaffing we’re putting our patients life in danger. And then they published an article that didn’t use the word understaffing once and then later the same reporter published an article praising herself. That’s her first reporting thought state intervention. And like, because of her first article, the state initiated maternal health program. Well, the maternal health program was to teach the nurses at our hospital to be less racist, even though the nurses at my hospital are almost exclusively black and Philippine x people who for decades have been protesting that we are not given the resources necessary to provide safe and efficient care to our patients. And so if they are not receiving safe and effective care, it’s not because we don’t want to provide it to them, and we are being racist towards our patients. It is you the state that has continually failed to give us the resources necessary resources that we need, that is causing the the care issues here, again, like I became a midwife, because I wanted to help birthing people. And so I kind of was faced with these options of, well, I can keep working as a nurse, and watch people die, I can get a job as a midwife, and make a little bit more money in the system, and keep watching people die from the same things from the same policy decisions, or I’m gonna get involved in changing the policies that are causing people to die. And that was not an easy decision. That was not a quick decision. That was a decision made, after almost two years of knocking on people’s doors, talking to organizations and sharing what was happening at my segregated black hospital, and asking for help and support and essentially getting a lot of like, That’s terrible. We would love to support you if you want to fix that problem. But we don’t have the capacity right now to work on that. And so, you know, I had these options. I knew that if I left the policy work alone, that there there were not a lot of other people to pick it up, continue to draw the connection between low care quality and segregated putting this in air quotes a high minority serving facilities, and the population level health disparities. And so knowing that and having the privilege to take some time out of the paid workforce to be able to focus on that, I really thought that was the only kind of appropriate response as a human as a as a human and as a member of my community. Yeah, like, morally, I didn’t see a lot of other ways to go. I think it’s very easy, particularly for doulas and midwives, who see themselves as somewhat outside of medical industrial complex for them to see these huge systemic issues and to think well, like at least I’m providing good care to the patients when I see them. Well, that’s true. I mean, that is essentially the definition of white saviorism to think that you as an individual in your individual interactions are going to be able to make up for for centuries of systemic oppression, you know, I really tried hard to give excellent care to the patients I was caring for in the neonatal intensive care unit. And I was working there I pursued all sort you know, check my CV, I’ve all sorts of NICU-related certifications. And there’s like very few hats in the birth world I don’t wear and I like did all of those trainings to become an infant massage instructor and a neonatal developmental care specialist because I wanted to provide the best care possible to the patient in front of me. And still probably I think it’s eight babies that died of preventable causes in the five years that I worked at at downstate. Because one well intentioned nurse does not make up for the fact that we couldn’t afford a physical therapist or an occupational therapist or a pediatric interventional radiologist. And so if you are seeing problems in front of you that are bigger than that What you can solve? In the time you like, between when you punch in and punch out at work? Well, who else is going to tackle those problems and try to solve them? If not you? And if not us who are in the birth world? Like I think us, you know, folks in clinical roles have some kind of notion that they’re like people behind the curtain, who like really care about birth justice, and are tackling it from a policy angle? And the answer is like, they’re Yes, there are a handful and I don’t want to discount their work. But compared to the number of doulas and midwives who think they’re having a huge change, but are in no way plugged into those organizations are working with others towards systemic change. We’re really just continuing to, you know, we’re doing violence management, obstetric violence management, instead of ending obstetric violence. And when we get paid to do that, when that is our profession, when we benefit from that, it is incredibly insidious. And it is and when you if you are a white person who is getting paid to benefit from a system that hurts other people, like you, the even it though, obviously, it was not your intention, probably it was the opposite of your intention, when you got into health care, it does not change the facts on the ground, that the you are benefiting while other people are hurting. And if the things that you have done so far in your career have not affected any kind of real or systemic change, they, it is unlikely that they will in the future. And it is it is time for us as white people to take responsibility for the ways we benefit from that system. You know, if you’re a middle class person living in like in a nice house with your leased car, and you’re going on vacation once a year, like you are living a nice, blessed privileged life. And the money that’s paying for that is coming from a system that abuses people, we have to take this step, take steps back and and examine that system. And whenever possible, take steps to extract ourselves from things that oppress other people and participate in. So we need to have access to dismantle those systems and continue to take steps to build new and liberated systems in their place. Like when I say I’m not a sociopath, I just I want to highlight specifically the work of Fannie LeFlore, who is a licensed social worker who wrote a series of essays, one called the sociopathic roots of racism, why history repeats itself. And she pretty much describes in that piece, how white people have adopted sociopathic ideologies, essentially, as a way to deal with the cognitive dissonance of being raised in a country, we are told is amazing and super great, but that has also actually abused and violated the rights of a portion of its citizens. And so essentially, by not thinking about it at all, who is the is the easiest way to deal with that? Like the easiest way to deal with the cognitive dissonance is not to be cognitive…
Maggie, RNC-OB 28:24
Just ignore the whole thing….
Katy, Midwife & Activist 28:25
Yeah. So you know why? She says white privilege gives incentives to collude in maintaining a system that gives us unfair advantages. This is why racism represents the nation’s shadow, it requires massive denial for the white population to collectively pretend that racism no longer exists, even while we benefit from it. This points to the realization that white supremacy ideology demands people to pour a building block of lies that require the blunting of their consciousness. So as maternal health providers in a country where black babies are three times more likely to die before their first birthday than white babies, black British people in my city are 12 times more likely to die of pregnancy related causes than white people. And I think it’s super important here to to highlight the work of Dr. Joia Crear-Perry, Dr. Dorothy Roberts, who have talked extensively in their work about how this is racism and not race that causes these health disparities. So if anyone’s thinking, well, maybe people with African ancestry or with African genetics, maybe they’re more likely to get diseases that kill them before they turn one. No. A. it’s absolutely not true. B. the science, any science that would support that is totally bunk and like, been disproven. When we see racial health disparities, it is not because there is anything wrong with black people it is because there is something profoundly wrong with how we treat black people. in this country are nowhere so pronounced than here and infant maternal health outcomes. So like, if you are a white health care where you know, a white maternal health care provider and you cannot right now articulate the way in which you are benefiting from a system that oppresses people, let me invite you into the work of anti racism and into the work of starting to understand that and, and really caution, and it mohnish you from non participation because you don’t think it’s relevant to you. And if racism, you know, if the way black people are being cheated in this country is not relevant to you, it is almost it is 100% a result of the past racist actions we have taken to segregate white and black people so that those issues would not affect you. And and you again, choose to adapt this sociopathic ideology to understand the world around you on a premise that really is a false American history or a no American history.
Maggie, RNC-OB 31:06
Absolutely. I mean, we’ve and we’ve talked about it, we’ve touched before on other episodes about, you know, white fragility and white freeze and the fact that our, you know, our health care system is majority, you know, white, especially with it, you know, nursing and know, you know, what we do and physicians and midwives, you know, it’s about 70 to 90%, you know, made of people who identify as white. And so there is, you know, there’s a huge discrepancy there. And one of those things that happens as people and I say this, again, as a white person who certainly has had this, as I’ve, you know, worked through these as well, it’s that sense of recognizing how much wrong has been done things that you have done wrong, feeling a lot of guilt and concern about that, okay, like, where do I go from here, that will not also just cause more harm, because of, you know, my ignorance. And so I, you know, in your work, as you work to kind of get people organized, and start hooking people up, are there, you know, maybe some key steps that you can give to birth workers who are, you know, who are hearing this and are feeling really called to take action, but are just feeling like, completely overwhelmed by all that is wrong in the system. One of the things we’ve talked about is really this play between the system. And again, there is much that needs to change in health system and our birth care system, and weighing that with still the personal responsibility and autonomy that each of us have to take action in our immediate, you know, area. And I know you’ve touched on that already in this. So I think if there’s a way to give kind of people idea for like, what are the either just personal actions they can take and or what are the things you can be bringing up with your hospital management, your community organizers, you know, which which level you want to be on?
Katy, Midwife & Activist 32:45
Absolutely. My first thought in response to that question, essentially, like how, how do we make this quick and easy for people who are overwhelmed is, is essentially instead of me trying to make the action steps quick and easy. Is there any way we can make you less overwhelmed. So one of the things I’ve learned while organizing is one of the probably the biggest gap right now, in the maternal health landscape is people who understand health policy well enough to be able to turn the ideas and the the research of what we know, helps improve maternal health outcomes, and turn that into actual legislation that we can put up and try to get passed and implemented. And the I think those gaps exist, because everybody thinks somebody else is going to do that. I’m learning to write bills right now myself. And what I know is that it is not impossible, you know, if you got through nursing school, you can write a bill. It’s not more than a, like a certain kind of essay does take time, and it takes commitment, and it takes kind of seeing something’s, you know, sticking with an issue, and seeing it through for a while, you know, to really get into that deep structural change that we need. And so thinking about how can I make this easily accessible for people overwhelmed my first eyes again, like, Can we make you less overwhelmed? Are you one of those nurses that has like 500 hours of PTO saved up? And it hasn’t been on vacation in years? And like, could you take a day off a week, and for the next couple of months, and that’s the day that you commit to your, your personal growth and learning and so and like, that’s the day where you’re going to read the books and catch up on the news and reach out to your Congress person. And you’re not trying to fit in to the million things that you’re already doing. You’re choosing to let go of things in your life that either don’t serve you or don’t serve you as well or that maybe you have the privilege to be able to move around to be able to have time to focus on this. I go back and forth because many healthcare providers do not have the option to work less or to make less money but also a lot of health care providers do, a lot of us could make less money could work part time and still pay our bills could meet all of the necessities in our life, if we worked less, to have more time to spend on other things.
Unknown Speaker 35:15
And to spend working in thinking about structural change, I’m about to get to all of the quick things, like all of the easier ways for people to start to get involved. But I guess I just want to start with the premise that like, if you really, if you really don’t have time, time in your life right now, to participate in building a new world, the world is crumbling around us 300,000 Americans are dead, because our health system did not serve them well. So like, if you can keep a roof over your head and food on your table, and work less to have more time to dedicate to this, please do please think about how you can structure your life in a way where you aren’t fitting this in, in the in the margins. And where if you have the privilege to focus on this in a in a more holistic way. And to go deeper that you that you do that? I think the you know, something I say about privilege is that like essentially the only appropriate thing, I the only thing I felt comfortable of doing with my privilege is using it to create a world that would no longer confer to me privilege because of my race or my family’s economic standing. You had said before like, you know, speaking for those who don’t have a voice and not, you know, my thought process is let’s go beyond that and dismantle the system that makes some people voiceless, like, I don’t want to speak on behalf of anybody else. I want to say, well, like what are the barriers? And then how can I dismantle how participate in dismantling those barriers and that is something that will probably take you starting to use your PTO, or making significant changes to you know, the book I’ve read, the things I’ve listened to the conference I’ve been to that have helped me that have been so fundamental in my anti racism journey. And so fundamental for me understanding, you know, the things that I’m able to articulate now, were only because I chose to work part, like, instead of getting a full time midwifery job, I stayed and work part time as a nurse, you know, a lot of what I’ve been able to do, I’ve been able to do, because of this decision to stay part time in my job, and to work less to make less money, so that I would have the time to put towards this. You’re like, okay, definitely, but it’s going to take my boss months to approve the change. Yeah, or that is not economic, you know, you would lose that roof over your house, you know, like you aren’t in a position to be working less. I think the some easy, some easier ways to get plugged in to working towards this systemic change. I’d say first off, is look up who your elected officials are, and follow them on whatever social media platform you use the most often. So I think many people know who their congressperson is, who represents them and Washington, but not necessarily who represents them at their state’s capital and at the state level. And for, for me, you know, the hospital that I worked at where all this was going on was a state run hospital. So like, and that’s kind of when I realized, Oh, I don’t both, I guess I have to work with the state government to fix things that are happening at the state hospital. And I don’t know anything about state government. So again, like this, that wasn’t unintentional, like this is kind of an intentional decision. I’ve been going to New York Public Schools my whole life. And the my teacher for participation in government when I was in the 11th grade was a football coach who didn’t know who our congressperson was. So the fact that I’m like, that you may feel lost, interacting with, with government, government on all its various levels, like, that’s that, probably an intentional decision for us disempowered, and for us to not realize how to most effectively use our political voice. But the I think the best easy the best quick way to start countering that is to really familiarize yourself with the people who like who in a literal way represent you at your state and at the state, local, local, state and federal government and start paying attention to the things they say the things they’re doing the policies they support, and ask yourself, do those align with what I you know what i what i value is, are they representing me well, and if the answer is no, then to start getting involved with the with other people in your area to change who represents you for years the there 63 state senators in New York, and for years, almost all of them voted to approve a budget that gave 15 years million dollars to the two white serving State University of New York hospitals and upstate New York and Long Island, but not to the black serving State University of New York Hospital in central Brooklyn. So, like, every senator who voted to approve that budget did so in the name of their of their constituents in New York. And if you are a New Yorker, and you’re thinking well did my like, do my senator vote for this? Well, if you don’t know who they are, you don’t know yet. So let me first get to know who your representatives are, start following them to start clueing you into what’s happening locally, then the second is to start making relationships and start looking for who is already doing the work in my area.
Unknown Speaker 40:50
And get connected with them, to learn from them learn what they’ve been doing in the past, what hasn’t haven’t worked to work towards the issue that you care about, and then support the work that the are, that support the work that they’re doing. And, you know, start finding where your place is in the community of people who, who long before you realize this was an issue realized it was an issue and started working on it. So second, I’ll get connected with organizations that are already doing this work, learn from them support the work they’re doing. And I guess here I’ll plug some of the or like the specific organizing work that I do. Often, like when I say that I’m a birth worker like that I organized birth workers, I almost mean that in like the most literal way possible, in that I have a database with many birth workers in New York who I’ve met who have come through teachings of mine, you know, who are reproductive, just who are Reproductive Justice League minded, and I have them in a database by their constituency of who their congressperson is, and who their state representatives are. And so when somebody new comes through, and they live in a district where we need that Senator support on a specific bill, I can say, Oh, we need your senator support on this specific bill. And here are the five other birth workers who live in your district, who you can work with together, getting that support, I So reach out to the organizations that already exist. Also, check out follow me on Instagram at Brooklyn grows, fill out the form in my link tree for the movement to birth liberation. And then wherever you live in New York, or like in other states, if you live in other states, I’ll just email even say whether or not have other people in your state and let you guys take it from there. And if you are a New York, there’s a lot more going on in New York than other states, because that’s where I’m based, but kind of start to loop you into the work that we’re doing. And really, one of our main goals by organizing this way is so is to make it easy for doulas in between births for nurses in between shifts, you know, for midwives in between appointments to be able to have like, okay, people who have more time wrote the bill. Got it here. And now we just need support. Here’s the two minute script and the number of my person. I’ve met with them before on these other bills. And I can just dial in and say, support this.
Maggie, RNC-OB 43:14
And we’ll link to that and your your site and everything in our show notes. Everyone can find it easily.
Katy, Midwife & Activist 43:19
Oh, great. Thank you so much. And then lastly is just to start reading. So revolutionary black activists, Assata Shakur, who said, “No one is going to give you the education you need to overthrow them.” And I think that is really important for us to remember, like, who made the nursing schools, who determined the nursing curriculum, who determine what you did and did not learn when you are on orientation. And the answer to many of those questions are, you know, the nursing curriculum originally was determined by hospital administrators and white women with privilege who essentially wanted to profit off of the on paid labor of nursing students, which is like the only thing of value hospitals had to offer to their communities when they were opened, because there wasn’t like surgeries or medical procedures that you specifically needed to be in the hospital for, like the thing the hospitals had to sell was nursing students free labor. And then after you finished your nursing school, which was three years of uncompensated, working all the time, if you are a rich white woman, you would become a nursing professor. And if you were a working class person, you would usually go into private duty nursing, but there weren’t like experienced nurses working in the hospitals. There’s a great book I read on this: Hospitals, Paternalism, and the Role of the Nurse, which came out in like the 1970s. They get into, like, kind of the economic exploitation of women being the foundation of American hospitals. So anyway, that is to say, like, there are a lot of very important, very factual things that many white adults do not know. Because it has for, for whatever reason, probably intentionally left out of our education. And it is our responsibility to go out and seek that information and to learn it as professionals, as as people who care about the work that we do. So if you are in the birth field, and you’re not regular read, like regularly reading a couple books a year about birth, like, what’s what’s going on with you, like, you know, if you don’t like it enough to be reading about it in your private time, then like, anyway, and also add, if you if you really don’t have the time to to read extra, then how can you be advocating for yourself to have more continuing education time built into your job responsibilities, right, totally inappropriate for you to be go year after year after year without you know, a significant investment into your into developing your understanding of how to support birthing people, oh, you asked for quick things. And I just talked for a long time [laughter]: look, look up and follow your record your representatives, look up and get in touch and start working with other people who are represented by the same people by the same elected officials, so that together you can push them and work towards change. And lastly, start reading. So you know what kind of change you’re you’re working towards, and are better situated to participate in the movement towards our collective liberation. And I’ll put out that Efe Osaren, who is at the Doula Chronicles, she has a blog post “25 Books every birth workers should read” and they really are 25 bucks, every birth worker should read. I’m about halfway through and working on it for two years now. Right? If you’re wondering where to start, I’d send you there.
Maggie, RNC-OB 46:57
Awesome. Well, we I will check that out. And I’ll link it in the show notes as well. So everyone can find this because I’m sure that’s a great list.
Katy, Midwife & Activist 47:02
You had asked previously about specific policies that people can be working towards. And I really, I really want to put out and emphasize Medicare for all there, there’s, you know, a position paper just came out that’s like oh, it outcomes would improve and mortality would lower if we extended postpartum coverage from 60 days to a full year. And it’s like, okay, yes, that’s true. Also outcomes improve, will improve, and mortality will lessen if we give everybody health insurance all the time, similar to many of the things that we’ve talked about today, like the decision not to go to Universal led to universal health care in the night, you know, between the 1940s to 1960s, when many other industrialized nations were making that decision decision in America to go to instead of private public system was almost entirely informed by interpersonal racism. With the American Medical Association, which was segregated to be white up until like the mid 70s, the white doctors who made up that organization did not want to have to take care of black people. And they knew that if everybody was on the same insurance, there would not be a legal way for them to sort who they could who they would and would not take care of. But if instead, we have private insurance that you get through your employer, and remember, almost all places of employment at that time, practiced racial segregation. And then we only require the the types of employers who employ white people to offer health insurance at their jobs. And everybody else is just going to have to go uninsured or deal with a public system that reimburses at a significantly lower rate and, and basically guarantees inequitable access to care. Because if you pay two different if you reimburse doctors, you know, two different prices, right for caring for patients. What else are you doing besides saying these two lives are worth different? There is a heart hierarchy of human value, pay more attention to the people that were spending more money for you to care for? So I think like no, a Medicare for all has over 100 co sponsors right now, on the national level. And the way we get more co sponsors is for folks to look up and see is my Congress person on this bill, and if not pushing and organizing locally to get them on that bill. And if your congressperson is not somebody who would get on that bill, then you have two years to find somebody who would and vote them out in 2022. And in New York State, we have a state level Medicare for all bill that for the last two years has been one vote away from being able to pass. So if you are a New Yorker forget about Medicare for all and zoom in on the New York Health Act. Because if and when we pass the New York Health Act and prove that single payer works in America, that state level program can be a model for going to a national program, I didn’t want to end without plugging like, yeah, healthcare is a human right. And we there, there is a policy out there that actually would make that true would actually make that a lived and embodied value in our society. And that is Medicare for all, or improve Medicare for All. So please get involved in that fight being somebody who cares about people’s health should be synonymous with wanting everybody to be able to have access to that health care.
Maggie, RNC-OB 50:36
Well, and thank you, Katie, I really appreciate you speaking to all of this. And I hope for all of our listeners that this really serves as an opportunity to be called into this work. And to, you know, take the time to reflect on your practice, reflect on your privilege, reflect on what it is that we can all do to create a future where we do actually provide exceptional birth care in our country to create a birth care system that is not rife with racism, and structural inequalities. And when we as birth pros truly feel that we are taking part in helping someone to be their healthiest self, where we feel part of a system that honors and respects the autonomy of those in our care where our birth activism can grow and push boundaries. Thanks so much, Katie.
Thanks for tuning in. We love to talk birth, and we’d love to talk about with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we’re Your BIRTH Partners across social media. And in particular, we invite you to find us in our Facebook group, which is Your BIRTH Partners community. There we have a chance to talk a little bit more about the topics from this week’s podcast, and get a chance to work through some of the difficult parts of applying these concepts and change your practices out in the real world as we all work together for more collaborative, inclusive and equitable care. As a reminder, you can check out our show notes for this week’s episode to find links to the articles that Katie shared with us, and we’ll also link to the book listing or the 25 books that every birth pro should read. Thanks for being here with us. Till next time!
028: History & Future of Collaborative Birth Care
Maggie, RNC-OB 0:05
Welcome to Your BIRTH Partners. I’m your host, Maggie Runyon, birth nurse, educator and advocate. And I invite you to join us as we break down barriers and cultivate community, discussing issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is, and are so excited to learn together. So today, we are discussing collaborative birth care. And we are joined by Dr. Nathan Riley, who is an OB GYN who’s done a lot of work on community and growing birth advocacy in his role as an OB. And to gain some context around that, Nathan starts by sharing a lot about the history of medicine and how we kind of developed this supremacy and hierarchy within medicine where that causes a lot of challenges as then we work to truly be in collaborative care with all of our colleagues across the disciplines and all the different roles that we have as birth workers. So we’ll share that and a lot of our vision for how we move past where we’re at right now. So that we can truly have collaborative care that meets the needs of the individual birthing person in all of the married facets that that presents us. So I am really excited to welcome you all into this conversation. On to the show!
All right. Well, Nathan, I am just delighted to have you on here to have a conversation about collaborative care, and where, where we’ve been how we got so far away from it, and kind of circle around with some of the ideas we have for hopefully getting back to that. So if you want to just introduce yourself to our audience and tell us all about you.
Nathan, MD 1:51
Sure. Thanks for having me, Maggie. It’s a pleasure. Really, it is like of all the opportunities to just talk about what you you know, everybody talks and talks and talks for for somebody to ask you to come on to their platform, and to say a couple kind words is really, truly a privilege. So thank you. So I’m Nathan. I’m an OB GYN, currently not practicing ob gyn, but I’m actually also a hospice and palliative care physician, which is very, very similar in its practice, believe it or not, and that’s kind of one of the things that I’m always harping on people to understand is that the way that we care for people at end of life is very, very similar to how we care for them during the beginning of life, so to speak. So my practice is predominantly right now hospice, but one day in, you know, the 15-20 year span, I imagine opening up a birth center/hospice center, it’s going to sit on the same property somewhere in the woods, with chickens and all of our own produce growing and, and water charging stations, and just this in this central area where families can commingle during these two amazing human experiences that we can, that we can share together. And so that’s that’s sort of who I am, I’m also working on a holistic gynecology practice to sort of, because I see that what I’ve been studying and sort of my approach is really helpful in that in that realm, and I haven’t really been paying homage to that through my hospital based birth work, but now that I’m not doing hospital based birth work, and I’m eventually going to end up back in the community, or in the community to begin with, it’s going to kind of just where I belong, whether that be that be home birth, birth center work, whatever, or just birth advocacy, which is what I’ve been doing for the past several months since we had our baby back in February. And, and that will be a combination of Eastern and Western philosophies to meet some of the needs of women’s health that is not just very easily satisfied by a birth control pill or surgery, which is what most of us learn to do for virtually everything. And I don’t know too many people who are super excited about either of those options every single time. But anyways, that’s me.
Maggie, RNC-OB 4:03
Right. Wow; that’s awesome. I, I think I think that’s great. So I you know, I came upon your podcast, I don’t know, maybe last year at some point, and have listened to several of the episodes and one that really drew me into what you are, what you’re about, and what you are focusing on was the episode that you did when you were preparing to leave hospital based birth practice. And I think part of what drew me to it is because birth care in the hospital is really hard. And it is hard on the people, the birthing people. It is hard on the people who are offering that care. And I just really resonated with a lot of the frustration that you expressed about kind of your journey through medicine through medical school into residency and then you know, practicing as a physician, and you know, as a nurse, like so many that is mirrored in our interactions that we have with those in our care when we’re not able to, to, to do or be enough of what they need, because of the constraints of, you know, working within the hospital system. And so I really wanted to talk about collaborative care with you, because I think it’s something that’s like, has that feeling that it’s kind of like a buzzword checklist like, of course, collaborative care, we’re all collaborating. Yeah. But, as you said, when we were emailing back and forth about this topic, like, it’s not enough to just say, right, we’re all supposed to get along, everyone works a little harder. And we all just kind of make it work. Because there are several things that have been intentionally set up to make that very difficult, if not impossible, particularly when you’re getting outside of the hospital realm and trying to work in between the community and the hospital, like you want to do in your kind of grander vision. So I wanted to kind of start in reverse with kind of the history of modern obstetrics, and where physicians have kind of positioned themselves. Within this, if you want to kind of give us a little bit of your understanding of that, and how we’ve kind of gotten to this place.
Nathan, MD 6:12
Yeah, I think every great story in conversation starts with a really, really nice history lesson. And some context. So for anybody who’s listening to this podcast, you were without a doubt, trained in a system that is patriarchal by nature. And I don’t mean men are bad women are good, it’s not what I’m talking about. What I mean is that there was a that there is a system of rules put into place as to how you, as the employed person, are supposed to execute your position, right? And you were, you’ve got a superior, who’s organized by some other superior and ultimately goes to some other superior, etc, right? There’s this hierarchy. And at the end of that hierarchy, are the people who are actually on the ground caring for one another.
And so if you grew up in this system, as a medical trainee or nurse trainee, midwife trainee, whatever, if you grew up in the system, you were told that you have a place, right, here’s your spot, this is your domain, and don’t dare encroach on somebody else’s domain. Well, if we, if we were to use to look at that, through the end of life care proceedings, me as a physician, I don’t have too much to offer. Right? If I just take my medical school knowledge, or my residency training, or whatever, I don’t have too much to offer, apart from the symptom management, right? Like, let’s give some medicine for this purpose. Right. And that’s, that’s what modern medicine is, or at least Western medicine is right? Let’s find the problem. Let’s meet this meet it with a solution. Well, the end of life, there’s a lot of needs that are not met by medicine. In fact, most people, many people don’t want medicine. So what is my role then? And and we we we approach birth, the way that we approach death, we approach birth with this idea that as long as you’re a cognitively intact, upright walking, bipedal human, you probably can do all of that other stuff, that you went to medical school, and now that makes you special, you have this special superpower, that you can walk into a room and fix things. Well, you can’t fix death. And you also can’t guarantee a safe birth. Most births are safe, we can we can say that probably 999 out of 1000 are safe. But the majority of things that doctors are doing, are in order to eliminate the risk of that one in 1000. And that’s okay, we as a culture, appreciate that. And we need doctors to do that. The problem is that what if a person has emotional trauma or they have some sort of sexual abuse in their in their past or they have some other social work need or spiritual concern, whether it’s at the beginning or after you’ve lived this human experience? Who do we turn to? Well, just because you’re an cognitively, unimpaired human, you don’t have the training and the skillset to take care of the spiritual, emotional, psychological needs of a dying human, or a birthing human. And I, I challenge anybody to convince me that those two that these two events aren’t the two most perfect but also most avoided events when we’re sitting around Thanksgiving dinner or otherwise. So, and I am getting to the history lesson, but how we got here is we have physicians who walk around as if because they went to medical school, specifically a western US accredited medical school, they now have domain over all aspects of the human experience. They know it all because of course, they know what the normal stuff is. This is the fluffy stuff to you know, that we, we, you know, we can talk about in humanities and whatnot, but that’s not the medicine you weren’t “good enough” to do the medical thing and that’s why I’m here. So thank god, I’m here. So we have this God complex, I don’t mean that lightly, we really, we really are trained. And if you’re a surgeon, you’re trained that if you’re not the best surgeon in the room, you better hand your scalpel to somebody. So I am not also giving this lesson so that ob gyn so bad about themselves, but if you’re trained as a surgeon, and you’re not the best one in the room to do that surgery, ethically, it’s not, it’s sort of imperative that you actually hand that scalpel to somebody else. So you’re trained to think that you are infallible. And as a result of that infallibility, other people must be fallible. I described this sort of system in order to illustrate that what we’re lacking right now within our modern medical system, and, to your point about collaborative care is that we have people within the system, who think that they’re a sort of end all to every issue. But it gets worse than that, because even the people who, who trained in all this medical stuff, at some point, they decided I’m going to step away from the table. And I’m going to go and worry about the medical stuff, while some other business person steps in and actually says, Doctor, you are so important. We pay you a nice salary. It’s not a great salary, but it’s a really good salary. While we take care of the rest. And so now what you see there’s a recent article, and I think it was JAMA, the article really looked at the expanding health care workforce, right. And the vast majority of our health care dollars now are not going to you and nurse me a doctor, the social worker, the chaplain, the people that are actually on the on the ground caring for people, it’s actually going to hospital administrators and the business of providing medical care. And so what we’re seeing between me, you know, talking down to you on labor and delivery, or speaking poorly about a doula that comes in, even though that doula knows this woman better than anybody, they may even be their sister, or their aunt or somebody else, like, this is like the old school way of caring for one another, and we’re gonna dismiss it, that’s actually horizontal violence, this is actually not about me versus you or versus anybody else. This is about me versus the system. And that’s why I had to leave the hospital, because it didn’t allow me to not only take care of you, the person who’s administering drugs in the middle of the night, while I’m trying to get sleep, it didn’t allow me to take care of my family or anybody else, either or myself. It really was just a matter of caring for things in order to check the boxes from the C suite that the C suite had passed down to us graciously, while they’re walking away with millions of dollars per year in salaries and bonuses and all that other stuff. How did we get here, that’s what you asked. It’s important to illustrate where we got to before we can talk about how we got here. So, you know, for about four centuries, I think that the big issue that men have had with women, I mean, it goes way, way, way, way, way back, there were some ancient civilizations like ancient sumur, where women were actually worshipped for what they provided to the equation. But you fast forward, and we’ll get to that a little bit, the woman, the goddess of the feminine, right, the church of the goddess, that was a thing, and that still should be a thing. But what happened probably in the 13th 14th century, up through the 17th 18th centuries, especially in Europe, and we had our own version of this in the United States, but the witch trials of Europe were a perfect, they were exemplary to what we’re at what we’re actually seeing nowadays, which is this kind of siloed set of skills that we expect people to have in the hospital. And what was happening then, is that we didn’t have a professionalization yet of medicine, there wasn’t a doctor walking around. But we had a church and state who felt very, very threatened by women who had skills to care for themselves in ways that God could not. So instead of God providing you healing through prayer, you now actually have herbs and you have tender human touch, and you have maybe some,
you know, tinctures and things like that, which very, very quickly became witchcraft, you know, that magic. But what women were practicing during that time was not magic at all. And I do actually, I believe in magic. I think that there’s a lot of important things that we can’t actually observe through our randomized control trials. But that’s a different conversation for different time. What women were practicing was the use of stuff that they knew worked based on what their mother told them what their grandmother told them what their great, great, great, great, great grandmother had told their progeny. And it was passed down in through empirical evidence, they knew that if you give this plant during this time of the cycle, that it decreases your fatigue, right? And, like what I’m talking about is, let’s find some herbal remedy for heavy menstrual cycles. Right? And, and the woman takes that in they become more productive in whatever capacity they operate, you know, in their family or whatever. Right? But that is modern medicine, like they had pharmacopoeias that were practiced through what eventually became midwifery. But we’re not even talking about midwives, we’re talking about the, the sage, sort of respected woman in a small town or village who actually just had this knowledge, and maybe it was written down, maybe it wasn’t, but they knew what to do. Well, if you can care for yourself, you don’t need a state to tell you what to do. And you don’t need to actually pay taxes, or pay into some sort of coffer, to get that care. And you certainly don’t have to pay to the Catholic Church, or the Protestant church for that matter, in order to have the blessings of your pasture and God to get better from your maladies. So fast forward, you know, millions of women died in Europe, during these witch trials, right. Towards the end of that, they actually started to see the emergence. And it actually wasn’t even towards the end of that actually, earlier than that, in the middle of the witch trials, the role of the physician actually became critical, because you actually will see there’s a lot of texts this the Malleus maleficarum, I think is what it was called, it was like the Witch Hunters guide from the 13th century or something. It actually describes as well, how do you identify a witch? Well, a doctor will give you will give you no credence to that to that claim. And so once you have one person who’s now claimed as a witch, you torture them, and you get them to accuse others. And now you have other women who, and so it’s slowly you squash out this knowledge base. And I’m not going to go further into detail about this, because there’s plenty of books out there to read about this. But you can imagine how then after the witch trials, they didn’t eliminate all of those healers, like the healers that at that point, the women who were doing this, this great important work, they, they were really that the healers of the people, right. And that, that that kind of understanding, still kind of live, because poor or otherwise, what we would call an underclass or, or underserved people still had to go somewhere, right, and there was still that little bit there. So they didn’t need to squash it out. They didn’t need to hang every single person who possibly had that knowledge. But it’s certainly allowed them to then further clarify, oh, the women who are attending births that was kind of like the little Bastion left of where women were, were so valued in this space, and that and that gave birth to gave birth to the modern midwifery movement, which is very, very, very, very old.
And so, you know, you now then are left with like, Oh, well, well, there’s just a few people left doing this. And those few people are now living with this narrative that has been developed the mythology of like the dirty old housewife, right? Like, it’s an old wives tale. This is all part of our history. And those women continued to do the, you know, perform the role of an of an obstetrician until men started feeling like well, maybe we could take over a part of this, there wasn’t a lot to go around in the 17th 18th centuries, and into the 19th century. So you know, they developed mechanical ways of helping to deliver, quote, deliver babies, not birth babies, not to attend or catch babies the way we say now. But like, let’s put two big salad prongs in and let’s pull the baby out, you know, and if you only give license to certain men who actually were barbers, barber surgeons, they call them the the sort of license to use these things. Well, that actually eliminates most business for the midwives not that you needed those to do it. But you create the story that this is this is the right way to do it, right. And there’s there’s middle upper class men that are telling you this. So we’re still dealing with classism and sexism now. But if you fast forward then to the sort of professionalization of medicine, it was systematic in the way that women were kicked out of the profession, it was made impossible, there was a whole there was a propaganda scheme. In order for white rich men, to be supported by other white rich men in order to professionalize the the sort of what we now considered standard operating, you know, procedure, where a birth is kind of now considered more of a surgical procedure than it is an actual natural, physiologic process. But the midwives could have told us that we push them out by creating a space for white male physicians to do this work. And there were a couple female physicians, and they actually probably were the dis most disliked by the feminist movements of the time, because they were saying, hey, hey, those lay midwives get them out of here. Like, like, Look at us. We’re the ones in the white coats like, you know, and it’s like one out of 100 are actually women. So what what did we do later? Well, and actually, I should mention the flexner report, there was this report that came out I think in the 1830s, something like that, where some big money like the Carnegie’s and Rockefellers actually finance this stuff. Of every single medical training facility in the United States, and they kind of gave them a grade. And if you weren’t in the in the good graces of the flexner report, you weren’t going to get money in order to open up your hospitals and your facilities and your medical schools. And they found that, hey, if we have medical schools that allows us to take care of more people and open bigger hospitals to make more money, well, women weren’t going to be a part of that, especially old wives. Right? Who, right, they had sort of characterized midwives as for hundreds of years now. So fast forward to now and we’re left with a system in which predominantly white middle to upper classmen myself being one of them, I’m not gonna not gonna lie, I was a shoe-in in for medical school, you know, go through residency, you don’t see many people of color, you don’t see a lot of you do see a lot of women nowadays in medicine. But it took us a long time to get there. And the biggest concerns that I developed when I was in my residency training, which actually feed into why I left hospital based medicine were people, my colleagues saying things like, Well, did they go to medical school, you know, fill in the blank, the doula, the midwife, the labor and delivery nurse like you? “Well, I’m glad they have an opinion, did they go to medical school?!” Like that is actually not your original thought… What you are actually regurgitating is something that was passed down through 50 generations of sexism, classism, and the professionalization of a sect, a specific sect that sort of defined how we should be practicing, so to speak, the attendance of birth, and women’s health issues.
It was one little sect one little idea as to how this can be done, and through money and power in classes. And we actually just wiped out all the competition. So by you saying, Oh, you didn’t go to medical. So you’re literally just regurgitating it’s the most unclassed, the most an educated thing you could say. Because you don’t even have any idea what the relationship is for this person that you’re that you’re demeaning in labor and delivery, when they’re coming to you for help. You’re demeaning them. And they’ve got a patient who needs your help, and they might know everything you need to know about them. But you walk in and you say, “well, glad you you took them for a home birth, like, well, that was really smart, huh.” And then we go and publish things just to, you know, confirm our biases about where birth should take place, just because we’re we’ve got this stronghold, and we’re losing grasp of it. Now I say we because I still consider myself a part of the system, but we are losing that stronghold. And we are doing everything in our power to disparage the people that can actually do this, right. Mm hmm. And my greatest secret is I wish I had gone to midwifery school.
Maggie, RNC-OB 22:48
Oh, yeah, there are so many layers to all of this. And I think we see, particularly in our country, obviously, the impact that all that had in crowding out the lay midwives, the, you know, the old grand midwives have, you know, particularly from the South, old Black women who had been birth keeping, right, for generations for everyone, including these little white babies, who all of a sudden, these white men decided they needed to protect with all costs, by putting all of this into this, you know, allopathic medicine system. You know, the, that reverberates so much today, in terms of the, you know, maternal mortality rates, that we have the infant mortality rates that, you know, impact Black and, you know, other individual color, so much higher, you know, three to four times more for, for people during birth, two to three times more for infants by their first year of life. And I think one of the things that is hard for people and like you said, and myself as a white woman who very much is, you know, part of this system, and does this work in hospitals, like it is hard for people to accept the intentionality that was behind this system, that this is not something that just happened and we’re stuck with it. So I do appreciate the history lesson really spelling out kind of some of this, where we have come over centuries of work.
Nathan, MD 24:11
Yeah, and one thing that that I forgot to mention that you brought in so beautifully is that the work of midwives of women attending women in birth, not only is it is it ancient, like we just described, I mean, this goes back as far as humans were attending other humans and caring for other humans. But in the professionalization of nursing, which you and I talked a little bit about, before we started recording, the professionalization of nursing took all of those middle, mostly, I mean, it was actually all three classes. And it was really a kind of spanned the classes. We created this role for women in medicine that allowed that allowed us to say, well, there’s this place here, Isn’t this great? And a lot of feminist leaders really supported that role. Like, hey, look, here’s a place for us like we do have a really good thing to do well with as the white women went there and got out of birth work. Who was going to do that work, it was going to be a lot of indigenous and Black women and women who had still been doing this, but had sort of like flown under the radar, so to speak. I mean, I don’t mean to make light of the role of that any Black woman or any of her ancestors has had in this country, it’s been a tragedy. And I absolutely believe that. On the other hand, at this time, people didn’t care what Black women were doing, because they weren’t a threat to the the sort of patriarchal white, upper class system that was being professionalized right within medicine. So I’m glad you brought that up. Because it wasn’t until later that those midwives also are being, you know, persecuted, and continue to be persecuted for doing this great work. And so, fortunately, I think you have colleagues, I have colleagues, there are people that are sort of rising from the ashes, so to speak, and bringing this work back. And so I guess that’s what we’re here to talk about. How can we get them?
Maggie, RNC-OB 25:58
Yeah, exactly. So I mean, I think this, there is, is really complicated history that makes it like we had said, This is way more than just, let’s we’ll get along. It’s not like a moment for everyone to just somehow put aside their differences and come together, which is a lot of what we hear spoken about. So especially, you know, if you’re the people who are in power, it’s easy to say, “Oh, well, sure. I mean, just pull up a chair at the table, I guess. And let’s do this.” While having there be absolutely no path for anyone to to do that. And so one of the things that, you know, I, I feel like I have had an issue. And so most of my work has been in hospitals, but I’ve also been involved in, you know, the home birth community. And one of the things that I think just really reverberates when we talk about like collaborative care is the idea that every community birth worker, I know from midwives, doulas, childbirth educators, anyone who’s involved in you know, kind of body work and takes care of pregnant and you know, birthing people, they all have referral lists out the wazoo. They have so many colleagues who they know to refer to, if someone comes to them and has something that’s going on, it’s outside of their expertise, their profession, what they can take care of, they are so quick to say like, Oh, hey, I know so and so who does this? Oh, they’re, you know, what, they’re really great at this, I think they’d be really good fit for you. They have all of this ability, including, obviously, reflections of the hospital birth, they’re available from, you know, birth facilities to, you know, physicians and midwives, and you know, all of that they have all these resources, and they’re really well versed in all that is kind of available as options for people who are coming into their care. And then the other hand, the vast majority of hospitals, and physicians I talked to do not have such lists there may be going to have like, Oh, sure. I mean, there’s like the childbirth education at the hospital. Yeah, you could go to them. And that’s fine. And that’s good. And I’ve worked in hospital childbirth ed, that there’s nothing wrong with that. But you know, they’ll have these couple of like, kind of rote things like, Oh, yeah, that you could do that. Or like, oh, but how many of them have a list of doulas, you know, that they’re going to refer patients to or even to let them know, like, Oh, hey, you feel like you would really benefit from maybe acupuncture? Chiropractor anything’s like, it’s just that is so rare to see kind of that return. And they certainly even if they have a name, they’re not gonna be able to tell you anything about the person just like, oh, I’ve heard this is a person in our community live look kind of locally. And so I feel like that piece of it like when we are trying to change, birth care, and I say this as someone who I, my goal is to change birth care from the inside out from being in there and doing it is like, how do we do that? When the people who care the most about kind of effecting change in the system continue to be excluded and pushed to the outside?
Nathan, MD 28:34
I think for and I didn’t have an answer to this until just now. So bear with me…
Maggie, RNC-OB 28:40
It’s the perfect timing for it.
Nathan, MD 28:41
Right, just just in time. So what one really important thought that I have now is that if you look at the so the way of the birth plan, right, the birth planning thing, I had an attending in residency who used to say, you know, “when people show up to get on their airplane, they don’t hand the pilot a flight plan, like who’s to say they have any sort of right to give us a plan as to how their birth is going to go.” And like, there’s so much wrong with that. But the biggest part of that is that you don’t even understand what the point of creating a birth plan is. They’re not; it’s not a dictation. It’s a conversation that you weren’t willing to have. And so now here they are. They’re bringing it to you in narrative form in nine pages, and you’re making fun of them for it. I mean, that’s, that’s Unfortunately, the experience I’ve had with a lot of docs. Absolutely. It’s not a surprise. So back, like back to our history lesson. Women were using empirical evidence as wise. I don’t want to say wise elder women, they weren’t even necessarily elder women were being women. And they were young and they were beautiful. And they were still doing this great work. Like they weren’t in a little old lady in some hut, like this was an incredibly important role. And they were passing this information down because nobody else was Doing it, nobody thought that it was useful to care for one another. And that’s an inherently feminine quality, which is why women are so important. We’ll get back to that. But the reason that men feel so threatened is that like women actually, were doing things that worked. Hmm. They were demonstrating like, oh, if I give you you know, it wasn’t eye of the newt, but like, let’s say it was eye of the newt, like eye of the newt totally takes away your diabetes like, well, that’s way better than injecting myself with insulin. Right. You know, the herb logy, like all of the all of the things that we now kind of laugh at, right? Like, how about like, the role of compassionate touch for people like there’s ways to touch people that make them feel better? Well, just because we don’t have some Harvard study that says that it doesn’t make it invalid. But at the time, the men didn’t have any evidence that they had something that worked better. But there was not even a medical sciences like that this thing that dates way back, but there wasn’t really a practice of medicine. We were still in like humor theory, around the witch trials. So intemperance, right, which was a Galen, one of one of Galen’s concepts. And not to say that there’s anything wrong with that either, like that was pretty darn, like pretty, pretty special and pretty useful. But it wasn’t to replace the empirical evidence in empirical really means, like, I have done this 1000 times, and I’ve seen it works 900 times. That’s pretty good odds, you know, and so, so. So in order to change the system, from within, I’m a little bit discouraged by the ability to change it within. Because it’s not just, it’s not possible to demonstrate how it can be done well, within the thing where it’s not being done well. So what I mean by that is, if we had more physicians and nurses and women who are going to the birth center, or homebirth route, and more entities that were willing to, to acknowledge that there’s good work being done here. Like in other words, if we had a giant Instagram account that could show just how freaking great birth can be. And we have a lot of them. I don’t mean, to say that. But if we had like, sort of like this centralized notion, right, like, like if we as a culture could, it could understand just how important this event is, and how beautifully it’s being done, attended mostly by women.
That, in some ways, is drawing now women out of the hospitals, and when I have colleagues who say, hey, like, Can you believe people will have homebirths, and I’m like, I kind of want to have home births. And you know, and, like, I love the idea of having home births. Like I think it’s a really beautiful way for us to in fact, when my wife and I had our baby, and about 10 months ago, when I checked her here at the home, because of because of course I checked her when people are like you did that like “Yeah, because like she’s my wife, and we’re intimately connected.” I checked her she was nine centimeters. So had we waited any longer, I would have just been having a baby right there in the bedroom, which wouldn’t have necessarily been bad because we went to the hospital and had a completely unintended unassisted birth really. So and the reason I say all this is that what we’re what we’ve what we’re demonstrating for people is that, hey, this is not an unsafe option. And yes, bad things happen. But bad things also happened in the hospital, whether they want you to believe it or not. So here in the homebirth setting, not only are things going well, and it’s drawing women away from the hospital, and getting them to question like, this hospital based birthing thing is not doesn’t sound great anymore. Like maybe I should explore some of these other ideas, home birth, even free birth for women who have actually had for many women who have actually just had a bad experience. Like this actually is way better. You know, and for many women who haven’t had that experience as well, I don’t want to say people only do free birth because they’ve had a traumatizing experience in the hospital. But the vast majority of people are thinking about that only because they’re cultural sort of tendencies to believe that being in a hospital as a safe place is going to care for me inside and now. It’s starting to change. And that’s why the hospital systems like let’s do everything we can to really disparage this practice, like, yes, there are some bad things that happen. But there’s a lot worse things that happen from my experience in the hospital, where women are having vaginal exams without people introducing themselves first. I mean, that in and of itself is a harmful practice. It’s not it’s not just like, not ideal. It’s suboptimal, like this is a traumatizing, dehumanizing thing that we’re doing two women every four hours based on some arbitrary clock somewhere. And I know you know what I’m talking about, because I was chastised by my nursing staff when I was in residency and they were like, do we really have to check her in I’m like, “the attending’s mad at me like, what do you want me to do?” I still have nurses I wish I could, like have coffee with them and be like, “I am so happy that you pushed back.” Because otherwise we’re not teaching people that you don’t need to go by the standard labor curves. There’s there’s one ways of doing this. So this is a long answer to your question. But what we’re doing now what we’re, I say we because I’m a huge advocate for this. What we’re demonstrating as a birthing community is that there’s better that there are other ways to do this. And in many circumstances, that’s better. So that’s a serious threat to the hospital system, which is why there’s a lot of disparagement. That’s why there’s a lot of reinforcement of what we’ve been doing in the hospital. Because if we admit that we aren’t doing it well, then what are we like, the second best? Or what are we I mean, like, this is a natural human thing. This isn’t just a medical thing. This is how people get you to go to their place to have their car fixed, you know, right. They want to be the best. They’re number one, the number one Nissan sales, and they’re in the region.
Maggie, RNC-OB 35:44
Right, right. Yeah, I mean and we’ve talked about that, too, like often in birth communities, especially when we’re talking about changing birth care, it can come across it, you know, that we’re anti-ob-gyn, that physicians are just the worst around. And obviously, my belief is not that at all, I believe that physicians learn a very particular skill set in their training, which is very valuable. And at times what is needed most in a situation. However, it is obviously not what is needed, right, every single time, just like my skill set, as a nurse is not what is needed in every birth at every moment. I mean, that’s just because that is because we are all human. At the same time, you know, it’s not the job of a doula to feel like they’re supposed to somehow cover for everyone’s singular needs during, you know, their birthing, it is no one’s responsibility, it shouldn’t be any one person’s responsibility to provide all of the care and all of the different realms from, you know, the physical, to the spiritual, to the emotional, that someone has during a completely primal experience, like birth. And you know, to your point is the same thing, when we talk about the end of life as well, like, we put way too much pressure on ourselves, to be the all for that. And so, you know, I say that, because I think when we do this, it’s for many of us who have worked in the hospital system, who have spent a lot of time and money learning to be a medical profession and take care of people during birth. And who did that, obviously, with the best of intense, it can be really hard to swallow the fact that we’re not doing the job, or the best job of doing this. And, and I say that not because, you know, this is not it’s not to meet people feel guilty, or just beat yourself up about it. Because like I said, I still am a nurse in the hospital. And I am constantly learning from speaking to people from you know, from reading books and articles and working, you know, with other birth workers, about the ways I can improve my practice, the ways I can do less harm and be more supportive. And, you know, all of us are looking to do that, I think there is so much about the way that we have set up the hierarchy in birth care, where we have positioned physicians right at the top at the pinnacle, that then it puts all of the pressures ultimately on them. And I have been a part of care that has not been ideal, and I have been told, nope, you did everything as a nurse, but the doctor did not. And that doesn’t sit well, because I do think we are a team and we were all working with the same information and trying to do you know, the best thing. And so I do feel like that pressure that gets put then on physicians, it is a lot to carry. And I really do feel like that is where true collaborative care would come in. So if instead physicians were able to just be in charge of the part of the care that they have trained to care for. Yeah. And we actually had, like consistent networks of care that involve people who specialized in, in the mental health piece of it in, you know, in doulas who are there for that emotional connection that people need during an experience like this 100%. Right. You know, if we have people who are actually doing that, and doing that, well, that that would take away some of some of the pressure and some of the antagonism that goes both ways to know it, because it and I, because of that, because
absolutely people out in the community have been maligned again for much longer, everyone’s just pushing back against them. People don’t want to let them have space, in hospital birth, they don’t want to acknowledge that as a legitimate and safe choice. You know, people have wanted to make it seem as if having a home birth is because you’re concerned with the optics, you know, because you just want the candles and like you really love your bedspread. No, like it is because that is where you feel you will receive the safest care on all of the different levels that are available to that, you know, I think people we have again, we’ve been trained and it is it was intentional and very effective that you know, the hospital that is for safety, and that’s where you’re gonna get this great care. And that is deeply, deeply embedded in people. And so it is hard to push through that and see a different option and recognize that safety right can be achieved in other places. And that is one thing that I’ve heard, I believe it was like Cristen Pascucci with Birth Monopoly. I think she had recently had a post talking about that idea. Do that like, right, we need to really push that piece of the safety component, a birth outsideof hospital that it’s not being done just for like the fuzzy feelings and the fuzzy feelings matter, so that is the reason you’re doing it, that’s also valid, because it’s your choice as an autonomous person. One of the concerns, I guess, that I have is that as we keep going, and we have these, you know, the, the birth care system in the hospital that is desperately clinging to what it has by continuing to publish, essentially the same article over and over again, looking at data and trying to pretend that it’s all either. Exactly, you know, you know, and then we have people and I think the pandemic is certainly amplified this, you know, we have had a surge, obviously, an out of hospital birth, as people have recognized it, like, oh, shoot, maybe the hospital really isn’t the safest place to have a baby right now.
Nathan, MD 40:48
And more limited prenatal care. And yes, we are not having worse outcomes. Sorry, I probably took that that probably stole your thunder, sorry.
Maggie, RNC-OB 40:54
no, that’s good, [laughter] thunder to be shared. But like the as we are having these two things, kind of these competing pieces of it, you know, my goal. And again, I say this, as someone who’s like, I’ve worked in hospitals and home, I had a hospital birth, that was beautiful. I’ve had a home birth, that was beautiful.
Nathan, MD 41:10
That’s such a cool, experienced you you bring such great personal experience to this conversation.
Maggie, RNC-OB 41:15
Yeah. And I think it’s, and it’s important to me, because I don’t find that they are mutually exclusive, like, and if I was to have another baby, I might choose to have another home birth, I might choose to have another hospital birth, I wouldn’t know because I wouldn’t know all the circumstances of that birth. And all the things that would go into it at that time in my life, physically, mentally, every other way. And so I feel like sometimes there’s this idea that people feel like they have to like, you have to dig your heels in, right on one side of something, instead of just really trying to focus in on that the individual piece and the ways that we can work together so that we actually have our, our individual skill set. And again, the reason that you spent time and money, a lot of money training to do a job. And that’s whether you train you know, as in the medical profession or outside of work, like you’ve spent a lot of time and energy learning to do this well, right. So often, we don’t have the opportunity to actually do that.
Nathan, MD 42:12
I think that was so beautifully put, you really it really was I don’t really have much to add to that I I do want to draw in some other ideas that. So first of all, in my sort of monologue about home birth, I’m also not saying that home birth is the only way to have a baby and I want to I like want to make that crystal clear. What I’m in support of is a person’s right to choose what they feel best about. And for some reason, in the medical system, we preach that, but we don’t actually walk that walk. And what’s important for you, Maggie, is that when you get to the point where if you have another baby, and you’re there, wondering what would be best, it would be great if you had a provider who would say “Wow, well, what do you think is best? Where do you feel most comfortable? What was your previous birth? Like? Tell me about your experience? What are some of your fears, what brings you joy, what’s important to you?” And that’s what we do in an end of life care. And I think that, I think that when we start to do that, we actually start to have a conversation, which is called birth planning, by the way, everybody. We have a conversation about who is this person, I am not just a technician here, going through the motions of putting on this Darth Vader look, and putting a thing under your butt when you’re when you’re on the labor and delivery bed. Like that’s not your only job, it doesn’t have to be your only job. And yes is to harken back to a little bit of what I said about this sort of role that we play as physicians, you have an extremely important skill set for modern humanity. And I want to I like will say that, again, you are extremely important to the system. But you’re not the only person that a birthing woman needs in order to feel safe and to feel heard. If you can expand your vocabulary, you might be a little bit more of what you are. But the good news is you don’t have to be every other person. You don’t have to be a nutritionist, or an exercise expert. You don’t have to be a diabetes educator, you don’t have to be a doula or a person who has sat with a person who’s been in labor for 34 hours, you don’t have to be that person. You also don’t have to rush out of your house to go to somebody else’s house, like midwives do. In order to comfort the partner, while you’re also comforting the birthing woman. You don’t have to do those things. There are other people out there that can do that for the people that that that feel like that’s the right thing for them. I’ve been harping on this at talks I’ve been doing I just gave a talk at the University of Louisville Grand Rounds kind of thing. And the whole the whole point of my talk was You don’t have to be everything like why aren’t we right off the bat identifying that we have the skill set and when we’ve done our job, why can’t we feel comfortable bringing in other people to help us? That should be a sense of relief? Yes, sure. Be because you can’t do everything as a nurse, I can’t do everything as a doctor. But if you need me to do surgery right now, I can get a baby out in 30 seconds and that baby and that mom are probably going to be okay. If, if everything from the time when I decided to do that until the time the baby comes out, there’s a good chance that we’re going to have a good outcome. But beyond that, if I’m not, if I don’t have the skills, why can’t I feel comfortable, and that’s, I guess, the heart of what needs to change. And so by demonstrating in a home birth or birth center community, here’s how things could be done. The reason I brought that whole monologue in is because we can demonstrate that it can be done differently. And it’s going to be a multidisciplinary approach or transdisciplinary approach where I have a little skills in your area, but you need a little skills in my area. But like, Hey, we’re we’re going to work as a fluid, we’re going to be an amoeba here, and we’re going to do whatever it needs to happen to keep people feeling. Okay, we can’t guarantee a good outcome, but we can at least make this experience suck less. In the event that there is a bad outcome, then if there’s a good outcome, then man, we’ve hit every piece because we’ve got all the important people there to make sure you feel safe and cared for by your community by your people.
Maggie, RNC-OB 46:16
Right. Yeah. And I feel like on that note, I feel like it would be like remiss to have this whole conversation, and not talk about having more cultural congruence, in care. And in the paths that we have towards people getting into any of the medicine, midwifery, nursing, doulas all of it right, that we have more people from all of the different communities, but especially from those that are typically been really underrepresented, and intentionally excluded from this has not been random. So we do we need more, you know, we need more Black midwives, we need more birth keepers for all for all of it, any of our Black and Indigenous and all other communities of color, we need more people who already have establishing these relationships within their community to be the ones that are then there, right, offering care. And I think it’s very easy. And again, like it’s, again, very much taught to us in a lot our medical and nursing kind of that whole savior piece. And it’s really the white savior ism that comes into it, that you know that you’re gonna write in your white horse and fix it with your magical nifty, you know, medical knowledge. And so I do just think I also, I want to be very clear that like collaborative care, absolutely has to be between, you know, all of these different people who have intentionally studied, but it also very much about that relationship with the person who’s who is in care, and the other people who support them in their community. And it’s not about coming in and like having a care management piece of it, that is a really important piece. But it is no more important than actually having the person who’s making care, picking out who they want to support them. And having that be respected.
Nathan, MD 47:55
That’s right, by everyone. That second part, it’s extremely important to. So it’s not just about giving choices, it’s not a sushi menu. Yes, it’s about providing the information that’s required to make an informed decision while providing the room for the refusal of treatment, if it’s against cultural values, or your personal experience or values, or you just don’t feel right about how it was presented. And then we support you and your decision. I mean, that’s, that’s the collaborative care model. That’s like, I’ve got your back. You got me if you need me. That’s what we all need to be doing. Not just the doctors, but everybody needs to be doing that. Like this is not your, you can’t control this. You can’t. But the medical system loves to protocolized things and give us checkboxes and yes, lists are important for doing major surgery. Lists aren’t as important if we’re attending to a person who’s going through one of the most scary but also exciting and joyous opportunities of their life. Mm hmm.
Maggie, RNC-OB 48:57
No, and I feel like we often to big size at the end of these conversations, because there is just a lot there. There’s a lot and obviously, I mean, I, we could unpack this for several more hours as we keep kind of diving into all these different, you know, pieces we’ve seen. But, you know, as we’re coming to kind of coming to a close, I just want to say to our audience, like I am so grateful for everyone who tunes in and who listens and takes part of these conversations and who you know that comments on social media and gets in touch with us to talk about how this is impacting your practice and your community as you’re kind of reaching out because I really do believe that that it is possible for us to change this. This was very intentionally made to be this way. And we can very intentionally undo all that and create something that actually serves everyone who is involved in birth. Obviously, most importantly, people we’re caring for but all of us who provide care as well. And so I really appreciate everyone kind of listening and taking this to heart and then hopefully taking this into your spaces and getting back in touch to us to see like what is happening in your community. How are you going to make a difference in creating some inroads, and getting rid of some of this toxic crap that is stopping us from actually making change? So, thank you so much for joining us for this conversation. Is there anything else you want to share with us, send out to the room?
Nathan, MD 50:21
No, it’s again, it’s just such a privilege. If you know you’ve created something really great in your podcast and in your in your network, and it’s it’s truly an honor, that somebody would value my input enough to say, hey, come and chat for 45 minutes. That’s pretty rad. So I, it’s my privilege.
Maggie, RNC-OB 50:42
Thank you so much, Nathan.
Nathan, MD 50:43
Thank you for doing the work.
Maggie, RNC-OB 50:44
Absolutely. Well, we’ll keep doing this work together.
Thanks for tuning in. We love to talk birth, and we’d love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, where your birth partners across social media. And in particular, we invite you to join our Facebook group, which is Your BIRTH Partners Community. There, we have a chance to really dig into the topics from each week’s podcast as we talk about the challenges that we face changing our birth care practices. And we’re also excited to share a new resource with you all this week. So we’ve developed a little form for you to get a sense of who are the birth partners in your community, who you might benefit from developing relationships with both personally as you know, a professional, and who are the people who those in your care, anyone who’s out there getting ready to give birth, who are some of the birth workers out there who might have talents and skills and expertise that could help you as you are on this journey through pregnancy and into early parenthood. So we will be sharing that form that resource with you in our show notes and you’ll also be able to find it on a regular website. You can also check out our show notes for more information about Nathan, and we look forward to hearing from you all about how you are making collaborative birth care a reality in your community.
Unknown Speaker 52:06
Thanks for being here. Till next time.
029: Unpacking Pelvic Biomechanics & Birth
Maggie, RNC-OB 0:05
Welcome toYour BIRTH Partners, where our mission is to cultivate inclusive, collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
We are excited to be back and kicking off season three of the podcast. It has been a little bit over a year since we first started talking with you all. And we are really excited to frame this whole season coming up around the concept of biases and benefits. So in our experiences, when we go to have conversations with people and we have different viewpoints and different opinions and different ways of practicing, oftentimes, we’re seeing that that comes from a place where we perhaps haven’t given enough thought, or we have learned from inappropriate or incorrect sources. And so we end up with these biases that impact the way we provide care, and the way we relate to each other and to our clients and patients. And so, throughout this season, we’re going to be bringing up topics that we think have either had a skewed perception presented to many of us as birth professionals, or ones that we think just need a little bit more of our attention and awareness to understand the potential benefits. We are going to be kicking off this series today by talking about the pelvis and pelvic dynamics. And we are really excited to have a special guest on with us to discuss that. Brittany Sharpe McCollum is a pelvic dynamics expert, and she’s going to give us all good information about what brought her into this work and why this is what she focuses so much of her professional energy on. We’re eager to share this conversation with you all and hopefully start a dialogue about how we’ve kind of ignored the pelvis and what brought us to that place and where we can kind of go from here. Onto the show!
Alright, well welcome Brittany, we are so excited to have you join us on the podcast and just have a chance to dig into all things the pelvis and pelvic dynamics. And so if you want to just kind of introduce yourself a little bit to our listeners and let them know.
Brittany,CCE,CD 2:30
Yeah, sure. So my name is Brittany Sharpe McCollum. I am a certified childbirth educator, certified birth doula, and a pelvic biomechanics educator, I am based out of the Greater Philadelphia area. I teach childbirth classes for expectant parents and provide all the support and lactation support and movement and base classes. But also a large portion of what I do is trainings for clinical and non clinical birth professionals, the training them, the trainings themselves are not clinical trainings, but they are full of non clinical education that clinical providers can use to decrease their rates of intervention. And really, that is at the heart of what I do is restoring that autonomy to the person that’s giving birth, pelvic biomechanics trainings vary in time from like one hour workshops or half hour webinars to things as long as full day eight hour workshops. And really what pelvic biomechanics refers to is understanding how the bones of the pelvis move apart from one another, and what changes are created in the available space in the pelvis when that happens. And then we take that information and we apply it to the labor and birth process. There’s a little bit about fetal positioning in there and a little bit about where the baby is in the pelvis, and then a lot about how people are moving throughout their laboring processes. And one of the myths that I come across a lot in the work that I do is this idea that if somebody gets pain medication that they can’t move, and now it’s like a ball that goes out the window. And that could not be farther from the truth, because movement is of course part of comfort in labor, but it’s also a huge component of progress in labor. And that’s backed by study after study that has shown that moving throughout the laboring process can shorten the amount of time someone spends in labor and decreased risk of intervention. So that’s a large part of what I do is pelvic biomechanics. And then a lot of what I do is kind of the other side of things working with expectant parents helping to implement a lot of this stuff, but also kind of providing just general childbirth, education and empowerment and skill building and confidence building for more positive birth experiences.
Maggie, RNC-OB 4:34
Yes! You are such a wealth of knowledge. I’m so excited to have you here. So I feel like in our in our talks leading into this, we need to kind of like reverse first and figure out how did we end up here. I had said in you know, in my like nursing education, the idea of pelvimetry as still kind of vaguely out there, ideal pelvic spaces and shapes and you know, all of that and as time has gone it felt like that at one point we were carrying about that and maybe in the wrong way. for the wrong reasons, and now I feel like it’s kind of like it fell out of vogue and moving and what the pelvis is doing kind of isn’t there. So do you want to kind of touch on that like historical piece of it.
Brittany,CCE,CD 5:11
Yeah, where we came from? Sure. So there were two OBs last names were Caldwell and Moloy in the early 1900s, who studied skeletons and studied X ray images and classify the “female” pelvis into four basic shapes. And they did a whole lot of different studies on these four basic shapes. And they determined that the “female” pelvis has four basic shapes and everyone falls in every you know, birthing person falls into one of these four basic pelvic shaped categories. And what’s so fascinating is that this became the guide for understanding the pelvis in obstetrics and midwifery moving forward. So even to this day, in obstetrical texts and midwifery texts, the Caldwell Moloy classification of pelvic shape is taught, despite the fact that even as early as the 1940s, people were coming out saying this isn’t accurate. It’s too precise of a classification. We can’t classify pelvises in this way, as early as like 13-14 years after their first studies came out, people were saying wait a second, this doesn’t seem accurate based on additional information, yet for some reason. And it’s it’s, I’m sure we can theorize about this. But it’s not totally clear why there was never much questioning about this, it seems to me like this is how we’re going to proceed moving forward. And I think my theory is that that idea of classifying pelvises into being more or less ideal for birthing babies fell very easily into the racism and bias that is part of Obstetrics. And we can totally touch on that more. But it was like a self fulfilling prophecy. And the fact you could say, well, this is why this group of people appear to be having more difficult births, which again, like we could break that down to, but we could let’s just blame it on pelvic shape and say that they’re just inferior, this group of people is just inferior and giving birth. And this is part of this, this strain of inherent bias that is still part of Obstetrics and midwifery today. And of course, you know, we’re speaking really generally. And I want to make sure that we give credit to all the midwives & OBs that are doing things differently. But just generally speaking, it’s this, this has continued to perpetuate bias in obstetrics and midwifery care up until this day, and we have a lot of research that has come out saying, in fact, no, there are not four basic pelvic shapes. Instead, people have variations of these pelvic shapes. And there can be different dimensions in you know, all three different basic planes of the pelvis. But it’s a really kind of it’s been a very, very, very slow road, getting to that point where there’s greater awareness of that. And even now, I think in the in the greater birth community, there’s still I mean, it’s part of all trainings, there’s still, this focus on this four basic pelvic shape idea, despite the fact that both obstetrical information and anthropological information doesn’t support it.
Maggie, RNC-OB 8:20
It’s so frustrating, it’s no matter how many conversations we have about different topics, there are just so many things that that really circle back just how much during obstetrical and midwifery nursing education, we try to put things into a box, that it’s not a box at all. And so we tried to make it one. And that hurts everyone involved, because we are pushing, we’re pushing everything in. And we’re trying to just say like, yep, it’s black and white. These are the things Oh, great, we’ll have these for pelvic shapes, and that will let us make some bigger judgment call about what’s going on. Yep. And that it’s not like you said, it’s not based in good science, it is not based on fact and reality. And I think, without getting too far into it, but obviously the racism that was inherent in that decision and who had the gynecoid pelvis shapes and the eurocentrism there, like it is so pervasive into how we then continued to function and to to work as a birth industry. And it’s really overwhelming how much that continues to this day, like you said, in all of these different facets when you are learning about anatomy within birth, it inevitably comes back into it, right?
Brittany,CCE,CD 9:39
Yeah, absolutely. I mean, they these oppressive forces, particularly against birthing people of color have really been in place from the start of this country. And so, when we then can, you know, when these two OBs then come up with a system of pelvic classification that only furthers this idea of again, certain people not having ideal “birthing hips,” you know, it just again, like “Oh, yeah, this is why like this is this is why we’re seeing this,” for example, like, some estimates are as high as 50% of enslaved birthing people died in childbirth, in the 1800s. up to 50%. I mean, that’s insane. And that’s not caused by the birthing person that’s caused by all of the problems, atrocities of being enslaved, yet, then they see these big numbers. And then, you know, not even 100 years later, we have this information that says, Well, this pelvic shape that people, particularly of African descent are more likely to have, which is not true, not based in current research. It’s a narrow pelvic shape that causes babies to get stuck. Well, then that’s that must have been why we’re seeing so many people that are enslaved die in childbirth…NO. How about the idea that there’s severe malnutrition, that there’s severe trauma and violence, like, it’s just it’s mind blowing to me, that we can, we can pretend to boil it down to something so simple as that. And to have all this information coming out for years for literally decades, saying this isn’t true, this isn’t true. Yet, we’re still being taught these basic ideas that have no basis in anthropological or obstetrical research.
Maggie, RNC-OB 11:27
Yeah, someone is able to put out their information. And even if it’s immediately, near, days later retracted, even if it’s that quick, it’s out there, you know, and some people who, who want to believe that who want to push that narrative, they latch on to it, and they run with it. And it’s hard to kind of get the horse back in the stable there. And so I think, what’s, what it’s think is awesome, and why we want to have you on here to talk about is it like, yes, there is a different way to do it, there is a different way to view this. And it’s hard for those of us who were kind of like, trained educated to believe this about the pelvis, it can be hard to kind of like get that idea out of our head and then practice differently and kind of be reflective of that. So what do you kind of see, when you are educating birth professionals, both clinical and non clinical, what do you kind of see are like the big hurdles that we can kind of get over certain ideas that we have to let go of? And how do you kind of jump through that to a different way of thinking?
Brittany,CCE,CD 12:22
Yeah, so the two, like, if we’re gonna really boil it down to like, very basic things, the two things that I see that seem to really affect people’s labors and births, is when a provider thinks the baby’s posterior, I think that can change the way a provider view someone’s birth. And I think the other thing is that providers who really believe that pushing a baby out with the legs far apart, is going to create space in the pelvis, which is not true. But those are two things that are really simple. And I see very, very commonly, and they completely can affect the way someone’s labor unfolds, this bias that we have against posterior babies is definitely, I think, kind of inherent in this idea of a classification. But also, you know, part of what attributes to a bias against that posterior position is the idea that someone who has a posterior baby may be more likely to have back pain so that we see someone that is, you know, having a maybe a harder time managing their labor than somebody whose baby is not posterior. And immediately we think, well, this labor is harder, this person’s pelvis might not be as ideal, or the position of this baby is not as ideal. So immediately, I think for a lot of providers, the idea of the C section creeps into their head, and just the fact that now they’re viewing this labor as less likely to wind up with a vaginal birth, will potentially change the way that they care for this person, it may change the amount of time that they give this person at different points in labor, it may change how willing they are to incorporate different movements and positions, they’ve already gotten it into their head that this labor may be more difficult, maybe more likely to wind up in a cesarean. So maybe we should just start planning for that. But I think that’s a huge way that we see. Is it well, that that pelvic classification, miseducation about pelvic classification, and a lack of understanding about bodily mechanics affects the way providers view over if they’re, if a baby is posterior, we can work with the posterior baby when we have the skills to understand how to move the body and how babies tend to rotate and descend and how to tell if they’re, they’re taking that more conventional path of rotation and descent or if they’re kind of doing their own thing. We can totally work with that; posterior babies do not mean cesarean birth, but I think there is this kind of bias against that positioning that makes us think that posterior babies are potentially more of a “necessary” cesarean. And then I don’t know if you want to touch on that…
Maggie, RNC-OB 15:08
Yeah, it was like a lot to unpack there. But I think the one thing and that I’ve heard this from birth professionals of all stripes, the idea of you know that LOA baby like that that’s what we want you know. And so I feel like I certainly know for you know, myself and other friends when you’re pregnant and you’re getting close and you know you’re entering the end of that third trimester and you’re kind of being more aware of like, “Alright, are we in that ideal spot?” And so you’ll sometimes baby is great, and you just feel like, well, what a good pregnant person I am…babies right where they’re supposed to be, it’s gonna be so easy, like, check, you know, whatever. And other times, you are
Brittany,CCE,CD 15:42
And that’s dangerous too.
Maggie, RNC-OB 15:45
You know what you think like, Okay, we’ve got it. And then other times, I mean, you’re going through literal gymnastics, trying to get baby into this position, that isn’t necessarily ideal. And I feel like that, if you want to touch a little bit more on that piece of it, because I think that idea that we again, like kind of in tangent with this pelvic shape idea, we got this impression that LOA or bust. And then we do a lot of work to make that happen. And maybe that’s what needs to happen, but maybe it doesn’t. If you want to kind of like break down some of that piece about how we as providers can like be aware of what your baby is, but in a bigger context.
Brittany,CCE,CD 16:24
Yeah, yeah, sure. Wow. So yeah, you brought up so much stuff, I can talk for like hours, little like phrases that you said. The position that a baby assumes, ideally, in late pregnancy is the position that the baby generally needs to be in in order to navigate the inlet or the top of the pelvis. So the position that is ideal for a baby at the end of pregnancy, and the start of labor is very dependent upon the available space for the baby in the top of the pelvis. But we don’t know someone’s pelvic shape. And you know, we can’t provide or can’t determine from an internal exam, what someone’s pelvic shape is. And we’re not getting pelvic symmetry, X ray pelvic imagery to determine the shape of our pelvises. And even if someone did have an idea as to the shape of their pelvis, it does not take into account the movements that can increase or decrease available space age different again, like each different plane or level of the pelvis, the inlet is the top, the mid pelvis is the middle and the outlet is the bottom. So you don’t know what pelvic shape we have. Nobody typically knows what pelvic shape we have, unless we’ve had X ray pelvimetry in the past, and someone has really sat down with our dimensions and like kind of worked through it and figured out like, well, this is more oval shaped or this is more narrow here, which isn’t happening. And so this idea that we’re trying to get babies into one specific position, when we don’t necessarily know if that would be the ideal position for that baby in our body sets us up to feel a lot of pressure and a lot of stress and a lot of anxiety at the end of pregnancy. Or like I commented on when you said like, oh, let’s pat myself on the back because my baby is lol. Well, that’s, that’s great, if that’s the best position for your baby to be in for your problems, which we don’t know, maybe it is. But also then our emphasis has become well, things are going to be smooth sailing, because my baby’s LOA. And that’s just one piece of the puzzle, we still need to encourage descent and rotation and babies are amazingly active during the laboring process and wiggling their way down. Babies are not necessarily going to stay LOA. And also babies may extend their chin or tilt their head or wiggle their little hand up by their head, there are so many other things that can play into it. So I don’t want anyone to feel anxious or like “oh, gosh, now my baby’s LOA and now I have to worry about it;” NO. But instead just recognize that the position of the baby is a very kind of transient thing, babies are going to shift and take advantage of the available space. And if we keep utilizing movement through labor, we keep giving the baby that opportunity to find those little changes of space that they need to work their way down and out. Yeah, so I think that’s all really important. I don’t think people should be stressed out at the end of their pregnancy, trying to get their baby positioned a certain way. What I do encourage my clients to do though, which I think is really important is pay attention to how they’re aligning their body and pay attention to how they’re positioning themselves. are they spending hours a day (and this is the reality for a lot of us) hunched over a computer? Or are they slouching back on the couch because they’ve been hunched all day. Now at the end of the day, they need to slouch to watch TV, right? Like are they doing that? Or are they seated in a way where they’re sitting up on their sits bones so that their pelvis is neutral? Are they elongating the front of their bodies so that they’re giving the uterus lots of space in both the front and the back of the body? are they spending time in positions that helps to release tension in their body? Like all of these things I think are really Important to focus on because then if we’ve created the space for our babies to find the most ideal position in our bodies, that’s what that’s what I consider to be optimal, optimal positioning is in relation to the pelvis, the baby is moving through, which we don’t know what pelvic shape that is. But we do know that if we give the baby lots of space to work with, we can trust that they’re probably going to maneuver their way into a position that is working well. And if that position may not be working well, if we remember to utilize movement, especially movements that are appropriate for changing space in the ideal plane of the pelvis, then we can really help to keep that labor process progressing, even if a baby was in a position that wasn’t so ideal to begin with. Yeah.
Maggie, RNC-OB 20:42
Okay. So for all of us listening, I think it’s really helpful because I think this is like, it is so counter to the way we’ve tried to think about in the past, right. And I think that is because like we said, you know, we, there’s a large part of us that like, we like rules, we like order, we like understanding like, this is how things can go. And birth continually shows us that that’s, that’s not possible. But we still crave that little bit of, you know, control. And so I think if you could say one more time, what you said about like, so optimal fetal positioning is, so that we can have like that sense, we are talking as birth pros with clients to empower them to feel that way too.
Brittany,CCE,CD 21:15
Sure. My favorite way to say it is optimal fetal positioning is optimal in relation to the pelvis the baby is moving through. Yes. And so we give our babies lots of space to work with in pregnancy, and we focus on alignment, and we focus on decreasing tension in our bodies. And we may utilize different techniques from lots of different ideas or methods in order to accomplish that. But rather than focusing on getting our baby’s position to a specific way, let’s focus on aligning our bodies and releasing tension and giving our babies lots of space to work with. And I think that kind of checks the boxes of giving people something to focus on which, yes, I totally agree with you. When we are facing an experience like labor that feels somewhat out of our control. It’s really nice to have certain things that we feel like we can control, but it also takes off that pressure to force our babies to be in a certain position. And the thing with you mentioned I’m going to jump on this because you mentioned the gynecoid shaped pelvis, which is one of those four basic classifications that Caldwell Moloy came up with, and again like this is theoretical and disproven since then. But this idea of a gynecoid shaped pelvis is a pelvis that is wider side to side at the top than it is front to back at the top. And so this pelvic shape if somebody does happen to have like a characteristic of a gynecoid shaped pelvis, this typically favors a baby being in an LOA position. But that’s just one variation of pelvic shape, like LOA can be a great position for some babies and for other babies it’s not and an ROP position can be a great position. For some babies, in some pelvises, and for other babies, it’s not. And again, just to emphasize, we don’t know what pelvic shape we’re working with, what we do know is how we can universally create space in the body and also in the pelvis.
Maggie, RNC-OB 23:09
Yes, I think that’s so helpful for us as we’re thinking like having these conversations with people to just keep that and I feel like for, you know, for our clients, for pregnant people, acceptance that whatever pelvis shape you have, known or unknown, there are ways we can work and still create space and still optimize that so that you don’t have to feel down and out before you’ve even had it if someone told you way back when you had some pelvic shape, and that you’re now feeling a lot of like limiting beliefs around that, that we can let go of some of that and realize that there are still ways for us to work to optimize each experience around that.
Brittany,CCE,CD 23:45
Yeah, yeah, definitely. And it’s interesting if you go down the rabbit hole of searching things about pelvic classification, which again, I would not suggest doing, because it is not considered to be a research based way to approach the pelvis at this point. But if you just happen to do that, you’ll find all sorts of interesting information about things like how different body shapes can signal to someone like what pelvic shape they have, again, not based in any sort of, you know, research that is well done and applicable, but it’s just sort of…
Maggie, RNC-OB 24:15
“Birthing hips.”
Brittany,CCE,CD 24:17
Right, exactly where someone has narrow hips, like these ideas. And like you had mentioned, these are things that sometimes people grow up hearing about too. So it already has planted this seed of possible doubt or possible confidence in somebody’s ability to give birth. And then, you know, like, let’s, let’s look at the flip side of it. If somebody has been told their whole life, you know, that they have birthing. And then they they’re, they’re like expecting to have this like smooth labor because they have birthing hips and then something gets complicated immediately. their confidence is going to plummet. They’re going to feel like Well, what’s happening, something’s wrong with my body. And that’s totally not true. You can’t tell from the outside if someone has birthing hips and quite honestly, I like to remind people that Anyone who’s carrying a baby has birthing hips, like we all got birthing. It doesn’t, you know, there’s not that you can’t look at some of them outside and be like, Oh, yeah, that person’s gonna have an easy time with their labor. And that person’s gonna have a hard time totally doesn’t totally not applicable.
Maggie, RNC-OB 25:16
Yes. Yeah. And it is. It’s just it’s pervasive in society. And we’ve focused so much on external bodies and what they look like and what that tells us about their abilities. And like, that plays through really strong for birthing people as they’re hearing stories from their family and positive or negative kind of taking all that information in to try to kind of, like, dictate somehow how their birth experience will go.
Brittany,CCE,CD 25:40
Yeah, yeah. And this is totally a different topic that is, I think, relevant and worth its own podcast, but its own podcast episode. But this idea to that in pregnancy, all of a sudden, people can now just comment on your body. Like, that’s crazy, right?
Maggie, RNC-OB 25:55
Don’t get me started. Yes. Right. Right. Yes. Yes. And it’s hard because it’s so like, we’ve all done it, and obviously, I’ve trained myself not to do it now. But it is so part of our assumptions about what is going on. And it really flows right through that. Yeah. So and then so the other piece you touched on, so that one piece and I feel like for everyone listening, like that piece about this optimal fetal position is related to the pelvis it in great, so you do not have to worry about trying to help your clients get into one set position. And the other piece you touched on was close knee, open knee pushing our belief around pushing and what ideal position there is for that.
Brittany,CCE,CD 26:38
Yeah. So I’m constantly having my mind blown when I’m at birth, and we’re like, we’re doing all this movement, and we have a provider that’s totally supportive of it. And then it comes to pushing, and the providers like pull those legs apart and make space for the baby. And I’m like “oh my gosh,” like immediately, I just feel like, oh, like everything, all of my excitement about how supportive and knowledgeable this provider was, has just gone out the window, because now we’re at this point where providers like, okay, they’re defaulting to whatever they’ve they’ve learned in their training, which provided the clinical providers don’t they don’t learn biomechanics, pelvic biomechanics, I mean, it should be a part of all obstetrical midwifery training, because it’s just to me seems so obvious. Like, if we’re going to be supporting someone and trying to get a baby out of their pelvis, why not learn everything about how the bones of the pelvis move, but really, I mean that that information is rooted in like physiotherapy and kinesiology. So when we can take our this information from these different disciplines and utilize it and obstetrics and midwifery, it’s really powerful. But I’ve been at so many births, where providers say pull the knees far apart, make space for the baby. And as a doula, it’s a challenging position because I am not a clinical provider, I can be asked to leave the room. And I feel like oh, like this is totally going against everything I talked to my client about. So when we pull the knees far apart, what winds up happening is that the femurs which are the thigh bones, they’re connected at the hips, now the hips are in the lower third of the pelvis. And where the femurs connect to the pelvis, that’s the true hips. When we rotate the thighs externally or pull them outward, we get pressure in at the hips, which causes the space at the bottom of the pelvis to decrease, sometimes by as little as a centimeter, but it could be significantly more than that could be possibly as much as maybe even three centimeters.
Maggie, RNC-OB 28:33
And every centimeter counts!
Brittany,CCE,CD 28:36
That’s just as we say, another thing I like to remind people is that when you’re pushing a baby out of your pelvis, every centimeter…so when we externally rotate the thighs pull them far apart like that, we get less space at the outlet of the pelvis. Internally, rotating the thighs, bringing the knees in closer than the hips actually creates more space because it pulls out on the hip. So you get an extra centimeter maybe even as much as three centimeters at the outlet of the pelvis. But pushing a baby out with the knees closed is so foreign to many providers, it goes against everything they’ve ever seen in birth, and it goes against the position for pushing a baby out that they’re most comfortable with, which is somebody birthing on their back, somebody is birthing on their back, or even in a semi reclined position. Having the knees together means that the provider can’t easily see what’s going on. And that can be challenging for a provider because they’re used to watching every step of the baby’s crowning process. Side lying is a great option for having the knees together. But a provider has to be familiar or comfortable with moving to the back of the person to catch the baby. Which again, always amazed at how providers really need to be in the front of the like we can just move around to the back and we can catch the baby from behind. You know, midwives have always said throughout history “babies are born out the back” you know if somebody is pushing the baby out there in all fours and the providers bye by catching my baby, we can, we can utilize that same concept by having somebody birth on their side, knees together provider catches the baby from behind. But it’s just so different than what they’re familiar with that there’s often a lot of reluctance. And again, I want to put out there, there are so many providers that are that are open to new things, and that are recognizing that there’s always more to learn. And I’ve been at birth, where I think in my year as a doula there, I think it may have been even the first time that providers have caught a baby from behind. But it’s so awesome when they see it happen. I know then that it’s like, oh, this is possible. And hopefully, they’re going to bring that into future births. So there are providers out there that are constantly willing to try new things and learn new techniques and recognize that there are limitations to to conventional obstetrical midwifery training. But there are also a lot of providers that surprised me and how willing they appear to be supportive of position changing and things like understanding biomechanics. And then when it comes down to it, it kind of default to a lot of things they’ve just been doing for years.
Maggie, RNC-OB 31:05
Yeah, and I think that I mean, obviously, that we’ve talked about, and we continue to talk about, like, there are just there are limits and how much you can learn in any any training program, formal or otherwise. So, you know, even for midwives and doctors, nurses, you’ve gone to school for years to learn how to do this, you still are only, you’re still only able to get so much knowledge and ingrain it into your practice in that amount of time. And things do change. You know, so even if the best way, best practice, when you learn with something, it’s going to change and acceptance of that. And realizing that doesn’t make you a bad provider, you don’t have to feel guilty about every other birth that you didn’t do it this new best way. Because I feel like for me, certainly, I feel like I was like, I don’t know, a year late to like the close knee pushing. Like somehow it just, it missed me. I don’t know, I had my own baby and somehow, like when it kind of became like this whole everyone’s doing it. I was like, how long have we been doing this for? Just like, I just I missed it, you know? And so I remember being like, “Oh, this makes complete sense.” I remember the first time that I sat there and felt my sitz bones and moved my legs. And so for those listening, if you try to figure out like what are they talking about, if you sit there you put your hands on the bottom of your pelvis, there’s your sitz bones, you move your knees in and out, you’ll feel like oh my gosh, I just opened my knees, which looks good, better. You think that’d be better, but shoot now sits bones are out of my fingers. They’re way inside? Oh, I move my knees and oh, they’ve actually created more space there. So the first time I ever did that least I was like, Well, of course. And that makes complete sense. But so much of it, like you said is that like control peace and the our desire to have full understanding of the experience. And so for us on the outside, not in the birthing person’s body, being able to see with our eyes, that baby is coming down further the baby’s crowning fields confirming to us Yes, as an outside observer that yes, things are going the way they should. That doesn’t actually matter, us knowing that the baby is getting closer to crowning, doesn’t actually change what the baby’s doing, but it feels like it and so I think that’s one thing to definitely let go of. And doing that. It’s like knowing “Okay, we’re gonna do some closed knee” pushing for several contractions, we’re gonna push a while like that. I don’t need to check each time, I can trust that we are effectively pushing that baby is wiggling just the way that they need to. And then we’ll try another position in a few contractions and see how that’s going keep doing that and not feeling like we need to have that like ownership of the movement process to monitor and track how it’s going at each step. And I thought that was like a big thing for me to kind of like shift my understanding my role in supporting pushing.
Brittany,CCE,CD33:38
Yeah, I love that you said that. And I think what you said about for a provider, it’s confirming to them to be able to see what’s happening. I think that is very much what’s happening like when I when and I haven’t been able to put words to that and you just did for me. So I appreciate that. Because I’ve I’ve been in rooms where we’re we’re doing close knee pushing and like, based on what I know about observing someone birthing, it looks to me like it’s working like they’re they’re feeling their contractions strong enough, possibly even with an epidural that they don’t need guidance to know when to push. Maybe we’ve been doing that close me pushing her asymmetrical knees, like leading up to that point. And maybe there’s been an exam at some point that verified Yeah, the baby came down a centimeter or so, in my head. I’m like, “Yes, this is working.” And then when a provider feels like, okay, we need to be able to see what’s going on. I It always feels to me like, oh, like now we’re going to open this person’s knees like that. But I think what you said is really spot on. Like for the provider. That’s not necessarily they haven’t necessarily just observed a birth, like they haven’t just watched things shift in a person leaving because they’re in and out of the room. They’re not there consistently the entire time. So I think there it is, like this sense of confirmation that comes from watching the baby descending, like literally seeing the head coming closer. And I think it’s a huge testament to the body that we are able to push babies out in positions where we narrow the space in the pelvis. That’s amazing, but yeah, I think that’s really interesting. I think that Yeah, I totally agree with that people get confirmation from watching the baby descend as opposed to just being like, yeah, we’re going to trust that knowing that close knees actually opens the outlet, we’re going to trust that the baby is coming. But sometimes that’s not enough, when that’s not what you’re used to. Yeah, yeah.
Maggie, RNC-OB 35:17
So permission for everyone has been wanting to know that you can just let that go. You cannot observe each moment and things will still happen. You have it! It’s hard. And I think so much again, it just comes back to how we’ve been trained and indoctrinated to think about our role as birth professionals as providers during the birthing process.
Brittany,CCE,CD 35:36
So I was gonna say to add to that, too, it’s not only coming from providers, but when the average person is getting most of their information about birth from the movies, it’s what we see in the movies.
Maggie, RNC-OB 35:46
Yes.
Brittany,CCE,CD 35:47
And so that’s going to impact the way that the individual person thinks people should push baby that when I teach classes, one of the questions I ask is, what is the most common birthing position when no one tells you what position to get into? And sometimes people are like squatting all fours, which is what anthropological research tells us, but a lot of times, people are like, on your back. And it’s like, well, that’s really common when people are told to get on their back. But yeah, actually, let’s talk about what position you pass about moving on in Do you pass a bowel movement lying on your back? Yes. If not, then you probably wouldn’t throw the baby on your back, either in less than one told you to get into that position.
Maggie, RNC-OB 36:24
Yes. I mean, that’s always helpful imagery, just for people to think about, like, what are you actually trying to do now? Okay, so So now, let’s like think through it, because I think it is it is, it is an all of the media we consume. There is so much about how in TV and movies, how we depict the whole from your water breaking. And mere moments later, you’re there pushing the baby. Like, I mean, there’s so much anxiety and stress, we give people about a birth experience. It doesn’t have to be there. But I do believe that the very first time I was helping someone to do closed knee pushing when I was still fresh, doing it. And I so maybe I didn’t have like my lingo and technique down for it. And I was just unable to like, communicate effectively how to do it, because they just felt like no, like, like, I pull my knees back. And like I do like this. And I was like, Yeah, okay, yes, yes, yes. But it was like very hard to walk through it. Because we were both unlearning this feeling about like, what does it mean, to open your pelvis? It that does not mean to open your knees. But we see that and it is it’s reinforced and like everything we’ve seen, and so trying to help them get into that position was I mean, we were laughing because it was funny, as I’m trying to like wonder like this? No, like, actually, your knees are together. Now the exact opposite of what we’re doing now. No, just we couldn’t seem to like make it happen. But I think that is it’s just because it’s again, it’s like these biases we get about the way things have always been done, that make it hard for us to like, step through and into a different way of being. But yeah, yeah, the news is we can do it, we can eventually see things model things. And I think it’s really helpful. Now I know you have resources, and there are like great videos of people doing closed knee pushing on YouTube. And it’s all over the place now so that you can kind of walk through and see it and visualize that and even then show it to clients so that they can have a sense of like, this could be a comfortable way for you to help get baby outside while you’re pushing. That, you know, helps you to kind of like back that up and start giving our brain new imagery to like, think about and make connections with.
Brittany,CCE,CD 38:12
Yeah, yeah, it’s funny. Like I’m like totally in this birth bubble, where like, I’m surrounded by birth professionals and people that are like, constantly wanting to learn more and, and I’m like, yeah, closed knee pushing is all the rage. And then I go to a birth and I’m like, Oh, my gosh, the providers know about me. And I realize like, oh, wow, like I it’s so it’s so normal to me, that when I want to do I end up in a situation where it’s not being supported, which is actually quite common when I’m attending births. I always feel like Oh, man, like there. I was thinking that everybody knew about it.
Maggie, RNC-OB 38:46
Yes. Yeah, I think it’s still working its way, I think it’s still trickling it is trickled. But it’s continuing to trickle out and get there more so that there’s more like, understanding about it. So I appreciate all like the work that you and so many other like educators do about, like getting this out into the mainstream and posting on social media and everything so that we can just start to see it because, and the pandemic has messed up too, because we’re not having the same kind of conferences and meetings that you know, we once were, we’re not seeing each other in the same ways to like, have more natural conversations about stuff. And so it’s helpful just to continue to blast it out there in the world.
Brittany,CCE,CD 39:17
Yeah. And for expectant families, like pregnant people. I think that the prenatal education component is so important. Like if the first time you’re going to practice a pushing position with close knees is when you’re in labor, there are going to be so many other forces at play that if like people enter into this phase, I know you know this, like this phase in labor, where they’re just so singularly focused on pushing their baby out that if someone tells them to do something, they’re just going to do it because it’s way easier to just do what someone’s telling you in focus on pushing your baby out than it is to be like, “Wait a second, that’s going against what I know, let me process that.” You just don’t have enough ability to divide that energy into two different things like baby eating something with a provider and you know, pushing your baby. So if we get familiar, if we create some muscle memory in pregnancy for these positions, they’ll be easier to utilize in labor. If we practice the language, whether as the birthing person or a support person, the language that we’re going to use to help advocate for that if we practice that language in pregnancy, that’s going to make it more kind of easy to do those things. And then also remembering that this is instinctive like, this isn’t. This isn’t me saying like, no, this is how we should tell people to know like, this is instinctive stuff. I’ve been at so many births, where people instinctively pull their knees together. And then the provider says, Oh, no, no, you’re fighting it pull the legs apart? No, they’re they’re pulling them together. Because they’re like, again, going back to a bowel movement. If you’re passing a bowel movement, you don’t do it with your knees hiked all the way out to the side, your knees come together, or maybe there’s a little asymmetry, you know, and you’re just like, oh, and that’s what people are doing instinctively. But those instincts are kind of overrun by then what providers are telling you. Yeah, so I think getting familiar with it, preparing to advocate for it in pregnancy, maybe even talking with providers ahead of time. And if it’s feasible, finding a provider that is familiar with different ways of managing labor, or “managing labor” that don’t, you know, increased risk to the parent, and increased risk of long term pelvic floor damage, which are all things that we see with those wide leg pushing positions. Yeah, so I think prenatal education is key. And I, you know, I mean, obviously, I’m a huge fan of doula support, and a huge fan of childbirth education classes, but like you said, you can go on YouTube and for free, you can find out this, I can’t, I don’t necessarily think that that replaces a great birth class or replaces doula support in any way. But there, there should not be a financial limit to your ability to learn these things and practice these things. Because there are so many good free resources out there and social media definitely has changed our ability to see birth happen. And it is one extreme to the other. We have like the regular media, like movies and TV shows showing birth. And then we have like, raw birth footage that’s coming up in our newsfeed and Instagram, which, you know, I don’t necessarily I think maybe we should have something in between where there’s a little context for some of that raw footage. Otherwise, that can be a bit jarring to people that might not be ready for it but there is the ability to find a lot of information out there that is free of charge. And and yeah, how do you feel like you’re ready to advocate and be actively involved in your birth? And again, like that’s with or without pain, medication movement close me pushing all of that as possible with or without epidurals.
Maggie, RNC-OB 42:38
Yeah, yeah, I feel like as we wrap up, if you want to just kind of speak to that a little bit more, because I do feel like when we when we were talking, before we started recording, like that piece of you know, whenever when epidurals became very popular for pain relief during labor, in the hospital, as like hospital based birth pros, we kind of felt like check, like the epidural is taking care of pain. So we don’t have to worry about, you know, like you spoke to earlier about kind of like the movement piece of being a pain reliever. But we also then kind of just like radio silence on why did movement matter? in labor? Why have people always moved, you know, through labor for millennia? So if you want to kind of like close this out with that piece of it in terms of like, how are we looking at movement as just a crucial part of any labor? not dependent on pain medication?
Brittany,CCE,CD 43:30
Yeah, definitely. So I think we typically associate movement with comfort, which then we associate with unmedicated birth, because if somebody has an epidural, they’re probably pretty comfortable. I mean, statistically, they’re far more likely to be fairly comfortable than not with an epidural. And so there is this idea of like, okay, that labor is being managed, we can just focus on the other things that we have to do. But movement is, of course about comfort, but movement is also about labor progress, when we’re shifting that space, and the contractions are rotating and pushing the baby down. And this is even before we get to the pushing phase of labor, the uterus is still tightening around the baby and pushing the baby down a little bit. When we incorporate movement. During that process of dilation. We’re helping the baby to find those changes of space, which help the baby to continue to descend and rotate, which decreases the likelihood of babies getting “stuck in the pelvis,” and decrease the likelihood of things like the terrible term failure to progress in labor, which is being phased out and replaced by labour arrest, which I also think is just as bad. Anyway, so we can decrease the interventions that come with a baby possibly getting again, like “stuck” or labor stalling out, can help with labor progress. All the research that we have on movement in labor shows that it can help labor to progress. Also, though, I think, you know, we have to remember that movement also aids oxygenation of the baby, the more we keep the laboring person moving, the more the umbilical cord moves freely. I think a lot of times we incorporate movement, if there is a concern about the baby’s heart rate now it’s like let’s get this person moving, why not move preventatively to keep things shifting. So I think that’s a big part of it. So not only comfort, but also labor progress and oxygenation of the baby. And one thing that I love to point out that I think is really important when we’re including movement in labor, is that it helps support people to be involved in the process, which leads to better feelings of satisfied satisfaction with the birth for both the person giving birth and their support person. So if we give support people a specific role, like, let’s ensure that you’re helping them to change position, every couple contractions, or your role is going to be rocking this peanut ball between their legs so that we keep shifting that space in the pelvis, partners or other support, people are now more involved. They’re more invested in the birth process, which helps the laboring person to feel better cared for better supported throughout the process, and helps the person that’s providing support from feeling disconnected from the process. So if we’re talking about emotional well, being in labor and birth, I think movement is a part of that too, because it helps support people feel like they have a role in helping the process to move along. So I like maybe I’ll just share my 543 guideline?
Maggie, RNC-OB 46:16
Oh, absolutely. I’m a big fan of the 543 rule!
Brittany,CCE,CD 46:20
I in teaching birth classes for like, almost 15 years. I have found that the beginning when I was teaching, actually, for several years into teaching, I’d be going over all these different positions, and some are for epidurals, and some are for unmedicated births and like all these positions, and even for the support person that is like really wanting to be involved, there is this glazed look in their eyes, because it’s like, oh my gosh, how am I gonna remember
Maggie, RNC-OB 46:43
Information overload?
Brittany,CCE,CD 46:44
Absolutely, information overload. So after like years of teaching things, that way, I finally realized like, Oh, I should make this easier for the people that are providing support. So I developed this really super simple rule, I call it the Blossoming Bellies 5-4-3 rule. And so that’s the just the name of my business. The 5-4-3 rule basically, is this: change position, every five contractions, choose one of four basic positions and the basic positions that I use are standing, seated, all fours and reclined. So any one of those or any combination of those, and change up space in the pelvis in three different ways. And the three different ways are how you move your thighs, whether like we talked about internal or external thigh rotation, how you’re doing movement in the lower back the sacrum, so whether we’re rounding or arching the lower back, and then creating asymmetry doing something on one side of the body and not on the other. And so the 543 rule, change position, every five contractions, choose one of four basic positions, change them up in three different ways, helps you to come up with different labor positions, and helps you to remember to move throughout labor without necessarily having to remember a million different positions. And I also like to emphasize that although we do talk specifically, like in my trainings, and in my classes about positions that are great for different points in labor, depending on where the baby is, movement is more important than anything else. So if you’re like, I can’t remember what opens the top versus what opens the bottom. That’s okay. Because if you just remember to incorporate changes in position and movement frequently, that’s going to be more important for keeping things moving, because by default, you’re going to find a position that’s working. And for those couple of contractions, it’s going to really help to create some progress.
Maggie, RNC-OB 48:28
Yes, I do. I love that rule. And like you said, I think it’s such a helpful, just like paradigm shift from “Okay, I need to know exactly, you’re in this position. And you’re how many centers dilated the baby was in what Okay,” and then you’re trying to think through all these things, which, even for really experienced labor support people who do this professionally, that’s, that’s a lot to like, think through and remember, and like the heat of, you know, the moment and especially for the birthing person, or you know, their family member, support person, it gets to be too much. And so I think that, again, like the freedom of knowing that like, right, focus on movement, I think the 5-4-3 role is super helpful for just having like, I think it’s really, it’s specific enough to let everyone know, like for support person who likes to have a job, it’s good for them to know that like in five contractions, I’m going to do something different, great. And that’s really helpful for us too. It’s helpful for me, you know, as a as a labor and birth nurse, when I am taking care of multiple people, it can be helpful for me to get guidelines, like I’m going to come back at this time, and we’re going to change this way. If for some reason I’m not back then you can still feel free to go and do that and at any point to even sooner, but like just giving us a little bit more of a framework to work within. That doesn’t feel like you’re just spieling at someone as you’re trying to kind of like help them so yeah, so I do I love that and I love just that focus on movement. I feel like it gets back to that the beginning of conversation about like that the optimal piece of it that like right, we’re just trying to help this baby. We’re creating space. We’re letting the baby move within wherever they are, and find their their way down and try to try to manage everything obsessively, like many of us are want to do.
Brittany,CCE,CD 49:55
Yeah. Yeah.
Maggie, RNC-OB 49:58
Thank you so much for being here. And hearing all of this with us. It’s so good. Is there anything else you’d like to share with our audience before see anything like coming down the pipe? Like we’re reminded, like, where can they find you? workshop training coming up?
Brittany,CCE,CD 50:10
Yeah, sure, absolutely. So twice a year in Philadelphia, I teach a creating space workshop. It’s a full eight hour workshop full day eight hour workshop for birth professionals, it has contact hours approved by acnm. So for people who are nurse midwives, nurses, they can get continuing education that’s coming up in April, I always have it in the spring of the fall. This year, I’m doing both an in person workshop, which is limited in capacity because of COVID. But then also a virtual workshops are two different dates. So we have a virtual or we also have it in person. And then I also have a whole bunch of webinars, if you’re just interested in like, kind of checking things out in this kind of a more condensed way. I have different webinars that are just an hour long. They focus on different topics of pelvic dynamics, you can find those on the website, some of things coming up that are live, like we’re on a webinar on peanut balls for labor progress, coming up in May, so that’ll be cool. But then I also have a bunch of recorded things on the website that are all available. The webinars are 15 bucks each, and a lot of them have contact hours approved by ICEA. Yeah, that’s awesome. Find info there too. Yeah. And then social media is a great place to find me and my ridiculous reels that I make. I do like a lot of the the reels that I do on Instagram and stuff, I do focus on pelvic dynamics. So you get little 15 second snippets of ways to like potentially make labor a little bit easier, or a little bit more, you know, conducive to dissent and rotation. So that’s always a good place to find information that’s up at blossoming bellies birth, little snippets of information there that can piece together.
Maggie, RNC-OB 51:38
Yes, your social media game is strong. I always love seeing your posts. And I can speak to, I got the chance to take the Creating Space workshop last year, I guess, like early, early pandemic times. And I got to the virtual options, so I can attest to it was excellent. Even I know sometimes you will get weirded out about doing kind of these like active movement kind of classes virtually. And Brittany does a great job of really like bringing it in. So I definitely appreciate that. And if you’re listening to this in real time, we are also going to be giving away a slot in the virtual workshop that’s coming up. So we are coordinating that with Brittany. So if you’re listening to it, this week that we’re airing it then we will have like information for you all to enter that if you want to just like dive deep into this, we’re going to do the virtual one so that our audience all over the place has a chance to share in Brittany’s wisdom there. So we’re really excited about that. Thank you so much, Britney, and thank you for being here and just sharing all of yourself with us.
Brittany,CCE,CD 52:26
Absolutely. It’s so fun to talk about this. Like I said before we started recording, like I could talk for like 10 hours. Like, are we gonna be able to get it all in?
Maggie, RNC-OB 52:34
I would listen for 10 hours as well. But for our audience who maybe has lives outside of this, but we’ll let them go here. [laughter]
Brittany,CCE,CD 52:41
Yeah, so this is awesome.
Maggie, RNC-OB 52:46
Thanks for tuning in. We love to learn and grow alongside with you. Please follow us at Your BIRTH Partners across social media. And in particular, we’d love to invite you to join us in our Facebook group, Your BIRTH Partners Community. There we have a chance to talk a bit more about the topics retweets podcast, and work through some of the difficult parts of applying these concepts and change your practices out in the real world as we all work together for more collaborative, inclusive and equitable care. That’s also where you’ll find more information about Brittany’s upcoming creating spaces workshop and the giveaway we’re doing for it. We’d also like to remind you about our show notes which can be found on our website, yourbirthpartners.org. There we’ll share more resources some suggested readings from Brittany and suggestions for how you can incorporate pelvic dynamics awareness into your practice. Till next time!
030: Masculine-Identified Birthworkers
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation, as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
In this episode, we are continuing our series surrounding biases and benefits. We’re looking to topics where because of a lack of knowledge or understanding or inaccurate information, we’ve perhaps developed biases around an idea, or we just haven’t explored it enough to really understand what the potential benefits can be. So in that light, we are turning our attention this week to the hyper-gendered world of birth work, that often actively excludes people who don’t identify as women. What it comes down to is that there is still significant work to be done to grow our understanding and acceptance of the place of all genders within birth work. In previous episodes of the podcast, we’ve talked about the effect that environment has on the non-binary, gender non-conforming or trans person experiencing birth care in our country. And unfortunately, the reality is that it’s actually harmful some of the practices that we’ve put into place. And of course, there is a time and place to recognize and acknowledge the power of birthing women and honor the journey of mothers. But there’s also plenty of room and space and value in talking about the experiences of all birthing people and using inclusive language to represent expectant parents and pregnant folks. And so as we continue to reflect on this, one thing that came to my mind is how gendered the birth professional, birth community continues to be. And I think this is for a myriad of reasons that are worth exploring and understanding why there is still not as much acceptance for masculine identifying birth workers to be actively involved in our communities, and to talk about ways that we can change that to be more inclusive, more welcoming, and ultimately to meet the needs of all the birthing people that we care for. So to that end, I’m really excited to welcome on Jessie Ray Spivey, as a guest on the show this week. Jessie is a doula and has an incredible why to share with you all about what brought him to birth work and how he’s pursuing this and what it means for him to be a Black man in birth work. We’re also joined by Pansay Tayo, who will be sharing with us some of her experiences and how she’s grown to understand the relevance and importance of including masculine-identified doulas in the community. On to the show!
So we are so excited to have a special guest on today. And I am just so thrilled to have you here, Jessie and wanted to explore more about your work and what brought you to birth work. And we’re gonna dive into all of this. So if you want to just kind of introduce yourself to our audience and it just give us the you know, the highlights of kind of who you are, what work you do, and what brought you to birth work.
Jessie, Doula 2:56
Absolutely. My name is Jessie Ray Spivey. I am the creator and founder of The Doudad, which is a platform and space that encourages masculine identified persons to be a part of the birthing process and the ritual that is birth. My mother has largely influenced my decision to come into birth work. She has been working in birth for over 15 years now in Sacramento, where I’m from, I’m based in Oakland, and that’s where I do my work as well. But she’s been a huge inspiration on my journey, just seeing her work in underserved communities, providing doula services, and support for people who don’t have that support during pregnancy, which is super important. So yeah, I’m very happy to be here.
Maggie, RNC-OB 3:43
Absolutely. Great to have you. And Pansay, do you want to just remind everyone who you are and how you’re involved?
Pansay, Doula 3:50
Yes, I am Pansay Tayo, owner and operator of Sacred Butterfly Births and the Sacred Pause Red Room community sacred space. I have been part of Your BIRTH Partners for some time now and very grateful for that. I am a doula and placenta encapsulator, also teach childbirth education classes, facilitate and host sacred ceremony for pregnancy and postpartum trainings, and glad to be here.
Maggie, RNC-OB 4:20
Yay. Well, thank you so much. I wanted to bring you all both on here because one of the things we’re doing through this season of the podcast is exploring all these places where we have kind of our blank spots. Where are we there as birth professionals, we haven’t explored a topic enough so we don’t understand the benefits of it. And or we’ve kind of developed our own biases around it based on limited knowledge. As a nurse who’s work predominantly in hospital spaces, one of the things that I often see is that there is there’s just a little bit of a rub when masculine defying birth workers are in this space, outside of male OB-GYNs… So it feels like often you know, OBs came in 100-150 years ago, swept through, totally dominated what up till then had been a space that they were really excluded from, pushed everyone out to the side. And then slowly, nurses were allowed to kind of come back and enter that space. And that was kind of accepted. And then you know, we’ve kind of really teensed back in with having more doulas and more community support kind of accepted within the hospital sphere, but that there is still kind of this like, ooh, male-identified doula or having a masculine-identified labor and delivery nurse is still kind of seems to like catch people off guard a little bit more. And so I wanted to have the opportunity to kind of explore that idea a little bit more. And, you know, what, what’s going on there? You know, why are we still kind of having that? I’d love to hear from you all kind of touching on that piece of it.
Jessie, Doula 5:51
I mean, I can jump in and say that, even based on my experience coming into the birthing industry, there’s still taboo around a masculine identify person being in a space that is largely women centered. And I think that it just, it’s, it’s what society has drilled into our head, that there’s this definite that there’s this fine line, and between what women do and what men do, and there’s no kind of some time in between or intermingling. And it’s an outdated mindset. I think that goes back to even some, some of the other things that come along with that, from those mindset. It’s like, you know, women being in the kitchen and things like that, like, you know, I just think that that those things all tie to those old mindsets. And it’s unfortunate, but I do see and hope to be a part of the change.
Pansay, Doula 6:43
From my standpoint, this is, you know, personal experience in the hospital setting doing the births when we’ve had maybe a, you know, male nurse, or is different, it’s different. I can’t say that… sometimes you do get the same reaction from the client, when it’s a male doctor, right? I’ve had that also where they are very insensitive, you know, to the, to the client to the patient. I’ve also had that with male nurses. I mean, as recent as last year, I could recall a male nurse telling telling my client, you know, all “it’s not that bad. It’s not that bad. It’s not that bad. You can do this, my mom, my mom had all of her babies. So easy.” I mean, I really couldn’t believe what he’s saying. And I’m like, wow, you’re not helping. Right? All. I mean, it was so insensitive. The other part of that is in a hospital setting clients are already on uncomfortable, right? Strangers, you know, where they have to undress. We have a lot of women who has has dealt with, or has past trauma of sexual abuse. So even when you know, doctors come in, male doctors come in and maybe want to examine them, they feel uncomfortable with the male presence with unresolved trauma or just from their past experience. Again, it’s only from my experience that you know, with the male nurses that it just makes the client uncomfortable, you know, that they feel safer, and more relaxed with, you know, a woman that kind of knows what she’s going through.
Maggie, RNC-OB 8:32
Yeah, mean, I think that piece about sensitivity is, is huge. And it is so unfortunate that your client experienced that from a nurse of any gender, and certainly, you know, I love being a labor and delivery nurse, and I work with many amazing colleagues. But we do all have different styles, and some of us are, truthfully, just not really well equipped to handle every situation. And we’ve touched on this before in previous episodes of the podcast, but I think this is an important piece to note about, you know, trauma informed care is crucial. And it really should be the foundation of any care that we are providing throughout you know, the whole pregnancy, birth, postpartum spectrum. And, unfortunately, it is really lacking in a lot of the traditional education that we receive, you know, nursing, medica, midwifery schools. And so we’ll certainly you know, in the show notes link to some trauma informed care trainings that are available so that you know, those of you who are listening if some of these are kind of touching on, you know, sensitive parts for you and situations that you’re not sure how to handle best to really support the person who’s in your care. Those are some great resources to arm yourself with so that you can take better care of everyone rather than relying on, you know, pat or misinformed responses that can actually do more harm. That being said, absolutely within that piece of it, we need to respect what, you know, the client, what the patient wants and what they’re comfortable with. And I do wonder if like you said that there tends to be a little bit more hesitancy around the labor and birth nurse instead of the physician, that feeling is that comes from the intimacy that feels like it’s in this space, compared to maybe like a more clinical feel that a physician exactly maintains. I remember in nursing school, one of my friends in my clinical group, he did not, he was not able to see any birth and be a part of it, because clients, patients were continually just not comfortable with his presence, and certainly we ask that of everyone, because they it’s, you know, it’s a shared experience. But I wonder, you know, Jessie, as you kind of moved into this and pursuing this work, how do you kind of combat that, that, unfortunately, there, for some people, for maybe even a lot of birthing people, there is kind of this little, like, they’re not used to, like you said, just that, you know, the way we’ve set up our culture, they’re not used to as much as looking to a masculine-identifying person to provide that sort of more like, nurturing, caring presence.
Jessie, Doula 11:28
I think mention of sensitivity was really hitting the nail on the coffin is that men are taught to not be sensitive. And so for me, I was raised by and brought up around a lot of women, and so I was taught or, you know, brought up that it is okay to, to be sensitive, and I tried to be really sensitive in the work that I do, because this space is, you know, a protected space. And it is such a ritual. And so I think that changes things for me is because I am sensitive to the fact that not every client is going to be, you know, warm or receptive to me or want to work with me, and that’s okay. You know, but the clients that I do work with, I am sensitive, because I do and I try, I try to make a point to learn, and I have taken the time and energy to learn about, you know, the woman’s body and what goes on there. And I really try to exert that in what I do. And so I feel like that maybe makes people more comfortable when it when I let them know, I can show them that I do know what I’m doing. I do know what I’m talking about. And I am just as capable as a female doula or my female counterpart.
Maggie, RNC-OB 12:37
I wonder to because I think this is such a, like, multi layered issue. And something we’ve talked about in you know, the past on the podcast is obviously that, you know, not all birthing people identify as women, you know, and so, I also think there’s that piece that part of it is that us as a society, we are stretching, in our understanding of what this is, and I think, like you said, you know, none of us are going to be the perfect care provider for anyone, you know, none of us are perfect, none of us are going to meet the needs of you know, every single person. So, I think it’s really important that as we keep, you know, working together, and we’re having referrals, and you know, we’re growing our community that we’re also recognizing that for some people, and that is whether they you know, identify you know, as femme or masculine of center, but that, you know, there is going to be more comfort actually, with having someone who is bringing more of masculine energy and who, you know, is having that flip side of the coin. That for some people they really want kind of that divine feminine sacred piece of it. But for a lot of other people, they also really they’re tuning into their own kind of strong, masculine, powerful energy. I don’t know if you all want to kind of touch on that piece of it, too.
Pansay, Doula 13:52
Well, I definitely go ahead. I definitely feel and understand, you know, your exact words, as far as we are stretching in our norm. Our norm is no longer, you know, our norm, and we’re learning, I have to say, you know, personally, I am learning, you know, of the stretching and we do need, you know, someone to meet the needs of the people that I can’t serve or the people that are not comfortable with me. Right. So I definitely know that there is a place for the masculine doula, you know, in this work, you know, we don’t want anybody any birthing person left out everybody needs support. And in this day and time with things changing so rapidly. I love the fact that you’re here, that you’re here and I truly believe that the gifts that we are given we are given those gifts because people are waiting for you. There are people that your name is already written in their birth story. So here you are. Here you are. So though, you know, all of us might not understand that fully, you know, when we think about, you know, you know, a male doula, what is he doing, you know, here you have a purpose and a place in this work. And for a lot of birthing people, you’re going to be the perfect match and provide them, you know, excellent support. And we have to understand that we can’t do it all, you know, I’m just one tool, I cannot take care of, you know, every birthing person. So, you know, with that, that our mind should be open. That, you know, though I don’t normally have, you know, handle certain types of clients, that there are doulas that are prepared and equipped to nurture and nourish them perfectly. Hmm.
Jessie, Doula 15:49
Yes, I definitely agree with you. And I think for me, one of the reason that I even saw myself started to see a path for myself was because the clients that I’d shadowed and seen my mom working with were young mothers who were doing this alone. And so I saw myself often being able to slide into that position of support where there was nobody, there was no partner there, because they were giving birth by themselves, the partner did not, you know, want to be a part of the process. And so it was encouraging for me to as a black man, whether or not I’m queer, I’m still a black man. And I think that I wanted to be able to highlight and showcase, there are black men that are supporting birth in a positive way. And that could be it doesn’t have to be the partner, it could be. You as a brother, as an uncle, as a nephew, as a cousin, you could step in when one of your family member says they’re pregnant, and they don’t mean to be doing it alone, you can step in and say I can be the doudad for them, you know what I mean?
Pansay, Doula 16:53
Yes.
Maggie, RNC-OB 16:54
Oh, I love that. I think that’s just so powerful reframing, like you said, who was allowed, you know, like, who is supposed to all those kind of preconceived notions that we have like that. Because, like you said, I mean, I happen to be I have a younger brother, he’s my only sibling, we’re very, very close. And so absolutely, he has supported me through plenty of different life experiences that I don’t have a sister, who’s going to be there, you know, in that role. And so I think for so many people, like if that is, your person is, you know, your brother, your cousin, your best friend, since forever, happens to be a guy, that’s all, that’s fine. And that that doesn’t mean that they need to step back, you know, they don’t feel like there doesn’t have to be this, you know, the veil get drawn, and that they’re not allowed to step in and be a part of, of that piece of it. Do you feel like when you’re Jessie, when you are working with clients? Do you do find that once they start working with you, and they kind of does that open up for them the idea of reaching out to other, you know, family members or loved ones who can provide that support? Like, do you ever get to kind of like, have conversations with them about that? Or does it not get to that level?
Jessie, Doula 18:06
I think I encourage that, that’s actually kind of the motto of the doudad is just encouraging. Not just the support person to support but the village and creating that village, whoever that village is, you know, because oftentimes, if I’m there, and there’s a support person and a birthing person, what I do, the support person can do too. But I’m also you know it as a doula, we’re not just supporting the birthing person, we are supporting the birth as a whole. And so the support person needs support to sometimes that person sitting there like, they have no clue what to do. And you have to be able to be a guide for that person and say, let me show you that you could be you know, rubbing their feet or, you know, helping them breathe are whispering sweet nothings into their ear to help them feel better. You know, that’s, that’s definitely something I try to do. Absolutely. Yeah.
Margaret Runyon 19:02
I think that’s really important. And I wonder, too. I know Pansay we’ve talked about this too, in the past where sometimes how people are viewing the role of the doula that people can get concerned about like replacement, you know, that sometimes partners get worried about like, “Where do I fit in with the doula if they’re the one doing stuff?” And so I think that’s just so it’s so nice, how you’re able to really kind of step in and show like, yes, this is how we all are.
Jessie, Doula 19:29
All hands on deck!
Maggie, RNC-OB 19:30
Yeah. Yeah, I just made that much more just inclusive and collaborative. Instead of it being it’s not a one person show or a two person three person.
Jessie, Doula 19:40
There have been instances where the support for the birthing person is heavy, heavier, and it and there’s been instances where it’s lighter because the partner is stepping in. But you know, I think it’s just all about it’s like it’s all a collaborative effort. So whether or not, I’m doing more or less, or the partners doing more or less, as long as we’re all doing something And that mean helping the birthing person. That’s all that matters. Yeah.
Maggie, RNC-OB 20:07
That’s great. And then I think one of the things you touched on Jessie, you know, as a black man, you felt was really important to step into this. And you’ve watched your mother in, you know, in her role through birth support. And one of the things that I had noticed, through several trainings that I’ve taken over the last year, is that there are a lot more masculine identifying birth workers really stepping into this space. And I certainly credit that in part to the trainings that I’ve had the opportunity to participate in, really actively cultivate inclusivity in who they are reaching for birth workers. So they are making sure that people of all genders feel comfortable being in their trainings. And as part of that I have noticed, while certainly all races represented in these courses, that there have been a lot more Black and Brown, masculine identifying doulas stepping into this space. And so I’ve been reflecting on what is really pulling so many more Black and Brown folks to really support this work. And, you know, wondering if you want to speak a little bit more to the effect of the racism driven disparities in perinatal morbidity and mortality that we are continuing to face? And, you know, if you’re seeing that reflected in how kind of the birth community is, is growing in, or if that’s just something I’m seeing, you know, in my own bubble?
Jessie, Doula 21:38
I think you’re 100%. Right. I think that, at least for me, that’s one of that is one of the main reasons I do this, because our communities are being hit the hardest, and Black women and Black children are dying, more so than any other race. And I think that that is one part of the problem. The other part of the problem is the reasons why they are the fact that they’re that’s the reason and the the racism behind that that goes on in the hospitals that the treatment of Black and Brown people in a hospital, it speaks to a different issue. And I think that’s what makes the motivating factor for so many people want to change that. And when Black men find out about that, I don’t think they know that a lot of them don’t even know that, that that that’s happening, rates around birth are happening. And that could also speak to a different issue. But that is the issue. And I think when they find that out, and when they go through the births themselves, I think I’ve met a lot of guys or more masculine identified individuals who experience births themselves and see all the things they don’t know and all the things that they thought they knew. And then inspires them to want to offer that service and educate and help other individuals and families. So it definitely encourages…those those, those statistics, disparities encourage other Black men to be involved and Black people to be involved. Really, I’ve seen doulas male female identified or, you know, otherwise identified and want to be a part of changing that. And I think that that’s an amazing thing.
Maggie, RNC-OB 23:18
Absolutely, I mean, we certainly need people of any gender to step in, and, you know, and also any gender and any race to step in, to educate themselves on these disparities to become more aware of the racism that is inherent in our birthing system, so that we can actually do more than just talk about it, change policies, change systems to make it equally safe for everyone to come in, and, and have their baby and I am so appreciative of, you know, the work, both of you do. I know Pansay you also work predominantly with Black and Brown families to support them in, you know, in their birth journey, so that they can receive amazing care and really be supported through their process.
Pansay, Doula 24:05
Yes.
Jessie, Doula 24:07
Yes. Thank you both.
Maggie, RNC-OB 24:09
And then I think, you know, as we, as we kind of wrap up this discussion, I want to talk about like so as, as birth professionals, as fellow birth workers, what are the ways that you feel like we can particularly kind of help to do change this narrative, and to create more more acceptance both kind of for us on professional levels that when we meet someone who’s a, you know, male identifying doula, we don’t go like, “ooh I have never met someone who does that” and kind of how do we navigate that on that kind of professional standpoint for ourselves? And then how can we also just kind of keep pushing this idea that you’ve talked to so well, that really, anyone can be providing, you know, excellent birth support, it isn’t something that has to be reserved for only, you know, part of the population, right.
Pansay, Doula 24:56
I feel just as you know, we’ve done here being things that were that we don’t know about, we need to, you know, do our part and research and learn more about it. You know, it’s only fair before you make judgment, you know, of something, you know, for us to come together and, you know, common spaces to discuss that work and what is the common ground here of health and helping the community and, and birthing people. So I think that just move past, you know, your quick decision, and dig a little bit deeper research, get to know, you the reasoning, of why they’re here, and also understanding that there are people that, you know, that are in need of their services. And that’s been sticking out the most to me that, you know, just off the top of my head, I’m thinking of a few of my belly buddy moms,for childbirth education, where we would, you know, help some of the young mothers and he would have been perfect for, you know, personality-wise, I know that there are people that would gel and align with his services, so perfect. So knowing that that that he has a place, he has a place within this work, and it’s a very special place.
Jessie, Doula 26:12
Thank you. Thank you. Thank you, I think these kind of nice conversations, the desire to even know this, one of the things I will say is coming to into birth, birth work, there are people that they may not be unwelcoming in the physical sense, like they may not be actively doing things tend to be unwelcoming to you. But sometimes by not even acknowledging someone’s presence. That’s, that’s a sign I think, and, and so just acknowledging someone and saying, what we’re, you know, getting to know the whys of, why it why people are interested in this work and what why they’re doing what they’re doing, I think is opens the door for more people to see and understand. You know, birth work is not a female industry. It’s not, there’s no, there’s, you don’t have to be a female to work in birth work. It’s like anything else in life, you don’t have to be things that in life aren’t limited to your gender. So that definitely doesn’t apply to birth work. And it doesn’t apply to birth either. And I think once people are able to shift their mindsets and get uncomfortable, because in order to grow, you got to get uncomfortable, right? I think once people are willing to get uncomfortable, is when we can really be comfortable with what’s going on in birth and it’s changing. There are male doulas there, they’re coming. They’re here, they’re already here. They’rehappening. There’s masculine identified birth workers all around I know some amazing individuals who are masculine identified birth workers and who have had the experience of and the ritual of birth themselves and now are turning that into work themselves, to educate others on how that process went for them. And I think that’s an amazing thing that I myself am even learning so even though I’m here to change and teach people things, I’m here to learn as well about things I don’t know. And I think if we kick that mindset off, and we keep doing the work and focus on the work and and keep that the why we’re doing the work is in keep that important. I think that’s what’s really going to change things and make things different.
Maggie, RNC-OB 28:19
Yes. Oh, there’s so much good stuff there. Yeah, I obviously I completely agree with you too. But just that acceptance and like you said, just broadening our horizons, listening to other people’s stories and just changing the personal narrative that we all have built up through from our you know, our childhood, whatever we understood birth to be about or not, you know, who we saw supporting it and then you know, certainly as we get into professional spaces, like opening our eyes to see who’s around us because to your point, obviously, there are plenty of people out there who have been doing this work who are doing this work, I think social media gives us such a great opportunity to you know, change our ideas around a little bit, broaden our horizons if in our local community we aren’t seeing this yet you know, if you personally don’t have someone that you can refer to you know, right in your community that you know and we’ll certainly when we you know go through the podcast and put on like show notes and stuff we’ll be linking to you know, some other masculine-identifying birth workers who you can you know, like and follow and you know, see kind of how do they support birth what is you know, what else are they kind of bringing to it so we can kind of learn more about that that lens kind of grow our our understanding about you know, what it means to to be a birth worker.
Jessie, Doula 29:34
Definitely.
Margaret Runyon 29:35
And I love your point about just the why like, I think you have such like I loved listening to your why and but what brought you to this and I think absolutely all of us who work as birth rose like have a really powerful why.
Unknown Speaker 29:47
I think it’s important as a man to or at least for me as a masculine identified birth worker to have that because that’s the first thing people are gonna want to know. Why are you here and I’ll be able to tell them and not only will I be able to tell them I’m showing them as well.
Maggie, RNC-OB 30:02
Yeah, absolutely. Oh, that’s beautiful. Well, Pansay, Jessie, is there anything else you wanted to kind of share with our audience before we wrap up here?
Jessie, Doula 30:12
Stay tuned. Follow my Instagram @thedoudad. I am going to be premiering my series spilled milk season two is going to be premiering in April. And I’m really excited about that. It’s a series about birth work. And I’m really going to up the ante with the level of conversations I’m having next season. So you can catch up on season one in my igtv channel on my page as well, as well as my other series, the hot chocolate Chronicles, which focuses on lactation awareness, and I just wrapped that up, a Black History Month edition of that up so you can catch up on those episodes on my page. And stay tuned for season two of spilled milk.
Maggie, RNC-OB 30:54
Oh, yes, that is so exciting.I can’t wait. I want to go through and see, I caught one last month. But I’m excited to go back and see the first season of spilled milk as well.
Jessie, Doula 31:03
Absolutely.
Pansay, Doula 31:04
Thank you so much for joining us, Jessie.
Jessie, Doula 31:07
Thank you, Bo, both and thank you for doing the work that you do. I’m inspired constantly by people, great people doing great work. So thank you for inspiring me. And thank you for having me today.
Maggie, RNC-OB 31:19
So excited partner with you.
Pansay, Doula 31:21
Very nice to meet you.
Jessie, Doula 31:23
Likewise. Thank you.
Pansay, Doula 31:24
Yes.
Margaret Runyon 31:27
Thanks for tuning in. We love to learn and grow alongside with you. Please follow us at Your BIRTH Partners across social media. And in particular, we’d love to invite you to join us in our Facebook group, Your BIRTH Partners community. There we have a chance to dive into this week’s podcast topic a little bit more deeply and work through some of the challenges of taking these topics and actually changing our practice so that the birth care we provide is more collaborative, inclusive and equitable. You can also check out our show notes for more of the resources that we mentioned in the show including information about trauma informed care and where to find Jessie’s latest offerings including the next season of spilled milk. I look forward to hearing your feedback. Till next time!
031: Postpartum Care Failings & Foundations
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth gear communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation, as we step out of our silos, break down barriers and hierarchies, and step into the future of better birth care.
Here at your birth partners, we love to talk about all things pregnancy, birth and postpartum. And certainly a lot of the topics that we cover, tend to fall more into that immediately surrounding the birth period, and really preparing for that piece of it. And one of the things that we wanted to cover is postpartum. And there is way, way more to postpartum care, then we’re going to touch on in this one podcast episode, of course. But we wanted to start laying the groundwork for someone conversations we look forward to having in the future. So we want to take this time to highlight some of the major flaws in the system, some of the ways that we have ignored the reality of postpartum and the challenges that are inherent in that period. And we also want to talk about some of the ways that we think that can change and some of those are big system changes that need support, so that we can change legislation that impacts insurance reimbursement and time off from work, so that people can have access to the services they need, and the time to actually take advantage of them. And some of them are things that we can do as birth workers, ways that we can support our clients to make sure that they reap the full benefits of the postpartum period and aren’t rushed through it. And some of them are things that we can do as loved ones, friends, and for those of us who go and give birth ourselves, ways that we can be more cognizant of the two worlds that we occupy during that immediate postpartum period as we transition from being pregnant to being a parent. And ways that we can show ourselves grace and understanding and love. So I am so excited to share this conversation with you. On to the show!
We are going to dive into all things postpartum care, and I’m really excited to have Ray Rachlin and Pansay Tayo with us today to talk about that. So if you’ll just want to quickly remind our listeners about who you are and what you’re up to, and then we’ll get going.
Pansay, Doula 2:41
I am Pansay Tayo, I’m a doula located in Baltimore, Maryland. I do now own and run a sacred space with the community The Sacred Pause Red Room, a space to come and just be to escape from the world and just connect, I do hold childbirth ed classes here, my prenatal visits with much clients, sacred ritual and ceremony to tend to the spiritual body, as well as the emotional and physical body, I am a placenta encapsulator and yes, Sacred Butterfly Births.
Maggie, RNC-OB 3:19
Yes, doing all the things there.
Ray, CPM 3:21
Ray Rachlin, my pronouns are shey & they, I’m a certified professional midwife and licensed midwife based in Philadelphia. My practice is Refuge Midwifery, and I do kind of home birth in the greater Philly area & South Jersey as well as home IUI, Fertility Care and like education around LGBTQ birth.
Maggie, RNC-OB 3:39
Ok, so yeah, so we want to talk about postpartum care this week, and acknowledging some of the things that we can do better some of the benefits of postpartum care that are typically kind of missed in the way we have set up postpartum care from a kind of health care legislation, insurance reimbursement setup, and where are we finding kind of those gaps in in coverage, and really what people need during this really pivotal transition period in our life, and kind of dive into some of the ways that that we can do postpartum care better, and how we can kind of change the ways that we’re connecting with folks. So, you know, just kind of setting the stage a little bit for where we’re at. Now, what do you typically do when during the postpartum period, when you’re kind of talking to clients and maybe start first by talking about how do we prep them for the postpartum period?
Pansay, Doula 4:29
Well, my preparation first of all, I think that preparation is vital, vital for the health of mom, baby. One of the main things I focus on is helping clients to change their perspective, and their knowledge of what postpartum care is. Most of us are alike with, you know, remembering what we seen when we were you know, younger or what what the doctors are telling us, you know, what postpartum should look like, or the medical, you know, community. So, really just enlightening them and educating them on how important postpartum is, it should fulfill one the future house, you know, a lot of times just thinking about right now, but what about 10 to 20? You know, years, you know, from now what about when you if you would like to have more children, but the importance of, of rest and bonding, for, you know, mom and baby, when you look at other cultures, you know, it seems that you know, we are, we are the culture that does not honor the postpartum time period, you know, it’s almost a, you know, rush, rush, get back to it, you know, type of feel. So helping them to, you know, see and connect with the sacredness of postpartum and how important rest, and the proper nutrition is how important it is to prepare the village, the family to, you know, do be very active and helping and assisting a mom and not just, you know, kind of sitting in her face, you know, just wanting to hold the baby, we’re looking at that timeframe, that six weeks is not enough time to get one detailed, as far as the types of foods that mom should be eating those foods, you know, helps to bring in, you know, her milk helps you know, her body to restore and heal her organs, you know, to heal her muscles to to regain, you know, pre pre pregnancy state, or to help with postpartum blues and postpartum depression. So, and the other component of that, but I think we forget is that, you know, these are new positions for both of them for the mother and the father. And as much as we try to teach and educate of what to expect, it still hits very hard the moment that baby comes out, and I almost see it on every client’s face like the next day like, “Oh, what is this?” You know, so make ensuring that proper preparations are made for when that hits, okay, do we have a meal train? You know, going? Do I have a postpartum doula? Or do we have you know, family members kind of, you know, what will be staggering, you know, and with meals cleaning, helping mom bathe, and also, again, detail the specific foods that she needs for healing and milk production and to, you know, regain all the vitamins and minerals and things that she has lost.
Ray, CPM 7:36
So on the home birth midwife, friend, I think, first, I want to say that the reason I can do a lot more postpartum care then kind of in the mainstream medical system is because homebirth is really poorly covered by insurance. And so we just have a flat fee that includes postpartum care, regardless of how much insurance reimburses or doesn’t. And also, that also allows us to have a lot longer prenatal and postpartum checkups. So I typically I like to start talking about postpartum planning with folks somewhere between 30 to 32 weeks that can talk about, like, you know, how do you want to feed the baby? Have you gotten a breast pump? Like, I have a like handout on like, what’s normal in the first week? Like, what can you expect? If you’re healing from a C section or from a vaginal birth? What can you expect that your chest is going to do? encourage people to do like, kind of like, making kind of a postpartum planning sheet or, you know, around, like, who is going to help feed them? Like what are the things that they’re going to, like bring in their community for with support, which has definitely been a lot harder with COVID. And then who were their resources, like, if you or your partner like is having a crisis moment, like, you know, who are the friends that you’re going to call or like, maybe the support groups that you’re going to reach out to, or the therapists are going to check in just kind of like having a your a postpartum care plan for your family together, including, like, you know, when whenever things like hitting the fan, like, who were pre going to, and, you know, I think I homebirth those tend to do a lot of like self education. But I think still there’s a lot of ways that our culture, which is like just so cruel to postpartum people, really doesn’t set people off well understand like the amount of rest and the amount of food that we need and like I think there’s this like desire to like, you know, participate in the world or like you know, just there’s like the tension with like having like your own life and on social media with like, what the body does too can really lead to a heart experience for some but regardless of like, where and how the birth goes, you know. I always like you know, as a midwife I’m like can you do one week in the bed, one week on the bed, one week near the bed? And if you can’t do that, can you do five days you know in, on, around, and if you can’t do that, three days like and if you like wind up having to go to the hospital for job this like can you like restart that when you get home? Like I think there’s lots of ways to create this like postpartum cocoon and I will do, pre-COVID I would do four home visits in the first two weeks, and then a six week visit in the office. With COVID, I’ve been doing like three home visits in the first two weeks and then like a telehealth in the week next time. So usually if I want to catch people around 24 hours when they’re like what’s happening with my body, it also in addition to like doing kind of like, this is what’s happening, what your healing is going to need in the next few like days to also like, do the like midwifery thing. So it’s like doing the newborn metabolic screening, but congenital heart defects screening at that time. And then I like to come around three days, because typically, milk comes in around a three or four. And it is super, super intense, emotionally, physically, it’s also the time that the babies can have their lowest weight and that we’re assessing for jaundice. So you know, like, both like making sure we’re kind of helping babies, they clinically healthy and while at that time, as well as just like having a supportive, you know, midwife come to your house and be like, “yeah, this is really hard. This is super temporary, like, this is how we’re going to get you through it with your body. This is like, you know, these things are normal,” like this is, you know, just kind of like having some guidance to get through that. And then like, you know, at a week, I used to come to people’s houses and typically doing that on zoom right now. Virtual check in and then coming back at like two weeks round. Okay, like, is this baby back to birth? Wait, do we need to like help, you know, just really trying to help catch nursing issues before they become problems. And like, if we can’t fit up with a breastfeeding issue, develop students triage it early I have, I work with people who really typically want to rester chest feed. And so catching an issue before it becomes like a weight issue with a pediatrician can be a really, really big deal. Because then we can like support the milk supply or someone you know, and like, while we’re like working out a latch issue. And then, you know, around four weeks, I often talk about, like, are you Yeah, like, are you ready to like, want more do you want to start doing breathing exercises to teach your abs to turn on again. Two weeks, I’m like, maybe if you want to go for a walk, go for a walk, if you want to give it two more weeks, give it two more weeks. But just like talking about slowly increasing levels of activity, not going more than like 40 50%. And then like giving it four to five days and letting your pelvic floor be the guide. And then somewhere between four and six weeks, I asked about if they’re interested in returning to intimacy and if they’re not, and what’s normal, and how to like both gauge with within themselves, and also how to kind of care for their body when they’re ready. And kind of also doing like, mental health screening at all those appointments to just yeah, again, like catch things before they cause problems. If you can catch a mood disorder in the first week or two, you can help people pull out much faster than if it’s been going on for a few months.
Maggie, RNC-OB 12:36
You both just touched on so many really important pieces of it. And I think one the timing that you just talked about. Ray, I think is really crucial. Because I think that’s, you know, when during pregnancy, you know, typically people have somewhere in between, you know, 10 to 15, more, you know, kind of appointments and chances to check in with their provider, and then following the hospital birth, you have like one, maybe two before you’re kind of just released back out into the wild. And, you know, we see that that it’s not enough. It’s not enough to spend, you know, a couple of days kind of like full on recuperating. And then Okay, yeah, maybe we check in in two weeks, if you had a cesarean birth, and then you know, everyone else we’re checking in around six weeks, you know, again, to kind of get your like, bill of health to be back, you know, off to the races, and that’s like really inadequate, and that for those people who are waiting six weeks in between birth, and then like an official followup with their provider, like you said, You’re not getting a chance to pick up on feeding issues before it’s become a really big deal. You’re not getting a chance to understand how mental health is going. And so many people push themselves way too hard during that initial postpartum period. And, you know, Pansay touched on this as well in terms of just like how, what our expectations are society for this time. And absolutely like, the US is the “go, go, go” culture is such a part of how we typically relate and I think parts of living through this pandemic has probably helped that piece of it a little bit because there is less to do and less to go out. And there’s there aren’t activities to participate in, in the same way outside in the world. So I have heard from a lot of people who have given birth during this time, that this kind of forced pause has actually led them to take a little bit more care of their physical body because they haven’t felt this same urgency to like get back out there and start you know, moving around and meeting up with people over the place. And then at the same time, there’s been that flip side of it, where the mental health is always something to be conscious of and you know, aware of, and then having a baby during a pandemic where you don’t have that same access necessarily to all of your support services where it’s so much harder to get in touch with people, where the limits of a telehealth or a virtual visit, versus being in person with people to discuss issues like all of that piece of it has been amplified so much more. And we know that we’re seeing higher rates of postpartum anxiety and postpartum depression. I think that that tension there between how do we as we go forward, as we come out of the pandemic, how do we really allow ourselves still that time to, to rest and to be and accept that we don’t have to, you know, the snapback culture in terms of our body, you know, that we’re not just trying to immediately get right back to where we were pre pregnancy. And I think for so many pregnant folks, you’re, of course, so excited to have the baby and meet them and kind of move on to that piece. And then you are also really clinging to who we were before the baby, and that there are parts of it that postpartum then you’re trying to just get back to that piece. And so for many of us, that means like, sure, you could go out meet up with a friend, and, you know, get a cup of tea, or you could go, you know, for a hike, because that’s how you really connect with nature. Like there’s all these things that we do pre birth that help us to center into who we are and how we relate to the world. If you can talk about how do you coach clients through that piece of it through that transition, and kind of weigh the benefits of actually being able to slow down during postpartum with that desire to be your full self out in the world as a parent?
Pansay, Doula 16:24
As the doula again, showing them the flip side of what’s being taught and ask them, definitely the benefits of, you know, taking that time and not trying to get back to the person you were because the reality is, you are a different woman on the other side, once baby’s born, so enlightening them about the transition that is actually taking place, the physical transition, the emotional transition, and a spiritual transition that is taking place in pregnancy, and postpartum you know, the importance of that, that 40 day window, and getting to know the person that you have become, and are becoming, because you are a new woman, each and every Earth. It seems that, you know, once once you bring this type of information to clients, it’s, for some of them, it’s like mind blowing, like nobody ever, you know, told me anything about a 40 day, you know, spiritual window. And, you know, during during that 40 day time, you know, they say that, that is when you know, women are closest to the grave. Because childbirth is a lot of work, it’s a lot of work, it’s hard on the body. And I’ll hold being as open, you know, we just brought forth entire you know, spirit or you know, human So, you know, helping them to realize how to nurture and nourish that shift in your life in your being in the physical body. And also showing them the tools Okay, how do we go about doing this ceremonial baths, you know, honoring the sacred period, energetic or, you know, body work sealing ceremonies, healing teas, it’s, it’s usually welcomed very much, you know, once you know, I have these conversations with clients, so much so that, you know, some clients I see maybe every seven days, or, you know, seven day, the seventh day, the 14th, day 21, and moving on up to the 40 day for the entire sealing ceremony, which encompasses very reflective day for them to be able to, you know, look at the entire transition that’s taken place, and also celebrate themselves celebrate the, you know, beautiful work that they have done, and honor stillness, and not try to, you know, race back to the way that things are being you know, taught to us, my biggest hope with all of this is that we bring on an amazing shift and how we do postpartum you know, without children so once we make that change within ourselves, we know that our you know, our daughters are watching, you know, sometimes the babies are a part of our, you know, ceremony, the ceremony and spiritual baths. So, you know, this will bring change, you know, going forward with generations.
Ray, CPM 19:20
I feel like this question really, maybe resonate with the idea like that birth and death are very much the same, like in terms of how you got to go to this otherworldly place where time goes away. And I think the processes really mimic each other and I think there is a loss with birth, you know, there is a loss of the person that you were beforehand and it might be welcomed and desired and it also might be really traumatic to have this like fully adult human that was lived in the world for 20, 30, 40 years and that to go away overnight and to you know, for day and night to go away all these things but I think kind of like kind of setting up that that like As a part of the experience, and that’s okay, reminding people that there’s going to be a point where they like, get to, like feel like them full selves again, and they won’t feel like this really vulnerable open place, but it’s not right then. And how, you know, like, how are they going to like kind of care for themselves in a time that like, they’re just very vulnerable and like, need no rest, and like nourishment and support. And that looks like really different for different people. I think our culture really does a disservice in this idea that like, yeah, like, you got a healthy baby, that’s all that matters, and all this stuff, and that it’s like, the best thing in the world because it’s like, not like, it’s like, yes, like, babies are awesome. And also, they can Yeah, really complicate your life. And I think holding more than nuance or holding the more than mixed feelings and making space for that instead of it having to be something which is shut down, like, create space for like things to move in that time.
Maggie, RNC-OB 20:53
That hold it being able to hold both of those things and being able to love your baby being so excited that you are now a parent and enjoying and relishing in parts of that whilst also dealing with like the really challenging parts of physically, your health, mentally adjusting to reality, you know, the relationship that you have with your partner with other children with everyone else in you know, in your world also shifts, you know, during that, and I do think that is really, it’s really hard. And I personally like that it is hard to take all of those pieces of how your life has changed in in wanted and unwanted ways, you know, and know how to how to move forward in a way that feels really like authentic and genuine and honors the feelings you’re having, whilst also still trying to get to, to that place where you feel steady, where you feel like, “Okay, this is okay, we can do this, we’re moving forward.” And I think so much of us, I know there’s been more attention lately about, you know, kind of the harms of like toxic positivity. And you know, we don’t always want to just brush everything over or gloss it over and just kind of power through that has been present so often in the postpartum period. And like you said, it’s there’s also that piece of how how we all support postpartum people, you know, people tend to ask so much about the baby, people want to come over and hold the baby and talk about that. And the person who just gave birth is like, “I’m still here,” you know, like, and they’re just we don’t, we don’t spend enough attention on that piece of it. And I think that certainly plays in into the mental health complications that that come up there. What do you find is helpful, really, as you’re processing with clients, that identity shift, and kind of what are the some of the things that we all can do as birth workers in various, you know, clinical and non clinical roles to really support that mental health piece of it as we’re, as we’re talking to people kind of beyond the like, oh, here’s your, here’s your postpartum mental health checklist, where are you at with these things here, some sort of rubric to fill out, we get a score, and we say you’re good or not.
Pansay, Doula 22:59
I feel that providing providing the space for birthing people to, to open up, you know, I see where some women where they want to, you know, I’m okay, I’m going to be the strong one, I’m okay, I’m going to press through this, but inside it hurting. Inside, you don’t want to voice that you didn’t like how your birth went? Or you’re not connecting with your baby, you know, or, you know, I’m really sad, because, you know, baby isn’t latching, you know, my body is supposed to just be able to do this naturally, you know, all those things? are we providing safe space? That’s important, safe space, where we are comfortable, saying, “I don’t feel so good about this right now.” I know that focus on, you know, natural birth, you know, or how fast the baby became, you know, all those things that we’re trying to hold up to these measures, you know, being the strongest one, I did it, you know, I did it this way, you know, I bounced back so quickly. So what support, people are around saying, you know, sometimes sometimes we have problems connecting without baby, you know, there are challenges that can come with breastfeeding, and that’s okay. It’s all right. Letting them know that it’s okay. And that is it’s normal. It’s a part of the norm. Yes. And helping them to feel comfortable enough to voice those things. And those are the type of conversations that I had from the beginning. Because you know, everyone they are highlighting, you know, baby, baby, baby, and it’s, you know, everything just butterflies and roses. Right? But who was talking about the challenges, and I see that when clients are aware of what those challenges can be and know that, that it is a norm, then it kind of helps their shoulders to relax. They Okay, I’m a part of the normal. Yes. And once you know and feel okay, with reaching out and voicing that I need help. This is what I need.
Ray, CPM 25:18
Yeah, I think so much of it is about not rushing, you know, like, if you just go through an Edinburg scale? And there’s not that kind of like, “how’s it going? Are you sleeping? How’s your butt?” like slower time for open ended questions were like, the stuff can come out. You know, I think there’s a lot of shame around, like some of the things that you just said up like, you know, like, I’m not connecting to my baby, like our culture is like, “Oh, you do it. And it’s instant. And it’s perfect.” And it’s like, it’s not like that for a lot of people. But just having more like space emotionally and physically and time to like, ask open ended questions and then hear the answer and like, reflect back help people, like find the resources they need, whether it’s in themselves or in their community, or like with, you know, professional support, changes things, you know, just like having to, like sit with people, like really can change things and ashamed or ignoring or minimizing is kind of the opposite of what we need.
Maggie, RNC-OB 26:17
Yeah, absolutely. That is, like, it’s so hard to come by that support, and the way that we have set up our healthcare resources right now for a lot of people and you know, and that’s, that’s really disappointing, and it leaves a lot of, it leaves a lot of people out, a lot of people slip through these cracks, then when they don’t have access to someone who is willing to take time, and ask those questions, and, and really, you know, be there for them and, and realize it, like so many of these issues are not going to be magically wrapped up in six weeks or in, you know, the 60 days that you know, is covered by Medicaid right now in our country for you know, pregnant people like there has been a big push there, you know, to, to change that legislation around Medicaid to increase access to the people have, they have more time to connect with people, they have more time to resolve issues that come up, and people are not just thrown to the streets uninsured, they don’t know who to turn to they don’t have the funds to access resources that they need. I feel like from a larger birth community, we need to be putting more of efforts to think of those system changes we can make as well so that everyone has access to someone who was able to like sit and have those questions with them and that it’s going, you know, we need more people to we need more postpartum doulas, we need more mental health therapists who are really focused on the mental health issues that come up, you know, during all of this, and who are you know, because it’s not, I think it’s not fair for anyone right now that like we expect people, you know, typically, you know, they have good rest of the hospital. Hopefully, they have a supportive partner or, you know, other family members, friends who were able to help wrap them in some support, at least during that, you know, initial period. But then for so many of them, like because of family leave policies, like their partner is probably going back to work after a couple days, maybe a week or two, if they’re, if they’re really kind of lucky in the system, a lot of us live so much farther away from our families than we did in the past. You know, people don’t necessarily have someone right there. And then I feel like add on to that by just taking away then like the access people do have to services to their healthcare provider, by kind of, they barely have a chance to reach out to them. And I know when I do, like discharge teaching for people who are leaving the hospital after having their baby, people are so hesitant about the idea of ever calling the pediatrician or ever calling their ob or midwife again, if there’s an issue, like we’re talking through, “hey, this could come up, this would be normal, this be something you’d want to call for.” And they’re like, oh, like, they don’t want to bother anyone they don’t want to impose on, you know, on someone else. And it’s not how it should be like, we want people to feel comfortable reaching out to us, we want people to know that like that is, that’s our job, we want to support you on this. And then we need to have better social nets in place and structural nets in place to really catch people. So then like your ob, of course, doesn’t know everything about postpartum care or your midwife or anything else. But these people, they can refer to these ways we can be more collaborative about it. So that if what you really need is postpartum doula, we really need to see a therapist or you really need some help with childcare so that you can focus on yourself a little bit like we need to have better ways of working through that piece. So it’s not like we’re just doing such a disservice to people during postpartum.
Pansay, Doula 29:50
This this particular topic has frustrated me and has brought me a lot of sadness over the years to the point Well, I’m really, I’m doing something about it. So I’ve just, you know, in addition to my postpartum visit that my clients get, you know, and it’s usually three to four hours of, you know, yes, we want to talk through the, the birth story, but I always, you know, want to be of service. So, you know, sometimes I’m washing clothes, cleaning the house, whatever that a need, then, you know, you still find, like you said, partners on the work, you know, nobody’s around. So I’ve built in four to six additional hours of postpartum, I’ll be using my mentees, paying them, but it’s built into every contract. Now. So it just saddens me that, you know, once I’m done with my visit, it’s a week later, you know, I get these calls, and nobody’s around, you know, they’re sad and nervous, you know, that the baby, maybe hasn’t had a bowel movement, it’s all these things for new mom or new parent, or the fact that, you know, she wants something to eat and can’t get down the steps. And it’s like, Okay, this, this just can’t be. And again, as much as you talk to, you know, maybe the mother in laws or, you know, the family and stress, the importance. Some, a lot of times we run into this, you know, so you know, that the more and more I can add more hours, you know, to my clients to be able to give to them, I will. But it’s it’s sad, a change has to come.
Maggie, RNC-OB 31:22
There is obviously there has to be a shift in the way that we’re the way they’re doing it. And like you said, the way that we’re supporting each other, you know, that you’re pulling in additional doulas who are looking to provide more postpartum care like that there are there are more ways to bond that within, like the birth community to provide better support. And obviously, I’m, I’m all about that’s like, the whole cornerstone of what we’re doing here is trying to talk about ways that we can always bring more people like into the circle, be connected, be on the same page about what we’re, you know, looking to do, but I feel like there is such an opportunity, you know, like, we know that somewhere around like a third of the, you know, perinatal mortality, like the deaths that happen, happened in the postpartum period. And like, we are missing an opportunity to, to be there for people. We are missing it; these are preventable deaths, because we’re not there, because we don’t have access to services, because people aren’t reaching out because there isn’t enough, and so we do….
Pansay, Doula 32:24
Yes.
Ray, CPM 32:27
Maggie, yeah, you’re talking about like, lack of system integration, you know? I think, I feel like all these things that are kind of piecemeal, it sometimes just felt like putting a bandaid on like a giant gaping wound, you know, and years ago, I had a client from Germany, who told me that, like in Germany, the government pays for you to have a midwife stop by your house every single day for 30 days. And, like, I think I do something like 60 times more postpartum care than most people get in, like a typical hospital based care setting just was like, hours wise. And I just like, couldn’t conceive of like, what I would do every single day for 30 days, but it’s just like, yeah, more support and like, more consistent support needs to be like, in your home, you know?
Pansay, Doula 33:12
Yes.
Ray, CPM 33:13
It was, like, you know, there was this move for us by ACOG to like, move the postpartum appointment to three weeks postpartum. But like, that’s still people having to leave the house. You know, there’s just, yeah, I mean, like, the integration has to be like, home based care.
Pansay, Doula 33:28
Yes.
Ray, CPM 33:29
For where they’re at. And like, you know, I do think telehealth offers some options for that. But it’s not everything, you know, you can like, you can only do so much lactation support, you know, on telehealth.
Maggie, RNC-OB 33:41
Absolutely, at the hospital, where I work at now, they within the last, pre pandemic, but I think it was the beginning of 2020, or the end of 2019, they took away our visiting nurses, so we used to have this visiting nurse so that at least postpartum people could, you know, it was part of their discharge planning that they would get to have somebody would come by the house, you know, two ish days after they left, have a chance to like check in see how things are going if baby needed extra tests, or, you know, if there was, you know, more support needed, that there would at least be someone there, come to their house, put eyes on them and maybe see what’s going on. We lost the funding for it. And that was purported to be because that there was an interest in it, that they didn’t have enough parents who wanted that. Which we were surprised to hear. Because in our experience there a lot of, sure not every family wanted it, but but a lot of parents were looking for that we’re looking for someone to just be there and yeah, and check in. And so I think that is something that has happened like across I think that’s just a slice of what you know what I’ve seen, I think that’s something that’s happened across where we take we’ve instead actually, like taken away these programs and whether that’s under because of a misconception or lack of comfort that like parents have with what that visit would look like or is this invasive. You know, are people there to check up on something versus there to really support? What is you know what’s going on? But absolutely, I think it would be phenomenal to see integrated within the community care, like, these are the people who, you know, you’ve seen them in, maybe you see them in your prenatal visits, and you know, okay, this is whoever they’re going to come and they’re going to be part of, and your friends know, they’ve had that person also come to support them. So they, you know, you kind of prep for it, like that idea of just having recreating some of that network of support, to really be like, these are familiar faces, you’re looking forward to them coming, you understand that support, and it’s built into it. And it doesn’t feel like it’s a like, it doesn’t feel like it’s necessarily just like this, check the block like medical checkup piece of it that plenty of us don’t want that. I don’t know. I feel like there is, there is something to that. And I absolutely, I mean, countries around the world, again, as we’re always talking about here they are, they are doing such a better job with perinatal well being than we are here, despite us spending the most money on it, you know? I know, I think like, it’s Finland, I think they are the ones that sent up like that box, it’s got everything from like the little bassinet for the baby sleeping and like a million other things ready to get out, you know, there’s family leave policies around the world that you know, provide, like a whole year or two of leave off of work so that one or both parents are able to support baby’s first year in this transitional period, like there are just so many other ways that we could be providing
Pansay, Doula 36:31
Right.
Maggie, RNC-OB 36:33
…encompassing support, so that people aren’t left in, you know, in the dark. And so for everyone listening, like if that’s something that’s important to you, please look into these policies, like see what you know, what’s happening on a political legislative level to increase that support and to make it so that we actually change some of the a lot of it always comes down to money, unfortunately, but that we’re changing those systems that we’re increasing funding, so that we can have better care all around. And we’ll link to some of that stuff in the show notes of some people who are really like working towards that and how you can kind of partner in that piece as well. But, you know, as we’re kind of closing this out, like, is there anything else? Pansay, did you want to share any more about kind of the sealing ceremonies and how you kind of helped to kind of close out that period or anything else you want to share?
Pansay, Doula 37:18
Yes, it’s, it’s been an amazing journey, educating you know, the community and women, you know, on the importance of celebrating and honoring pregnancy and postpartum. And these traditions and ceremonies, you know, to do that, the sealing ceremony is a beautiful, reflective, you know, time for mom to focus on transition from pregnancy, you know, to birth, and truly just have a day of celebrating herself and also, you know, women nurturing and nourishing her, you know, with with amazing food where was being held, it’s decorated so beautifully with, you know, delicious aromas, bodywork and ceremonial baths, you know, for special things, teas, massage, but she’s able to really just sit and think about this transition that’s taken place. And again, it’s safe, sacred space for her to be able to voice the likes, the dislikes, What was this? What is this experience been for you? You know, how do you feel husband and partner is feeling about it? You know, all, you know, ways that she may need help, she feels like that feels like she needs help moving forward. So just just time when no rush is put, you know, put on her we do call in the village I have other sisters that, you know, they come and they take care of the baby so that we can, you know, take care of our mom, someone that’s in a kitchen, you know, cooking. Yes, it’s a beautiful time. And I love how it’s it’s picking up more and more people are you know, calling and reaching, you know, reaching out, but the education is being put out there that, yes, pregnancy is an amazing thing and we love the babies, but on the birthing person deserves to be nurtured and nourished to we can’t just leave them, you know, on the side and it’s bigger than the physical, what’s happening with their heart, what’s happening with their mind, you know, what time what what type of trauma and fears you know, out there and to to address that, to love on them and address that. You know, doing that we’re helping so many things we’re, you know, we’re helping the next pregnancies to be better we helping the body to be, you know, more healthy and capable, we’re helping the relationship. We’re helping the generations of children to come because they’ll pass these traditions and education, you know, down to them. So yes, yes, yes. I’m thankful and grateful for the opportunity to be able to serve in this capacity.
Ray, CPM 39:47
I think the one other thing I want to add is that all like perinatal health care providers need to learn how to do appropriate pelvic floor and diastasis recti assessment at six weeks postpartum.
Maggie, RNC-OB 39:57
Ooh, yes.
Ray, CPM 39:57
One of the biggest problems We have in our society is that we treat peeing yourself when you sneeze as normal for people who’ve had babies, and it’s not, it’s a sign of dysfunction and for healing, the poor healing is caused by or in part by our cultural, insane expectations on postpartum people. So, having hands on training to learn how to assess for prolapses, for muscle tightness, as well as muscle laxity, and diastasis, recti. And either like, there’s definitely a range over the years of like how much you can like, help people in office and give them just like programs to do on their own to heal that and others who like I automatically send a PT. And that’s a little bit of like, an experience thing of like, how many you feel. But if you’re not checking, if you don’t know or not checking for prolapses, and informing people and helping them create plans, you’re setting them up for like a lifetime of like pelvic floor issues that like if you heal in the first year, you’re going to have a lot better results than if, you know, your uterus falls out of 10 years, 10 years after you gave birth.
Maggie, RNC-OB 41:01
Yes, we’ll be diving into pelvic floor PT in a later episode of this season. Because I think it is something that like it’s so important, and we are treated as like an extra or a bonus or like saying that, like, you’re not going to refer someone to help PT unless it’s so serious, instead of realizing that like all of us need functional. Yes. That’s that’s the standard, we all should be meeting. And so pulling in the kind of expert advice and treatment that is needed to help people do that. Like that’s not something you don’t need to like, hold that out, like, keep giving those referrals out, like, let people know, talk about it at your appointments. And so thank you so much for bringing that up. Right? Because I do think that’s so that is so important. And we have totally internalized that idea. Like you talked to plenty of folks in their, you know, 30s 40s 50s, who like, Well, of course, I pee when I run or laugh or sneeze or jump up and down or dance and you’re like, No, that is not something you have to live with just because you had a baby. Absolutely. I love that call for everyone to be more informed about that, and educate yourself so that you can make sure the folks in your care also being healthy.
Well, thank you both so much for having this conversation and digging into all this today.
Pansay, Doula 42:21
Yes, thank you for having me.
Ray, CPM 42:24
Thanks for having me.
Maggie, RNC-OB 42:25
We hope you’ve loved listening to this and you’ve gotten some good information that you can think of as you approach next birth you’re involved in. And we’d love to hear from you too. As we you know, said this is certainly not an exhaustive list of postpartum practices that you found helpful. So we’d love for you to join the conversation and share with us what works for you and how you are creating better postpartum experiences. We’d love to learn and grow alongside with you. So please follow us at Your BIRTH Partners across social media. And in particular, we’d love to invite you to join us in our Facebook group, Your BIRTH Partners community. And that’s where we really have a chance to talk a little bit more about the topics on each week’s podcast and work through some of the hiccups that come when we go to take these conversations out into the real world with us. And we’ll also highlight in our show notes, some of the people and practices that you might want to share with your clients and loved ones, some book recommendations, some courses you can take, and some other great resources. Thanks for being here with us as we work together to create more inclusive, collaborative and equitable care for all. Till next time!
032: Bias in Pregnancy Over Age 35
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy respect and equity i’m your host maggie Runyon labor and birth nurse educator and advocate and i invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies, and step into the future of better birth care.
This week we are turning our attention to pregnancies over the age of 35 this is certainly a topic that we have developed bias around as a society as birth professionals and sometimes is internalized by many pregnant folks who are considering what our options around fertility and pregnancy as we get older so today we want to come on and have a chance to break down this issue and consider what the purpose is of discussing age with clients at different stages in their reproductive journey…when they are considering pregnancy, when they’re already pregnant, and then once they are preparing to give birth. We want to talk about the terminology and how that has perpetuated stigma and adds often unnecessary anxiety at a time when so many people are already feeling hyper conscious of their body and their abilities. In addition there are several potential benefits of having children at a later age and those are so often left out of the narrative in discussions around family planning. There are a lot of great resources already that discuss the evidence around pregnancies over the age of 35 in terms of relative risk so rather than focusing solely on that we wanted to focus on the biases that we carry into this space, how those are perpetuated by the terms we use, and consider how pregnancy support can look in otherwise lowers pregnancy over the age of 35. And we have Ray Rachlin on to share their experience with this and explain more about how they hold this information, educate about risks and benefits, and support patient autonomy around this in their practice. On to the show!
All right so we are going to be discussing advanced maternal age or discussing any of the pregnancies that happen after 35 years and so on here with us is Ray Rachlin. If you want to remind so who you are real quick and we’ll dive into that.
Ray, CPM 2:21
Yeah sure. I’m Ray Rachlin i’m my pronouns are she and they. I’m a certified professional midwife based in philadelphia and i do homebirth throughout the greater philadelphia area and south jersey and also a lot of fertility care of my practice as well as provider education
Maggie, RNC-OB 2:37
Great awesome so yeah so i think maybe if we could just first start by talking about like the terminology when we’re looking at kind of like biases and how we’re setting ourselves up as care providers and birth professionals to think about this and then also the impact that it has on those in our care i feel like the terminology piece around these pregnancies adds a lot of unnecessary stigma.
Ray, CPM 3:00
Yeah i mean i also personally try and use like gender inclusive language and like having ama and like not having an alternative to like advanced maternal age is like you know and also like i think there’s like two kind of parts of the question the first is like on the language front you know we have this like idea of declining fertility which is true for some but not for many and also we see that like you know bodies change as they get older. Like we’re more likely to develop diabetes as we get older and that’s also true in pregnancy and then there’s the question of stillbirth which we definitely see an increase of after 40, under 40 is more unclear, there’s also genetic conditions things like that but in trying to, something like bmi, and trying to like capture who’s at risk for more conditions we end up just being really offensive and rude to most people. Where like most people over 35 can like have healthy normal pregnancies, some are going to have additional complications and we’re going to see that it increased rates but that doesn’t does that mean we need to treat everyone over 35 or everyone over 40 as like a walking disaster no. And the language or like especially the geriatric pregnancy stuff you know really fuels the fire i’m like treating people like a potential bomb versus like they’re having a pregnancy and maybe a little bit more likely to experience a complication but also probably not, because most pregnancies are not high risk.
Maggie, RNC-OB 4:21
Yeah oh absolutely I think being labeled geriatric pregnancy or an elderly pregnancy like feeling like a dinosaur walking into your pregnancy like that isn’t adding anything positive to the experience and i don’t…I assume that those terminologies were developed they felt convenient to whatever researcher was looking into it and i would love to see just like you said i would love to see a more like neutral term for it something that also like kind of flows more quickly so we could all be referencing it as something that is both like gender inclusive and also just more fact based and and not trying to make it into something that it isn’t. I think that as you touched on too, is that I think when we consider all of these potential risks and the conditions associated, there are different things for like, fertility, pregnancy and birth. Do you want to speak a little bit during like, oh, when would you perhaps like to have a baby? There are a couple of different pieces within that, that that relate to like your odds of becoming pregnant versus your odds of having a successful pregnancy?
Ray, CPM 5:22
Yeah. So yeah, I think like, the first thing is like the kind of the the number of like, you know, 35 years being like this, like cliff of fertility, that data comes from milkmaids in the 1700s in France. So we have the general decline in fertility with age. And also, like, infertility in our society is really common, like one in eight people, or heterosexual couples will experience in fertility. So, you know, I think that there’s a lot of things that are affecting egg quality, sperm quality life, we live in a very toxic environment, and those things are reflected in our genes. So you know, while we like, we do have like stricter criteria. So like that diagnosis of infertility comes up, like after 12 months of trying, if you’re under 35, in six months, if you’re over 35. And then if anyone like meets the diagnostic criteria, they’re like, the general kind of counseling and fertility clinics, and that your chance to get conceiving on your own is 5% per cycle, which is like, scary and hard. But also, it is like hard for, like, you know, because like where are we getting this data? This data is, like, an infertility, we’re primarily getting from people seeking infertility treatment, that does happen as people get older, as they also have better access to health insurance, you know, because of infertility treatment is not covered by lots of insurances. So there’s still like, it’s like, yes, egg quality can decline with age. Also, it’s like not necessarily like the cliff that we all think of, it’s just more like a gradual decline. And you might be a little bit more likely or even moderately more likely, but you don’t know unless you try. But I think sometimes also, like egg freezing is sold as like a, you know, a solution to age and I don’t, unless you freeze an embryo, like frozen eggs, don’t always successfully like thaw and be made into embryos. So I don’t always love that as like, an alternative is like perfect solution that you’re going to have these young eggs as old as you want. Like, it’s just, you know, bodies are imperfect, and also really resilient. And fertility is like a thing that we really can’t control. Like we have, like, we can have some effect on with like, the way that we live, like, if we’re getting sleep, if you’re getting enough calories, if you’re moving your body, if you’re like reducing your toxin exposure, like environmental toxins, but it’s a process that’s largely out of our control, which is really hard in our society. And like the medical model, like we have some tools, but you know, they aren’t like perfect fixes, either.
Maggie, RNC-OB 7:49
Yeah, absolutely, I do. And I wonder how that impacts the emotional, mental health piece of going into conception, if you’re already feeling like you’re carrying this weight of being that much older, and your eggs aren’t, you know, like, they’re maybe not going to work, and then people around you. Again, just because our society has been so focused on this, they’re already talking about that, you know, other people when I was talking to a friend, when she was considering getting pregnant again, with her second, her mother was really adamant that like, you have to do that now or else. Like, this is a foregone conclusion, you’re not gonna get pregnant again. And she really didn’t want to space her children that closely. And so it just added this extra like, tension and feeling like she had already, she’d already failed. They haven’t even tried to get pregnant, over 35. And already, they were like, behind the eight ball, I would love to see that change and how we’re, like you said, how we’re kind of presenting that cliff versus slope of fertility potential. Yeah.
Ray, CPM 8:52
Yeah. And I think like, you know, also like, some people will get pregnant on their own at 40. And will like, be fine, and other people will like struggle greatly at 32. Like there’s not, there’s no absolutes in any of this. I do think, though, that like, because of the way society set it up, like there’s this, like, emotional pressure that comes with age, and like the feeling that you’re already behind, which, you know, you don’t know until you try.
Maggie, RNC-OB 9:14
Yeah, absolutely.
Ray, CPM 9:16
Like, it is true that people who like have a hard time getting pregnant, like people who have IVF pregnancies do tend to have more complications. And like, you know, as a midwife, I’m just like, here are the things that were preventing you from getting pregnant also going to show up and like, it’d be important to carry but like, we don’t, we don’t have clear answers on that either.
Maggie, RNC-OB 9:34
Yeah, absolutely. I think the other piece, so if you kind of can talk through a little bit, because I think that piece of how you explain this to clients to those in your care, like if you have someone who comes into care, and they are over 35 How do you kind of set up that discussion about what relative risks might be there?
Ray, CPM 9:55
Yeah, so over 35, you know, I mean, we counsel everyone on genetic screening so just like what your genetic screening options are, what they’re looking for, like what you might do with that information and i think people who feel the pressure of age like are probably more likely to do some than others but you know others don’t. They’re like i don’t you know this information wouldn’t change my to do with this pregnancy and so we’re still having an informed conversation about that you know and just like also having an informed choice conversation about gestational diabetes screening well because we do see that in higher rates and when we’re doing normal prenatal care screening for blood pressure issues. You know between 35 and 39 we don’t have clear guidance on like, we do see there’s like this general slope of like we’re maybe seeing increasing complications and then the thing that we’re the most scared of is stillbirth and we still you know as a profession like no like we have never figured out how to keep all babies alive and I doubt we ever will, like we’ve never been more powerful than nature but we’re like trying to identify like who’s at risk and there’s not a consensus and so some places do nothing other places do a lot. I think the arrive trial has changed things where everyone’s like well let’s just induce everyone at 39 weeks that’s where we have the best outcomes but you know inductions are not without risk and also we’re adding incredible amount of expense to the healthcare system without clear benefit that. it’s not like we’re lowering the stillbirth rate like the NICU outcomes weren’t different in the arrive trial so it’s really unclear and i say between 35 and 39 aside from like genetic screening gestational diabetes like just talking like yeah you’re at increased risk like it’s normal care. When someone’s over 40 i do have a more intense conversation with them about advanced age and pregnancy and i often times i’m like let’s start with evidence based birth article on AMA you know i think Rebecca Dekker and her team did like an incredible job really like pulling through like all this like really scary information to be like what are the actual risks and the actual like the general increased risk of stillbirth is 3.92 in 1000 and you know that’s not nothing; it’s higher if it’s your first baby over 40, and it’s like a little bit lower if it’s not and then we talk about like what are the tool proriders are trying to use to catch this risk.
Maggie, RNC-OB 12:16
Yeah i mean i love the evidence based birth pieces i think it’s really important in all of the work that Dr Dekker has done to really distill all of this like complicated and nuanced information in these research studies and call out the kind of were some of the gaps in what they were looking at. I was reviewing the article and you know getting ready for this podcast and it was one that they talked about like just the huge variety in some of the studies that have been referenced and the time period you know we have changed a lot in terms of our overall birth outcomes from the 50s 60s 70s till now so in some ways when we’re looking at that evidence and then using that to like extrapolate to our population today it’s apples and oranges you know to some point and that’s outside of the the age discrepancy.
Ray, CPM 13:04
yeah it’s like unclear and i think that thing i always like to kind of like send home to people is that you know like we do know that there’s like a general increased risk over 40 and we have really mediocre tools to try to figure out which babies are at risk like we know some things like people who have growth restriction like those babies are at risk, people who have a genetic issue those babies are at risk people with gestational diabetes like those babies are at increased risk, but for everyone else like the people who actually have low risk pregnancies you know we’re not sure and we’re trying to figure out who by doing lots of ultrasounds, like lots of non stress tests and it’s not clear that doing a lot of non stress tests improves outcomes. This puts people in this like challenging ethical quandary because like we don’t know how to figure out like which babies are going to need help and which are not you know. And maternal fetal medicine practice or you know in a high risk or hospitals they’re just like why would we go past 40 weeks like we know you know this the safest time for a baby to be born is between 39 and zero and 40 and six and you know since we do see stillbirth rates go up like the longer you’re pregnant they’re like why would we even try? But there’s lots of reasons, you know? There’s lots of reasons to stay pregnant just like there’s lots of reasons to induce and you know like informed choice and shared decision making should be at the heart of all prenatal care, but it isn’t always. When i think i feel the same way about increased monitoring where you know we don’t have like clear good data that it’s going to improve outcomes but you know like it might sometimes pick up a baby that’s struggling and also more likely it’s going to lead to an induction than it is going to prevent the stillbirth. and like where do people fall on the like how much monitor do you want to do, like how much information do you need, what’s gonna make you feel like safe in your pregnancy or what if you had an adverse outcome like would you feel a lot of like regret and shame that you didn’t do those things? Or would you feel like solid and that you’re like, yeah, this is not gonna improve things. So why would I do it?
Maggie, RNC-OB 15:09
Yeah, absolutely. I feel like that’s a theme, obviously, that we’ve talked about in some of these conversations is that coming back to that autonomy piece and actually having spelling out all of that for the client, so that they are able to choose what makes sense for for their risk profile and for what their desires are around birth? And what would I guess, you know, one of the things too, when, when I was talking to a couple friends about this, one of them said, like they actually incurred a lot higher costs with their ama pregnancy, because they had additional screenings and ultrasounds and everything that actually ended up to like, several $1,000 more than they otherwise had, because the way their insurance was covering for the birth, which is fine. But that didn’t necessarily line up with what they actually felt like their risk was, how they felt like the pregnancy was going and was otherwise low risk. And so it ended up feeling that they were kind of pressured or coerced into doing all these extra tests that didn’t actually line up with what they needed, and then cause some extra financial strain, that was not really appreciated when also welcoming a new baby into their family. So I think that piece of it too isn’t you have to consider with like how the health insurance and reimbursement landscape is that sometimes when we’re asking people to do all of these additional tests, like in addition to the the impact it potentially has on like, their well being in fetal well being is the like, the overall picture of how it’s how often I have to take off work to come and fracture screenings, how are they paying for all of this? So that’s like an important piece of it, too. And then if you can see a little bit for, like, from the home birth side? How does that impact? Like, are there…do you have a strict cutoff for in terms of if people are still able to birth at home based on age do you do you have any kind of like screening qualifications around that
Ray, CPM 16:59
I don’t have an age cutoff, I do like do a formal informed choice conversation over 40. And like, we do talk about transferring for induction earlier, like sometimes maybe going 41 instead of 42 weeks of pregnancy. But you know, like people to be able to start labor at home like you need to be like really, really low risk. And we don’t also don’t have data if like, you know, differentiating between pregnancy stillbirth versus intrapartum stillbirth, so we don’t actually like, once you’re in labor, I treat you like every other person in labor. It’s not like there is the point where babies like the placenta suddenly is pooping out and and if like the placenta starts to poop out, we’re gonna hear that in the hearttones. So like that, yeah, we just kind of do like, yeah, if you make it to like spontaneous natural labor, we’re just doing normal birth. Yeah.
Maggie, RNC-OB 17:45
I think what’s interesting about what you just said to is your perception of the birth at that point. It’s, it’s equal, kind of feel like, right. Okay, so now we’re in labor, you obviously have all the same monitoring that you’re doing for everyone the same things you’re watching for, you know, as a clinician, but I do think that broadly, in our society, it like that piece of it, the provider’s perception of risk plays a huge role in how labor progresses, how they are, you know, “managed,” I do think, and I know, it was, you know, reflected in some of the articles, I was reading that piece of whether the provider thinks like, Ooh, this is, you know, an AMA, this a older pregnancy, we’ve got, you know, placenta, that might be, you know, deteriorating, you know, the egg was older to begin with, all these different things that are kind of like, lining up in their head, kind of all, like those strikes against the pregnancy or against the birth, that changes the management piece of labor. And do you feel like that? Was that like, a very intentional piece of your practice of kind of, like, separating waste from that, then once you’re in labor, you’re kind of treating it like anything else?
Ray, CPM 18:49
I mean, I think that was just how I was trained, you know? Yeah, like, if someone has, like, you know, conceives, has a normal course of pregnancy, like, the chance of like, going from low risk to high risk during a birth is low, like most people that enter labor, low risk, stay low risk. And so people have been having babies for a really long time. And like, the point of having a provider is to like pick up when something is shifting, so that from that’s going from normal to not normal, so we can treat it and like that’s my whole job is to like, hold space for normal, and identify when not normal is coming up. And like, that’s also going to be true for age, like do I hold a little bit more like, you know, the oldest person I’ve attended to homeless 46 and I definitely think about that pelvis and like, that pelvis has is a little bit more rigid than someone who’s 36 or 26. Yeah, like so I think a little bit more about shoulder dystocia. Maybe I would even transfer more conservatively. I think, you know, something that maybe people don’t realize homebirth midwives do is like we’re sitting calmly and like smiling and like in my head, like I’m having a million thoughts a minute. I’m just like, Is this okay? Let me like, constantly like assessing and being very alert while like appearing very calm. And so yes, I’m always having a conversation in my head about, like, is so safe and appropriate, like, you know, is this like, is home like a safe and reasonable option? Or is it not? And also, like, I can kind of hold that and both use, like my clinical guidelines and experience to be like, are we in the range of normal? Or are we not? If we’re not in the range? Normal? I don’t want to be home.
Maggie, RNC-OB 20:25
Right? Absolutely. Yeah, I do. I like how you explain that piece of it. Because I do think there is that perception that homebirth midwives are sitting there attending birth, like in some ethereal zone, and maybe some are, but…
Ray, CPM 20:38
I feel like I just doing math in my head all the time, I’m like, okay, you know, this person was this dilation at this point. And then they’re this dilation at this point, this is their rate of dilation. So if that point happens then we’ll be here, and if not like, these, the points that I need to do these interventions, to, like, try and move things along with these positions, like, I’m just like, doing like math and physics in my head, like, constantly. And then like, yeah, it’s taking this long, because it is, but like, doesn’t mean like, my wheels aren’t like turning like, you know, constantly.
Maggie, RNC-OB 21:08
Yeah, absolutely. What is it like that range of normal that it that is very large, in labor and birth, about, like, what is accepted, and what your, you know, kind of what your tolerance is for recognizing that and not feeling like you need to, you know, rush or control the process overtly. We touched on this briefly, was there anything else you want to add in terms of like, you know, we we know that there are outside of age, all those other factors in terms of like, diabetes, and preeclampsia other blood pressure issues? Like, those are potentially at you know, that risk obviously, is going higher? And that could be what is more what is impacting the pregnancy outcome? labor outcome, then, like, age as a separate entity that we can’t totally, you know, take out of the mix? Do you encourage people to be kind of like more aware? Do you do anything extra around that to try to, like, decrease those risks?
Ray, CPM 22:01
Yeah so I think like, I, philosophically, I’m not a huge fan of treating things that aren’t a problem. But I do like to counsel people on like, what are the things that we know have healthy pregnancy, like exercising like 150 minutes a week, so like, three to four times a week, you know, decreases pregnancy complication by 60%, like so we have really good evidence that like getting regular exercise is going to help you control your blood sugar and help you control your blood pressure, blood pressure issues, like lead to like preeclampsia growth restriction, like all these things that are going to like put you and your baby at increased risk. And then like counseling on like diet, and like doing a diet diary to folks and giving, like direct feedback around like, protein intake, vegetables, water, like how to actually, like, eat a well rounded pregnancy diet, I care way more about what people are putting on their body than the number on the scale. And also, like health history. So like I do sometimes use like herbs to help people who either have a history or have like creeping blood pressures, try and keep their blood pressure within a normal range. And, you know, always transferring if we get to, like above 140 over 90, but you know, sometimes, you know, with like herbs and exercise and lots of Epsom salt and, you know, dietary changes, like we can either like keep people’s blood pressure within normal limits, or like keep their blood pressure normal for longer, which is also going to improve their outcomes. Absolutely.
Maggie, RNC-OB 23:26
Okay, great. That’s really helpful. And then, I think as we were like, kind of wrapping it up, I want to just kind of also touch like, I think for people out there who have been feeling all of these kind of just like, there’s all these things that can go wrong with a later pregnancy, that there’s a lot of concerns, we have around there, I think we don’t talk about like the potential benefits to people who have their babies later. And that those are like things that we can encourage and counsel people about as they are like considering what their fertility options if they’re trying to think is it time, like do I need to start making a family right now? Or is there time for anything else that might be you know, going on in their life? I know I saw some you know really interesting answers about like, like you said, in just feeling more stable obviously, as we get older, potentially get more stable housing or jobs have been you know, family situation stuff and then also kind of the impact of like I was reading recently that there’s some evidence to that like having your baby actually keeps you living longer like that the act of having a baby over 35 like it keeps you younger, and that they women who were able to have their last child after 33 are actually more likely to live to 95 and are twice as likely than those who had their last child before their 30th birthday. So there’s like actually like a big like there’s good evidence to that shows that like there are benefits as well to this not just like you might be okay, you might actually have other like positive things that come from it to that I think we should probably be like encouraging more clients.
Ray, CPM 24:48
Like kids have like higher literacy levels. You know, I think the thing that best prepares people to parent is to be as ready as possible, you know, and having unplanned pregnancies while they can be ready welcome and really joyful if you’re like not ready emotionally physically financially spiritually it’s harder and it’s like harder on your mental health and that’s harder to like attach to the child it’s harder to parent you know i think i like in the realm of enthusiastic consent like i want people to like be able to like actively choose and be like i am prepared i’m wanting this and welcoming this and sometimes age can really offer that like i felt the things i want to do and you know like this is something i’m like really choosing this life change and everything that comes along with it and it’s what a blessing to be able to really enthusiastically consent to you know like a really really really big change in like life and attitude and everything else.
Maggie, RNC-OB 25:47
Yeah absolutely yeah and i think i mean obviously that’s what i think we hope for all people going into you know pregnancy that through that process they are able to get that feeling of feeling like yes they have the support that they need they are emotionally mentally prepared for this huge transition that does not happen at some magical time there is no universal time yet that ticking clock is pretend you know so there is it’s not like oh at 30 or 32 years was to suddenly know like yes it’s time to be a parent. I think because there’s been just such a shift worldwide you know people having their you know babies later we’re gonna keep continue to see more of that and you know because we have better access to fertility options to help people who you know who needed who haven’t been able to conceive that that’s you know that’s going to continue and having more kind of confidence in caring for those people without feeling like there is a black cloud over their pregnancy will help everyone all around have a better better outcomes better experiences because we don’t need to be carrying our like biases and baggage into someone else’s ideal birth time.
Unknown Speaker 26:55
We don’t.
Maggie, RNC-OB 26:57
Anything else you’d like to add on this, any other takeaways?
Ray, CPM 27:01
I don’t think so i think we’ve had to cover the gamut you know it’s hard because there’s a lot of prejudice but i always want to say like you know if you get to labor like the birth part is normal it’s like the pregnancy stuff is the one that like you have to make these like do more evaluating or making more decisions around but like the birth is the same yeah we don’t have any evidence that it’s different .
Maggie, RNC-OB 27:21
That’s great perfect well thank you so much for having this conversation together
Ray, CPM 27:25
yeah thanks for having me
Maggie, RNC-OB 27:29
Thanks for tuning in we’d love to connect about what struck you about this episode how have you supported birth and pregnancies over the age of 35. If you are someone who had a pregnancy over the age of 35 how were you best supported by your providers? what were the things that were done or not done that moved your experience? we love to learn and grow alongside with you, please follow us at Your BIRTH Partners across social media and in particular we’d love to invite you to join us in our facebook group Your BIRTH Partners Community and there we have a chance to break down the topics for each week’s podcast and work through some of the parts of applying these concepts and change your practices out in the real world as we all work together for more collaborative inclusive and equitable care. You’ll find more information about the evidence surrounding pregnancies over the age of 35 in our show notes; we look forward to hearing what you think. Till next time!
033: Pregnancy and Birth Support for Young Parents
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back, as we continue our season covering biasies and under explored benefits in perinatal care, we are turning our attention to supporting teen or younger parents as they grow their families. Last week, we discussed pregnancies over the age of 35. And the biases that we hold around that. And so this week, we wanted to juxtapose that with the idea that a lot of us, unfortunately, have been conditioned to just have a lot of unconscious biases and judgments that inform our care around the “right” time to become pregnant. And that is not necessarily our fault alone. But it’s something that we need to be accountable for, so that we can change it and provide better support. So as we think about pregnancy on the other side of the age spectrum, we want to examine how are the ways that we can best show up to support teen parents? How can we take away some of the stigma and shame that is often unnecessarily associated with these pregnancies? What are some of the best ways that we can reach this clientele to help engage them and information about pregnancy and birth and aarenthood. And to inform that conversion, I’m really excited to have SeQuoia Kemp as a guest on the show. She’ll be sharing more about the work she does as a birth worker, and in particular about the way she has really pursued her passion in supporting teen and young clientele as they prepare for birth and parenting. On to the show!
So well welcome so very much, SeQuoia. Welcome to the podcast. I’m so excited to have you here to share with our audience a little bit more about your work and in particular how you support younger parents through pregnancy and birth and postpartum. So if you want to start by telling us about yourself, how did you get into birth work? What led you here? What are you doing?
SeQuoia, CD 2:06
So hello, hello, my name is SeQuoia. As you all probably know by now. I am a Black feminist birth worker in Syracuse, New York. And, you know, I saw my first birth and I was 14 years old. And that was all it really took from that moment. I was like, I want to be it I wanted to help deliver babies and, um, and then you know, so like, I’ve been studying I remember writing papers in middle school about like premature birth & writing poems about how it’s not the mom’s fault and like, over my mind, just just I’ve always been very inquisitive person. I was diagnosed with ovarian cysts around the same age so like my introduction to maternal health or gynecology, ob gyn and like, it was very personal because I was being told at 14 that I “Oh, you might lose your ovaries.” So all of these questions about like motherhood and just just it made me just trying to understand what was going on with my body as a person who was just just got a period a year before all of these things have just it sparked just this inquisitiveness about birth about the body about mothering. So the first birth I was about 13 or 14 years old, so you know, just doing my own all my projects on you know, birth work, and then transitioning to college. You know, senior year I was like, I want to be an OB, I want to be Doctor Kemp. But you know, I learned about doulas. Oh, backing up so I always attended I was a person like “you having a baby…can I come?” that was my family role prior to becoming a doula and then I learned about doula work doing a research project in school. And I was like, I’m already doing this like I’m already you know, I was learning stuff teaching myself well, how so let me help my cousin breathe. You know, I was already it sounds like I’m already a doula, but I let me figure out what this doula stuff is about. And I got trained in 2013 and certified October ’14 and it’s been my whole life ever since. I just I love being a doula I aspire to be a midwife one day so I’m grateful for all the moms and cousins who let me you know practice [laughter] and get my foot in the door and you know, and even to this day, like, but the first mom that I, my God sister’s mom, who’s I recorded her birth. And like, even now she’ll just like “I’ll never forget you was down at the end of the day recording and look at you now, you’ve got your own doula business.” So it’s just so nice to know that like, you know, the people in my life really have inspired me to do this work. So that’s really how I got it to like here. And then you know, I’m a nurse just graduated from nursing school in just December.
Maggie, RNC-OB 4:48
Oh congratulations!
SeQuoia, CD 4:49
Thank you. I don’t work as a nurse like in the traditional sense, but I’m using my nursing knowledge to really provide some more thorough education in the doula work that I do. So, yes, that is a little bit on I recently co founded a center the Sankofa Reproductive Health and Healing Center with three of my amazing colleagues, friends and sisters, and you know, just trying to, you know, improve access improve, you know, body literacy, reproductive wellness knowledge so that, you know, people can take care of themselves as we are fighting to change or build a new system where everybody has access to good care.
Maggie, RNC-OB 5:31
Oh, yes, that is that is a dream for me. I love the work you’re doing. And I love your, your passion for birth and how you’ve been able to, like, play such an important role for your loved ones and your community. And it’s awesome.
SeQuoia, CD 5:46
Yeah, it’s, it’s definitely a good experience. Yeah,
Maggie, RNC-OB 5:49
so I invited Sequoia on here. And I think we somehow I started following you on Twitter, as one does, and love what you’ve shared about how you provide birth support. And then a few months ago, I forget the exact tweet, but you were sharing about how you provide support for teen, younger parents. And I just love the way you were framing that experience and how you were just talking about how like you were able to uplift them and how they uplift you as well. And so I wanted to have you on here to discuss that in this whole season, we’ve been talking about all these biases, then, you know, unconscious to realize we all carry, just because we’re, you know, flawed people growing up in a flawed world. And I think there has certainly been like a, you know, societal judgement around the age at which you start having babies. And I think, unfortunately, teen younger parents have suffered a lot because of that. And so I want to just kind of, have you share a little bit about like, what, you know, what kind of led you to currently want to support that clientele and just kind of give us a little bit of your background with working with younger parents.
Unknown Speaker 7:00
Yeah, I mean, I think the first thing is that a lot of my friends would be were becoming mothers, you know, in high school right out of high school, so, or I just remember, I grew up in a very, like Christian background. And so I remember the whole, like, if you know that you find out that someone so got pregnant, and it’s like, someone so feels comfortable coming to you. And I’m like, “Okay, well, I don’t know what’s going on. But like, what can I do?” And so like, so much of my teenage years, was like, “Oh, so like, my friend got pregnant, SeQuoia, you know, like, I don’t know what a doula is, but SeQuoia a doula.” And so like, you know, I don’t know, I’m not a parent, I played a role in many of my friends who were teenagers at the time having kids. And so I think, like being a teenager with him, you know, I was able to understand, like, you know, you got to worry about school, and then you got to worry about, you know, finances and like, are you gonna get kicked out? Or do your parents gonna lie to, you know, stay at home? Or, you know, just all of these questions like, I would ask myself, like, “what would I do if I was 16? And pregnant? Right? Like, what would I need? And what would I feel like I would want?” and then trying to be that for, you know, teen parents. I think that, like, you know, just, and I think that also, I just reflect on like, just family, like, just watching how family, I’m just listening to stories about my cousin who got pregnant at 16. And like, she wanted to finish school, but couldn’t figure like, you know, my background is in public health, I forgot to say that I got a public health degree. So I’m always thinking about what, what is what you know, are the social determinants of health, like what around them is leading to like a lack or what can lead into like success and like prosperity and flourishing as young parents? So I think that just again, by nature of just always try I’m very solution based oriented thinker. So like, if I see a problem, I was always just like, well, how can I help? So I think, you know, becoming a doula, you know, at a time where I was like, I was getting I was, you know, getting in college. And not only like, now I recognize the issues, but now at this public health degree is helping me to develop solutions. And, you know, coming in bringing that to the work that I do, and so, you know, for many people, a doula is just like really like birth support, right? Like we think about like birth support, make it think about doula care and very rigid ways. And as a doula who had a public health background, I kind of accepted that my doula care is going to include like connecting them to resources, like if my client, you know, is like wondering whether or not they might like how are they going to do this? Like they want to keep their baby but how are they going to do it? You know, like connecting them to somebody who can help them plan like okay, this is how you do like a little budget. This is how you know, we Have calls, we had donations like really just trying to meet the needs to alleviate that stress. Like, that’s really my central point like listening, reflecting and saying, “Okay, I have an idea about that.” And so letting them know that like this is this is a space where you can vent, but we’re going to come up with a solution after so that they can feel like, there’s hope and that. I think about, a good portion of my clients were within like 18-19 years old. And I, you know, also I think, like, maybe still being young, that helps, like I said that that common age great range. And that gets to a point where I’m like, I still feel like I’m at some times, like, in conversation with them. I’m like, Oh, I want to talk, like, you know, it’s so being able to just have these moments where it’s like, what’s going on? And like, sometimes I start my sessions off with, like, “what’s going on?” You know, we’re talking about, like, what does it mean, to start a family, and like, um, you know, Black feminism is a very central part of my work. So it’s like, maybe, you know, I have a young dad who thinks that like, has a set idea about what manhood looks like, and be able to, like, help him unpack that. And like, maybe if he if he’s exhibiting toxic masculinity, talking about, like, ways that it’s okay to express your feelings, it’s okay to communicate, because communication is going to be very part, very important part of parenting. And so it’s, it’s about, like, preparing them for the actual act of the birth, but kind of helping them unpack, you know, mindsets that they may have developed, that in the long run are going to be a little bit more harmful than, you know, than just being Oh, being okay, with being emotional, be okay with being a nurturer. And so, I feel like a lot of my time time with them, is really just kind of unpacking and giving them that space, to question and wonder. And, and because, you know, you know, a lot of times parents like what you did, like, you know, today, like, it’s time to figure it out. But if they could come here and say, you know, what’s that, I don’t know what I’m doing. I’m like, “Alright.” Or “my parents say that I can live here, but I gotta have plans. “So let’s make a plan.” Because we because housing is an important need. So, you know, a lot of it is like coaching, you know, supporting cheerleading, and like literally, co creating, like these plans so that they can have like housing, you know, food and necessities to really have that starting probably be important.
Maggie, RNC-OB 12:25
Yeah, oh, my gosh, well, that and it’s so unfortunate that that is not just like, the baseline for every pregnant person, anywhere like that is what we should be doing, we should be surrounding with that support that goes beyond just, you know, support at the time of birth, which is a very important time, that is a moment in the midst of everything else that they’re that they’re doing and how they’re growing as a person and a family. And I was wondering, could you can you elaborate? You touched on the some of them like working through mindset, working through shifts working with like family dynamics? So I think, we know, certainly sometimes birth workers can hold, you know, biases about taking care of younger clientele. And like you said, just some of the kind of like, shame or stigma that can come with that. But I also think there’s something about like, when, when the, how do you help, maybe when the pregnant person is navigating their own feelings, like they feel like they did something wrong, or that their parent is, you know, making them feel like they should be ashamed about what is what’s going on? Is there kind of do some tools, you help to work through that with them?
SeQuoia, CD 13:25
Yeah, I mean, I think I am type of person. And I mean, anybody in my family could tell you that I’m like, I care about which i think but I’m like, “you are about to go into a huge new journey,” what you want to you want to ask that you can hear people out, right? So I have one, one, teenager and mind who mom is a teen mom, right? And so for your 16 year old daughter to be pregnant, it’s this mentality that like, you did something wrong, or why didn’t it? Like why couldn’t they come to you or, you know, that this failure as a parent, and I was like, you know, you didn’t fail? Right? Like, yes, you had a child at 16. But look at how much you’ve done. And like, this could be a moment where you can give your daughter the opportunity to say, these are the struggles I went through, this work so that you don’t have had those same struggles. Like, like, I so with my clients, I’m like, like so that one client on my mind, where it’s just like, your parents are going to always have an idea of who how they want you to raise. But at this point, it’s like where do you see your life like I always respond to them. Because we I mean, depending on who you know, that night like negative and positive self talk is very important and like behavior medicine is like really a huge way of understanding the psychology on the understanding the messages. So you know, for me, it’s like reminding yourself that you are doing everything you need to do to put yourself in a position to be successful to have a healthy family. You So when we had those moments of doubt, like journaling introduced them to meditation, I connect them with other young moms or moms who may have had babies at a young age who, who are like I’ve been there with you, what do you need, so like, really, you know, connecting them to other people. And like one thing I learned about in psychology, it’s like normalizing situations, like not normalizing it in a way. It’s like, Oh, well, your mom data so you can, but like, recognize that what you’re feeling is normal with this doubt, this insecurities. These are normal feelings, and it’s okay to feel this way. And I’m here to offer that support, and often referring to therapy, because sometimes they, a lot of times, they’re navigating, you know, they might be navigating trauma, they might be navigating, like different parenting styles that may have not been supportive, right. And so just really trying to help them understand that. It’s not that they failed their parents, or it’s not that their parents failed them. But as a community, maybe we can that we could think about all the different things that probably would have avoided the situation. But right now, you’ve accepted that you’re going to have this baby. And so we’re going to unpack these things, but I’m going to always push you forward, because you can’t wallow in staying that we, how do we get you to a point where you could come to a self acceptance. And so and i also I see how grandparents are angry at birth, but as soon as that baby comes, they are all over the baby and outside, like, I get to tell them nine times out of 10 when this baby comes, your parents are gonna flip the switch. And that’s exactly what often what I see is that it does, so I really just like, you know, let’s talk about I start my, my sessions off with meditation most of the time, and I’m just giving them you know, opportunities to express themselves, specifically because like you, I mean, one mama, she was just like, she was struggling with the fact that her daughter was happy. And now she gets to feel joy, you know, it’s like, do you expect you to do you think she she understands that she disappointed you, that in and of itself is is a burden that you know, to weigh? So it’s like, at some point, she gets to experience joy, because at the end of the day, she’s bringing new life? So do you want her to be angry and sad and depressed her entire pregnancy? Or do you want her to just be happy and to experience joy? And I think she’s she had to step back and say, You’re right, you know, so I’m very much a unpack in less than a year out. What what how do we deal with this? Yeah,
Maggie, RNC-OB 17:36
I think there’s so much power. And just, like you said, kind of like naming all of that that’s happening that like, right, we’re complex people, and you are allowed to have a multitude of feelings about your pregnancy. And I do feel like I think it must be really impactful for like a parent, if you were to hear that, like, you know, as birth workers, when we think of like supporting younger parents, if we think of like, helping them with those dynamics that like, I, I feel like most people, if they were able to have that conversation with their family, with their community at large and say something that effect like, “Hey, I understand this wasn’t this wasn’t planned, we didn’t realize that this was what was gonna happen. But I want to find joy in this process. And I would love for you to find joy with me.” That that is that like moment to pause and realize like, Oh, right, like, that’s an option. You don’t have to just keep wallowing or doing the what if game or you know, any of that stuff like that the that is not productive. At that point of, you know, of the journey. And I, I love that that’s something that’s been really like, important for you, as you, you know, to help your clients to kind of transition their mindset. And yeah, and think about it.
Unknown Speaker 18:45
And I mean, my take is like, this is a family affair, right? So it’s not saying that that mom who was dealing with those conflicted feelings, like I see this as, like, a amount of for healing, right. So like, maybe mom still, still is probably grappling with their experience that they faced, and they know that it was hard. And so, you know, it’s, you know, being able to have let grandma be angry, like you can you can be angry and you can have, it’s okay to feel these things. But well, that’s not projected onto the pregnant person. Right? Because we’re not saying that these concerns, you know, disappointment is not valid, but it’s okay. But we got to process it away from the pregnant person, because a pregnant person really should be figuring out how can how are they going to stay healthy? How are they going to navigate this scary system that they you know, how are they going to prepare for this? And then you know, and now they could, they could so it’s like, you know, essential part of my work is like being non judgmental, and really like trying to see the best in like a grandparent Who, who, who might be having differences of opinion. It’s like how can we all get to a place where we’re understanding each other and so that This can be a good environment. And, you know, and I’m happy to say that that young lady, I’m thinking about graduated high school got a job, like, you know, it’s something she’s like, I don’t have anything to prove to anybody else I have to put my daughter, right, like, so. It’s like, we need community, we need people, we need support, like, that’s what a team person need, they need support. If you feel like you can’t do that, at that moment, recognize that, and then, you know, and for a minute, I was kind of being like the liaison. And then once grandma came to a place of acceptance, and allowed their herself to feel excited, then everything just came out together. And so I think about, I think that specifically as Black women, you know, we’re expected to just forge through and path through and play, you know, and just like, don’t think about failing, just be strong. And in that moment, it’s like, it’s okay, we got a lot of this, it’s a lot of disappointment. We’re feeling that’s okay. But, you know, Joy is isn’t as a centering thing that we don’t really get to experience socially, in the way that other people of other races that are, you know, different demographics do. So I’m always like, okay, now what we’ve done to the joy, right, we talked about it now, what we’re going to do to start to join this piece, and it’s really, it’s really nice to kind of see that transition from, you know, the button has to be like, I love my baby, I love my grandbaby. You know, I didn’t think I was gonna become a grandma 47. But it is what it is, you know, being able to see that, that growth and that family bond, because what we do know is that the one of the biggest markers for success as a person is that support network. So it’s like helping the family to be a good strong support network. I know that even after I leave, and I’m not the doula anymore, that that we set a foundation for success by building a supportive network around that team, or team period.
Maggie, RNC-OB 21:51
Yeah. Oh, absolutely. That’s beautiful. I mean, that. That is you want to see that for them as they continue on, you know, their journey. And Parenthood is a, it’s a long road of navigating and a lot of complex, you know, pieces that that go on. And it is hard. You know, certainly I think having a baby at any age, there’s a lot that changes, there’s a ton of shifts, and there’s a lot to prepare. And it is like you said there, I mean, there are so many different pieces that need to fall into place, especially if you’re still thinking about finishing up school, navigating living situations, you know, making more, you know, room for that. And so to have the family be just on board and ready to be really active participants in that like that beautiful. One of the other questions that I have. And I realize I, I have realized in my experiences as a nurse that, like I have probably been under prepared kind of for supporting that dynamic. And I think it’s obviously it’s a very different relationship when you’re, you know, a doula who’s been able to kind of establish care from an earlier time and really build that relationship. I don’t know if you have any insight because I, I’m thinking back about a couple births that I attended, where there was just, there was a lot of animosity. And I think there’s still a lot of negativity around the pregnancy. And one I think of in particular, the grandmother to be, was like, really berating her daughter during labor and like really mad that she wanted to get the epidural because she felt like she needed to just power through this because this is, you know, like, it’s kind of like you deserve this because you did this thing. And there was a lot of just really negative energy. And it was many years ago, and I think I was just I was younger and less less aware. But I would love it if you know, if you feel like you can speak to any of that piece of like dissolving some of those kind of interactions, if they’re still happening, like as we’re going to literally support birth and like the birthing process.
SeQuoia, CD 23:43
Yeah, I mean, I can definitely see that dynamic. I’ve witnessed it, you know, I always go back to like the why, right? And it’s like, why, like, as a doula, because I’ve seen it like, right, like the moms like, :you’re not gonna get an epidural. We don’t get epidurals.” And I think it’s been one time on Black women specifically, is that when you think about like, our reality is that a lot, a lot of them, not all Black people have traumatic birth incidents, but many of the Black mothers that I deal with, they are coming with their own traumatic birth experiences. And because we probably they have not ever had a space to actually deal with it. Or maybe they didn’t even name it or call it trauma. It’s like when they see that child going through it, it’s like, well, I get asked to have back problems or when I got an epidural, I’m gonna tell my client, my daughter, you don’t get no epidural. Right? So it’s like trying to understand what is leading this grandparent to be to be making these statements to be understanding, right. And so I mean, I’ve seen some nurses like if, if the people and the birth team seem to be like taking that autonomy away, because like, that’s the essential like, at the end of the day, yes, there there are pros and cons and risks and disadvantage. And advantages, but this is not your birth. So finding ways to say, “okay, you know, I, I think that we want, we all want here, what’s best for you the birthing person,” so like recentering that, and like sometimes I have to, you know, do that with provider so I feel like are being a little bit pushy and that given my client time to like, really process and sit before they make a decision. And sometimes it’s called, you know, we call it it’s called reframing. And that’s what like I learned in my doula trainings like, if you feel at any moment that the person who is birthing or laboring that their power or autonomy is being stripped away, just like asking them what what do you want, you know, or saying, Well, I think everyone in this room wants you to make a decision, that’s going to feel good to you. And so it kind of puts, it kind of puts it on everybody else to be like, if that’s not happening, you need to get on board really quickly. But in a way, that’s not directly being like, you’re being a great bad, horrible grandmother, you need to get out, you know, and so I think, and I think it’s different also depends on it, you know, I could do it, because like, if we got a cultural, you know, it’s like it gets, it gets missed, and mixie. When there’s cultural differences, there’s racial differences, because it’s a can get real messy. But I think it’s simple thing that someone can do is like, Well, what do you want and like, and like, you know, showing that, you know, I care about you, as your nurse, I’m caring about you, I don’t want you to be in this, you know, uncomfortable pain, but also using that as moments of education, like, you know, what, if you are fighting the labor, it can stall, things you cannot need, you’re gonna need that energy to push. And so like, in a way, you’re talking to the client, and you’re centering the client, but the people in the room are also hearing that education. And the idea is that they will be like, let me check myself. Because at the end of the day, it is her birth, and sometimes it works. And sometimes we have to keep recentering. But I think that’s one thing, a nurse, if I was a nurse, I would try to just like make sure, I’m being very loud and clear. It’s like I support you, I support. You knew what you want, or addressing those concerns. But in a way that like, if you can, if you hear passing comments being like, Well, you know, I understand that people do have varying experiences for epidurals. But it is like, if this person is really not tolerating the labor, this can actually change outcomes. And so what we really want is for her, if, you know, I just I that’s what I do, like a lot of my clients are like, I don’t want epidural. And I’m like, okay, but I still can’t teach you about epidural, because you’re getting that moment, you could be in labor for 72 hours, you might need it, I literally can’t relax you so that your body can, you know, progress. So it’s one of those things was like, I think in nursing school, we really talked about the power of education, and, and going in and like asking questions, I think asking questions. So because in those moments, what I see is, as my clients not being heard, like my patients not being heard, and it’s like, do I intervene? And I think, I think yes, I think in most cases, just like kind of feeling it out. And finding ways to like, connect with the client. Because what I know is that some people don’t like clients, they leave birth and like mine, oh, my mom, like you, I even have clients like apologize to the nurse, like I know, my mom’s ex right now. But I know that in my experience that the client really values like make that real personal connection and people make that nurses make during the process.
Maggie, RNC-OB 28:30
I really like that that framing of it because I do think they’re like you said there can be different just cultural, familial relationships and not feeling like you want to interfere with that, while also obviously still wanting to always center or the autonomy and that is not different. If the person is 14,15,16 years old, I think it does get muddy sometimes as you’re watching, you know, a grown person they’re talking about, and this is their child, but always remembering that like that pregnant person, they are fully autonomous for them and for their babies care and what they want to choose, like they are the parent, they get to make those decisions for, you know, their body and, and their baby. And then if you want to expand a little bit, I know you’re just talking about like the education piece, like are there Do you find that there’s different educational like tools or techniques or, you know, things that you found, like really helpful with this population? I think sometimes we think about like, obviously, you know, like as, as, as we age, it always feels like you know, the younger generation, like they’ve got just these different ways of thinking about stuff and technology plays a you know, roll in how we consume information at this point. So if you want to kind of touch on that piece a little bit.
SeQuoia, CD 29:35
This is my favorite part. Because my client, like I said, like, so I feel it. Well, I just turned 26 last year, and like, leading up to my my birthday, I’m like, it was like, I was going through this transition where I’m like, I’m not a kid anyway, I don’t know what it was. I think it was because like I went to, I went to University of Rochester for undergrad and you know, I wasn’t I was a kid at that moment. I was just that I was 17, you know, like, yeah, and grew into a womanhood during college. And then to go back to nursing school, I kind of felt like I was 18 again, but the experiences and the way that I was being treated by administrator was like, you’re an adult, you’re not like, and I’m like, I’m an adult, like, all these messages. It’s like, Oh, I gotta, I gotta be an adult, like, I don’t know, a light bulb just switched in my head. So I say that to say that when I am something that I had to accept to recognize one of my youngest clients is that, like, I usually email my clients, like a lot of my clients are, you know, they’re working there, the professionals, and especially they check the emails regularly. By client, she don’t say, an email, you don’t say it sound like, I’m like, Why is she not telling you? I’m like, she’s 19. She knows, you know, she doesn’t have a job that she has to check her email. So it’s like, I realized, and I’m like, Oh, so I’m, like, even like, I will text her from my work number. And she wouldn’t respond. But if I texted her my personal number, she will respond. So I was like, because she knows me as SeQuoia. The doula piece she like, yeah, you sent me all the business stuff that I need to do, but like he had, like, I was trying to figure out why she was. So I’m like, I gotta text her for my personal phone number. So she knows that she’s talking to SeQuoia. And not just as a doula who I have a former relationship with. For her partner. I’m like, I gotta send him graphics to read, right. So like, one like we get most of our appointments have been more of like, family counseling, like style, like, because I’m here, what’s going on? Let’s strategize. Let’s prepare, because I feel like younger parents, you know, especially with the unplanned pregnancy, they have their conversations that they have not Do you want to have baby vaccinated? Are you guys gonna move in together? It’s like what is, you know, if you don’t stay together romantically? What are you going to do? So, outside of the prenatal appointments, I had to do more of that like intermediate. Here’s a graphic about starting a family, like educated birth, I love The Educated Birth, their graphics are just so easy to understand. I use them to teach, you know, because I think that the one they don’t really know what they’re getting into, right? They just think like, Oh, baby, I’m gonna do my parents did, I’m like, hold up, there’s so much more. So I feel so you know, using, like, if I see a video, on Instagram, I’ll send it to that client, because I know she’s on Instagram. So trying to like meet her, you know, where she’s at sending her different videos of what home but she hadn’t home birth. So what home birth looks like, it doesn’t have to be screaming, it doesn’t even know we can play some torque music, we can, you know, do some playing some reggae, like it like just trying to show her different examples of like, what her birth can look like. And then making sure I’m being conscientious of like having videos that includes what the partner can do, because we’ll practice in a prenatal session, we do the double hip squeeze and all that. But I think for us, we’re like, as I’m still a millennial, so but in that, you know, I’m like, I know they’re on TikTok. I know, they’re on Instagram, how do I use TikTok, Instagram, and YouTube videos to kind of get the education that I need so that it’s within their, like, time span and mentor base? Yeah. Oh, yeah.
Maggie, RNC-OB 33:19
I love it. Yeah, I do think I think there’s like, there’s value in making like, just making it accessible, it’s fun, and it doesn’t always have to feel heavy. I’m a huge proponent of childbirth education, I think there is tremendous value in learning, you know, about the birthing process, but I do think sometimes, like coming in for, you know, a couple hours and consuming all that information all at once, like, any age, it just inevitably, a bunch of it’s going to just go over your head in one way or the other, because you just can’t physically take it all in and like process it. And so I love just being able, you know, that idea of be able to share like, yep, here’s a graphic, here’s, here’s a one minute TikTok video like that. This is gonna, you know, like, it’s that is how we’re, we’re learning and our attention span is changing with technology. So that is how we’re like, taking it in. And that in that it helps us get like a snippet. Okay, so think about whatever that that’s, that’s great. And I, I also feel like when I’ve thought to about, you know, clients, and especially for younger clients, who maybe just haven’t received a lot of information yet about just like how their body works and about like reproductive health care in general, I took care of her again, years ago, helping her postpartum and learning about, you know, education and going forward, and we were discussing birth control. And at that point, it became apparent that she was still not aware of what sexual activity had led to the pregnancy. And I realize like what a shame that she has been through, gone through her whole pregnancy, birth and she’s now postpartum and no one has really just like, taken the time to like, make sure she is comfortable with what and she was, you know, very young and just she maybe she hadn’t had that information yet in you know, like an education, you know, school setting. Right. And, and I, you know, maybe she didn’t feel comfortable discussing it with her family or they always Assume that she obviously knew how this had happened. But so I feel like that piece of just making sure that people have like, I think they’re just so many of us adults to who we are not well educated on what our body is doing. And, you know, and we need to know that in a deeper way for our like, our overall well being, you know, way beyond just pregnancy. And so I feel like obviously, like the education piece, you know, especially in the population, I feel like can’t be overstated how important it is to make sure people feel comfortable with their body and what’s going on, so that then when they’re raising their babies, they also have a solid foundation, and that there’s no shame in talking about our bodies, and sex and how all of this happens, like reproductive health is a body system, just like all the other systems and we have total brought on this stigma around it that doesn’t, it doesn’t need to be there.
SeQuoia, CD 35:47
Yeah. And that’s what, like one of my one of my mentor, as they’re always saying, like, like, they were like this, we when we say birth, like liberation happens through birth, it’s like, with each family that we’re connecting with, and was in and with each family, who are we like telling you like, birth justice? It’s not like a reproductive justice isn’t this abstract thing? Like, this is what it means in your context. And it’s like, then you are inspiring people, like we are changing, you know, it’s like, I just always think about, like, yes, we the larger thing is that, like, we want to, like lower, you know, lower, you know, lower, all it is statistics, right, all the isms, but then it’s like, wait, in the meantime, what are we doing now? And I think that is like, connecting these broader, like frameworks and ideologies, and then like, actually using it as moments to teach the families so that we’re actually transitioning from the old ways to more healthier and ways based on like evidence, but also based on the experience as well.
Maggie, RNC-OB 36:53
Yeah, absolutely. Well, as we, you know, wrap this up, are there like, you know, what are like the three things that you would say that would relate as birth workers of, you know, all stripes, ways that we can really help to support you know, younger parents as they prepare for their birth?
SeQuoia, CD 37:05
Yeah, I mean, I think the first part, the first part is just I always ask myself, like, like, like, introspection, self reflection, that is who I am, my mother gave me & my sister journals when we’re young. And so I’m always like, you know, reflecting on moral dilemma, right? So I think that it’s important for us to be asking to be asking ourselves, what do we need when we were younger? Because like, there’s, like, so much of the things that the our young parents need, can be connected, like I if my work can, is connected to this, this passion, it’s because of things that I experienced, like nothing, I wasn’t at mine, but like, did I need someone to talk to that I need someone who I could like, ask questions, and then not be like, ya know, that, you know, it’s like, what do you what do you need? What did you feel you need and like, being careful to like, not only learn this in nursing, like the first part of like, addressing your biases, or like, trying to solve the issue in the nursing is like, so how do you feel about it? Like, what are your personal? So I think like really reflecting on like, what did you mean, what do you feel like, and then the second thing is like, being in the know, so if you kind of get on tiktok, you know, or use these moments, if I go, I instead of like going right into education, what I do is like, tell me what you know about birth, tell me what you know about labor. So that psychological psychology, the psychological pieces, that it kind of helps them affirm that they know something, right. And then you can also reveal they don’t, because I think when people can come into him, like, you know what, maybe I do have a foundation, I feel like they’re gonna be more excited, they’re gonna be more open. And I can just see, like, the different texts that I use, people open up a little bit more. And that’s really what you want to me. Because when it comes to that actual learning process, you want that trust to be built. And I think that trust is built through honest reflection of yourself or your ideologies, and then understanding that student or that person, or that young person through what they already know, and building on that. Um, and then I think the other piece is, like, always remembering that their brains are still developing, like, this is something that I have to understand because, um, you know, and then I think that a lot of us like, as adults, we because we just, we figured it out, you just, sometimes you have to remember that this person’s brain is still developing these connections, these neurons are still being made. And so what can you do in that process, to make sure you’re depositing seeds that’s going to grow while their brain is still developing? Right. So and, and, and I think that I had to understanding why I always just be like, why are you Why Why are we making this disconnect? Like why can’t they see the abstract and then connect it and it’s like, because they bring probably the same theory. Yeah, I think it was a Piaget’s theory about the different frameworks that like, where age and then like, what what you’re preoccupied with psychologically, I think, like, you know, doing that research is going to be so important. Because now I’m like, I get it, I get Wow, why this person is fixated on being with their partner versus like, being a dad, like, the romance and companionship is important to them. And this baby is like, yeah, it’s coming for the baby’s not here yet. So in their mind, it’s hard for them to switch into daddy mode, because the baby’s not here yet. So, you know, trying to like understand how the brain is working at that age, or whatever age group they’re in, helps me to be like, let me give a little bit more grace, a little bit more grace, right? Because, you know, it can be frustrating. But it’s like, what grace do they need right? Now? What do I need to do as a as a doula, as a birthworker, as a nurse to kind of understand, so that I can always be like, remaining true to my, like, compassionate, and non judgmental framework? So those are like the three things that I really think about, in regards to how we can better support young parents. Yeah. Those are, those are
Maggie, RNC-OB 41:17
awesome. And, yeah, they like that. Especially that last piece of just remembering like that there are, like, there are just these differences in what we’re ready to, you know, do accept and process at that age. And like you said, just having that not jumping to the judgment piece more than frustration, which it which happens, natural emotion that can come up when you’re trying to help someone through it. And it seems like it’s not, you know, going that way, but just remembering that and then, and honoring, like, the, the fun that comes from it, too, you know, like, I think sometimes, you know, again, we focus on like, the potential, you know, negative or hardship of it, but like, right, like, there’s all this fun peace, like all that energy you have as like a young parent, like, you’re so close to childhood yourself, like you’re like, you know, you can be really engaged in play and these activities and like that connection with your child in a way that you can’t necessarily appreciate by the time you’re 25, 30, 35, 40, like, it’s just going to be a different relationship. And, and finding like the, the fun and exciting pieces of as well.
SeQuoia, CD 42:15
You just the last thing I’ll say is like you just reminded me about like, what am I like, by quiet? The baby showers, right? It’s like, there’s this thing where like, he’s like, “well, I don’t want to give a baby shower to my teenage child, because I feel like I’m saying it’s okay.” It’s like, or you’re saying that you need as many resources as you possibly can. And this is one way to get those. And so you know, it just like and that’s why I said like us maybe a certain dollar but like, I’m gonna do proud childbirth, education, preparation, that’s it. But to me, I like you don’t you don’t have anybody to go and do a baby registry. I’ll come pick you up. We’ll go to a baby registry. Right? Because it’s like, regarding like I said, regardless of what people do, if somebody asked you do you have a link, send that link when when Pampers and those baby clothes and stuff come in? Who could be mad at that, ya know what I’m saying? So that was my first, I never did a registry. So I have found one of my own one of my she was my client, but she was coming through my classes. And I’m like, let’s go to a baby registry because you need it. So yeah, keeping it fun. And as like as birthworkers like we we know all the ins and outs about the systems like we, we wrestled with that if I were in this world tries to make it better. And so just like, what, but we can also sometimes get focused on like the road and fight ahead. I think also like, just seeing young parents like get the blossom. It just makes me so excited. I’m just like, This is good stuff. You know, I love it.
Maggie, RNC-OB 43:46
I love your passion for this work. And thank you so much for coming out here to share it with us and help us to find it in our own.
SeQuoia, CD 43:53
Thank you for having me. I appreciate it.
Maggie, RNC-OB 43:57
Thanks for tuning in. We hope you really enjoyed this conversation with SeQuoia as we explored all the ways that we can do more do better, as we aim to support parents of all ages, and particularly our teen and younger parents as they step into the journey of parenthood. We love to learn and grow alongside with you. So please follow us at Your BIRTH Partners across social media. And in particular, we’d love to invite you to join us on our Facebook group, Your BIRTH Partners Community. And there we have a chance to talk a little bit more about topics for each week’s podcast, and kind of dive into some of the nuances of actually putting these into place as we go out and practice in the real world. But we recommend you check out our show notes. We’ll be sharing more there about Sequoia and how you can support her work with Doula 4 A Queen and the Sankofa Reproductive Health and Healing Center. We’ll also be sharing some more information and educational resources that we think clients of all ages will enjoy might be really helpful as you go out and care for your parents. Till next time
034: Unbiased & Representative Birth Education
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Hey there! Welcome back. This week, we are digging into all things childbirth education, birth education, as we go to examine how we are bringing all of this information that we are also passionate about, to those who are in our care. So we are diving into some of the issues that have been present in birth education in terms of representation, and where it has been lacking. And also addressing some of the ways that we can truly provide unbiased information that puts the power right where it should be, in the birthing person’s hands, so that they can truly understand all of the array of choices that are available for them, and are able to make really educated decisions that reflect their best interests, their desires, their hopes for their birth. And as part of this conversation, I am so excited to welcome Cheyenne Varner onto the show, she will be sharing more about what led her to birth education, and why that has been such a cornerstone and important part of her work is sharing more with families and with other birth professionals, and changing the face of birth education. So without further ado, on to the show.
So I am really excited to talk about this. Today we are diving into all things birth education, and how do we kind of meet people with where their needs are fill in gaps of knowledge, how do we model the births that we want to see and really like open up people’s eyes to what childbirth education can be. So I am really excited to introduce our guests. Do you want to tell us a little bit about yourself and your journey as a birth worker?
Cheyenne, Birthworker 2:21
Yeah, absolutely. Hi, I’m Cheyenne Varner, and I’m in Richmond, Virginia. I’ve been a birth worker for five, almost six years now started in 2016. And I mean, my kind of journey into all of this, I’m the oldest of four, we’re all pretty spread out. So I was really engaged and aware when my mom was pregnant with my sister, Ilan and my brother miles. And then my youngest sister was born when I was in college, and she came into our family through foster care, and then adoption. So she was three days old, and she came home. And, you know, it was really interesting for me to see my mom go through a postpartum period without pregnancy. Before it. And even when I was seven or eight, when my sister was, you know, being born, I was reading my mom’s baby books, like the thick ones and not like, you’re going to be a big sister book. And for a little while, I thought I might get into medical school and go, you know, try to be an OB. But by the time I got to college, I just kind of knew that wasn’t the route for me. So I kind of put all that stuff away and went into nonprofit work, wanting to do things that were educational, that were still really supportive of families and young people. And then in 2016, I learned about birth work. And pretty much I learned about it, someone in my network said, Oh, I know someone who’s a doula. And then I was at a training within a couple of months. Yeah. And I interned at a local birth center for some time. And yeah, I mean, the rest is kind of history. I started working with families in Richmond and beyond. I’ve done a couple, you know, births in other states, too. That’s kind of my birth work story. But at the same time that I was becoming a birth worker, I was also noticing that there were there was a lack of representation in childbirth education. And that’s how the educated birth and everyday birth magazine started. You know, all of that.
Maggie, RNC-OB 4:33
Yes. Oh, I love all that. I love that, like, we’ve been talking about, like the whys what brings us into you know, this work, and I just I love that it’s started at such a young age really, you just had this interest in and passion and like understanding more about such a pivotal part of people’s lives. So that’s beautiful. And yeah, so I wanted to bring you on today particularly to kind of dive into some of these like nuances of childbirth education and in this whole series, we Kind of discussing, like, where are some of the things that we hold biases? So whether we’re really conscious or unaware of them? And you know, where do we kind of then because of those sounds like miss out on, like the true benefits of something. And I felt like childbirth really fits into that piece, I think, probably for people outside of birth work, and maybe some even in birth work, childbirth education seems like this like, fuzzy, warm, like, overwhelming positive thing. And it is good and necessary. But I, I wonder if you want to speak a little bit to what you saw, then and elaborate on that when you came into work and how you started actually, like childbirth education was perpetuating some of these, like biases within birth?
Cheyenne, Birthworker 5:41
Yeah, I mean, what stood out to me automatically was that I really didn’t see black women represented in childbirth education materials, you know, I’m a black woman, I come from a family of black women and men, you know, lots of different skin tones, lots, lots of different hair textures, lots of different, you know, everything. And that’s what I was, I was looking to see people who, you know, reflected, me and all the people I grew up with, and a lot of the people that I would be working with. And I couldn’t find that. And so, you know, I started, I’ve always been kind of a hobbyist Illustrator. And so I started just creating materials of my own that, that showed that. And then once I started sharing it online, a couple local people were like, you should put this on Facebook and other people. And I was like, okay, and when I did, I mean, there was just an explosion of a response from people from all across the US who were like, “where did you get this? Wow, this is awesome. I’ve never seen this, no one does that.” And so that’s when I realized, like, oh, like, it really doesn’t exist, that, you know, there’s that kind of, you know, centering and as time has gone on, you know, I’ve kind of dissected this issue more and more, and found how, you know, I think it’s really, it’s a symptom of a much larger issue, which is that a lot of in health care and medical, in the medical world, the primary image of you know, a pregnant person is a white cis woman who is thin and in about her 20s, when you kind of narrow everything down, you know, that’s like the primary image that we’re we’re getting. And, you know, it’s not a problem for that image to be there at all. It’s just an issue, because not everybody fits that image. And so there is on a variety of levels, a disconnect between people who are taking care of pregnant people and those pregnant people if they’re not, you know, fitting that mold. And I think it also like it sends a message to people themselves when they’re going into spaces, and they’re seeing reflections of time in their lives that they don’t fit into.
Maggie, RNC-OB 8:09
Yeah. Oh, absolutely. And I yeah, I think it you know, it is it’s a symptom, like you said, of this, just this bigger narrative where white people have dominated everything in our country. And so because they were the people in in power, and that that has been able to perpetuate that, okay, well, of course, every birthing person looks like this. And it’s this, you know, picture of this smiling, cis-assumed, heterosexual, you know, married couple, like you said, in their 20s. While that fits many people. And, honestly, that fit me when I was, you know, giving birth. That isn’t everyone. And I think we do such a disservice. And we certainly do it, like you said, to the people who are giving birth who are looking around to see like, how does, how could birth work for me? How would I? How could this possibly play out and as like, in the bigger birth care community, we keep sending this signal to ourselves as birth workers that like, this is what birth looks like, this is what a person giving birth is going to look like and so these are the kinds of supports that they’re going to have. These are like the basic kind of cultural assumptions that they are bringing into birth. And that leaves so many people, the majority of people actually, out because we create such a narrow window for what is like accepted.
Cheyenne, Birthworker 9:31
Yeah, and there’s so many intersections, I think the the, you know, the overarching message is that we need to be more attuned to all the different intersections and really, you know, engage with people and create our education mindfully so that people who are coming from different perspectives and different experiences can still be spoken to and know still know that they are welcome within it because every white person isn’t going to isn’t going to ask identify with all of these images, either there’s a vast amount of, you know, variety and diversity within each race, each background, you know, each segment. But yeah, we’ve just, it’s just been something that I think the dots of why this is problematic have not been very connected and have not been very, you know, they’ve been underestimated this being an issue and the fact that it connects, you know, it connects to the kind of care that people are getting, you know, like, I sound like a symptom of a bigger problem. I think as people are understanding that this is an issue where we talk more about the maternal mortality crisis, and how that you know, impacts certain people more than others, then it’s like, Okay, well, we do have like an effect happening here. So how can we kind of rewind and look at the broader picture? And what things can we can we rework what things can be add to, you know, that’s really what we’re talking about here is adding so that there’s no longer just one image that comes up in Google one image that comes up in our heads. But we start to think in more of a spectrum and then more of a broader way.
Maggie, RNC-OB 11:15
Oh yeah, absolutely. And I do, I love how your, the work that you have created really touches on all of those different, like you said, different different racial backgrounds, different skin tones, different identities, so you’re having different, different, like, you know, family makeups, whether it’s single parents and you know, queer couples, it’s, I think I’ve seen polyamorous imaging as well, like, you are really covering all those bases, you’re speaking to, you know, cis bodies and trans bodies, you are showing that there is so much more than, and it’s and it’s also not just like, there’s not a binary. And it’s really to be inclusive of just like all of the different ways that that we show up at birth, and that all of those are like they are all dignified, they’re all worthy of that same respect and care, that ultimately will get us to equitable treatment, which, like you said, we’re, unfortunately nowhere close to that. And those racism driven perinatal mortality disparities can’t change unless each of these pieces all come together from the care provider practice that we put into place to the imagery that we have that reinforces what what a good birth looks like, and what people want. And I’d love to if you can kind of speak to that piece. So you have the representation within your work in terms of like birthing people’s identities, but then you also have done such an incredible job about really showing, showcasing a huge variety of what, what birth should be. And that’s, that’s a very heavily in quotes, because I think a lot of you know, a lot of times we get this kind of like ideal birth image, which is obviously not the same for anyone. And yeah, so if you want to kind of spend like, how have you, through your material also shown, like really a diversity of experience and goals within birth?
Cheyenne, Birthworker 13:11
Yeah, so I can step back for a second and say, for anyone who might not be familiar with the work that I do, the educated birth creates educational materials, teaching tools for birth workers and childbirth educators, and other reproductive health workers. And so a lot of it is illustrations, I do handouts that are, you know, infographics that I try to do my best to really condense information and make it simple, a lot of it is like jumping off points, so that people who are teaching things can like use that as like a starter with their clients. And then, you know, dig into more detail, expound upon that, beyond that, and, you know, we have an Instagram account, we share all kinds of educational things on there, a lot of it is illustrative and kind of infographic handouts, when it comes to showing kind of the spectrum of you know, quote, unquote, good birth or what, you know, different births can look like. I think that, you know, I just have tried to look at a lot of different stories, you know, reflect on the experiences that, you know, I’ve seen my my clients go through families that I’ve worked with, and and think about, you know, how can I think a lot of it is kind of expectation setting to I think what I strive to do whenever I’m writing something about, you know, birth is again to like center it all around the person who’s reading it rather than a specific outcome or, or, or thing you know, whether we’re talking about positions that you’re going to be in, throughout labor or in birthing like, I just tried to, like, show the plethora, like show as much as possible, and make statements that are more like, you know, you will just With your, you know, for support with your care provider, you will listen to your body will, in your labor, figure out what the best call or just the decision that you feel most comfortable with is going to be. And I think some of that, too, is also holding space for the fact that even in those scenarios, we still don’t always have births that we feel great about, you know, sometimes it’s just not what we expected. And so it’s hard, you know, to grapple with, sometimes it is interfered with by providers who are not working with us in a in a really ethical or ideal, or kind, compassionate way. And sometimes there is trauma in our, in our birth experiences, or sometimes there is a true emergency and an experience. And then that is often traumatic, even though the care might be supporting us the best they can in that in that emergency. So I think I also just try to hold space when discussing birth, that all of these things are possible, and let that reader know, it’s okay. It’s like, a sheet cannot tell you, you know, what your outcome is going to be or what the right outcome for you is going to be. But we can tell you like, it’s okay that it’s hard, you know, it’s okay that it’s beautiful. It’s okay that it’s joyful, like, set all of that expectation and just try to try to wrap it up as best we can.
Maggie, RNC-OB 16:29
I love that I think it’s so important to, to keep saying that over and over. And over again, like there is this just huge range of experiences, and that none of them are inherently good or bad. Like it is so about what the individual person who gives birth and goes through it like how they perceive it. And I think that is I have had the opportunity to teach childbirth education several times over the years in a couple of the hospitals that I worked in as a nurse and then also like privately in the community. And I think one of the things that I’ve struggled with is that, you know, in many hospital based systems there is that whole, you’re kind…you’re certainly really educating about general general options, but then inevitably, you end up speaking to what the policies are, at, you know, the place of birth, assuming that they’re planning to give birth at the hospital. And I do think there is like there is value in knowing in knowing what you’re getting into and understanding like, hey, these are things that are going to be difficult situations, these are there’s routers, where you need to really like kind of push back and discuss this more with your provider. And that can be helpful. But I think there’s also just that that piece where there does still feel like there is a there is a thread there is like the way that birth is done here. And that can be really hard for someone who’s coming in who doesn’t know anything about birth, who has, you know, no background in it to like to work through the nuance of that and understand like, Okay, what, what do I actually want from my birth, and then I feel like a lot of when I was looking through for materials to teach in the community independently. So many of the childbirth education programs I came across, were just very dogmatic. Hmm. Kind of like, in some ways, like kind of the flip coin, like just that there is, this is how birth is is going to look, this is what your ideal birth will be realized when all of these things happen. And obviously, I do think there is power in, in visualizing, you know, what you want your birth to be, and in walking through that, but I think there is just so many of them are really rigid, an expectation, and like you said, I think that that sets folks up to be disappointed.
Cheyenne, Birthworker 18:40
Yeah, I think the best example I can think of or something that I’m proud of, though, I think we did well as a Instagram post that we did about dilation that showed it as a chart of like, at the bottom, it’s like start and you know, at the other end, it’s birth, and then there’s kind of the expectation that there would be this straight line going from, you know, zero centimeters that mark straight up to 10 centimeters where birth happens, right? We expect that to be like a straight line. And when we you know, I was just listening to a podcast, where I don’t know if it was evidence based birth or birth pole, they were talking about Friedman’s curve, you know, the idea, you know, that birth and people do, you know, progress and dilate at a certain curve. And so we expect there to be like some consistency, but in reality, you have people who are like, not very dilated for a long time and then get dilated really fast and have a baby and you have people who get to six centimeters and then are not dilating further for a while and then get the rest and have a baby and you have people who like tylee really fast from the beginning. Like we did this graph where we just showed all those different lines, all those Oh, I love that. All those different things. And that’s how, you know i think you know, My perspective and the educated birth kind of philosophy of approaching these different options, or these different variables in birth and postpartum to being like, Hey, you could fall on the spectrum in any of these different places. Like, know that that’s okay. But also, like, we should know, and we should communicate with our providers and our support people to discuss, like, why maybe something is not, you know, dilating, or this is, you know, this is average for a lot of people in the air like we can still, that doesn’t mean that we just let everything go. And we don’t engage with the process and figure out what we can do. You know, it just means that we, we understand that bodies are not machines. Yeah, bodies are not machines. So, you know, we kind of we hold, we hold space for that. And I think a lot of the, you know, the onus for that is, is really on the people supporting pregnant people. It’s really on on care providers. And one other small caveat, I spoke with a oncologist I didn’t interview what there’s an oncologist, someone who works with cancer patients who I interviewed for my alumni magazine, because I, every once in a while, I have a little extra time.
Maggie, RNC-OB 21:17
[laughter] In all your free time?
Cheyenne, Birthworker 21:20
Yes, yeah. Now my free time, but it was beautiful. Because she, you know, I asked, she’s apparently very well known for communicating through really, really difficult conversations with her patients and their families. And, you know, I was asking her about about that. And she just said, Well, I do more listening than talking. And, you know, we spend a lot of time talking about things that are not medical at all. And we just, you know, there is always hope. But this is also life. So when people are coming to see me like, yeah, they’re expecting, they might have expected to live 20 years and have a diagnosis of one more year. And that’s difficult and awful, but like, you can still hold space within that. And she said at the end that they have patients who come back and visit them. And they’re like, and they’re like, what are you doing back here, and they’re like, well, we love it here. And they’re like, this is chemo, body love it here. And it’s like, you know, if a chemo doctor, and she also has learned about all kinds of holistic things, because her patients kept asking her about it. And so she decided to go do a fellowship in it, and come back and integrate it into her medicine. Like, if a if a doctor who works with people who are seriously seriously, you know, Ill that could be fatal can get to know her patients intimately talk to them about things that are not just medical, and make that experience so supportive, that many of them come back to visit. Know, then people who work with people giving birth should be able to make an experience that makes those people want to come back and visit.
Maggie, RNC-OB 23:07
Yes. Oh, I look Yes. That it’s so important. We, you know, however, we have, like you talked about, I think it comes back to that whole, like, within the medical industrial complex, you know, we’ve been taught to view bodies as machines, right? And so we are expecting like, yep, here’s another one coming in, they’re just gonna do doo doo doo doo, dilate, have the baby Check, check, check. And we miss the human component of that, like, an absolutely, if someone who is dealing with people who are very much in like a life and death experience that is really, really heavy, you know, we are on on the other side of that we are also living dealing with thing that is really heavy, but there is so much joy and possibility in there for us to connect with something that is such a shared experience, you know, like for the vast majority of people that I’ve worked with, over the years have had their own children, you know, and so certainly, like, you’ve been here, you, you have done this, yeah, we so often don’t even just take that time to like, just connect and relate that, like, while they’re having they can have a completely different experience than you had. This is still someone who’s like going through a major transformation, you’ve done this as well, you know, how heavy this whole period is? And yeah, we need to like connect and if that like, that leads me to that like that gatekeeping piece in terms of like, how do we make this information more accessible? Like how do we make it so that every birthing person is able to get more of the information that they they need and it’s not just limited by whatever their provider may or may not have found the time to, you know, discuss without better give an appointment?
Cheyenne, Birthworker 24:50
Yeah, I mean, my short answer to that is make it more human. You know, make it less like your, you know, your going, you’re doing some kind of academic, rigorous academic activity, and more like you’re learning about, you know, your body, the realm of possibilities of, you know, what can come up things to be aware of, you know, I think I, you know, deeply encourage all of my clients to go to a childbirth education class, you know, go to one where you can, you know, if it’s virtual right now, fine, you’re still going to be in a virtual classroom with other parents that you can connect with, you know, with someone live in front of you, so that, you know, if you’re reading a book, then it’s just you in the book, like, there’s no conversation there. And even if you have like me as a doula, you know, my door is always open my phone, you can always text me and everything like that, but it’s really significant to be able to ask lots of questions and hear other people’s questions and, you know, hold space for each other in in that you guys are maybe all new all first time, or some of you are all second time, or some of y’all have a bunch of kids and you can kind of commiserate with each other. Like, talk with each other about what that’s like, I think there’s so much just on like a physiological and mental level that we, we get, you know, I think a lot of this is really about, it’s about making people aware of things so that they’re not blindsided in the moment and feeling like deer in headlights, like stuck on what to do next, it’s also just about them being heard. And seen, and, you know, it can just reducing the stress of, of not knowing what to do. And I think a lot of people it’s like, at the end of it when they get done with a, you know, learning, I think from my prenatals, it’s like, it’s not just about them feeling like they’ve gotten all the knowledge because everyone’s dealing with their everyday life. At the same time. You know, nobody’s existing in a pregnancy in like a vortex where like, all they’re doing is being pregnant all day, they have work, they have family, they have like, friends, they have all kinds of dynamics going on in their lives. So I think a lot of it is that coming out of these appointments, they feel like, okay, I did something constructive, productive, like, you know, that’s good to do. But I also like, have this person on my team. And I was able to, like, spend this time with them and talk with them. And like, I have a good feeling about the fact that we’re going to, you know, move forward together. I think that that does, like, does a lot. Yeah.
Maggie, RNC-OB 27:56
Obviously, I mean, I just want to see so much more of that connection, you know, and finding those ways. And like you said, I think there’s that there’s that power in taking in information. And then there’s also just tremendous power in just in being heard and being seen for like who and where you are, you know, right then in, in that moment without, you know, stripping away the the pretense and the what we think we should be feeling or should be doing in, you know, given moment. And I think the other piece, too, and something that you’ve done really with, like, every birth magazine, is really like that power of storytelling, and the benefit that that has for both the teller and you know, the person who gets to, to take that in, do you want to kind of elaborate on like, what, what led you that way? Cuz I think sometimes, like, so many of us, obviously, when we’re pregnant, we hear all sorts of birth stories. And unfortunately, many of them have a negative impact on how you start to view the possibility of birth. So I’d love to hear more about you kind of how you’ve approached that.
Cheyenne, Birthworker 29:04
Yeah, so everyday birth magazine came a year after I became a birth worker and started the educated birth. And the reason was, I was going to my ob at the time. I now go to midwives for just well person care, I left that ob practice. And I was sitting in the waiting room forever, like a lot of us do. And I was reading the magazines that were there. And I have that same moment where I was like, I don’t feel seen. I don’t feel like this is really written with me in mind. I don’t, you know, get this I’m looking through it and I see maybe a little bit of marketing to black parents, and you know, Latin parents, but like not a lot of genuine. Just not feeling genuine to me. And so, right around that time I was also working with my first postpartum client, who was, you know, and there’s a wonderful woman who does marketing, and is also Asian American. And so we, you know, as we were sharing postpartum time together, when she wanted to just talk about things, we would just talk about stuff, you know, when she wasn’t napping, or taking a shower or something. And so it just kind of, she was kind of familiar with my work, too. So we had started talking about different things. And I had mentioned my idea to do a magazine and she was like, it’s happening, this is gonna start, it’s gonna be out by Mother’s Day. I think it was probably was in the fall of the year, before we started everyday birth magazine, and with her, you know, support and really, enthusiasm and encouragement, we got our first issue together. And it really was about and it is about, you know, integrating real life, you know, into this educational context where I wanted it to have that same tone, that same feeling that people would receive from the materials that were making it the educated birth, but with real photos and with people’s real birth stories, and they want no, I was like, there’s going to be a home birth story, there’s going to be a birth center story, there’s going to be a hospital birth story, and every issue that people can see, they can have a positive experience in any of these places. And they can understand a little bit about the difference between them when they’re making their decision of what they want to focus in on. But they can no like, it can be good. Because it’s crazy. But I think the reason why people do word vomit all of these terrible stories about birth to other people, especially pregnant people, is because we’ve not integrated this part of life into our normal conversation. So when they see a pregnant person, or they find out that they’re, you know, someone that they know, his partner’s pregnant, it’s like that door in their head opens up to their, you know, traumatic birth story. And they’re like, this is my opportunity. No, like, nowhere else. Can I talk about this? And so is this really like, awful? Like, that’s not the that’s not the one to talk to you about it. But we just haven’t made it normal to have space to discuss it. So I think, you know, it goes back again, these are like symptoms of other. We had comprehensive sex ed, if we had like it normalized, that we just integrate these things into normal life, then people would not be word vomiting this to pregnant people all the time.
Maggie, RNC-OB 32:50
Oh, that’s such an important insight. Yeah, I have never I had, I appreciate you saying it. That way I hadn’t totally like filled out that piece of like, what makes people then feel like, this is the socially appropriate time for me to share this information with you. And that, that piece of like, if you have not had the chance to like to tell your story to process it and to like integrate that into the rest of your experience. And you just have it in this like, little traumatic box that is waiting for like any ink toy, I think when we haven’t taken the chance to, to take that time. And to inter process it on our own. There’s so much to be said about how the the bias it goes into, like sharing about traumatic experiences and taking time to process things are impacting your mental and your emotional health. So like you said, then you don’t just see someone who is pregnant and think I think sometimes that, you know, wonder is that? are you sharing it in that way that you think like, okay, I just haven’t got a chance to talk about and also do you think you’re protecting them? Like, do you think you’re sharing something in a way that like, maybe this will help you not have this experience if I explained that this is what happened to me, you know, but instead it just comes across, like more of an attack than, than a defense, I think more often than not,
Cheyenne, Birthworker 34:04
yeah, I’m sure in some of the contexts people are thinking like, you know, I want to tell them this so that they know, you know, and then that’s where, you know, again, the you know, advice that’s not asked for is just hard pass on that one, you know, and it’s cut, you know, it’s coming from a good intent. It’s, I would say probably the majority of the time most of the time people are really you know, wanting to share something meaningful with other people but yeah, it’s just falling a little short.
Maggie, RNC-OB 34:40
Yeah, I love that imagery that like picturing everyday birth magazine and picturing like, materials from the educated birth being what is filling up spaces around the country that like when you walk into your ob your midwife whoever’s you know, office it like, rather than ns solicited advice or just the barrage of like, intense medical information all at once, it is like too much to process that, like, if you have you have the magazine to like, take a copy, you get to like view these injury these stories one at a time where it’s not just like information overload. Yeah, I would just love to see like, the handouts that you’ve created. Right there. Yeah, in the waiting room, like, yeah, take it. There’s some laminated copies, if you’re looking at here, but like, yeah, take one home look at like, I feel like we could just have that set up in a different way. So that people are able to, like, access the information that they that they want, and that they’re ready for, and have time to like, process and reflect and then like, ask those questions that next time that they’re bringing it back to their provider, they have a chance to be like, Hey, I, I read this, I looked into this more, I looked at, you know, this article, or I looked up something else here. And I have more questions, and it feels like a more natural unfolding of information throughout the whole time, you know, we’re lucky, like, we’re pregnant for several months, but there is there is a lot of time to, to actually familiarize with us, like with this whole transition is going to happen. And I feel like maybe we’re not, I don’t know, taking advantage of that. But as much in terms of how we could kind of appropriately dole out some of this information to reach people like where they are so that it doesn’t feel like
Cheyenne, Birthworker 36:26
a barrage. Yeah. Because again, I mean, everybody’s living their lives, everybody has to deal with work, how they’re paying the bills, what’s going on, in their family, on on with their housing, what’s going on with the world being on lockdown. So, you know, we, we have to reach people where they are, and if this, if this knowledge was just, you know, integrated into what we learned growing up, you know, if we didn’t first learn about it when we’re pregnant, and then that would really make a huge difference. And there are lots of communities where that is the case where people do, you know, grow up seeing births happening, and, you know, with people who are talking about it, like, you know, I, you know, our culture today, here in the US is just, I mean, when hospitals were created, they just moved at, you know, they moved everything to the hospital space. So we’ve gotten disconnected from it, and nothing has like really come into adequately fill, fill that gap.
Maggie, RNC-OB 37:38
Yes. Oh, I do. I love the idea of this being like you said, being part of when we’re talking through like, health, education, sex education with earlier, Junior High High School, you know, when we’re really meeting people were like, this is all stuff to just like be aware of, because again, birthing people are going to be around you the rest of your life, you may as well know at least a little bit more about that experience, instead of feeling just completely shocked when you’re finding yourself and now like, Oh, you You are the expected family and
Cheyenne, Birthworker 38:06
Right. Yeah, and to have it. And to have it talked about as normal as where we haven’t for dinner. Yeah. babies born. No, yeah. And like this trauma, scary, gross thing, you know, where it’s like, you know, I think we did watch a video of a birth when I was in fifth grade as a as a part of health education. It was like, it was like, you know, oh, this terrible thing is, you know, being shown to us, and everybody’s like, Oh, this is gross and terrible. You know, rather than learning about it,
Maggie, RNC-OB 38:38
yeah. For my curious place of just like understanding something else that’s, I know, well, and obviously at age, it’s everyone’s very cognizant of bodies and filling a lot of like, I think, a lot of growing pains that are happening there in terms of like, understanding bodies, and how they relate to each other and how that works. But I was really one of those kids watching like, tlcs birth story way back in the day and just like, hammered by the whole like, process of it and how it all how it all work. So yeah, I love I feel like there’s also I don’t know, if you’re seeing Haley’s book birth ABCs I also think it’s a great it’s a board book that is made for you know, I mean, any anyone of any age, but you know, especially to me, like kids when they’re really little just to see, like in that same vein, like this is just, these are like little snippets, like this is normal. Yeah, some babies are born at the home. Some babies are born at a hospital. These are like, this is a midwife. This isn’t Yeah, this is a do it. Like, these are what all these roles are so it doesn’t feel like it’s, you know, it’s not something scary. It’s not a secret. It’s not anything bad or shameful or abnormal in any way. This is this is normal life. So
Cheyenne, Birthworker 39:41
you say the truth you talk about what something is, in different ways as people, their minds, they get older, their minds, you know, grow in information and understand things differently. And so yeah, any I mean, they’re probably lots of Kids out here who’ve, you know, come from birth work families. And so they grow up, they become adults. And they’re like, so good. Because it was normalized in those spaces.
Maggie, RNC-OB 40:11
Yeah, absolutely. We have little like picture, we had photography at the birth with my kids. And so we have little like picture, one of like board books that show like pictures of that. And my kids love just like looking through them and seeing like, oh, and that’s when we first met you. And like, that’s what was happening. So I hope at least that they’ll feel like it’s more just a part of life. Obviously, I talked about birth and babies all the time. So hopefully, that’s trailing through, but Well, thank you so much. And is there anything else you would like to like, share with us before we wrap up?
Cheyenne, Birthworker 40:39
Yeah, you know, I think, you know, when I talk about why representation and reproductive health education matters. I talk a lot now about Jenny Joseph’s easy access clinic model and the JJ way, where, you know, the cornerstones of the care that they provide, there are access, connection, knowledge and empowerment. And, you know, evidence is showing studies and research of, you know, the work in her clinics has shown that there are better outcomes, they’re less preterm birth, less low infant birth weight, and, you know, whether they’re birthing in the clinic or in the hospitals, but they’ve, like, gotten care at the clinic. Yeah. So I think that, you know, the work that we’re doing it the educated birth, I would say, connects largely with the knowledge and empowerment aspects of, you know, journey, Joseph’s model. And so the more the quality of our care matters, and the experience that people have, when they walk in the doors, or they first engage with people, you know, are they feeling like they’re welcome? Did they feel invisible to they feel like a burden, or misunderstood, or an afterthought, you know, like, these things really make a visceral difference, especially, you know, things compound, right. So if someone is having a really stressful time or experiences medically, then I think it matters even more the quality of the care that they feel like they’re getting, or if they’re just having really hard time at home, or at work, or wherever, again, it’s like, if the quality of the care they’re getting for their reproductive health is not good, then all of that stuff is confounding and making the issue more difficult. You know, our hope is really that people use this, you know, people integrate it into their, their teachings, and that it does spread and it is it becomes the norm, it becomes the standard. And, you know, wherever people go, they feel like, they’re welcome to learn, they’re, and they’re taken care of. So I think when it comes right down to it, you know, humans want to feel loved and cared for, and they thrive in that, and they do not thrive, with the lack of that with the denial of that we need to work on making that fully integrated into every working person’s experience.
Maggie, RNC-OB 43:14
Yes, I, there’s so much so much there that we can that we can do to increase that. And helping everyone to find their, their place within it. And then so for listeners who would like to like support your work more who want to be more involved in the educated birth? What’s like the best way for them to do that?
Cheyenne, Birthworker 43:31
Yeah, no, visit us on Instagram at be educated birth. Our website is the educated birth calm. We’re also on Patreon. So we definitely invite folks to come out and support us on Patreon, there are lots of different perks and different things that you can get as a patron. So that’s patreon.com/theeducatedbirth
Maggie, RNC-OB 43:52
That’s awesome. I am really looking forward to hearing all the feedback from this and hearing how how everyone is kind of taking education around birth really to the next level so that we can include everyone in this process and see better outcomes because of it. Thank you so much for joining us. And I really appreciate it.
Cheyenne, Birthworker 44:11
Thank you for having me.
Maggie, RNC-OB 44:13
Thanks for tuning in. Well, I hope you love this conversation with Cheyenne, as we dissected more about what the future and the possibilities of childbirth education are, as we all move forward. And if you want to experience this for yourself, you’re definitely want to head over to our Facebook group, Your BIRTH Partners community, where we are going to be sharing a giveaway for some materials from the educated birth. So join us there to enter into that. And otherwise, we’d love for you to follow us across social media, where were Your BIRTH Partners. We want to learn and grow alongside of you. So please head on there and let us know what you’re thinking. And tell us a little bit more about what really struck you from this episode. You can also check out our show notes where we’ll share a little bit more about Cheyenne and The Educated Birth and everyday birth magazine and will also share some other resources as you go to expand the information that you are sharing with clients through their pregnancy birth and postpartum. Till next time
035: Chiropractic Care for Pregnancy & Birth
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth gear communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
So welcome back to the show. This week, we are exploring chiropractic care. And so you know, putting into context in terms of all the ways that we can support ideal health during pregnancy, birth and postpartum. And chiropractic is a tool, an option for a lot of people. During this time, however, there continues to be a lot of stigma around it. And so to dig into all of this and understand a little bit more about what chiropractic is, what it isn’t, the role it can have, what pregnancy birth postpartum conditions it can help us to care for, help us to address. We are having two special guests on this week, we have Dr. Sharon Dongarra, who is a chiropractor, and Pansay Tayo, who you all know from previous podcasts, who will be sharing more about her personal journey with Chiropractic and the work that she did with a chiropractor for over a decade. So we are thrilled to have them on to share a little bit more about their practice share with you all. On to the show!
So welcome. I am so excited to have you both here to just really dig into all of the benefits of chiropractic care, especially in the pregnancy, birth postpartum continuum. So if you want to just start by just sharing with our audience, a little bit about yourself and your work.
Dr. Sharon Dongarra, DC 1:55
My name is Sharon Dongarra I’m a chiropractor. I have a practice in Baltimore, Maryland, with a focus on women and children. But I see everyone, I’ve been a chiropractor since I graduated in 2010. But I’m pretty sure I’ve been a chiropractor since the moment I was born, it feels like it’s something that’s just a part of me. So I feel really gifted to have such a wonderful work to be able to come to each day and lift people up. So I’m not sure what else you would love to know about me, but I’m pretty much an open book. So if you have any questions you let me know.
Maggie, RNC-OB 2:31
Absolutely. Well, we will be throwing the questions at you as we go here. Perfect.
Pansay, Doula 2:35
Good afternoon. Thanks for having me back again, Maggie. I am Pansay Tayo located and I service Baltimore in the surrounding areas. I am a doula, a placenta encapsulator childbirth educator. I am the grateful owner of the Sacred Pause Red Room in Reistertown Maryland provides serene and sacred space to nourish this to calm the spirit, mind and body of our beautiful pregnant mothers, postpartum mothers and also the women and children in the community. I also have a doula mentorship program that I run and happily, you know, help the new doulas in Baltimore to you know, get a good start and they have careers in addition to that. Yes, mom, and grandma. And this topic here is very special and dear to my heart. Chiropractic care is where I first you know, seeing, you know, natural healing take place. That was my introduction into the world of seeing the body heal itself. So thank you for allowing me to be a part of this conversation.
Maggie, RNC-OB 3:37
Yes I am so grateful to have you here. And yeah, I actually I first met Pansay many, many years ago now because you were involved in chiropractic care and sharing it with so many pregnant and birthing folks and so grateful for that connection we have. Yeah, so yeah, so we want to just kind of just start to break down a little bit more about chiropractic care in this you know, series, we’ve been talking a lot about, what are kind of some of the some of the things that we have either like we hold kind of some biases around it. And maybe that stops us from really understanding fully the benefits of it, particularly when we’re operating kind of in our in our hospital based medicine. And so I was wondering if you know, if either of you want to kind of speak to just kind of basics of like do’s and don’ts, what is what is chiropractic care, kind of what does it, what does it encompass? What does it not encompass, just to kind of like lay some groundwork for us
Pansay, Doula 4:29
The doctor can take that first.
Dr. Sharon Dongarra, DC 4:32
I’m happy to um, my goal is to not to be too chatty during this chat. And so when you start talking about chiropractic, I can ramble on so I’m happy to be a good listener as well! I think you know, chiropractics interesting, because it’s very much like lots of things. For example, a midwife… tell me about what can emcompass midwifery. Well, it depends on what type of midwife you are. You are home birth midwife, or you are hospital based midwife. And so even within chiropractic, there’s different types of chiropractors. So I practice as what we call in the profession as subluxation based chiropractor. Sub-lux-what?! Subluxation based chiropractor. And I guess if I can just break that word down sub means less than lux means light and ation is state of being. So it’s a state of having less light. And it sounds a little esoteric, but I guess what it’s really referring to is kind of, as Pansay said, natural healing, it’s that spark that innate intelligence within our body that seeks to heal itself. So as a subluxation-based chiropractor, that’s kind of what chiropractic encompasses, for me, that is what I do, I look for the presence of subluxations in someone’s body, which is essentially the malposition, of spinal vertebra. But more importantly, the fixation of those vertebra, and the resultant nerve irritation, that results as the fact that it’s occurring in that area. So it’s my job to look for those to find those, and then remove those for a person in a way that is safe as a practitioner. And then very immediately following as a priority feels safe for the person that’s on my table. chiropractic is, I guess, different things for different people, I have lots of people who come see me when they’re not feeling very well. And they know that chiropractic will give them a little relief within their system, and give it a chance to heal from whatever it’s stuck in, whether that’s neck pain, or back pain, or headaches. Lots of people use it to prepare for birth and delivery because they want to ensure that their pelvis is balanced. And structurally, everything moves. Well, we certainly want good movement there when we’re thinking about delivering a baby. And then also, of course, as a subluxation based chiropractor recognizing that there’s, you know, your nervous system is participating in that environment, we want that to be as clear as possible. throughout that process. I guess what chiropractic isn’t is regular medical care. I think it functions very differently, we operate under a very different philosophy. chiropractors are really looking for the mechanisms that are right in the human body and just kind of restoring those normal mechanisms versus trying to be alter, alter them or change them. And in a way that is unnatural. So there’s that could be a very, very long conversation. I think that what I would also say is it’s not the type of thing that treats any particular conditions, right. So people most commonly consider a chiropractor or chiropractic for pain, but I don’t treat any conditions in my office, whether it’s neck pain, or back pain, or anxiety, or ADHD or any of those things. Again, my job is just to look for areas in the body where we’re having trouble perceiving what’s happening there, and therefore trouble managing that within our own innate intelligence. So it’s just sort of a little bit of a taste, I guess, to answer that question.
Pansay, Doula 8:30
Yes, exactly. That’s, that’s what I learned. And that’s what I know, chiropractic to be the natural healing modality, that modality to allow the body to heal itself and removing those subluxations of blockages, that’s preventing and causing, you know, challenges, you know, in the body? And again, yes, what it’s not, it’s not medicine. It is it is very, you know, hands on, and just freeing the body of those challenges to to allow the body to do what it naturally supposed to do to work towards healing.
Maggie, RNC-OB 9:08
Yes, yeah, I really like that. Just that thinking of kind of the difference in terms of how it’s aligning, aligning the body kind of within itself, and not necessarily like usually you’re not as a treat anything. Do you think? Some of that? Do we think it’s because of that, that there’s kind of this rub between like chiropractic medicine and like allopathic medicine system, like is it that, you know, hospital, but we tend to be very kind of focused on like fixing an issue. And that, is that why there’s not a connection with it? Or where do you think some of that kind of like bias or misunderstanding is coming from?
Pansay, Doula 9:44
I feel that, you know, with with Western medicine, you know, the focus a lot of times is not believing that the body is capable of healing itself, and that we need to intervene. We need these interventions in order for healing to happen, like the body is not capable of healing, you know, healing itself, talking to tons of professionals, you know, over the 12 years without I was, you know, working for a chiropractor. You know, it’s true that they you know, they believe the chiropractors are “quacks” that is the exact terms that I heard over and over again, if they’re quacks that they are, you know, that they’re fake, and that they, you know, believe, you know, try to trick people into, you know, believing that they can do this type of healing, and that it’s that it’s not real, and that it’s so far, you know, from the truth. So just like I see, with pregnancy, you know, in birth, with Western medicine, they don’t believe that the body is capable and was created to do this untouched, on its own. Right. So it’s the same thinking with chiropractic like, No, I have to put my hands in it, you need my machines, you need my medicine, you know, you need my test in order for your healing to take place.
Dr. Sharon Dongarra, DC 11:06
It’s the philosophy that so different, and so sometimes it just causes this friction, you know, and both chiropractors and medical doctors are both guilty on our parts for perpetuating that. I think, in a lot of ways. You know, you mentioned interventions, and we know that some interventions lead to more interventions lead to more interventions. And so, you know, that’s frustrating as a chiropractor, when you hear about, you know, for example, inducements that may not necessarily You know, I’m not an OB GYN, I have to be careful to stay in my lane. But if you have a first time mom, and she’s 40 weeks, and she’s you know, now she’s 41 weeks, do we need to intervene? Is it, isn’t it normal for a first time mom to kind of go over? And do we do we rush the situation, and then now we have to do something else. And so I think that I think you just really hit the nail on the head that that just the philosophical fundamental difference is, it’s hard for us to reconcile with each other. I’ll also say, I think there’s just a little bit, you know, I don’t know if you’re, you know, but in the in the early 80s, like the 1980s, not the 1880s. But in the early 80s, there were a group of chiropractors who actually filed an antitrust lawsuit against the American Medical Association for trying to discredit the chiropractic profession for telling their patients that if they saw a chiropractor, they would not care for them, telling telling, you know, doctors not to associate with chiropractors really literally trying to ruin the profession and get rid of that level of competition. And so I also think there’s just some residual sour grapes there that people don’t even know that where they’re necessarily getting their biases from. And, boy, isn’t that true in all kinds of ways, and human nature’s given these biases, and we accept them on, you know, without further investigation. And I think also, you know, we talk a lot about science, and I think there’s in the medical field, I think that they feel that chiropractic is very sorely lacking in science, which if you ask a chiropractor, we would disagree. But you know, the gold standard and science and research is like this randomized controlled study, and how do you do that with a chiropractor? How many are a chiropractic adjustment? How do you say, you’re going to line up, you know, 100, people who all have neck pain, just as an example, and give them an adjustment, but it’s going to be at a different level, it’s going to have been there for a different amount of time. And it’s, you know, who is at the same chiropractor giving the same adjustment at that, you know, so it’s very difficult to to research chiropractic in that way. It’s not funded by major drug companies. It’s not funded by major medical schools, right. It’s, it’s funded by people like me, who say, you know, I’m going to give several $100 a year to, you know, researchers who look at Chiropractic and I mean, there’s tons of case studies and anecdotal evidence. And if you’ve ever been adjusted, and you get up off the table, there’s a feeling that you have, and to a certain extent, the proof is in the pudding. You know, it’s hard to give words to that feeling. So I can understand the confusion, I can understand kind of the backbiting that happens, but the people who suffer are the people in the middle and so it’s, it’s my job as a chiropractor, and as a human actually, to kind of, you know, sometimes set my ego aside and seek to understand first and then share where I’m coming from as it relates to that. And I think that that if we all did that if we all held space for each other where we’re coming from and and Educated the consumer, which is what we are, you know, we’re not patients. And we don’t call people patients here we call them practice members because you’re you are a healthcare consumer. So it’s my job to teach you what chiropractic does. And then it’s your job to, to figure out how to best use that in your life in a way that you feel gives you an optimal amount of health. And you know, some people get on that train like Pansay and never get off. Like me, you know, it certainly saved my life when I was in the pits of despair. And some people they get on, and then they get off, and then they get on again, and then they get off again. And really, it’s not my job or anyone else’s job to force that value. It’s my job to tell the chiropractic story and be here for people and care for them in a compassionate way.
Maggie, RNC-OB 15:51
Uggh that’s so good, like I’m just processing everything. I think there were so many like deep truths in that that just like you said, they extend beyond the chiropractic relation, I think that is our That should be our relation, like you said, as, as human beings, who are attempting to understand and support each other. And, you know, obviously, all of us a huge tenant of, you know, everything that we talked about here with Your BIRTH Partners is that idea that right? You know, we all have these different skills, talents, educational backgrounds, things we are able to bring to the world, you know, and in my humble opinion, if we were to actually just each be able to offer those up to people, and support them with what they actually need, at that moment, we would be in such a different place, instead of so many of us feel this, like push and pull to try to be something that we’re not or, like, you know, cover too many bases, because we’re trying to, we think we’re helping someone. And we step way outside of that, or we start putting our own like you said, all those unexamined biases they stop us from seeing the person is like an individual has their own needs have been said, Every person, like you said, Every health care consumer, especially during such a time as pregnancy, and birth and postpartum if they were able to see like, here are all of the options here. Here are the million things that have helped people through having their babies for millennia. What of these do you think might be helpful for you? And certainly for some people, that’s going to look like really very minimal, you know, interventions, or using chiropractic or massage. And for some people absolutely, like, they desire medication, to help them through it, they want to take herbs, some people, you know, like, I think if we were just able to just present all those options as a buffet style, instead of making it seem as if like, you’re on this super strict menu over here. And I guess maybe that leads into my next question like, with this understanding of kind of these ways that we have maybe created kind of some walls up, and it can be hard for people to kind of like relate back and forth. How do you all think we can kind of move for as like moving forward? How could we all as birth professionals in our listeners or across, you know, all sorts of different professions within that? How can we help support clients to know more about chiropractic care and understanding that might be something that they want to have as part of their experience with whatever else might be in or not in that?
Dr. Sharon Dongarra, DC 18:29
Pansay, I think you’re probably best to answer that one. That’s right. That’s your wheelhouse, lady!
Pansay, Doula 18:35
yes. There, you know, throughout my 12 years, you know, working in chiropractic, yes, that was my, that was my job, how do I go into these communities, you know, with people who knew nothing of chiropractic, and I made it to a point to go into my own personal that was one of my request for the doctor that I worked for, Can Can I go with the people who look like me, because we never wait, like, like, really knew anything of this, they never heard it when I was coming up. And I can recall being in the office and seeing elderly people, you know, come in the office and come in one way, but you know, walk out without their cane, and feel better. So I wanted to take it to my grandmother’s, and my, you know, my Auntie’s and my father, you know, and tell them about it, but yes, and the education is they are me, my sister, all these years now. I mean, that’s a part of her normal, you know, health regime is chiropractic. So education is is key, we, I think it should be presented in a way that you’re meeting the person where they are, right. So you know, as the as the marketing, you know, manager, sometimes I will go out with the doctor. Sometimes the doctor will just send me out. So, you know, of course, if it was just me, the community was able to be more comfortable with giving me the truth. of how it was presented. So I know I did very well at meeting them where they are. So they were just able to drop the barriers and just listen, like I’m not trying to force you, I’m just giving you a, you know, what is another option for you to include not, you know, not to stop going to your doctor, but that’s your choice. But another option to include in your healthcare and they were very receptive, you know, to that my family was very receptive to that. So we have to be very mindful of how it’s presented. Because if you come pushy, delivery, delivery is very important, you know, so, um, even with, you know, my clients, majority of my clients, you know, have chiropractic treatment throughout. And, you know, I share my own personal experiences, you know, in there with, you know, being pregnant with my daughter, even, you know, to take it back a little further conception, you know, how, you know, I was helped with, you know, breaking up scar tissue chiropractic help break up the scar tissue for me, even to, you know, conceive if I had several miscarriages and ectopic pregnancies, and, you know, Western medicine told me, no, it’s over for you, you can’t have any more children, you know, but then I was introduced into chiropractic, you know, care, and it’s like, Ah, no, here’s another option for you. Right? And it works. She’s, she’s 12 years old, and she’s here. So I share my story of, you know, pregnancy and postpartum with chiropractic care, and it’s still working wonders with all of my clients, they absolutely love it, it helps us, you know, to have easier, you know, birds, more comfortable pregnancies, you know, to prevent that pregnancy. sciatica, you know, just because we’re pregnant, we don’t have to suffer with these things that we, you know, we think they’re just supposed to come with pregnancy. No, there are natural things and healthy things that we can do. So, you know, meeting them, where they are not being overbearing, you know, not saying to stop doing XYZ, but here’s another option for you research it, and I do provide them all with, you know, research, research it, and I am, yes, a case study, you know, that I’ve experienced it. So, yeah, that’s that’s how I approached approach it. It worked, then, and it still works, you know, and it still works now.
Dr. Sharon Dongarra, DC 22:17
Hmm. I agree. I think I think one of the beautiful things about chiropractic is it just makes sense. You know, I feel I feel as though we’re more empowered to understand about how our car works than we are about our own body. And I think that’s one place where chiropractors shine is that, you know, there’s no choice but to explain things. Because if you think you’re just going to go in and get an oil change, and then you’re good for the next, you know, 3000 miles, is that what it is? You guys have just told on myself? I’m not very good with my car.
Maggie, RNC-OB 22:48
Haha! so many depends on what kind of oil you’re using, you know, it’s different.
Dr. Sharon Dongarra, DC 22:55
Yes, we don’t really have much of a choice, but to tell the story of how it works. And, and it does, it just makes sense. And I think it paints a saying, if you if you share the story, and you share what it does, and we share our own experiences with Chiropractic and how it’s changed our lives. I think that helps normalize it. And then I think as a practitioner, it’s important not to alienate other practitioners. Yes, we have a way of just being so excited and so passionate about chiropractic that we want it to outshine all the things, you know, and and the truth is that while I love chiropractic, and I think most people could benefit from it. There’s not one thing that’s gonna fix everything for everyone. It’s just not gonna, that’s just not gonna happen. Right? Right. So I think we just have to have, again, just respect for each other and where we’re at. And that that delivery is so important, no matter who you’re talking to about.
Maggie, RNC-OB 24:00
Yeah. Can you speak a little bit I know, Pansay has started to touch on some of them. Kind of those, quote unquote, like common discomforts of pregnancy, that, like you said, you know, we tend to see kind of in the in the industry, like, Oh, sure, yeah, it’s a lot of people have this feeling a lot of people have that feeling. Can you speak to which ones of those like, Are there again, each with recognition that each person who comes into it is going to have their own, you know, health history and myriad of things you’re looking at? Are there like just a number of kind of like, common things that you typically see during pregnancy that you’re able to assist people with?
Dr. Sharon Dongarra, DC 24:31
Of course, so, you know, one of the things with pregnancy is, you know, it’s sort of the trifecta of life stress. You know, in chiropractic, we talk about different type of stressors that affect the function of your body and there’s, you know, obviously physical stressors if you’re in a car accident or chemical stressors, you know, if you’re exposed to too many toxins and it’s causing inflammation in your body, it’s making things sticky or, or emotional stressors, you know, so angry or sad, you know, These different types of stress and pregnancy is all three of them, right? Like, it’s this beautiful, wonderful, exciting thing, but it’s also like, oh my god who issued me a baby, you know, it’s it’s your posture changes your your hormones change so that you’re more loosey goosey, right, so, so just, you know, just physically speaking, when we look at how the body has to change to adapt to being upright against gravity, you know, there’s, there’s, we often say, you know, kind of that belly kind of sway forward in the back kind of lean back and the head kind of come forward. And so as a result is gravity’s pulling down on our body, the mass of our body is pushing on our curves that normally support us in different ways. So, of course, low back pain is a really common thing that people have round ligament pain is a really common thing that people have, you know, so just different types of things like that different areas, you know, radiating pain down the leg, often are really only highlighting, dysfunction that’s been there all along, it’s not like it came up all of a sudden, when you’re pregnant, it’s just that pregnancy added so much for your body to accommodate to that now it can’t keep all the balls in the air, you know. So now we begin to kind of feel the effects of imbalances in the way that our pelvic joints are working, if one is stuck, what’s going to happen is that’s going to create a lot of wear and tear on the other one that’s making up all of the movement. So if I get it stuck joint in my pelvis, like my sacral, iliac joint, I’m not going to stop walking, or sitting or bending down to pick things up. It’s just that now that motion has to be made up in the side that is working. And then unfortunately, what we do is because that the sign that is working is hurting, it’s barking, it’s telling us, hey, this isn’t working in this partnership, you know, then we try to stretch it and poke at it and prod it and ice and heat it. And it’s not even the problem, right? So I find oftentimes, sometimes just educating people so that they have an understanding of what’s happening in our body, a lot of times muscles will feel very tight. And so people will want to be stretching them. And they like to use the example of a rubber band, you know, if you have one really quickly here. Yeah, if you if you take a rubber band, rubber bands, not the best analogy with a muscle crank, because because it doesn’t squeeze back. But you know, this is this is muscle tension. Okay, and that’s a good healthy tension. This is a muscle that’s really being stretched to the max. And does it feel tight? Of course, yes, it You better believe it feels tight. So the sensation is accurate. But how you would necessarily treat that one to be accurate. So, you know, you communicating with someone and saying, you know, it feels tight because of this? And then they say, oh, okay, and then they’re just empowered to stop stretching it right. So that maybe I went off track a little bit, but I think that’s what you were going for in terms of the types of things specifically as relating to pregnancy.
Maggie, RNC-OB 28:07
Yeah, yeah, absolutely. I think there are pieces that you start to touch on, too, is that idea of like, just speaking to that client comfort piece of it, because I think because of, you know, misinformation, and you know, things we’ve heard, I think the idea of like, chiropractic, spinal manipulation, messing, like, that sounds very, like, buzzword scary, right? It sounds a little bit scary, my spine like that, like, I need that for a bunch of stuff. So I’m just gonna have to kind of keep things you know, like, there’s just that kind of like knee jerk, like, Oh, I don’t know about that. So can you speak a little bit about like, how you kind of protect both like, physical and mental, more mental, I guess maybe like the mental safety around that piece of it and how you bring like comfort to your clients during an interaction? Absolutely.
Dr. Sharon Dongarra, DC 28:50
Well, first of all, Isn’t it fun, how we just know how important it is? Right? Like, we don’t really need anybody to tell us how important our spine is. Or like, Oh, my gosh, my neck. Nope. Be careful with my neck bone, careful. My spine like, inherently, we know this is the core of our being, you know? And how do I, you know, I asked every person when they come in, I say, you know, have you ever been to a chiropractor before? Yes or no. You know, obviously, you know, I want to “pop your back.” Right. And this is some chiropractors get testy. When we say things like pop your back. No, it’s an adjustment, but I don’t get testy about that. It’s, it’s a layman’s term, I’m going to choose my battles. You know, does that bring you stress at all? You know, and I opened it up because let’s face it, chiropractors are confronted with a negative brand equity from the get go. So I think just kind of grabbing the bull by the horns and just asking the person and, you know, nine times out of 10 people will say no, not at all. I’m so excited because they’re here, right? It takes a really brave person who’s really afraid to actually show up. You know, and, and still be afraid, but I say I let them know Well, you know, the if that feels right after the end of our meeting. And we try that just so you know, there’s many ways to adjust someone, if you don’t like it, you never have to do that. Again, there’s other ways that we can get that done. Okay? So the first thing is just ask people, where are you at with that? Like, what does that feel like the idea of that, you know, for some people, it’s, it’s scary, because they don’t want to get hurt. For some people, they’re not afraid, they want to trust me right at the onset. But the noise is scary. You know, for some people, they’ve heard a scary story from their great Aunt Sally’s closest friend’s college roommate, you know, and so it’s just, I feel like giving people the opportunity to express their concern is an important step. And then also just letting them know, we don’t have to actually pop or crack, you know, to make an adjustment, you know, an adjustment can be super subtle, really subtle, in fact, subtle enough to do an adjustment on infants, right. So I think the first thing is just to kind of confront the issue that you can bet that it’s almost everyone’s mind, and give them the control over what’s going to be happening. And I think that’s unique at a at a doctor’s appointment, right, is that you’re going to have any kind of control over what the next steps are and how you’re treated. And that’s not a criticism. That’s just because when you go to the medical doctor, and you have an emergency, they say, these are the tools that I have, and this is what’s available, you know, for you to use, this is what we’re going to do, it just kind of is the nature of how things go. But in chiropractic, we’re able to have a little bit more flexibility of, of comfort, I think, yeah,
Maggie, RNC-OB 29:16
I think that piece of it is like it’s crucial. And we’ve talked so many times on, you know, various episodes or podcasts about like, what a world it would be, if that was the standard for everything was just a complete change in the way that we have kind of consent discussions about each thing like, hey, the, again, these are the options, we could do this or that, Oh, you don’t feel comfortable, this, I have a different thing we could try. Let’s do that, instead of feeling like there’s a time constraint, the, we’ve got to get this fixed right now. And everything has to move so quickly like that, that piece obviously just helps that being able to slow down and have the conversation is so crucial.
Dr. Sharon Dongarra, DC 32:06
That’s more of a reflection of the medical system, and the people in it. You know, I think the doctors and, you know, they, I think that they really want their patients to feel comfortable, and they really want to serve them in the best way possible. But the system is set up such that they have to see more people and less time, you know, just just to be able to pay their bills and make a decent amount of money. Right. So and part of that is the structure of the system. Not not the people involved in their their intentions towards their patients, right? Oh,
Maggie, RNC-OB 32:37
yeah, absolutely. I think I mean, huge, huge system failure. And that I think most people who go into I certainly didn’t know, as a nurse, obviously, until you’re in it and doing it you realize like, Oh, wait, is this? Is this how we do this? Oh, that’s not really what I thought we would be. Mm hmm. And then you’re you try your best to navigate, you know, the system with the tools you have in the way that, you know, you can change something once you’re in it. But yeah, I think that is, that is a huge piece of I know, we had talked previously, too. And I think maybe it’s worth just sharing on this that like there is the that piece of chiropractic care in terms of like accessibility, because it is outside of the kind of hospital based systems and in terms of insurance and the financial component of like, paying for a, you know, a health service. I didn’t know, either you want to kind of touch on on that piece of it either.
Pansay, Doula 33:25
Yes, this this is an area that set me so much when I was you know, directly in the field, you know, I mentioned that I would, you know, intentionally going to the communities where I was from, to, you know, health fairs that was at school, and the people were excited, you know, they were excited, you know, to get their myovision scan, and for me to show them the areas that it showed that you know, needed help and subluxations and the information that I shared, they wanted to come and least try and they will come and then what happens, insurance wouldn’t pay for it. Right? So it’s kind of like your force, you know, without the finances being there to be able to pay cash money for every you know, visit, you know, you’re catching the bus from an inner city coming out to you know, the chiropractor. They could, you know, couldn’t afford it. And it’s like, you’re forced to go back to your medication. You know, gratefully over the years, though, I started to see more and more insurances open up not so much of the, you know, state insurance, you know, insurance through social services. But Blue Cross and Blue Shield America, remember when I first started, it was just like a no, right? No, you know, then they will open up and say, you know, well, okay, you know, we’ll give you this amount of visits, you know, with authorization. So we just had to start spending a lot of time on the phone with insurance companies and paperwork and tons of paperwork. You know, to get these visits covered to get the chiropractor paid. So more work, a lot of work if they would, you know, force us to do to get payment for these things, thinking about my clients right now, for the most part, I would say that I see that it’s still improving, you know, insurance wise and how they are covering, you know, more, but there still is a cut off, because majority of my clients at some point have to stop, you know, I just had a client the other day, she was like, I just can’t afford it anymore. You know, so, so yes, it’s it’s not an easy, you know, task. Yeah.
Dr. Sharon Dongarra, DC 35:36
Yeah. I feel like that’s something where we’re just still for kind of failing miserably. You know, as a as a, as a business owner, I decided not to take insurance for just that reason, like people would have different levels of coverage, their co pays would vary, it would be an exorbitant amount of work. And so you know, for me, I can just set a low cash fee and I can say, this is my fee. But it’s the same with you know, home birth midwifery, doulas, birth education, chiropractic care, massage, acupuncture, it becomes this very privileged thing, that people who do not have the resources are not able to avail themselves to. And so it’s disturbing and unfair. And I’m not really sure how to solve that problem, I’m certainly open to suggestions, and I’d love to hear them because it weighs on my heart to pants I because it’s like, the people who need it the most are the people who are, you know, restricted from all of those other goods services, you know, this is definitely a tragic problem as it relates to delivering the care, you know, and we can’t do it for free, because, man, we have to run a business, you know, we have, but it’s, it’s a problem that needs to be answered in some way.
Pansay, Doula 36:58
I think as business owners, you know, back back, then we would try to have at least a monthly promotion, that would help, you know, help some people, you know, giving back to the community in some type of way. And we made sure that was consistent, you know, every month, okay, we have, you know, this amount and to give away or to discount, you know, and I’m grateful to have worked with a doctor that was open, you know, to that, and just as, you know, in my business, I can’t do it for free by any opportunity that I can, you know, discount or have scholarships, or, you know, so grateful to be receiving scholarship money, you know, to be able to offer, it’s a it’s a beautiful thing. So I think if we stay consistent with that, at least try to help as many people, you know, as we can. Until things change.
Dr. Sharon Dongarra, DC 37:49
Yeah, I agree. It’s important.
Maggie, RNC-OB 37:54
It’s so; I mean, it’s so important, it’s so frustrating that, you know, we just continue to have such a uneven distribution of resources as of dance to, like you said, all of these pieces of health in general, and then you know, especially in this time that we lift up pregnancy, birth and postpartum as this like, you know, like we hold up on this pedestal like social media wise, it’s you know, like of course, everyone is honoring birth and pregnancy and then the way that it plays out in like society policies that we have in terms of access to like you said, all of these various health resources in terms of time off once you actually have your baby You know, all of these things that we then don’t actually provide on the like the other side of it it’s just kind of this like theoretical concept people are happy to put into but then we don’t have like the actual steps in place to let everyone get there.
Dr. Sharon Dongarra, DC 38:49
It’s important unless you’re poor Yeah.
Maggie, RNC-OB 38:54
Well, I absolutely really value the ways that like you do this work though, Sharon and Pansay as well that like that, there are all these ways that we can still like not to be like a downer like there are ways we can do this. There are all of those things they do add up you know, like making offering sliding scales, offering options offering discounts offering for you know, certain different you know, different rates of compensation, accepting bartering for like there are so many ways that we can still create a more even exchange energy exchange around what we’re, you know, what we’re doing, you know, as we go to kind of wrap this up, I think one of questions I’ve heard from people sometimes like I’ve certainly I know, friends and loved ones who’ve gotten like carpet adjustments, like during labor at birth, postpartum is there are there times like that it’s like, you know, ideal, too early, too late to kind of access chiropractic care within the pregnancy, birth postpartum, kind of like continuum?
Dr. Sharon Dongarra, DC 39:50
For me as a practitioner, if we don’t have a relationship before you’re in labor, that’s really hard, because I can’t really give you a you know…part of what Makes chiropractic so safe is just a very thorough and health history that we do. So you can’t necessarily approach a pregnant woman who’s in the midst of delivery and perhaps stalled, and, you know, really enquire about the safety of that. So, you know, so for me, that’s, that’s a little bit too late if I don’t have a relationship, otherwise, my goodness, it’s never really too late, you know, just you just, we can’t go back. You know, if I can you look at anything in your life, if you can have regrets, you can never go back and start something, you know, way earlier, you know, golly, I wish in my 20s, I ate a lot healthier than I did at that time, you know, but I can’t go back to that. So you can only really move forward with with where you are today. You know, as it relates to too early, I know, there’s no time that’s too early, you just…another great thing about chiropractic is, if you don’t have any subluxations, you don’t get adjusted that day, right. So there’s, if the need is present in the body, it’s not too early, it’s right on time.
Pansay, Doula 41:01
And thinking about timeframe, you know, even some of my fertility clients, you know, I feel like, you know, let’s not wait until you’re pregnant, you know, by the wind, you know, that they want to one of my recommendations to them is to Yes, go now we want the body to, you know, hopefully be functioning at its optimum level, you know, for conception, so, no, I don’t feel like it’s ever, you know, too late, you know, throughout pregnancy was beautiful and wonderful for me postpartum I was, you know, right, they are bringing the baby and, you know, baby girl adjusted, that helped with, you know, ear infections, and, you know, us that she had, you know, five days old, you know, and even my son with asthma, you know, chiropractic was so helpful, you know, where he was, wants to consider severe asthmatic, you know, definitely seen that decrease over the years with, with, you know, consistent adjustments. And, and, you know, to be transparent. chiropractic also educates you on healthier options overall. Right? So, right, this isn’t a fix all. You know, the adjustment? How are you eating? What are you eating? What is your lifestyle, you know, your exercise lifestyle, like, and that’s what I loved about, you know, where I worked, it was overall. So with myself, it was like, Yes, you have your chiropractic adjustment, but let’s look at nutrition. Let’s look at, you know, what you’re eating. And I think it’s helpful for, you know, all of us to make life changes. Right. You know, definitely helpful that, you know, these are also other things that could help with your overall, you know, health.
Dr. Sharon Dongarra, DC 42:43
You know, you’re you’re saying that, and I’m thinking it brings me back to those stressors that we were talking about initially, but it’s also having me think about, you know, there’s, there’s more gifts than we have to give than just the adjustment, right? So that like, information is free. Yes, you really touched me there, Pansay.
Pansay, Doula 43:02
Yeah. Thank you, I thank you for you know, I’d say it’s been many days in a chiropractic office that that I shed tears, just looking at the beauty of the work, really, you know, again, it’s nice to see of, you know, of a woman to come in and running from and, you know, an induction, a planned induction, like, this is not what I wanted, and to spend the day at the chiropractic office with us, you know, getting manipulations and one of the ball trying to get labor started because she didn’t want the medication and possible cesarean and so you know, send her on her way and get the phone call that the baby is here, you know, and they both are safe. You know, many, many, many, I can go one on experiences like that, where it just warms my heart and confirmed for me that yes, the body is truly capable of healing itself. And I feel that the doctors that are in this place, providing the services, you know, for our women, for our children, for the community, you have blessed hands, you know, I will tell the doctor all the time, like this is this truly, you know, a blessing to the community, that we do have the option even with the challenges that we can go somewhere that’s not putting medication in our bodies, and we’re leaving out feeling better, how situation, you know, medical situation, you know, is better. So I thank you, I thank you. I really do folk for for all that you do for the women, the children in our community.
Dr. Sharon Dongarra, DC 44:37
Thank you. And I can tell you, it’s a blessing for us to you know, my grandfather used to say if you do good, you get good and it’s certainly just, I’m lucky every day that I get to come to work and take care of people.
Maggie, RNC-OB 44:51
Thank you both so much for coming on here and sharing so much about your work and just your passion for giving people options and being able to really promote health and so many different levels as we’re looking to move through pregnancy and birth. And, you know, I appreciate it as like all of us professionals who are listening to this and trying to think about like, right, is this an option is is something I could be talking to my clients about? Is this something that you can find? Like, do you know chiropractors in your area? Are they someone you could network with, and get a relationship with so that you understand more about what, what their practice looks like, you know, like you spoke to earlier, Sharon, not every chiropractor, obviously, just like not every doctor and I remember, it’s good to practice the same way or have the same philosophies, you know, different ones are going to align best, you know, with different clients. But when we’re thinking about, you know, all these different, different chiropractor, different styles, different ways that people are working, are there certain qualifications or educational backgrounds that would be most helpful when we are approaching someone is in you know, is pregnant and looking for chiropractic care?
Pansay, Doula 45:56
Yes, yes, it’s very important that our birthing people know that the chiropractic that they seek should be Webster technique certified, so that, you know, these chiropractors should specialize in pregnancy and, you know, pediatric. And, you know, this safety is very important. You know, so that’s what we want to focus on the safety of the, you know, birthing person. So specifically looking for that specialization.
Maggie, RNC-OB 46:28
Yeah, that’s interesting. I think there’s always that idea like, you know, anything natural is safe. And you we know that obviously, there’s a whole, like, range of expertise, obviously, that you still need to have to protect, you know, facilitate health in the body, even if you’re not adding in, you know, additional medications, everything. So, I appreciate you clarifying. I’m always looking for more community, I’d love to see a more kind of incorporation of this into like, the overall options that people have and having it feel like it’s more of a standard instead of off the beaten around the sundae. Yeah. Well, thank you both, so much. Appreciate you.
Dr. Sharon Dongarra, DC 47:04
Thank you. Thank you both for being such great advocates for chiropractic care and birthing people.
Maggie, RNC-OB 47:09
Yeah. Love it.
Well, I hope you really enjoyed that conversation with Pansay and Sharon, digging into chiropractic care and how it can fit into pregnancy, birth and postpartum. We would love to hear from you any questions you have or things you’d like for us to explore more about chiropractic care and how it can be useful during this time. We’d love to invite you to join us in our Facebook group, your birth partners community, and that’s where we have a chance to really dig into some of these topics and questions and share a little bit more about our experiences with them. You can also follow us Your BIRTH Partners across social media. And we look forward to sharing more information about chiropractics in the show notes for this week’s episode. Thanks for being here. Till next time
036: The Rebozo & Beyond: Cultural Appropriation & Birth 1
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth gear communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation, as we step out of our silos, break down barriers and hierarchies, and step into the future of better birth care.
Welcome back. This week, we are diving into really deep conversation around cultural appropriation, and how that shows up in the birth community, and how we can recognize those pieces of it in ourselves as birth workers, how we can examine our own practices, and how we can learn a little bit more about the impact of our practices on those in our care. So, you know, as we’ve been walking through this whole series, and talking a lot about biases, I just want to make a point that, you know, we, we all have biases, we are all human. And that our hope with all of these conversations is that by engaging in this work, by listening in these conversations, and then taking them in continuing them with your loved ones, your friends, your colleagues, that we’re able to just examine and dig deeper and find some of our biases, and then grow and change because that’s all that any of us can want for each other from this life. And so, I have had the pleasure recently of learning with Montse Olmos and Mayte Acolt, as they have really drawn tremendous attention within the birth community to examine the use of the rebozo in particular, but also the greater story that that tells us about the role of cultural appropriation and white supremacy thinking within the birth worker community. And so I think that’s a really important conversation to reflect on. And I’m eager to share this episode with you and hear feedback. So on to the show.
Oh, welcome so much the podcast, I am so excited to have you both on here with us to really dig into what we are doing as birth workers to fight against cultural appropriation and to cultivate birthcare practices that are meaningful to us and to our clients. And also help to keep everyone safe and not further perpetuate harm. And so I am just thrilled to have you on here. If Montse & Mayte, if you want to just introduce yourselves to us and our audience and just explain kind of what brought you to birth work and we’ll go from there.
Montse Olmos 2:53
So my name is Montse Olmos, I was born and raised in Mexico, and migrated to the United States at the age of 15. While living in the United States as a migrant, I became pregnant with my first baby. And that’s what brought me to birth work. My own journey with pregnancy and birth and postpartum and I come from the Tutunaku people. It’s an indigenous group of Mexico, but I’m also mixed with white blood. And we have some black relatives in our family. Besides birth work, I am also an educator. I do online virtual classes, knowledge shares for birth workers around the history of that also, spirituality and birth, and even other topics like corn and just the ancestral story of of corn. I live in an indigenous community where my partner is from, and we are building our home and rolling our crops and just reconnecting to our lives and the heat from before we had to migrate. That’s who I am.
Maggie, RNC-OB 4:15
Thank you.
Mayte Alcot 4:16
Hi, everyone. My name is Mayte and I call myself The Womb Doula. I am a traditional sobadora since I was seven. I began learning self practice at age five and I migrated here when I was seven, but went back and forth between the States and Mexico for many years until my abuelita passed away. I am part of a wellness collective called our wellness community where we wanted to provide accessibility to services that are considered a luxury such as massage, acupuncture, counseling, yoga, chiropractic and what I do because if you look at what I do and you try to get the appropriated version of it, which is mayan abdominal massage, which is really problematic. It is around 200 to $600 for a session, and there are others who also do the work that I do, maybe not in the traditional matter, but charge up to 1000s of dollars to provide this care. So my mission and our mission really is to provide accessibility and accessibility looks different for everyone, which also includes having appointments available after work hours, it means coming in on the weekend, it means showing up in places in ways that other professionals do not…unfortunately, that doesn’t mean accessible. I am a mom of four, I’m married to my husband, we have been together for almost a decade, which is crazy. And I’ve been a birth doula since 2014. And 2015 is when I figured out how to be basically after the pregnancy of my first child, I figured out how to do what I love, which is above us and incorporated in a way that others could receive the care and begin to kind of get connected with it and learn about it, which was first doulaing. So I’ve been doing that for a while now, I don’t know how many years. And I’m also Tanaka, I was born there and raised in that way, for many until age seven, and then I came to the states. So I still hold many traditions such as our mourning, which I’m currently in until day 40, which will be next Monday. And there’s like a lot of complexities in that. And so that is one of the reasons why Montse and I are starting our podcast called Comadres_Indigenas. And you can ask that we would love for everyone who listened to, because we kind of talk about those complexities that we are often faced with. That’s it. That’s all I do.
Maggie, RNC-OB 6:48
[laughter] That is a lot that you do. Thank you so much for sharing all of that I love that y’all are starting a podcast. And I can’t wait to be able to tune in and appreciate that I think there is so much that I’ve already been able to learn from you from social media and your workshop. And I’m really grateful for how you’re sharing that with us. I wanted to maybe start by kind of diving into how I first get to know you through the wonder of social media is when you all started the petition around the rebozo use by, you know us birth workers and doula organizations a few months ago. And I would love for you to kind of explain a little bit about maybe that process and what what made it feel like, while, you all have been doing this work for, you know, many years. What made it feel like now was the time to really kind of step forth and start calling out some of those practices?
Montse Olmos 7:39
Well, I think definitely since I started offering this knowledge share along with my day, we have received a lot of like comments and testimonials stories from people basically sharing their experience with that, and also sharing how they learned about it in their doula training or sharing about how they’ve been hurt by it. That was I think that was definitely a big factor. But even as, as birth workers just in general, like, I’m sure Mayte that has had the same experience because we’ve talked about it like just being a doula and like talking to other doulas and going to births. We’ve seen how the rebozo is used. And we’ve seen how it’s applied on people’s bodies. And we’ve seen how it’s taught, right. And so, I mean, for me personally, since I became a doula, I became aware of what was happening like, when I became a doula, I had no idea that there also was this huge market, that there was a big industry around it. Specifically for birthing techniques like for midwives, and doulas. I knew the role as an everyday life, sacred textile garment that is used for so many other things. I didn’t know it as this “tool”, how it’s promoted now in the work world that specifically for me, wasn’t centered carrying your babies postpartum, like for postpartum care, but it wasn’t so much centered around birth. And then as a migrant in the states came aware of like how like big obsession around it around like it means to have one and at every training, and I saw that a lot of the times what people were calling out of also wasn’t actually one but it was, you know, whatever type of fabric they found, or something called a pashmina. I don’t know where that comes, I would have heard about that to being called a rebozo. Or just synthetic fabrics that are sold as rebozos that are like machine made or are from China. I know that you can find them online on Amazon and eBay on Etsy. And folks were using that as well. So that’s when my awareness began expanding. But I also want to say that one of the one of the things that really pushed us to release it is the experience that Mayte had with someone that was hurt by it. Someone that was hurt by her doula using on her. I don’t know if Mayte wants to share about that. That’s definitely one of the things that triggered the urgency to release it to do something to say something and to initiate a dialogue.
Mayte Alcot:
Yeah it’s crazy, because I think you and I wanted to talk about it. And like, even before we decided to write the petition, years before we both thought about addressing these organizations, but we were kind of like, Hey, you know, let’s wait on that. Like, we didn’t know each other then. But in our heads, we were like, “I don’t know if people ready for this conversation. Are they ready for what is about to happen?” And it wasn’t until I went to this birth, and this isn’t even the first experience. This is one of the most recent experiences where a I was called into a birth be due to something happening with decision a baby. And I was not the birth doula. I was only there to assist with that part. And upon arriving, I went to the restroom, I set my things down. And when I came out of the restroom, they were like an urgency and state of emergency. They were like, “okay, we have to go. We’re transferring right now.” And at that moment, I didn’t really know what was happening. Because it was, again, state of emergency. So what happened was that the mom had had a subchorionic bleed in early pregnancy. I had one of those with my firstborn. So I know a little more about it, then, you know, usually I already knew a little more about it than usual or than others. Basically what occurs is that the placenta, where the baby implants, it kind of detaches and comes back. So some blood is then released as its healing. With that later on in pregnancy come a few other dangerous such as placenta abruption. And it really shouldn’t be messed with like in anything that you read about it. It’s just says do not touch with the belly, do not mess with it. And that jiggle, wiggle, don’t do anything with it. So I think another problem with doula organizations training all these people is that they’re not really teaching them a lot about pregnancy. And about all these things, I can tell you, I never heard of it prior to having one in pregnancy, right? And many people haven’t. And so the doula thought it was a good idea as a last ditch effort to sift the belly of the mom as a way of relaxing or comforting or maybe moving baby’s position. I don’t really know what the doula was thinking. But as she began to sift the baby, the mom said that she had pain, and then bleeding, because her placenta had detached. She also had an anterior placenta so it made the placenta even more susceptible to any kind of movement in the belly. So after I went to that birth, I’m like, very next morning, I messaged Montse, I messaged our friend Emily, I was like, hey, like, what can we do to address these organizations right now. And so once they have been the awesome writer that she is, she’s like, “I’m gonna, we’re gonna do it. And we’re gonna write this petition.” And I was like, Great. Thank you.
Maggie, RNC-OB 13:38
Mmm. That’s so heavy. I mean, that I think there that just speaks that the bigger issue of us not having that, that awareness around what what we’re doing and how each of these things are, you know, are connected, like you said, Montse, I totally heard about the rebozo as a, like you said, a kind of a “tool,” you know, that it’s this, this thing that can be used during labor, pregnancy, you know, birth for increased comfort, in that, when we’re viewing it as this like, separate one little entity, and not having that framework for really how it is impacting the body and how all of these things are related, like we will actually cause harm, mental and emotional harm, for not getting things to work the way we want it, but like literal, physical harm. And I think there’s always just kind of that misconception that like outside of pharmacological medicine that like, oh, as long as we’re doing things that are “natural,” “holistic,” that they don’t have this power. And just as they have power to make things happen for good and health and improve situations, they also have power to then on the flip side, cause harm if we’re not actually experienced enough to do it. And I think that is such a major disservice that we did as a greater birth worker community that the rebozo has been introduced, like you said, it’s just this thing that can be used for for anything and you don’t even have to have a particularly good, like, reason or knowledge or rationale for using it that it’s just something that like is always good.
Montse Olmos 15:08
Yeah I think it. Well, I like the way that you put it like, just because it’s natural, it doesn’t mean that it cannot cause cause harm. Or it doesn’t mean that you don’t have to, like, learn it in depth. When I started as a doula in our training. I mean, in my training, I wasn’t presented with a lot of different tools and gadgets to use. My training was more focused on like, how to be an advocate and how to like, help prevent traumatic birth outcomes, because my training was very much focused on birth being a political act, and the dangers of black and indigenous women, and birthing people going into the hospitals right into public hospitals. So it was more around that. But then later on, just as a, for example, I was a member of the New York City doula collective, which is a very famous doula organization in New York. And I remember just seeing my colleagues, my fellow doulas, using things like essential oils, or homeopathy, right. And I’ve used essential oils in my life, I’ve used homeopathic medicine, sometimes it’s like the quickest thing that you have to take care of something of an ailment within your family, and it’s easily accessible at the store. And it works. Right. So I know it within that context. But I thought it was interesting how as doulas we are told that it’s okay, to go into the birthing space of someone else into the birthing ceremony of someone else. And use basically whatever we want to use, right? You can use the essential oils, you can use a homeopathic medicine, you can pull out your rebozo and do things. And I think about and I’m like, well, for essential oils, you have to know what you’re using and why you’re using it. There are strong ones that can cause adverse or severe effects in someone’s body, like clary sage, for example. And then if we look at homeopathy and like, I don’t know if there’s ever been any danger to come in homeopathic medicine, but I know that you go to school for it. I know that you go study homeopathic medicine, you go to school for it. And question, I think that that also doesn’t happen in that same way. Why do people think that you can grab this thing external for what you’re doing? Right. And so there’s traditional midwives that are also not all of them, but some of them do. There’s some others, like Mayte who integrate the rebozo in the work that they do, there’s sobadoros, so the rebozos, in the context of a practitioner, is one more thing that you integrate into your work. But you’re you have to know what you’re doing, right? practiced for many years, how to use your hands, you know, within a indigenous traditional context, you know, physiology and, you know, anatomy and biomechanics, and you understand the body in that way. And in order to understand that you don’t have to go to university, you don’t have to go and complete these extensive academic trainings, can also be learned just with your hands in daily practice. But it takes so many years learning also just got extracted from summer loaders, and was it as who use it, and just apply on its own to birth by anyone who doesn’t have all those years of experience with the body. And so that’s really weird scene, right like that are also being taken out of its original context and diluted and being commercialized and capitalized for the I want to say “benefit” because, yes, there can be issues in situations and I’m sure that it has helped a lot of people. And also now seeing folks who are being physically harmed with, like the story that might they shared his testimony of the consequences that happen when you share ancestral wisdom, without any sense of responsibility. When you share ancestral wisdom as a natural remedy, an alternative as something that’s just holistic, that is natural. And because of that, it’s sold with that there’s no consequences to it, that you can possibly have one because it’s natural, right, holistic. And what we’re saying is like, yes, the reversal can be beneficial in many ways, but Let’s not just dismiss it as something alternative, natural, holistic, and then central practice that involves practice science, it involves knowing the systems of the body, there’s science behind it. And one of the ways in which indigenous healing being delegitimized or dismissed or seen as savages, is that our medicines are not recognized as such, our systems for healing are not taken seriously. Or not taken, you know, just kind of like how Chinese medicine right you go and study, to be a Chinese doctor there years is behind that. And there are institutions that provide licenses and and it comes from an ethical practice, it’s part of a body of knowledge that belongs to a culture, right, maybe we don’t have institutions where you going certified, because our learning and our ways of sharing knowledge been built within this, that it comes from, and it’s going to happen differently every community. And so when folks say, Well, I really want to learn how to use it. So I want to know how to practice seriously professionally, well, you have order that uses it, and that wants to teach you and you have to go and community with your life with them. And have that level of commitment to it. You know? Yeah, that’s what I guess.
Mayte Alcot 21:51
Well, I think it’s really important to acknowledge how we’ve kind of bastardized all those practices in general, right. So let’s talk about herbalism. Herbalism is something that can be very dangerous. There’s so many levels to herbalism. But first of all, we are overly using herbs because of the fact that we believe because they’re natural, they cannot harm us. And that’s a big issue. Right? So there’s that nobody’s doing any classes, people are just kind of doing what they’ve heard what they’ve seen, which is, it can be fine. And it can also be problematic. So with all of that being said, then there’s also the fact that herbs are medicine, and we no longer see them as such. We no longer see them as sir, right. And then we we often do that to ancestral wisdom, we don’t see any science behind it, or we don’t understand it. So then we end up saying, Oh, it’s okay to do whatever we won’t fit without looking at everything else. Like when it comes to herbalism. We need more, we need to know what the lifestyle is we need to know is this person feeling? What is their mental health, right? What can we help with what is their blood type different herbs will react differently with different blood types, and sometimes will give you the adverse effect. And we hear this a lot with like valerian root, right? Oh, it puts you to sleep. But then there’s this one percentage that doesn’t go to sleep on it, and it wakes you up. That’s actually type O’s, we cannot sleep on it. And there’s so much more science behind it, there’s so much more there that we’re not listening to anymore. We’re not acknowledging anymore. Same with the rebozo so I also forgot to say I’ve had an apprenticeship from age seven to 15. That’s why eight years before I was allowed to touch a person on my own. So that’s also something to acknowledge that when it comes to ancestral wisdom, when it comes to the way that we are given knowledge, traditionally, it is a it’s years long of apprenticeship of sitting there, of respecting right and acknowledging its mentorship, apprenticeship and accountability and accountability, as my friend Emily says, is love. And so I just wanted to kind of add that on with everything that Montse was saying about, you know, how we are supposed to know more about the body and know more things before we apply anything on anyone else.
Maggie, RNC-OB 24:10
Yeah, that’s so important. And I think you both hit on this, just this the bigger overarching issue where there’s both the piece of like, grabbing on to things that are are not ours. And that, that characteristic that I think we see in certainly speaking for, like white birth workers in the US who get who learn about all of the ways that like the medical industrial complex and birthing our birth system here in the hospitals is really failing, birthing people. And so, you know, they feel this urgency that like, Okay, I need to act now I have to do something about it. And that’s, that’s good, and that’s powerful energy to harness. But I think because of that, so many of us, then we end up scrambling to pick up again, “tools,” methods to help. And we don’t always take enough time to actually learn about them to understand the full, you know, kind of the the science and methodology behind them and why they work and how they work. And that in our eagerness to like, act and make a difference and be supportive, that we end up overstepping our place. And I feel like that is something that as I’ve learned more about, like white supremacy culture, and how that has infiltrated everything in the US in the way that we learn about birth and birth support, I feel like that piece of wanting to change stuff, but not being in community, you know, like you said, You’re not undergoing an apprenticeship…you maybe you only have access, to, you know, a doula training that’s for a day or a couple afternoons and then you feel like you’re just kind of like, tossed out there. And you’re supposed to do stuff, but you don’t have a community necessarily to draw into, you don’t have that piece of the accountability that goes with that, to keep you on track. And to make sure that you’re that you are ensuring safety, and that you are being you know, respectful in your care, I think it was Sonya Renee Taylor, who was talking about accountability, you know, can only happen in relationship. And so if you haven’t established relationships with folks who can call you out, when you are doing things that are inappropriate, and problematic, and appropriative, then what do you have, you’re just kind of like floating along. And I think so many of us and I speak for myself, as well, like, as a white birth worker in the US, you see all these things that are happening. And you just think, like, Yes, I need to act, I need to do something right now. And so you, you try to reach out. But if you don’t do that, in a way, that actually is like rooted in your own cultural processes, that is rooted in the way that you can and should actually show for people in the skill set that you have in the time that you have to devote to the study complementary and alternative medicines, then you’re actually just going to do harm. And I think that’s something that’s really hard for people to, to hold and to understand that. While we can all be wanting different from, you know, our hospital based birth system we can, we can be upset at the constant over medicalization of birth. But that the answer to that is not to just go out and get 15 different trainings or certifications in everything under the sun to try to cover that by like you as as one singular person. And I don’t know if you all can speak a little bit more if you’ve kind of seen that that culture of that same has been reflected to you as you’ve been doing knowledge shares and working more with people through this.
Mayte Alcot 27:55
Yeah, I think that playing out right now is a good description of what’s happening with with doulas, right. So there’s a huge amount of responsibility that is being placed on us precisely because we live in a reality that but it’s not really serving people the way that it should, that we have a broken medical system, not just in the United States, but really globally. I mean, the C section rate in Mexico is off the charts. Like that’s just the standard practice right; episiotomies & cesareans are just standard practice in Mexico. So it’s not just the US is globally. And so I really do see doulas scrambling to get all those skills and tools that they can so that they can be of best service to their clients. And I know that the use of that it also can I just got dragged into that. And I know that it comes from a good intention of like I want to be able to help people in situations of need. I want to be able to know what to do. And I also want to say that like doulas, we are not just a we’re not supposed to be a band aid. The limitations are being placed on us that you know, we are going to guarantee those natural births or guarantee those those great birth experiences when in reality, doulas are going into the public medical system fighting the same oppressions and abusive behaviors as our clients. You know, I can see where where it comes to where the need to have the tools to have the skill and compassionate towards I’ve definitely felt the same way before. In my first five births as a doula were really traumatic experiences. I mean, the very first five births that I had to do to complete my certification with ancient doula services, ancient sound doula services in Brooklyn, I had to go into public hospitals in the Bronx, in Brooklyn, in Queens, and witness horrible situations of abstract obstetric abuse, like literal violence, you know, birthing people being forced into sterilization, people being being called deragatory terms, you know, in the midst of labor, nurses, just completely neglecting patients, etc. I saw some really horrible realities. And I had that same feeling of like, I need to be more prepared, I need to know as much as I can, I need to know all the things so that I can never again, just be a witness or prevent this from happening, right. And I have to like, there’s a lot intention in that. But then we also have to balance that out by acknowledging that we are there to do our best, the best of our capacity, the best ability, but we are facing a bigger monster, right? A seven headed creature like some economists called capitalism, right? Well, the medical public system is that same seven headed creature, there’s so many like things to to address with it, and so many horrors that come from it. And I think that also homebirth is being now seen as the alternative, right? Like, well, if you don’t want to go into the hospital, and the public health system and be abused and be be treated badly, hire a home birth midwife have a doula home birth, even even their own birth scene in the home birth community, we still see how there are midwives who men to the two birds with their biases, and with their racism, and internalized superiority and white supremacy, you know. Taking that rebozo workshop, or, you know, just extracting from other cultures, we should be putting all of our time and energy and investment into Black midwifery into support for those practitioners, people like Mayte even, support them so that they can continue doing their work so that more of them can come, so that people can have more access to these… to black midwives, to indigenous midwives, and to traditional healers, who have learned in the in the correct way, because they really do feel like they’re doing very crucial work. They they are the ones that know exactly how to serve their communities, they’re the ones that know exactly what the what their communities need. And if we just eliminate some of the obstacles and just build a more stable path for them, then we can have much better maternal outcomes and infant outcomes in birth. Right. And I’m not the first one to be saying this, this is not groundbreaking, so many black birth workers have been doing this work for decades now. Right, since the times of the of the Grand midwives of the South, since the times of indigenous midwifery, you know, before colonial times, like who have been struggling and fighting for this since forever. And yet, you know, here we are today, discussing whether the rebozo is a sacred textile or just a tool, you know, and sometimes I get tired, a little tired of the conversation, like, I feel like this should be known, they should be foundational, right? That indigenous technologies should be respected should be treated as such, should be regarded as science. And that not just anyone can come and apply them however, they please, that there is a learning process that comes with it. And that if we just support the people that are already doing it; we’d have a much better outcome, right?
Maggie, RNC-OB 34:06
Yes, Montse ended on such a important high note there, if we just support the people already doing this work, we would have a better outcome. It was such a privilege to get the opportunity to speak with Montse & Mayte for quite a long time. And we really dove into all these issues surrounding you know, the rebozo individually, and as a signifier for the greater cultural appropriation that happens in birth work every day. And then as our conversation continued, we were able to really dive into some of the pieces around accountability and ally ship and being an accomplice, which I think are all really important topics in their own right. And so we’re splitting this interview into two different parts. So you’ve just heard part one, and I hope you’ll be able to have some time now to reflect on everything that Mayte & Montse shared and to start to apply some of this to your own practice, to start thinking about it through your lens, what you bring to birth work in your background, your experiences, your trainings, and just be allowed to sit with it. I know a lot of is hard to hear, we’re talking about things that are hurtful and harmful to experience. And we realized this episode, may have brought up times when your work and your culture were appropriated, where your ancestral wisdom was dismissed, where you were hurt by the white supremacy and racism present in virtual communities. We also know it can be challenging to recognize these harmful behaviors in ourselves when they’ve been so intertwined in our trainings and our culture. And we’re grateful for the opportunity to unpack some of this with you. We appreciate you all being in here and tuning into all that we have to share. And we invite you as you process to connect with us. We would love to learn more about what you took from this episode and what you’re bringing forward. So you can certainly find us at Your BIRTH Partners community, our Facebook group, and we’re Your BIRTH Partners across social media. We’ll also be sharing some more resources in the show notes that link to Montse & Mayte’s upcoming knowledge share about the rebozo that really is an encompassing dive into everything that we started to touch on today and the opportunity for a lot more processing and sharing in a supportive open group experience. And we’re delighted to be sponsoring a slot in that; so we’ll be sharing more about that in our community group this week. We’ll also have in our show notes, more information about recognizing cultural appropriation in the birthworker community for those of you who want to examine this more fully. So thank you so much for being here with us and we look forward to sharing part two of this interview next week. Till next time!
037: Accountability, Allyship, & Anti-Racism: Cultural Appropriation in Birth 2
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies, and step into the future of better birth care.
Hey there, and welcome back to the show. This week, we are continuing part two of the conversation that I had the pleasure of having with Montse Olmos, and Mayte Acolt, which we started last week. So I had the chance to speak with Mayte & Montse for a really long time. And in the course of our conversation, we talked a lot about cultural appropriation and how that shows up in the birth community and holistic wellness communities in general. And in the first piece, we really spoke at length about their work specifically around cultural appropriation of the rebozo and how that has been co opted by a lot of white birth organizations. So if you didn’t have a chance, I definitely recommend for you to look back one episode and catch our first half of the interview. And then for this part, I wanted to separate this out, because we started to really dive into themes around accountability for community members, and discussing more of what it looks like to move from being an ally to being an accomplice in, in this work and birth work, which needs to be anti racist at its core. And I’m so grateful for Montse & Mayte for everything that they really call out in this and, and how much they explain of their process. And they continue to want to see birthworks change, you know, these are the conversations that I wish I had been having as I started out as a birth worker. This is the information that we need that I needed as as a nurse as a birth worker, you know, as a human caring for other humans. And speaking for myself, as a white nurse, I know how easily these issues are ignored in white dominated spaces, like we often see in nursing and medical and midwifery schools in doula trainings and all other births from childbirth education, lactation support, to you know, all of them. And it is way too common for these themes to be ignored or dismissed. And to not take time to really reflect on it. And so especially speaking to all my other fellow white birth workers out there, who are contemplating this and want to make sure that they are showing up authentically in you know, your own practice, as someone who cares for people and is given such an intimate, you know, glimpse into part of their lives, I hope that this conversation is helpful for you kind of framing your work and your practice and the way that you want to move forward and how we can all come together to learn more and make mistakes and try again and keep doing better. So, I am going to welcome you into this conversation with Montse wrapping up one piece that she had left us with at the end of our first part of the interview, and then I’ll go right over to Mayte. On to the show!
Montse Olmos 3:44
…And yet you know here we are today discussing whether the Rebozo is a sacred textile or just a tool, you know, and sometimes I get tired a little tired of the conversation like should we be explaining these things I feel like this should be known, this is basic, this should be foundational right? That indigenous technologies should be respected should be treated as such should be regarded as science and that not just anyone can apply them however they please that there is a learning process that comes with it and that if we just support the people that are already doing it we can have a much better outcome right?
Mayte Acolt
I completely agree with you on it that’s the thing we can be supporting these Black midwives, these Indigenous midwives, we can be helping the people that know exactly what they need for the for Black Indigenous People of Color, unfortunately, and me & Montse have had this conversation on a live in the past there is racism within midwifery there is white supremacy within midwifery and we’re seeing it very often. Homebirth will not be the same experience. If you get a Black and Indigenous, a Mexican, a Guatemalan, El Salvadoran, ya know, experience, and so on and so forth, then it would be with a white midwife that doesn’t understand cultures that sometimes even fears them. And I’ve had this conversation before, right? and cultural competency is not a real thing. I’ve tried to teach it so many times. And at the end of the day, there’s always someone that just doesn’t understand someone’s culture, and they’re afraid of that thing. Right? There’s so much more there than just about going into the home birth experience. It’s not just not learning that about a there’s so much more to this and people need to do specifically birth workers have to do better. midwives, doulas, postpartum, whatever, they need to do better for all of us, if that makes any sense. And we need to get this whole white savior thing out of the way as well. Like, you don’t need to be the one that services, but you can help those people. I think that’s something that Montse always talks about difference between…share what you always say, Montse.
Montse Olmos
So Maggie, you’ve been in the in the knowledge share about the Rebozo when we talk about difference between being an ally and being an accomplice, I feel like ally ship has been co opted diluted. It’s a word that is so easily thrown around, right, like being an ally, I’m an ally, I’m an ally. And I think that to be an ally, sometimes all you have to do is just post stuff on social media. And that’s it, you know, and then your real life doesn’t have to translate. But when we talk about being an accomplice, I really do propose that folks do their best to become accomplices, because an accomplice is someone who stands right by you, at the worst of times, right? So if we are out there at a protest on the streets, and let’s say I’m undocumented, or I’m a Black person, and you’re my white accomplice who’s with me at the protest, you know, that if someone is going to get arrested, or someone is going to get hurt by the cops, it should be you. Because the interaction with cops is not going to be the same. If it’s a Brown and Black body than if it’s a White body, right. And we know that, because we’ve been seeing it over and over, we’ve been seeing Black men being brutalized and murdered on the news by police, right. And so when I think about that, I’m like, we don’t really need allies, we don’t need people posting black squares, we don’t need people, you know, putting the, the hashtag, online, we need folks that are with us and are ready to put their bodies on the line and are ready to risk their livings or comfort for us. Right when you know, shit hits the fan. And so I think that someone who’s an accomplice uses all of their resources and privileges that they may have. And this can be the same as speaking English, having access to social media to a social media platform, or maybe owning land, whatever it is that you that you recognize as a privilege to gather all of that, and then build something, build a platform or build a space and just hand it over, you literally just hand it over to Black people who are doing the work and who need the resources and who need the support. So being an accomplice is a lot about giving up power, right? recognizing where you hold power and just giving it up or redistributing it in a way that you know, you’re going to impact communities in a positive way. And a lot of that work involves asking people what they need, right? So if you are going to go into a community of color, the first thing should be like, Am I welcome here? Like do people actually want me here? And if they do, like, so what can I do for you? What do you need? What What do you need that I can give you? Or that I can work with? Like that should be a basic question always. And a lot of what we see in birth work is like the opposite. Right? Like, you know, us trying to be saviors a striving to do what we think is best for people before asking. And considering ourselves allies just because we are, you know, putting up a charity donation here and there or you know, a hashtag or an image online when it happens outside of the virtual space. But I also don’t want to dismiss the virtual space as you know something that doesn’t work or that is not legitimate because a lot of good activism work happens online. And because you know, governments nowadays, they know that we are connecting online, they know that we are building entire communities online, and that we are reaching far places. And they know that a lot of the awareness and a lot of the just expanded consciousness that we’re experiencing right now, in this time in this era, is coming from the fact that we have access to so much information online, right? No longer can cops just hide the fact that they killed the Black men. Like now it’s, it’s online, you can see it. And I’m not saying you know, go and watch all those videos, because I don’t think that’s also part of the solution. But what I’m saying is like, we can use the digital space as part of our activism as part of our moral responsibility to be accomplices to communities of color, it can be one more way of doing it, but it shouldn’t be the only way in which we do it. We should also just go to concrete actions in real life and use the the powers and privileges that we all have, in one way or another, to benefit those communities.
Mayte Acolt
But that’s why we get censored, right? So if you are someone who has a huge platform, and you are following a Black Indigenous person of color, a creator, that is getting censored, like myself all the time, shout me out, share my stuff, shout Montse out, share her stuff, because she talks about all the stuff that is considered not within community guidelines. I really don’t know what I share that gets me censored, but I do. But that’s the whole point, right? Because we’re only speaking our truths. And we’re trying to educate, we’re trying to elevate you. Because when you know better, you do better, right? And so that is the goal. That is the end goal with both me and one say this isn’t about us. This is about something bigger, it’s it’s about our communities. This is about people who don’t have access to this knowledge, this is about awakening us, right?
Montse Olmos
Yes, Mayte. And with that, I’m so happy Mayte said that because some of the backlash that we received from the petition was from midwives in professional midwives in Mexico. And I and maybe we can go into that a little bit the difference between a professional midwife and a traditional midwife. So professional midwives put out a statement against the petition, and they put it out in in Spanish and English, I believe. And, you know, I guess they also watched our lives, the the live videos that Mayte and I have done. And based on what the petition said as well. One of the the gossips or arguments that was created from this is that, you know, Mayte and I are doing this, just to bring attention to ourselves and to promote our class, our bi weekly class on the Rebozo. And I have been very vocal about clarifying what it is that we do, because I think that it’s it’s easy to just kind of assume without really knowing what we do. And and you’re a witness, Maggie, because you’ve been in that in there, yes. So we don’t really teach birth techniques, right. So you know, when you come into the knowledge share, you don’t come to learn birth techniques, or anything to apply to another body. The Rebozo has evolved from other textiles ancestors of the Rebozo. So to now write and why that should happen, and what percent for us, and why we see it as a sacred a sacred textile. And and once we, we share that with you, we literally go into a few things that you can practice for self care, that are non invasive, that are very low impact, and that you know, if you if you wish to share them within your family, you’re more than welcome to do so. But our intention is that be relationship with a role sourced, using it on your own body and a daily part of your daily care. And then is to take that work and use someone else and learn more about it, then we can we encourage you to go in that can do that for you. They can they can share that. And then we even go into things like spiritual inquiry, right? Like how do you connect to your own lineage to your own family stories? Because maybe there is medicine there for you. Maybe there are birthing traditions there that you should know about. Right? Because that would be empowering and that also would create a cultural connection to your own people. Maybe your your original land, to your ancestry. And once you have that cultural connection, then there’s no need to come and appropriate other things right and talk about how cultural disconnection is the root of cultural appropriation, not knowing where you come from not knowing what your story is. So that’s really what the knowledge share is about. But something that Mayte and I became very aware of this whole situation of the petition and by the midwives, is that the conversation about race identity is definitely not the same in the in the US. And in Mexico. Right now in Mexico, we are still on a path of accepting mestizaje. Right. So mestizos, right like is this mix of the white Spaniards, the colonizers that arrived in Mexico and the Indigenous people, and then in some communities, we also add the African root, right? From all the slaves that were being that were brought over. So we have this very complex identity in Mexico, right. And these are very polarized realities, where you have people who are in city or urban, who grow up in that way. And then we have all the Indigenous communities, still in the rural part of Mexico, and that are constantly struggling all the attacks by the Mexican government. And so and traditional midwifery falls on that, you know, traditional midwifery is constantly being attacked by the government to disappear, basically. And so we have this reality in Mexico that is so diverse, and so multicultural. And the conversation about race is definitely not happening in the same way at the same pace. And at the same level, as it is in the United States, right. In the United States. We talk about whiteness, we talk, we talk about Indigeneity. And then those whose decisions are not quite clear yet, you know, so it’s very easy for, you know, someone who’s a professional midwife, for example, who come from the city, it’s very easy for a person like that to learn from a midwife or an Indigenous community to learn and then take it, take whatever they learned and go and sell it, which is when they’re also seeing right now. That’s really what’s happening in Mexico, a lot of professional midwives are taking elements from traditional midwifery, such as the Rebozo, but also the styles & ceremonies, the closing of the hips, etc, in those those elements, and traveling around the world to sell them, right found out that a lot of those midwives are hired by DONA international, they go to conferences, they present on the web, also, they have partnerships, and they do business come in and teach on the Rebozo and teach about just traditional practices in birth. And, and we got the impression that one of the, by our petition is because literally, this is something that is messing with their with their income, for lack of a better way to say… there’s a conflict of interests, basically, because the Rebozo has become a huge market, and sold and it’s not just the US, it’s Russia, into Europe, it’s Brazil. And a lot of those classes and workshops are being taught by professional Mexican midwives. And a lot of people don’t know the difference between the two, between the professional midwife and the traditional midwife, or Mexico. But that really doesn’t mean anything. You can be white and be born in Mexico, you can be born in Mexico and be from a super from the city. It’s important to remember that Mexico has 68 languages, 69 If we count language, 70 if we count Spanish. From those 68 different Indigenous languages, we have 300, more than 300 variants of them. And that just speaks to the amount of diversity in indigenous communities that we have. And not all of them use that are also only some of them. And the ones that do want to share. Some of them may share. And that’s okay. It’s important to respect that. And each community has a different story and relationship to it. So yeah, I want to provide that context. You know, just for folks to understand that that.
Maggie, RNC-OB 19:46
Yeah, I think that’s important. I think that’s saying that speaking from the way that the us a lot of times way we position ourselves in the world and the way that that influences the way that we think about other cultures. I think we have a instinct, to be like reductive in it, right? And so to say like, okay, yes, this is like the person who’s speaking for Mexico, this is the person who’s speaking for the Indigenous people of that. And I think what what I have witnessed in kind of the fallout from the petition that y’all put together is that there is that sense of people, you can always find someone to agree with you, right? You can always find a study to agree with you, you can always find social media posts, you can always find like someone else who’s in your corner. And so it feels like there was kind of a piling on then for organizations who, you know, have been affiliated with teaching Rebozo. And they were very eager, obviously, to see that there were some, you know, professional Mexican midwives, who were kind of willing to step out and say, like, Oh, no, it’s okay. We can all use our Rebozo, it’s fine. And while that is their experience, that’s their opinion, that’s their truth. I think there is a place that reminder for all of us that just like you explained, there isn’t just one, you know, there isn’t just one piece of it, there isn’t one answer. And that if you’re finding yourself, you know, as we consider issues around, not only, you know, the Rebozo, but cultural appropriation at large when you’re finding yourself in that situation where you just want to find someone else who already agrees with the way you feel about it, that you need to reflect on that, you know, that you need to dig a little deeper. And I want, in full transparency, you know, when I first saw about the petition, I had this initial little like gut reaction like, Oh, no, does that mean that this is going to like negatively impact birth and that people are going to have less access to, you know, the Rebozo and then due to talking with, you know, several friends and colleagues, other birth workers and taking time to process, that initial feeling and realize like, “okay, right, I am reacting to my frustration with the over medicalization of birth.” That is, like you would point to that is not solved by one person, it’s not solved by, you know, one, one thing, or one role, it is solved by a huge systematic change that has happened. So, I think, for some of us, when we have these, like, quick reactions, that we need to dig deeper and then realize, okay, where is that actually coming from? What are you worried about? What is making you seek this out to begin with? You know, to your point, like, are you? Are you going for a Rebozo certification? And, you know, you’re going to use essential oils, and herbs and all these things that are, that are great and good and important. But you know, are you doing that with understanding of that greater context? Are you doing that with that saviorism piece, which I have totally fallen into before, where you feel like, okay, yes, if I can just arm myself with enough knowledge, I can fix this. And that’s, that’s not how this work is done. You know, we need like you spoke to we need representative care, we need more Black and Brown and Indigenous midwives, who are able to provide culturally relevant care, to birthing people, because there is so much evidence that shows that that is actually what we need. And that is, you know, their stories, proven experience. And there is so many studies out there for people who feel good looking at, you know, tons and tons of data altogether. I feel like when we, when we see these moments pop up that allow us to like question ourselves, that we need to go down that route. And we need to explore a little bit more about our positionality. And this is for, you know, each of us as different birth workers, all of us have different, we have different roles, we have different kind of jobs and responsibilities that we hold in the birth space. And so really like tuning into what that is, and what it isn’t, and reflecting on the way that we can actually support everyone else in their world to have that community feel of birth, instead of feeling like it is something that we each need to be taking on like our own, like you said, I am so grateful that you all put together the petition, not because you needed it to uplift the you know, the knowledge share y’all do. But that knowledge share was so powerful. And I’ve talked to other birthworkers who did it as well, who had that same experience of really being able to finally like put together some of these pieces and understand more about how all of this, you know, kind of the the cultural appropriation, the white supremacy, racism, the just the abuses that are so present every day in our birth system, how those all are intertwined and the role that we play in it and then being able to really process that piece of stepping out of it, of kind of being able to step back a little bit from our experience, and be able to work through it. And so I just really, I appreciate how much work you all did to to build that, and to cultivate a space that really allows for that sort of authentic reflection, because I think it’s something that is, it’s sorely missing in a lot of the ways that we, we learn about birth, a lot of trainings we do there isn’t that, that space for and I think it’s really important. And then one of the last things I want to ask you all about is, you know, the where do we go from here in terms of like holding, holding each other accountable, those who who we are in relationship and in holding like these bigger organizations accountable about the way that we want to see, you know, education and awareness around birth support change.
Mayte Acolt 25:34
Yeah, like, first off, who out there is doing any kind of releases or acknowledgments of the Rebozo? are they teaching the Rebozo? And I just said also, but are they teaching anything that requires more than a weekend training? And I say this because I took I took the DONA training I did the whole weekend. I definitely learned about 15 minutes or so. And I knew it prior. But I definitely got to see how that happened. Right. But they also teach you some some trainers teach you essential oils, they teach you pressure, pressure points. I mean, there’s a whole class of spinning babies, right? are they teaching you anatomy and physiology? are they teaching you biomechanics? Right, are they continue all those things? I think it’s opening your eyes and acknowledging that. What are they teaching you? And are they taking the proper way? Are they doing it properly? Is there mentorship after they’re done? Right, that’s one way of kind of putting your money into those into, you know, organizations that are doing that work that are bringing in those teachers that are of Indigenous descent that do have programs of mentorship, right, that are there for more than just the money. We are very capitalistic here. And it’s all about the money. And it’s all about how fast can I get this knowledge? How quickly can I be certified? And how quickly can I do what I want to do to make money? Because a lot of people, a lot of us who have a lot of tools under the belt their belts, it’s not about how they can help the birthing person, but it’s about how can I charge more? And I’ve seen that in doula groups, right? We’ve all seen that. Hey, I’m charging $500. But I’m thinking that if I learn belly binding, I can totally charge like $600 or more, right? It’s also holding those folks accountable to that. That mentality. I don’t know. Montse, do you have anything else that you are thinking?
Montse Olmos
I’m thinking about just the response of major organizations to that petition? Like some of them, were very quick to make a statement. And for all those organizations, I’m really grateful because they didn’t think about it twice. They were like, okay, someone is saying something about this to all those are the CAPPA, DTI, Cornerstone, Manhattan Birth, Birthday Presence, etc. Ancient Song because they took a stand right away. They didn’t have to think about it twice. But then we also had the case of organizations like DONA, for example, that are just really not open to learning or unlearning what they think that they know about Indigeneity or thought of also. And so I think that just as far as accountability goes, I also saw that video by Sonya Renee Taylor talking about how accountability happens in relationship. Right. And when it’s outside of relationship, it’s punishment. And I do think that, you know, for example, I am not in relationship with DONA, right? I don’t know anyone from doing that, personally, the conversation with DONA began with a petition. And so I can see how maybe some of the ways in which we call for accountability, specifically with DONA was a little punitive, like on the side of punishment. But I also want to say and that’s a learning experience, obviously, for me, for Mayte. For an organizzationa as large as DONA, I don’t feel bad about using punitive measures, because I feel like they hold a tremendous amount of power and responsibility to others. And I feel like, you know, they should be the first ones to say, we’re listening, and we’re taking action. You don’t know, for example, they’re not really doing it. They’re just kind of saying, “Well, our friends, the professional midwives said that it was okay to continue doing our thing.” That’s where you stand, you know. So, moving forward, I really would love to see and taking a stand on things being firm on where, where they stand without us having to do all the work for them, without us having to release petitions, having to explain to them and educate them for free and all the emotional and intellectual work that Mayte and I have put behind this. I really would like for folks to just you know, educate themselves and come forward on and take a stand on their own to push them towards it, or offer them to it or provide the reasons why, you know, it’s super clear. And the reasons why should be part of our workers, right? The reasons why don’t Okay, the reasons why cultural versions not okay. I think that should be part of your training as a doula, I really do urge a lot of these organizations that are training and mentoring doulas, to provide more education on anti racism work on privilege, power, cultural appropriation, all the branches from you know, that stem from white supremacy, birth workers are doing political work, birth workers are doing really important work, and they have to have a political social lens to their work, because otherwise, then they’re just perpetrating white supremacy. So yeah, I think that if we all take care of ourselves, and we all educate ourselves on that end, and we do our best to just be, you know, decent human beings, then like, folks don’t have to hold us accountable. And folks don’t have to punish us. And I also want to acknowledge that we can be so much better about the way that we call folks in, and I include myself in this for sure. I’m learning, you know, to call in before calling out to be in relationship first, before holding folks accountable. It’s a process. It’s a learning process for all of us, I invite all of us to get in that learning process. And that’s definitely one of the main teachings that I got from the petition. Yeah. So thank you, Maggie, for providing this space. And for, you know, inviting us to your platform.
Maggie, RNC-OB 31:49
Oh, absolutely. Thank you both so much. I really appreciate you just coming on here. This has been such a like rich conversation, and you both have shared so much of your insight and your time and your passion with us. I really appreciate it.
Mayte Alcot 31:58
Yes, thank you so much for having us. I really enjoyed it.
Maggie, RNC-OB 32:03
I am just so deeply appreciative of Mayte & Montse for coming on and sharing so much about their stories and what they’ve experienced and what they’ve seen in birth work. They are doing such tremendous, hard and inspiring work. And I’m appreciative to everyone else out there, all the other folks in the birth community, especially the other Indigenous and Black and Brown, birthing folks and community members who take the time to call this out, who stepped forward and, and do so much and give so much of themselves, trying to help wrongs that truly are not their responsibility to fix. And I appreciate all of you who are out there calling in and calling out folks in your community when they need it.
I know that was a heavy and hopefully thought provoking conversation. I know it can be really challenging to examine our selves and our practices and our positionality within birth. And so it was created an opportunity for you to reflect on those. And I hope that you have people who you can turn to and be in community with to discuss the impact that your work has and to examine the ways that cultural appropriation could be showing up your work or has in the past, and what your path is forward, so that we can create a birth community that is based on mutual respect and appreciation, and keeps all of us working together. Certainly as you go to process that we welcome your comments and your feedback. You can join our community group, Your BIRTH Partners community on Facebook, and we also welcome you to follow us across social media we’re Your BIRTH Partners, it is really important to continue these conversations as we digest material and process how this shows up in our work. And I cannot more highly recommend looking into the knowledge share that Montse & Mayte offer. It is coming up next on May 11. And we will share details about that in the show notes and on social media so that you’ll have a chance to follow up with them and learn more with them and interest you. Thanks for being here with this conversation with us. Till next time!
038: Harm Reduction in Pregnancy & Birth
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back. In this week’s episode, we are diving into another heavy conversation. And this one, I don’t know that I can think of maybe a more biased topic in the pregnancy, birth postpartum continuum than pregnant folks who use drugs. And I think there has just been large campaigns of intentional misinformation about what drug use means, the impact that it has on pregnancy, safety and parenting. And so I’m really excited to be able to have a more intentional conversation, and to really consider some of the stereotypes that we have perhaps played into and believed and how that affects the way we treat people who are in our care. And so to help us to navigate this, I’m really excited to have Carlyn Mast join us, who is a licensed clinical social worker, who really works at you know, the intersection of perinatal behavioral health and harm reduction. So I welcome you into this conversation with Carlyn. Onto the show!
Well, welcome. Welcome. Welcome, Carlyn. I’m so excited to have you on here to talk about kind of all things, surveillance and support and harm reduction and really dig into how we can really just partner with those who are in our care to really support what they need on their pregnancy journey. So if you want to just tell our audience a little bit about yourself again.
Carlyn, LCSW 2:05
Yeah, thanks so much for having me. I’m really excited to be here. My name is Carlyn and I’m a licensed clinical social worker. Currently, I live in the Philadelphia area. But prior to moving, I’ve spent my whole life in Baltimore, Maryland. Prior to moving I worked at a birthing center at a hospital and was the perinatal social worker. So that means I worked on a mother baby unit labor and delivery, in an outpatient abortion clinic, and a center for high risk pregnancies does like fetal surgeries and things like that. So in addition to that, I also helped co found the prison support programs through the Baltimore doula project. And I worked with the Baltimore City Public Defender’s in their office of rental defense. So I’ve really worked at like the intersection of pregnancy, parenting and mental health, surveillance, all of those things, huh?
Maggie, RNC-OB 3:01
Yes. Yeah, that’s it’s, I love your your background, you just you bring such a rich experience to how we kind of interact with pregnant people. One of the big reasons that we wanted to invite you on here is when we learn about supporting pregnancy, we learn about it in this kind of like this, whatever “picture perfect,” kind of like ideal way that it’s all supposed to work. I don’t think anyone has that, you know, like that textbook, no one has the textbook life. And so one of the things I wanted to particularly talk to you about is harm reduction in pregnancy and what that might look like and how we can support pregnant people who are using drugs and make it so that they feel safe and that they are actually being cared for instead of criminalized.
Carlyn, LCSW 3:47
Yeah, so thank you for bringing that up. As a social worker, I consider myself a harm reductionist and I’ve practiced with a harm reduction framework. And I guess just to like, lay the groundwork harm reduction is a term that we hear kind of often now, which is great that it’s, it’s being discussed. And it’s kind of like out there in the public sphere. But for folks that aren’t super, you know, knowledgeable on it, in essence, really, it’s just a set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use. It’s also kind of a movement for social justice built on the belief and respect for the rights of people that use drugs. I like to think of it kind of as radical love and compassion for the folks that we work with. Here is autonomy, which those of us in birth work know is is really important, and sometimes something that that not everyone has access to. So what I love about harm reduction is it centers, autonomy and you know, nothing is for us without being by us. Does that make sense?
Maggie, RNC-OB 4:55
Yeah, I think there’s this whole like double bias that kind of comes up where we You know, where people who are pregnant are automatically just judged way more closely for anything that they’re doing with their bodies. And like you said, we just see so often that autonomy is not present in kind of just standard prenatal care and how people are treated both by, you know, birth workers and professionals, but also just by society at large, you know, like, we just seem to think that when someone is pregnant, all bets are off, and that they no longer get to choose what what happens to them. So I wonder in that context to where I think then there’s a good double whammy, where we also tend to treat people who use drugs in that framework that like when someone is, is using something that, you know, it’s an illegal substance, that all of a sudden, like all bets are off for how they want to how they want to handle their life, if and how they want to continue their drug, you know, all of that. And so, I wonder if you could touch on that kind of the, how those two things kind of intersect and what you see in your work?
Carlyn, LCSW 5:53
Yeah, so I think you you put it great. I mean, it is anyone that you know, works in healthcare or practices medicine, or has been pregnant or experienced drug use. I mean, it’s really like you’re working at the intersection of two very emotional, very, you know, people come like with a lot of emotion and a lot of ideas and opinions about both pregnancy and drug use. And like you said, You are kind of working at the crux of these things that are sometimes the only experiences where people feel totally comfortable to like come up to you and just like rattle off opinions. So it’s both like a very emotional time. But it’s also a very good a lot of opinions about drug use and pregnancy. So when I’m talking about pregnancy and harm reduction, I mean, there’s just a couple of things that I really like to keep in mind. Is that something that you would like me to talk abut?
Maggie, RNC-OB 6:49
Absolutely, yeah, I think that’d be really helpful to just be like, cuz like you said, I think it’s become somewhat of a buzzword. But yeah, there’s not always a lot of kind of deeper meaning to again.
Carlyn, LCSW 6:58
So I guess the first thing that I like to do is really just talk a little bit about drugs and pregnancy, because that’s something that there is like limitless misinformation about and there are, you could find a scientific study that could, you know, the conclusion could say whatever you want it to, but when we’re talking about consequences of drug use during pregnancy, on long term outcomes of babies, the science is is particularly terrible. There are there have been throughout history, many studies, particularly thinking of Dr. Chasnoff that wrote the one of the first papers on the impact of cocaine use during pregnancy, like back in the 80s. That led to the whole like “crack baby” myth. There has been throughout history, just like terrible science around this. But what I feel confident saying and I think what other informed healthcare practitioners would agree with me on is that there is not good science that suggests that there is any long term cognitive or behavioral deficits in babies are born exposed to substances in utero, the caveat that we know that alcohol use during pregnancy can lead to a fetal alcohol spectrum disorder. And we know that that can be harmful. But when it comes to other drugs and substances, there is not good evidence. There’s no evidence at all that that really points to, you know, babies that were exposed in utero having these like severe deficits and behavioral issues later in life. So that’s the first thing I like to dispel. Because so many folks that work in healthcare are not, you know, this may not be their bread and butter, they may not be super educated on this. And, you know, it is a widely accepted cultural myth that, you know, if you use drugs during pregnancy, your child may end up being learning impaired or having behavioral issues. And that’s simply not true. That is the first and foremost thing that I like to get out of the way.
Maggie, RNC-OB 8:58
Yeah, and I mean, that it that’s a huge cultural shift. That’s just that’s not what we’re, I don’t think that’s what we’re taught, both from medical nursing that, you know, background like that is certainly not what is what is written about in the textbooks. And at least I also think that’s just not what society that is not the story that we’ve told ourselves is certainly one that like there’s going to be long term harm, and that absolutely feeds into then this kind of poor treatment of it. So I think that’s really important to, to note and get out there.
Carlyn, LCSW 9:28
I think also, you know, we’re talking about using any substance during pregnancy, particularly anything that is not anything that’s elicit so it’s not legal, there is harm and there is risk, particularly when it comes to infection and overdose. And those risks are a direct result of the war on drugs and criminalization. So we’re talking about risks. You know, it’s important to recognize that, you know, some serious risks not to downplay you know, infection or overdose at all. But these are risks that could largely be mitigated if we were to practice through a harm reduction lens, and we were able to have access to safe supply and health care that really treated folks that use drugs. So, I mean, there definitely is risk, but it is kind of a result of this system, if that makes them. Yeah, absolutely. After we’ve gotten that out of the way, and we’ve talked about it, because there’s usually like, understandably, a lot of feeling, I really just can’t stress enough that pregnant folks make the best decisions for themselves and for their bodies. Pregnancy, as you know, is this really interesting, unique time and like window of change, where folks that may not, you know, have a ton of exposure to the health care system for whatever reason, typically find themselves interacting with it a bit more. So it is this wonderful, beautiful time that as health care providers or mental health providers, you have the you know, the chance to really formed a trusting relationship with with a person and not just to serve them during their pregnancy, but hopefully, you know, be the jump off for for better health in the future, I think one of the most important things that we can do as healthcare practitioners is really create a safe and non judgmental space for folks that use drugs, and people that are pregnant, and, you know, people that are pregnant have unique needs, a lot of times they may have other kids. So whether that’s, you know, creating a space that welcomes children, and, and maybe also has childcare or, you know, understanding that a lot of people that, you know, have the capacity for pregnancy may or may not have some sort of that history of sexual violence or trauma, you know, we need to be understanding of these things, but but really at the crux of all of this is really believing that our clients make the best decisions for themselves and for their families. Does that make sense?
Maggie, RNC-OB 11:54
It does make sense that I, that is certainly been I mean, autonomy is a, if anything is our core value, as you know, an organization here. And it’s something that comes up so often in our conversations about a myriad of topics, because it is just, it should absolutely be the cornerstone of perinatal care. And it’s not. And I think we see the reverberations of that, across so many different populations. So many different people are impacted by the paternalistic nature that we have set up in perinatal care, and it, it hurts us, it hurts the people we’re trying to take care of. Because just like that, it sounds so easy. Like, of course, we’re just going to create a non judgmental space for people to come in. And then tell us what, what do you need? Like, what, what what, what kind of support Are you looking for, but it’s not how our system is set up at all. And it’s not what we’re what we’re taught to do, you know, we’re taught to kind of come in with a checklist, and that’s inadequate, and harmful.
Carlyn, LCSW 12:54
Yeah. I mean, I and I’ve, I’ve gotten questions before, like, well, what can I do? Like, what where do I start? And I think the biggest thing and it may sound like silly, but the biggest thing is just listening to the folks that you’re working with, you know, what do you need, I know, they’ll tell you what they need, and understanding that that trust on the same, you know, the same note that trust may not be there initially, it may be something that you have to build, and you have to work in. Because, you know, historically, the health care system hasn’t always been kind to people that are pregnant, or, you know, people that are pregnant and are using drugs. So, you know, over time, little by little if, if that’s kind of how we’re practicing, we’re practicing through this harm reduction lens of centering autonomy, the trust will will begin to build.
Maggie, RNC-OB 13:41
Yeah, absolutely. I mean, it should be relationship based, you know, it’s we have this, like this window, you know, like, luckily, we’re pregnant for several months. And it feels like right, this is totally an opportunity where we are have so many check ins with people who maybe just haven’t had an opportunity to discuss it with a healthcare provider to say what kind of support they need that like, here we are, where we’re gonna expect to see you every month, every couple of weeks, you know, things go along, that there really is this chance for us to be open and accepting and let our relationship form and not feel like we need to go in, you know, drilling people on their first prenatal appointment, to understand everything about them instead of just allowing things to kind of unfold as it as they feel comfortable.
Carlyn, LCSW 14:24
Yeah, absolutely.
Maggie, RNC-OB 14:26
Yeah. And then I wonder, the other piece, I think that you touched on a little bit, and I think it’s challenging, perhaps, is that emotional piece of it, I think, someone who’s been, you know, a nurse in this field for like, a decade and worked in a couple of different institutions. And they’ve all had different policies, you know, around, how are we monitoring? How are we you know, assessing for drug use? What are we kind of asking for? And I think one of the things that I’ve seen across all of those is that there’s always someone who either has a personal experience or has had Past professional experience with someone who was using drugs. And then there was a really difficult outcome, maybe during the pregnancy or you know, right there during the birth, you know, or immediately afterwards, and they are really holding on to this past experience really dictate how they then interact with people who use drugs. And I’ve certainly seen it for people who have had personal experiences, you know, they’ve had a loved one who has used drugs and has had a difficult time. And so then they’re, they’re carrying all of that, you know, we heard you know…we’re not empty vessels, I think we think sometimes we’re supposed to show up like that, but they are holding on to a lot of kind of this negativity that they’ve had associated people. And it makes it really challenging for them to kind of build and give a fresh set of eyes to the person who’s right in front of them. And I don’t know if you can speak kind of like your social work background to how do we kind of navigate some of those, like, hold that piece of it.
Carlyn, LCSW 15:59
So yeah, of course, the the fact that you’re able to recognize that, right? Like in talking to you, if you were a co worker of mine, let’s say a nurse I worked with that came to me and said, Look, I’m having a really hard time with this, because of x, y, z in my past, the fact that you’re able to identify that it’s challenging for you, because of a personal experience is like step number one. So, you know, speaking to this, as a social worker, I think it’s always important to kind of check in with ourselves and understand where we’re coming from when we show up to this birth work, right? If I’m someone that had a really difficult experience in the past, you know, in this field, and it’s starting to, you know, inform how I’m seeing my client, or how I’m feeling about the situation, I need to check in with myself, and maybe give myself a little bit more TLC, and, you know, have a chat with myself like, it’s, it’s a tough space, right, like drug use, and pregnancy, both can have really difficult challenging outcomes and come with, you know, a ton of trauma, potential trauma. And it’s important that we’re able to kind of process our own past or things that have may happen to friends or family, and not have that, you know, impact our clients, if that makes sense. And one thing in the social work field, I mean, social work gets a lot wrong, I’m the first one to like, have an axe to grind with social work. But something that is built into our profession is this idea of supervision. where, you know, if you’re working towards kind of like the highest level of licensure, weekly, bi weekly, you’re meeting with someone in your field, a supervisor, someone that’s, you know, I’ve been practicing a little bit longer to kind of just work through this stuff. Like, we recognize that lots of things can be really emotionally challenging. And if we don’t put it somewhere, it has the potential to come and, you know, be in the room with our patient and our care. And I think it’s really important to just tackle that.
Maggie, RNC-OB 18:07
Yeah. And then I think if, we had talked about this a little bit before, like the I think there’s like two parts of it. Like, once you’re personally kind of able to, like have that acceptance. So maybe like you’ve, you’ve done your research, you’ve read about this, you’re listening to this podcast, and you’re feeling like Yeah, absolutely. Like, I want to support the autonomy of everyone who’s in my care. Sure, they’re using drugs, like that’s one aspect of them, I want to support, you know, whatever they need with that, I think then we also run into, like, a personal level of acceptance about it. And then policies, that at the work that could go very much in opposition to that, perhaps. So I don’t know, you know, if we want to dig into a little bit of that side, because I think that’s where sometimes kind of like rubber hits the road, I think most people do really want to, they want to support their patients. And then we end up feeling kind of like, our hands are tied by institutional policy and what’s kind of been set up.
Carlyn, LCSW 19:04
Regardless of how you feel about all of this, there is a lot of policy that, like you said, makes it really challenging to practice in kind of a compassionate harm reduction manner. So most hospitals, most birthing centers, drug test, either pregnant people or babies, and, you know, nobody, it’s it’s not super uniform, a lot of people do it differently depending on where you are. But all of this stems from something called CAPTA. And that’s a federal piece of law, the Child Abuse and Prevention Treatment Act, and I don’t have the exact date. I think it was in like the 80s. Maybe this was a thing, but it’s something that gets amended every couple of years and like keeps going but it is a federal piece of law that that is in charge of giving block grants to states. These block grants often go to fund like social service programs or aspects of the safety net, but what this, what CAPTA does, what part of it does is in a very twisted, misguided, horrific way it attempts to to deal with drug use and pregnancy. And it’s a very punitive, not helpful, you know, method of of dealing with this at all. But what it’s kind of turned into is the rules around what happens when there is a positive test. CAPTA doesn’t say that you have to test everyone or you have to test no one. It doesn’t give those guidelines, but it it says if there is a positive test, this is what has to happen. And and I think every case, it’s it’s reported to child protective services. So that does that make sense? Like a little background on why the done?
Maggie, RNC-OB 20:46
Yeah, absolutely. Because I think things are often just like done, because they’ve always been done. And so you’re not really sure where you have to go to then kind of start to unravel the process.
Carlyn, LCSW 20:54
Yeah, yeah, chances are, if your hospital or your clinic drug tests, it is because of this legislation, or in response to this legislation. So I know where I used to work, it was in we very, we got like, very in, you know, into the the technicalities of it, but it when I left the hospital where I was working, it wasn’t necessarily a mandated report, if a pregnant person was was tested positive for an illicit substance, but if the baby tested positive for an illicit substance, or a prescribed substance with the caveat that there was observe neonatal abstinence syndrome, so some sort of observed, like withdraw. That was a automatic mandated report to local Child Protective Services. So you know, and again, not everybody does this. This is not like a uniform thing across all 50 states. Every state does it a little differently. Some are like more punitive, others are less. But so speaking to Maryland. First off, I don’t, I don’t believe we should be drug testing any pregnant person or baby and I believe that firmly because I think we should have a good enough relationship with our patients, where they’re honest with us, and we’re honest with them. I don’t believe that a drug test is a an indicator of your ability to parent, a drug test doesn’t necessarily we’re not what are we screening for? We’re not screening for a substance use disorder, right? Like, plenty of people smoke weed here and there, they test positive, that doesn’t mean that they have problematic use or cannabis use disorder. It’s kind of this like, it just it doesn’t make sense from like, a clinical perspective, I think, but it’s, it’s turned into this like very punitive marker for who is an acceptable parent and who, you know, we don’t trust a parent. So
Maggie, RNC-OB 22:47
I think if you could just like say that part, even one more time, because I think that’s a that’s a big difference in and I think what we think we’re testing, so being very honest, you know, I certainly, one of the places I used to work, they, you know, routinely drug tested everybody who came into labor, I didn’t think too much of it. Like it was different from- we didn’t do that at the place I’d worked before. But I thought like, “Oh, I guess this is just how they do stuff. Okay, you know, whatever.” In retrospect, obviously, looking back, I wish I had questioned that whole process a little bit more to kind of understand, to your point, like, what are we actually? What are we testing for? What are we looking for? What is this information actually providing it? So I think if you just want to say that piece one more time, because I think there, we’ve crossed some wires there in terms of what what information a drug test can actually provide to us. And you know, one, one stop shop kind of thing.
Carlyn, LCSW 23:40
Just to say it again, a drug test is not a marker for ability to parent. So drug use has no bearing on your ability to parent and I have said this to countless people that I’ve worked with worked for, you know, I if I could kind of make that like my tagline, that’s what I would like to make it. But you know, how we drug test, you know, you can have a endless conversation about how coercive that is, right? Like oftentimes people that that come to the hospital for care come to the breathing center for care. When you’re signing those consents. Most of the time, you’re not being told, like hey, by the way, we’re going to drug test you and if you test positive, this is what x y, z could happen. So the way in which it’s done is also super secretive and unethical in my opinion, but it’s not a marker for your ability to parent what is the marker for is that sometime and in the past two weeks, probably you use this substance or had contact with this substance so it has no bearing on your ability to parent and and I think it’s really irresponsible and harmful for us to complete those things.
Maggie, RNC-OB 24:53
Yeah, and we do it all the time. That has been the standard is to yeah, use those as stand-ins for each other.
Carlyn, LCSW 25:02
Yeah, I mean drug use in and of itself is not harmful, right, it’s a normal part of human development to experiment with drugs. You know, if the the mom that loves to go to Target and drink wine is using substances just as much as the person that likes to smoke a joint or you know, casually use whatever it’s, it’s not, it’s not a marker for being a bad parent, you know, people been getting high since the beginning of time. And I wish healthcare clinicians could be honest with themselves really, like, so many folks that I’ve worked with in the past, like, I don’t know, when you were in college, or maybe you were a kid you experimented, it’s, we act like drug use is just this horrible thing, when, in reality, you know, it can be part of a good time it can be done a non harmful manner. And, again, it has no bearing on our ability to raise our child.
Maggie, RNC-OB 25:57
Yeah, I think it is like that. The illicit substance, the ones that you’ve decided, like, right, your nicotine, your alcohol, those are fine, those are regulated, we’re getting our taxes for them. That’s okay. But if you’re doing THIS… and I think that, I think having heard that, that was like a helpful thing for me to realize like, Oh, right, like, yes, we all use all sorts of different substances all the time. And absolutely, me having a glass of wine, while my children are sitting there playing is not making me a bad mom…
Carlyn, LCSW 26:30
No!
Maggie, RNC-OB 26:31
Obviously. And so you know, we’ve tried to make substance use this more encompassing thing, instead of recognizing that it can be, for some people, it can be an issue, it can be something that they want help with. And I don’t know, if you want to kind of touch on that piece of it, too, is how it comes up kind of within pregnancy. And as we’re developing that relationship with people, for people who want to make a change in their behavior, recognize that they are not comfortable with the way that their drug use could potentially impact their parenting.
Carlyn, LCSW 27:04
Yeah, so the beautiful thing about harm reduction, and the beautiful thing about meeting someone where they’re at, is the relationship and trust that’s built in just the act of not necessarily just coming out and judging somebody, but sitting with them listening to them, and saying, like, what do you want to do that, even if that moment, they may not be ready to reduce their use, or maybe speak to somebody that can help them out with medication over time, you’re more likely to get into treatment by utilizing a harm reduction approach than if you were strictly to be punitive. So just that human connection, and that empathy makes someone feel safe, it makes someone feel heard. And they’re more likely when they’re heard, and they they’re safe to come to you if and when they’re ready to reduce or stop use. You know, for folks that are interested in treatment, that’s amazing. And, you know, part of what I used to do at the hospital is help them with that, whatever that looks like, but not everybody is like, ready for treatment or wants to stop. And that’s totally okay. That can be another really challenging thing, things for clinicians to kind of come to terms with, is that not everybody wants to stop using drugs and and, you know, it’s okay, that’s, that’s their choice, that they have autonomy, they can do that not every choice is the greatest choice. But a person that continues to use as likely has their reasons for it. So our job becomes, you know, and when I say are like my job as a social worker, and a clinician becomes like, how can I help you make any positive change? Or any? Like, how do I help you be safe, whatever that looks like, how do we talk about that? So, for instance, if you’re someone that uses heroin, and you you know, your means of using it is by injection? How can we get you safe needles or clean needles? How can you know, is there a place around I know in Baltimore, there was Spark, where can I send you so that you can get like safe injection kids and you get you can get fentanyl testing strips and you know that, you know, you have a safe place if you need it. I think when we talk about treatment, sometimes the conversation immediately goes from Oh, this person is using XYZ substance, oh, they need treatment. That’s not how that works. We have to talk to the person, see, you know, what’s going on what they want. And if you know that person wants treatment, excellent. let’s hook them into, you know, a clinic or if they can come to our place to get it great. If not, what can we help them do to just like be a little safer?
Maggie, RNC-OB 29:48
Yeah. And I think again, I know from when I you know, as a nurse, I have a different relationship with folks and I tend to be meeting people kind of quickly at the hospital. I haven’t had the benefit of you know, months of time. talking to them and understanding kind of you know where they’re at. And sometimes it feels like, okay, we have this, you know, this drug screening that was positive for substance, and then it kind of puts in place this whole litany of things that have to happen. Can you speak a little bit to kind of like, what if we’re working in a place that is not following a kind of harm reduction framework? What are the ways that we can still kind of step in and support our, you know, our patients autonomy, kind of within that, a bit of a retrofit? For if that’s kind of where your system is still?
Carlyn, LCSW 30:33
Yeah, of course. So the first thing that I would encourage you to do is have a conversation and really read the law. So wherever you are practicing if you are at a hospital, and it’s routine to drug screen, every pregnant person and every baby, what’s the law around that? Why are we doing that? So the first thing is understand the law. So because this cascade of events doesn’t happen in a silo, it can impact the entire trajectory of someone’s ability to parent their child, you really want to know what that’s going to entail. So, number one, advocate that the people in charge, read the law and fully understand what this drug test has the potential to do to I think people in healthcare don’t understand Child Protective Services, or kind of better known as the family regulation system. That term was coined by Dorothy Roberts, people that are not necessarily in social work. It’s been my experience that other health care providers don’t understand what CPS or the family surveillance family regulation system is, it is it is not a friendly place. Oftentimes, I have heard nurses and doctors talk about, oh, this person’s, you know, they tested positive for XYZ, and they just need support, send them, you know, you’d have to report it to CPS? Absolutely not. We’re going to full stop on that. And let’s unpack why the family regulation system in this country, just like the police are deeply rooted in white supremacy and slavery, just like the police used to be like the runaway slave troll, Child Protective Services, the family regulation system, directly, deeply embedded in slavery, it is not a place of support, nor should it be used as one. That’s like the first hard point that I need to make. Again, a lot of nurses, a lot of doctors, a lot of people that may not have curriculum in graduate school that that kind of focuses on this. I don’t know. I mean, it’s not something that’s widely talked about, you know, at this point in, in kind of, like our cultural dialogue, right.
Maggie, RNC-OB 32:46
Yeah and that’s hard to hear. We want to believe in safety nets, you know, we want to believe that there is something… Yeah, but there’s a lot healthcare workers, I think generally like our, our vibe, one of the things we want to do we think we can help fix something. Yeah, we want to be able to Band Aid rubber stamp something. And it’s hard to know that, that that’s not what’s happening there.
Carlyn, LCSW 33:05
Now, yeah, full stop on there is no, like, you know, as somebody and this is just a caveat, like, I can count on one hand, the amount of times as a social worker and mandated reporter that I had to call CPS for something that was I was actually very concerned about when it comes to abuse or, you know, one hand, I mean, I could probably maybe three times CPS is punitive motive. It’s just it’s policing, it’s family policing. So along with understanding the cascade of events that can happen when you drug test someone or you drug test their baby, you also have to understand the system in which that’s working in it is a system that targets black and brown people black and brown families, far more than it does white. And it is designed to, I mean, it’s designed to punish families and to rip them apart. And I know that’s really hard to hear. And that is something that maybe folks that work in the child welfare sector may not necessarily agree with. But if you look at like the statistics of who is investigated and who is placed in foster care, it is it is a system of regulation of Black and Brown families. The positive is there are things that we can do to mitigate the need for interacting with that system. So I think mutual aid is the biggest, you know, safety net against having to get involved with this system. So, you know, if you’re just trying to give concrete, you know, answers if you are working in a hospital that utilizes a social worker, get with your social worker and say like what are the community organizations Does that provide pack and plays? who provides cribs who provides take home formula? Do we have like a milk bank or for a formulary that has infant formula, if this person is going home, and they don’t have the things that they need at home, can I give them formula? Can I give them a pump, you know, whatever. So accessing support from community organizations or individuals, I think is the biggest, you know, way to mitigate the need for for CPS involvement. Now, let’s say we have somebody that has, you know, tested positive, so we know that we’re their baby is tested positive. So it’s an automatic mandated report. Let’s talk about ways that we can decrease harm that’s done through this process. So what that looks like is charting from a strengths based perspective. Oh, I, you know, mother and baby bonding beautifully, or like mother very attentive to baby’s needs. I know, this is like very heteronormative language, but I’m sorry, that’s like, the way a lot of it’s done. So like, what are you observing or observing? Great bonding? Awesome, chart it like, what are you saying that could potentially help this person because, you know, I think it may be unsettling, but a lot of times these notes are read in court. And so whatever you’re writing, like, has the potential to like, be in front of a judge and so chart in a way that’s really going to help the family that you’re working with?
Maggie, RNC-OB 36:32
Yeah, because I mean, that is something that that isn’t that we can do in any system that we are in, you know, is really, and I think that, you know, the strength based approach, we’ve, there’s, we’ve talked before about kind of some charting and how that kind of falls along with liability and all that stuff. But I feel like that piece of just being really cognizant of the impact and the power, that our words written or spoken, have on the family’s outcome is just as important to keep at the forefront of our mind.
Carlyn, LCSW 37:02
Nurses, nurses in particular, can can be like, have the potential to be the best advocates, like the nurses that I worked with, at my old job. I like it would bring me to tears, like seeing them, like the way that they would advocate for the people that they were working with. And I mean, don’t sell yourself short at all, like you can really help the folks that you’re working with, like, God forbid, that note is read in in court, or, you know, this person does have to have this interaction with the surveillance system. You know, you can really help advocate for the least amount of harm possible.
Maggie, RNC-OB 37:41
Yeah. And then, you know, as we’re kind of wrapping up, do you feel like what are the other ways that we can move from surveillance to support,
Carlyn, LCSW 37:56
Stop drug testing your patients! I mean, that’s really like, yeah, stop, you know, coercively drug testing pregnant people and their newborns, and focus on building a trusting relationship with your patients where they can be honest with you, and you can be honest with them, making the mental shift from a, whatever outcome happens on a urine toxicology, to being a marker for being able to parent make the mental leap of separating those two. And, you know, I love what you said earlier about, kind of doing the work of checking in with ourselves and understanding that, like, we may come to this space with some difficult history, or even trauma, and we have to give ourselves love and give ourselves understanding in order to really come as as a clean slate and, and come at least understanding that like, we may have this past and we may have these preconceived notions, but we understand that not everybody that we meet is going to be the exact same way as our past or, you know, fit into this box.
Maggie, RNC-OB 39:08
Does that make sense? Yeah, yeah, that’s huge. I do I mean, like I, you know, there’s more like, this is something I don’t want anyone listening to this to feel like you already supposed to have arrived, you know, to this point, like, this is something that it takes consciously, unlearning. Yeah, we’ve been taught about it the way that like I said, both in like kind of a structural education framework, and also just society, what we have picked up about kind of cultural norms around drug use and how you’re supposed to feel and react to that. So there’s a lot to unpack there to then realize like, oh, okay, maybe I didn’t learn that the right way. Great. Now how do I go forward from here in a way that is still…You know, I don’t want anyone to feel like they are stepping so far out of their you know, comfort zone like you should still be authentic. In, in your interactions, and you know, like we said, recognizing where, where you can and can’t do that, and where do you need maybe more support? You know, where are there opportunities for you to, to partner with other people to talk about this with the social workers that you work with to see kind of understand get a greater understanding about your role and the impact that has on this whole, you know, system. This is not something that happens overnight. And, you know, we’re going to link in the show notes as well. A couple of really like phenomenal resources about trainings for, you know, harm reduction within birth work. There’s a really great, like lengthy PDF resources for everyone that talks about perinatal harm…the perinatal????
Carlyn, LCSW 40:41
Harm Reduction Academy.
Maggie, RNC-OB 40:43
Yes!
Carlyn, LCSW 40:44
Perinatal Harm Reduction Academy, I know the folks that put that together, and they’re fantastic. And I use it all the time on labor and delivery. It’s a fantastic resource.
Maggie, RNC-OB 40:53
Yeah. So we’ll you know, we’ll share that resource as well. Because I know that was really helpful for me in terms like reading through that and thinking like, okay, yes, like the, these are the steps, it’s really like spelled out in ways that are really kind of easy to chunk up and understand, okay, like, this is how we can move forward at this place. And so you know, we want to provide that to all of you so that you have a little bit more context for, for this work for how you can show up to really best support people and how we can make these changes in our perinatal health care system, like they don’t happen overnight, obviously. But we, we can still help one family at a time, to have a better interaction with us, to feel more supported through their birth and to your point, so that then they get the whole point is for us to help them so that they can go on happily parent, their child, you know, and I think just that separating a little bit more of that piece about like, our role, our expertise, what we are bringing to the situation and remembering that this is a snippet of someone’s life, that they are going to go on living, once they leave the hospital and just kind of being cognizant of that piece of it to like holding that space around that.
Carlyn, LCSW 42:09
Yeah and a snippet that has the potential to to really impact them. But like a snippet, nonetheless, there’s also Movement for Family Power, an organization that is doing phenomenal work around kind of abolishing the family surveillance state limit for family power, the great book, Shattered Bonds, the Color of Child Welfare by Dorothy Roberts, and then When the Welfare People Come by Don Lash is also really good for anybody that’s interested in kind of learning more about this system.
Maggie, RNC-OB 42:45
That’s so helpful. Thank you. Is there anything else you’d like to kind of share any other gems you want to leave us as we end up?
Carlyn, LCSW 42:52
No I just I think the fact that someone’s listening, and they’ve continued to listen throughout the whole podcast,
Maggie, RNC-OB 42:57
[laughter] If you’re still here…
Unknown Speaker 43:00
Means that you know, you, you’re at least intrigued and willing to learn. And that’s kind of the biggest part, like you said earlier, like give yourself grace. It takes a while to learn something, it takes an equal amount of time to unlearn something. So if you’re curious, I’m always you know, happy to chat. I’m on Twitter and on Instagram, I’m not on Facebook. Just, you know, do the work, read the stuff and and try your best.
Maggie, RNC-OB 43:31
Thank you so much, Carlyn. Thank you for having this conversation with us. I really appreciate it.
Carlyn, LCSW 43:34
Yeah. Thanks for having me.
Maggie, RNC-OB 43:36
Thank you so much for tuning into this conversation and sharing it with me in Carlyn. I hope that this was really helpful for you to perhaps reframe, or to affirm some of the ways that you’ve wanted to care for pregnant folks who use drugs, and ways that you want to navigate surveillance in the hospital, and think more about our roles and responsibilities as healthcare professionals. We’d love to hear your feedback on this. You can join our community group on Facebook, Your BIRTH Partners Community, or follow us across social media; we’re Your BIRTH Partners everywhere. We’d love to hear more about what you’re thinking and what this brought up for you and what you’re experiencing, where you work and where you care for pregnant folks. Definitely recommend that you check out the resources in our show notes. There’s a lot of great information there for changing practice and and creating a better system. But we can’t wait to hear what you think. Till next time!
039: Who Needs A Pelvic Floor PT Around Birth?
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth gear communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation, as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
This week on the podcast, we are digging into all things pelvic PT, and we are, this is just such an important conversation. And I think it is one that has been just really sorely underutilized. Physical Therapy in general doesn’t get as much, you know, kind of as many of the attention, referrals that really needs to help clients do well. And this is not different during the you know, the pregnancy and postpartum period. You know, when you experience something like pregnancy, and all of the intense changes that happen in your body, there is some healing that needs to happen after that. And then healing shouldn’t be happening bubble, people shouldn’t feel like they have to guess about if the changes that are happening in their body after you know, part part of our normal. And luckily, pelvic PT exists to really help us to understand more about recovery. They are a great resource for us, as you know, birth professionals who want to make sure that those in our care are, are really getting everything that they need. And I think there has been a lot of assumptions and misunderstandings about when pelvic PT is, is necessary or is useful. And so I’m really excited for Dr. Rebecca Maidansky, a physical therapist specializing in pelvic floor to come on and really share more about the specialty and about how we can all be you know, referring and, and how and when pregnant and postpartum folks should be looking for a pelvic PT to be part of their care. So onto the show!
All right. Well, Rebecca, welcome. I am so excited to have you on to talk to us about all things pelvic PT today. So if you just want to introduce yourself to our audience a little bit and tell us kind of about like just a little bit background about you and education where you came from what you’re doing.
Rebecca, PT, DPT 2:28
Yeah, sure. I’m so happy to be here. Thank you for having me. My name is Rebecca. I am a pelvic floor physical therapist and the owner of a clinic called Ladybird Physical Therapy in Austin, Texas. We specialize on perinatal health. So we do a lot of managing pregnancy pains preparing for birth, recovering postpartum, and then of course, other stuff as well. But that’s sort of our area of expertise. I’ve been a pelvic floor PT for for nearly four years. Now, I have a background in sports and orthopedic physical therapists, I work with a lot of a lot of active pregnant people, too, who want to get back to activity. So that’s sort of my approach is from kind of like this orthopedic sports realm, but we also we also really focus on just pregnancy and postpartum recovery.
Maggie, RNC-OB 3:11
Mmm, that’s great. That’s awesome. So you are you an expert in mind then to really dive into kind of all of this idea about like, pelvic PT! One of the things we’ve been doing in this season is really talking about areas where we’ve helped maybe hold bias as professionals where we haven’t maybe, maybe we don’t understand something enough, or we’ve kind of have ignored it or just kind of made our own assumptions that maybe aren’t based on what’s about. So I don’t know if you know, first you kind of just want to explain a little bit about pelvic PT, I think for a lot of us as folks existing in the world that it’s worth it when we think of like pelvic PT, it’s a kind of a narrow, a more narrow scope, perhaps in thinking like, “Oh, yes, it’s for something if you’ve had like a really bad tear, or you’re like, still peeing when you jump or sneeze years later,” but can you give us kind of a little bit of an overview of some of the things that you typically see, especially during the like pregnancy, birth, postpartum continuum?
Rebecca, PT, DPT 4:01
Yeah, absolutely. I mean, I think that the bias towards pelvic floor physical therapist, both in patients and healthcare providers alike is that we, we work with people who’ve had these like really traumatic births or having these really big issues and what the research shows, what we’ve seen clinically is that pelvic floor physical therapy can be so much more than that, there is so much that can be done preventatively to support people in their goals of whatever their vision for birth is, whether it is a VBAC, a Cesarean birth, a home birth, whatever it is a medicated and unmedicated vaginal birth. And I think that what we’re starting to see in our practice is that more and more people are becoming more educated about their birth and their recovery and they’re wanting that so what we see a whole lot of from a diagnosis perspective is of course, urinary incontinence, pain with sex, constipation, bowel incontinence, we see a lot of pubic symphysis pain SI joint pain, tailbone pain. But we’re also seeing a lot of people who are coming in, of course, urinary urgency, frequency that stuff as well. But we’re also starting to see a lot of people coming in who are pregnant who are feeling well, and who want to know how they can support their pregnancy, how they can support their birth vision, how they can support their postpartum recovery. And there is so so much that can be done to help meet those goals. And so we do a lot of preventative evaluations to assess if somebody has a diastisis recti, what their control is of their pelvic floor, if they know how to engage their pelvic floor, if they know how to push what their global strength is, if they need any strengthening during pregnancy, if they need stretching and relaxation, and then training for birth. And then also kind of setting timeline expectations for postpartum recovery. Because what we do also see as people who are feeling really, really well at three weeks postpartum, which happens, who then go on a run, and all of a sudden have prolapse and leakage and all of these things that could have been very well prevented. So I think that you know, pelvic floor PT is becoming better known for treating issues. But I think where we were, I really hope the field is growing as to preventing them in the first place. Hmm,
Yes! And that prevention piece is so important. Obviously, we’ve seen so much in just mainstream medicine about you know, and obviously, in recent decades about how important, you know, preventative medicine is and as prevention is worth a pound of cure, and you know, all of that piece of it. So, given that, Why? Why do you think that pelvic PT then isn’t really still seen as like, a standard of care? You know, why is that not that everyone just as they’re going off to maybe find a midwife or an OB, whoever is kind of caring for them during pregnancy… Why aren’t they also then at you know, whatever time in their second trimester may be going in and checking in with a pelvic PT?
I think a lot of it is our biases, our own biases, the biases of our healthcare providers, I think that a lot of people just don’t know. I mean, I think that the general public is just coming into the awareness that we exist. And, you know, it’s something that I think sounds very unconventional to people. And so if they’re just hearing about it for the first time, and it sounds kind of weird, I think that as soon as they’re met with hesitancy from their healthcare team, from their ob gyn, from their midwives, which unfortunately, it still happens, I think people are very quickly pushed away from it. And I think that our healthcare system does not do a good job of preventative care, nor do I think they do a good job of really caring for the quality of life of birthing people. And so I think that unfortunately, we are, we’re just living in a medical model that treats illness. And that doesn’t take, that doesn’t take prevention seriously. And on top of that, we are societal only trained to avoid talking about pee, poop and sex. They’re inappropriate. That’s what we’re told as kids, you don’t say those things publicly. And on top of that, I think that a lot of our medical community isn’t well trained on how to navigate bladder balance, sexual dysfunction. So it takes so long for a patient to even tell a physician or a midwife that they’re experiencing these things. And then oftentimes, they’re met with a provider who doesn’t know what to offer them. And so by the time I mean, in the United States, it took six and a half, six years on average for people to find a pelvic floor physical therapist or treatment for pelvic floor dysfunction. And I think that a lot of those are a lot of the reasons why, unfortunately,
Maggie, RNC-OB 8:24
Mmm. So six years….
Unknown Speaker 8:27
That’s the average for women. For men. I believe it’s four. I know.
Maggie, RNC-OB 8:34
I know, of course, no surprise that even present like that, that would feel like, you know, maybe women would have access to you know, an OB and it would be referring to that, that they still have even longer treatment times for an issue.
Rebecca, PT, DPT 8:45
I think a lot of that is I mean, a lot of that is also that we’ve normalized postpartum pelvic floor dysfunction. We’ve normalized peeing with coughing and sneezing. We’ve normalized never being able to jump without peeing. And so I think that that is a huge factor, holding people back amount of people I see who’ve been told like, “Well, yeah, you had a baby. What do you expect?” Or “Well, yeah, you’re pregnant. What do you expect?” We’ve normalized pregnancy as a painful experience, we’ve normalized being a parent being associated with all of these dysfunctions. And so I actually think that it’s a huge hindrance that people are going to see their OB-GYN being told that what they’re experiencing is normal. And we’re, you know, we’re conditioned to trust our physician, so you don’t look into it beyond that. Unless you I mean, honestly, half the time unless they stumble upon something on Instagram. And so it’s there, you know, that that’s a huge factor is that people just think they should be feeling these things.
Maggie, RNC-OB 9:41
Ah, that’s so frustrating. You know, it’s, it’s hard for something that is, you know, in many ways, it’s like universal experience, something that, you know, millions of people have babies every year, you know, in the US around like 3 million, 4 million, that there’s so many of us then that are going through this at the same time. And then instead of being able to, like, rally that together to, like, want better, to want to make the whole experience more comfortable, it ends up just kind of falling into like, yeah, it happened to me It happened to you like that there’s not that same drive to then to then fix it. And I absolutely I think like, social media has its flaws, absolutely. But but there’s so much good that can come from people than just having another place to look for information that hopefully they can bring to, you know, another whether it’s a, you know, a trusted health care, you know, professional failure and say, like, “Hey, I’m experiencing this…” or, like, “this doesn’t sound right, I saw this post on Instagram….” And it felt like maybe this is something that I should be looking into. Like, there is, there is power in, in that piece of it, but it needs to go so much, so much more because, like you said, so many people, they just you’re accepting it. And that’s and that I feel, you know, for, for all of us is, you know, birth professionals, like, it’s our job to, to break that down to stop that stigma to make sure that we’re really engaging with, you know, our clients and those in our care, to ask them and to not feel the need to, you know, snicker or giggle or be awkward about it, that this can just be as straightforward of a question as we have for everything else. All of the other bodily systems, we have that we ask our patients about, that they can also feel like, right, it’s, it is totally reasonable and Okay, and necessary to have those conversations with, you know, with your midwife with your, with your physician, with your nurse, you know, I feel like I it’s one of things that I have tried to really pay attention to as a nurse in the hospital, as I give people discharge instructions. I in the last couple years have really started honing in more on this idea that like, hey, couple things on this sheet. If these are still happening, you really need to let us know about it. Like it’s really not. It’s on here, because it might still be happening. But that doesn’t mean it’s, it’s normal, or, okay. It’s an actual issue. I feel like we need to be doing more in terms of people.
Rebecca, PT, DPT 12:06
I think that I think that it is kind of our responsibility as healthcare providers who work with pregnant and postpartum people to be loud about this stuff, and to kind of like really work to talk about it in a way that feels really comfortable and safe to the people listening because I think there are a lot of providers who have assumed that their patients will feel uncomfortable talking about bladder bowel, sexual dysfunction. And when people come to see me, this is usually how it goes. They meekly tell me there’s some sort of complaint, leakage, sex, whatever. And my response is, well, first of all, there’s then they’ll they’ll say, like, I don’t know, there’s too much information. There’s no such thing as TMI, your sexual health, your pelvic health is your health. And what I have seen every single time is the moment I say, there’s no such thing as TMI. These are things I talk about every single day, this is part of your health, just like everything else, all of a sudden, it’s like a floodgate opens with information because people want answers, they don’t want to have pain with sex for the rest of their lives, they don’t want to be too scared to go to the park and run around with their children, because they’re scared, they’re gonna pee their pants, they don’t want to feel these things. But I think that a lot of people have been met with providers or friends or close people in their lives who they tell the truth to, and they get a very awkward and uncomfortable response. And so it quiets them down. And I mean, I see it most in our older population, with young pregnant people, postpartum people these days, I think that there is more more discussion amongst around this stuff. But when somebody comes in who’s been having these symptoms for 20 or 30 years, it’s really hard for them to talk about. So we need to be able to really confidently have these conversations, and we don’t have to have all the answers. That’s not what I mean. But we have to be able to talk about it.
Maggie, RNC-OB 13:56
Yeah, absolutely. another thing I think, you know, it comes with practice, right? It comes from if you grew up in, you know, in a family or, you know, you weren’t educated to really have frank discussions about this, and you’re still feeling, you know, residual kind of anxiety or that this is a private, you know, matter. That’s something that like, Great you can practice, practice with your colleagues, talk through it, talk to your family, sit with a friend, talk to yourself, record yourself asking people questions about this until you feel like it’s something you can do just very smoothly, as much as you assess every other part of you know, their body, so that it comes out naturally so that they know you’re comfortable with it, they can be comfortable with it, too. I think there’s, there’s that piece of it where, you know, those, you know, birthing people, pregnant people, postpartum people don’t feel comfortable saying stuff, perhaps or they just accepted as normal. And then I think there’s also maybe this piece of providers who are maybe slow to give a referral. And so I don’t know if you know, I don’t know… I’ve certainly heard I’ve seen it in you know, in practice and I’ve heard from friends who’ve said something to their, you know, to their physician or their midwife after after having birth, that like no I’m having this issue. I don’t know is this you know, Is this normal? Is this okay? And that they, in one instance, a friend had particularly asked like, Hey, I think I need, you know, pelvic PT referral, I think that would be helpful, and that their provider was like, “Oh, no, we wouldn’t do that unless this is still going on, like, several months from now.” So I’m wondering too about like that. How you know, where that piece of it is coming from what you see in your practice?
Rebecca, PT, DPT 15:27
You know, I think that, I think that unfortunately, you’re what you’re describing is really common. I think that it you know, I, there are a couple ways to navigate this. So on one hand, I always tell people, you can ask for a referral. It is like, even if your physician says, and you don’t really need it, you can say I want it, and they should give it to you, unless there is some medical reason where they believe that you are not safe to participate in physical therapy, which is very rare. We do definitely still see some hesitancy in Austin, Texas, I have some really amazing relationships with local OBs and midwives who openly refer and it’s incredible. And the ability to be able to text back and forth with OBs about their patients care is so incredibly valuable. But we do hear these stories of people who say, you know, I asked, they said, I don’t really need it. And this is the problem when that happens. The problem is that then it pits me against their OB. And I have tried very, very hard not to do that. I don’t like to be in the middle of relationships between healthcare providers and their patients, because by weakening any individual relationship, you weaken that patient’s overall care. So by an OB saying, “No, you don’t need it,” even if that patient wants it, it puts in their head, that they might be wrong, but they might not actually need to come see us, they come to see us and they think and maybe you don’t really need this. I think that that hesitancy, and referring really comes from a lack of understanding of what a isn’t, isn’t normal, and what can and can’t be done about it. It is what I tell people, they should expect postpartum as you may have pain, leakage, discomfort for the first two to three weeks, it should get better consistently. But for a few weeks, I mean, you just gave birth right? Like you’re recovering, it makes sense that you might be a little bit uncomfortable. If it continues past three weeks, and it’s not getting markedly better consistently. That is when you need to start care, not at six months, 12 months down the road: at two to three weeks out. Because if we think about somebody, post op knee replacement, where they literally have construction surgery on their knee, right, they chisel the bone down with a hammer and saw, they put it back together with metal parts in place. They start PT the same day. Right the same day, realistically, our pregnant and postpartum, postpartum people should be seeing a physical therapist in the hospital before they’re discharged, they should be starting physical therapy immediately. But I think that we are worlds away from that being a standard of care. And that really scares a lot of physicians. Two to three weeks is where I think that if you’re still uncomfortable, we need to be having that conversation. And I also tell people, if you talk to your physician about it, and they’re really hesitant, and they say, you don’t need to, I don’t want to send you not yet, you can call a physical therapist still see them for an evaluation in most states, and most states, you don’t need a referral for initial appointment. And once you form that relationship, they can call the physician office all the time and say, “Hey, I saw your patient, I really think they’d benefit from care for this, this and this reason,” and the vast majority of the time, they’re like, “Yeah, whatever. That’s fine.” Right?
Maggie, RNC-OB 18:43
Yeah. Oh, that’s so interesting. Yeah, I think they’re I, you hit on so many important parts there. I feel like that piece of the trust that we build, you know, between our patients, and how that erodes when we start having those kind of those blocks in care and pitting each other against ourselves like that helps no one. And I think it’s this bigger conversation too. You know, if ideally, by two to three weeks, people who are having an issue are getting into care, and most people aren’t seeing their health care provider till six weeks, then obviously, we’re missing it. And we’ve talked, you know, at length on the podcast before about just the ways that we fail folks during the postpartum period. And this is a chief one of them, like we’re not checking in often enough then to actually pick up if there’s an issue and we’re counting on people who are also taking care of a newborn, and sleep deprived and getting to navigate a whole new body to be able to tease out I don’t know, is this normal? Do I need to find someone all of a sudden by myself like, right, it’s putting way too much pressure on them when they already are. In the midst of so many changes, and under just just physiological stress, recovering from birth.
Rebecca, PT, DPT 19:59
And that’s enough. One of the main we can talk about prevention and prenatal care and how important that is. But establishing care with a physical therapist prenatally, which I think a lot of people are still unfamiliar with the benefit of one of the main things that I tell people is that you can email me whenever you’re my patient, right? Like, you can contact me and say, “Hey, I’m feeling this… Is this normal?” And I will email you back and tell you whether, “hey, I think you need to absolutely call your ob about this.” or “Hey, I think that this is a really normal thing that we see in healing,” you know, like it, the benefit of having just that contact, then the amount of safety that that evokes in our in our patients is so incredibly valuable. And I think that in blocking people starting care prenatally, we are blocking their ability to have support in that postpartum period.
Maggie, RNC-OB 20:53
Mmm, yeah. So I think that one of the questions I had for you was kind of the too early to late, like, Is there a time that would be too early to seek, you know, pelvic PT, you wouldn’t be able to really can accurately assess the situation? Or is there a time that is just like, it’s, it’s too late in there? There really isn’t anything that came down at that point?
Rebecca, PT, DPT 21:12
Yeah, that’s a really good question. I think in terms of too early, it depends on the goals. And so if somebody calls me and they’re like, “Hey, I want to, you know, I need to exercise modification,” but they are, you know, six weeks pregnant. If you’re feeling good, you probably don’t need to modify that point. You’re like, I think that there, there are certain things that we can start that we should start at certain times. However, I see people who are, you know, 8 10 12 weeks pregnant, who are like, “Hey, is this too early?” And it’s like, it’s, you know, it depends on your goals, if you want to come in, and you want somebody to make sure that you know, if you want to ask questions, it’s never too early. If you want to have a general strength assessment with baselining. It’s never too early, your physical therapist will not do an internal evaluation during your first trimester. So that’s, you know, relevant to know. But that just means that maybe it’s beneficial to start preconception. I, when I discharge a patient postpartum, I tell them that they would benefit from, especially if they had leakage prolapse, I suppose they would likely benefit from coming in prior to getting pregnant the next time if they’re planning on having more children, so that we can get an idea of prior to this pregnancy, where’s your baseline, because it might be different, where it was when you ended your rehab from your last pregnancy? So in that sense, it’s never too early. It’s, it’s never usually during pregnancy, if somebody’s feeling really well, they’re active, they’re fine. I usually say like, Okay, come in around, you know, because we want to be mindful of resources. And so we we usually, we’ll say, come in around like the 20 week mark, for a prenatal evaluation, your body will start to change, we have a better idea of, are you having difficulty managing and abdominal pressure? What’s your exercise? Like? What do you like to do, and now we might need to actually modify it. But in terms of is it in terms of too early for postpartum recovery, which is a whole separate topic? Sure. I tell people, you know, the first week, if we had it built into our health care system, that you start PT immediately, nothing would be too early, you should start rehab immediately after any operation or procedure or birth. Generally, I recommend because we have to be mindful of the system we exist within, I recommend two to three weeks, which is extremely early in the minds of a lot of people as the beginning your postpartum rehab, and then it is never too late. It’s never too late. Whether you are five months, five years, 50 years postpartum, we see people improving with symptoms, just with rehab.
Maggie, RNC-OB 23:41
Yes, that’s really it. I think there’s that piece of that integration to the healthcare system. Like it would just, I would love to see pelvic PT at the bedside, that that’s part of people’s, you know, evaluation to kind of discharge and, you know, go home and get situated because I also think, you know, once we’ve talked about before, to like, just how hard it is, sometimes when you you have a newborn and you’re navigating all of that, like getting out of the house to go to appointment just feels hard. It’s just like another thing on your list. And so then you put it off because you know, whatever. And then you just you end up you know, missing out on that piece, I think for for people who are listening to this because they’re absolutely people in the audience who are still now many years postpartum. I think could you say that, again, like that there is you can still help someone if you are five years, 18 years, 50 years postpartum.
Rebecca, PT, DPT 24:36
It is it’s never too late. I think that it’s so unfortunate how often people call me and they say, hey, my mom has prolapse. She’s 70 I know there’s nothing that can be done, but I want to get ahead of it now. Usually, I say you both should come see me because it’s never too late. I’ve had people who are 80 years old, who’ve had leakage for 60 years who have improvement in symptoms at six to eight weeks, you know?
Maggie, RNC-OB 25:05
That’s amazing, and also so heartbreaking.
Rebecca, PT, DPT 25:08
Like, it’s heartbreaking. And it’s heartbreaking because when you look at when you look at the health impact of really simple postpartum symptoms like leakage, we see increased incidence of cardiovascular disease later in life. Because people are less active, they’re less likely to participate in sport, they have lower body image, they’re less socially active, there has really far downstream effects. And I think that when I talk prevention, I’m not just thinking how do we prevent you from having leakage during pregnancy and two months postpartum? I’m also thinking, how do we make sure we educate you that these things are likely to pop up again, during menopause? How do we make sure to educate you that later in life, it’s never too late, your body never loses the ability to get stronger. We treat elderly folks like they’re already dead. And there is I mean, that’s a strong statement. Yes, true. We are terrified of taxing them. And there is no reason to treat them that way. They can get stronger. They still have goals. They, you know, like, it’s very frustrating.
Maggie, RNC-OB 26:19
Yes, it’s so frustrating. Yeah. So and so I think maybe one other question I had for you is like so what do you see is like, kind of maybe like the most common reason you see people being treated? And then on the other hand, like, what’s the most underrated one that you wish everyone was getting checked out for?
Rebecca, PT, DPT 26:37
Oh, that’s a great question. I don’t know that there is one thing that we see the most frequently but the most frequent cluster of symptoms. I’m going to give you a little list urinary incontinence, like coughing, sneezing, stress incontinence, specifically, leakage with jumping is super common. But we also see a lot of urinary urgency and frequencies and people who feel like they have a small bladder, which like you don’t unless you’ve had bladder cancer or an operation on your bladder, you do not have a small bladder, you probably a pelvic floor tension. We see a lot of pain with sex, a lot of painful periods. Because oftentimes, tension in the abdominal wall on the pelvic floor can contribute to those pains. I think that one of the most underrated things that we see that I’ve been noticing more and more, it’s so common, and nobody thinks to treat it as tailbone pain. We seating so much tailbone pain, and we see I mean, usually what happens is we’re treating somebody and they’re like, “Oh, yeah, I’ve had tailbone pain for 20 years.” And it’s just like, crap, like, you know, that alone is a treatable symptom. losing a lot of tailbone pain, I would say, pubic symphysis and SI joint pain are also kind of underrated. Physical therapy can be really, really helpful for that during pregnancy and postpartum. And I think people think of it more as a chiropractic issue, but in reality, that’s the place where we see where chiropractors and physical therapists would really do better if they were collaborating on that together.
Maggie, RNC-OB 28:02
Yeah. Hmm. That’s interesting. And then what so for, you know, our audience who are not clinical birth workers, what are some things that you feel like they can be on the lookout for? if, you know, as they’re helping, whether it’s during, you know, pregnancy or in the postpartum period? Like, are there certain signs symptoms, complaints that if they heard it from a client, that that would be or for for the pregnant listeners in our audience who are thinking like, oh, shoot, what should I be on the lookout for? Do you have kind of like, big, you know, red flag symptoms that you would recommend that anyone could kind of assess without being a care provider?
Rebecca, PT, DPT 28:38
You mean, assess, like, if they realize they’re having them as, like a sign that they should do something about it? Yeah, you know, I, it that list is extensive, and I will, I will go down that road in a second. But I think the really the one thing that I hear where I’m like this is probably actually just a normal change that happens with pregnancy get better postpartum. Because I think that this is one where people are like, Oh, I heard you say that, should I do do I need to care for it is frequent urinary frequency during pregnancy, all right, like you have a baby sitting on your bladder, it is very, very common to wake up a lot at night to pee and to have to pee a lot during the day, because a baby might be literally kicking you or head butting you in the bladder. So that is I think, like, honestly, one of the only times that I will say like, no, it really might just get better after you give birth is really my normal change of pregnancy. If you’re still feeling that postpartum 100% is a sign that you should seek care if you’re feeling that prior to pregnancy absolutely is fine, you should seek care. But during pregnancy specifically, that to me falls within the range of normal in terms of what they should be looking for in terms of how people should be, I think kind of like assessing themselves. And it’s a tough question to answer because really, I think every single pregnant person would benefit from an evaluation. But if we’re talking treating a problem, I would say leakage if you’re having urinary incontinence with sneezing or exercise, if you are feeling heaviness in your pelvis Like there’s a weight in your vagina, that is definitely a sign that you should consider physical therapy, if you are having pain that is limiting your ability to be active. So a lot of times I’ll see people that are like, oh, it’ll get better postpartum, I have this SI joint pain, this back pain. And it may or it may not, but one of the best predictors of a healthy birth is being able to be active through pregnancy. And so making sure that you are treating any pain during pregnancy, rather than just waiting for afterwards. And I mean, also, just as an aside, it does not always just go away afterwards, we’re told people are told that that it’s not true. So pain leakage, heaviness, or anybody who feels like they are less active because they’re not sure how to be active safely. That’s another really big reason to see a PT. Yeah.
Maggie, RNC-OB 30:51
Oh, and then another question. Within the last month or two, I had seen something you had shared about after a Cesarean birth and see scar massage. And that feels like something the way you would demonstrate it was definitely very, like, independent, the birthing person, postpartum person can do it after their birth. I would love to see that like, in the mainstream for how we help people and because I know so many people who have had cesareans, who still years and years later have have pain or have loss of sensation, you know, and just have discomfort from where vision and their scar was, is that something that like anyone could do? Do they need to see a pelvic PT first to kind of like evaluate for that? Or where does that kind of fall in the mix of that?
Rebecca, PT, DPT 31:36
That’s a really good question. You know, I think that if somebody is if somebody scars healed, right, you’re at least six weeks postpartum, your scars healed, you’ve been cleared by your ob or midwife or your ob probably if it’s a cesarean, to you know, to return to normal activity, you are likely safe to begin working on your own scar, people, especially following an emergency c section tend to be very hesitant to touch their scar tend to be very averse, touching the scar. And so I think that if that is the category you fall into seeing a physical therapist can be really beneficial to help you create essentially a desensitization program. Because what I always tell people is there is very little benefit to blowing past your body’s comfort level. And just like blasting through it and ignoring your aversion, the benefit really comes from slowly graded exposure. And so if you feel fine, your scars healed, you’re not going to hurt it by getting some lotion and rubbing it around. But there’s really no way to do it wrong, the goal is to just get that tissue to be more flexible. But I think a lot of people tended to be pretty gentle on themselves or just scared to touch it all together. And I think physical therapy can be really beneficial for that specifically, or to just teach you various techniques, because it’s not just about pushing down and moving it around, there’s a lot of benefit to using suction to lift the scar up. And that’s something that you can do on your own at home. But a lot of people benefit from training on and doing.
Maggie, RNC-OB 32:58
Oh, yeah, that’s great. Because I do I think sometimes people think, you know, pelvic PT, right? This would only be something for after a vaginal birth. And obviously, there’s so much more that goes into it beyond that.
Rebecca, PT, DPT 33:09
yeah, I do think unfortunately, you know, 30% of people in the United States have a cesarean birth 30%. That’s huge. You said three to 4 million people give birth to yours. That’s a million people roughly who are having a C section every year. And so I it’s, you know, it’s funny when I talk about pelvic floor physical therapy for postpartum recovery on social media or in blog posts, or when I you know, when I’m talking to people, they people will usually say like, well, but what about for a C section? And my answer, the vast majority of the time is that there is no difference. Like you still need postpartum rehab, following up this area after birth, if anything, maybe you need more, depending on how you know how birth one because then you have you have 10 months of this increased progressive strain on your body and then surgery. I think that you know, largely when I talk about postpartum recovery, I am encompassing vaginal & cesarean birth together, I understand why people wonder if that’s the case. But the C section scar work is obviously something that’s, you know, kind of specific to this area and birth however there you know, considering the prevalence of tearing with a vaginal birth and the peronism scar massage is also very important following a vaginal birth.
Maggie, RNC-OB 34:19
So much we just need to incorporate into into our care and what we’re offering to people so that they have more.
Rebecca, PT, DPT 34:27
Yeah, yeah, no, I mean, I completely agree this conversation is making me think that I like really want to put together a handout and get it into the hands of the labor and delivery unit and hospitals, just like give it to you know, if nothing else, like here’s your postpartum recovery timeline, your cesarean scar massage handout like just give this to people when they leave. If nothing else, that’s better than nothing.
Maggie, RNC-OB 34:50
Oh, I asked one other person as well. That would be so that is such a need. We need something like that. I’ve worked in several hospitals now. And none of them have had anything even close to that, you know, we literally have like the check block of like, Oh, these would be things would be like an emergency. And outside of that there’s really very, very little information about like, normal variations of normal end, and how to kind of be aware of that. I feel like that would be such.
Rebecca, PT, DPT 35:19
I’m gonna do it. That’s my assignment.
Maggie, RNC-OB 35:21
Okay. Thanks. Thanks for coming on the podcast. And now you have homework. So. But yeah, I think that it’s just it’s such a neat, I think it’d be so helpful. Another reference, another resource to give to people. So it isn’t just this, you heard from a friend, oh, your mom said, she’s been dealing with, you know, incontinence for the last 30 years. And she had you. So I guess this is normal, you know, you’re not dealing with any of that. And also, again, because not all providers have the same access to continuing education or the same desire to, you know, look into it, that helps to kind of get to be somewhat of an equalizing force for a lot of the issues that come up with why people don’t have good access to, to pelvic PT. So I will be eagerly awaiting that, that resource.
Rebecca, PT, DPT 36:04
I will send it to you know, it’s frustrating. I think that, and that’s why these conversations, I think are so valuable talking to people, interdisciplinary conversations, because I, you know, we all live in our own little worlds. And that, for instance, would be so easy for me to create, because it’s something that I say over and over and over again, every single day of my life. It’ll take me 30 minutes. I’m going to do it tonight. But I think that when we, when we don’t have these conversations, these interdisciplinary conversations between providers, we miss these huge gaps, like these really obvious holes, that could very easily be filled if we had better communication between professions. Yes,
Maggie, RNC-OB 36:45
yeah. I mean, that obviously, that’s why I’m, I’m so grateful for you, and all the guests who come on the podcast really talk about like, their area of expertise and share with all of us as a greater birth community, because it is so easy to get in your silo, you learn one way to do things in school, or you get to you know, whether you’re practicing in hospital or out of it, you know, you kind of get into your little niche, you do kind of the same things every time because that’s just what you’ve always done. And it’s so easy to, to just miss whole things like this. And not even you don’t even know sometimes it’s blank spots. You don’t even realize that you’re missing this whole piece that that people need. So yeah, absolutely. No. Well, thank you, Rebecca, is there anything else you’d like to share with our audience?
Rebecca, PT, DPT 37:24
Oh, no. I mean, I think that we covered a lot of things. I’m sorry for going on a tangent towards the end. But I don’t know, this was amazing. I’m so grateful that I have got to have this conversation with you. And that we got to dive into into some of these topics.
Maggie, RNC-OB 37:38
Thank you so much, Rebecca, really appreciate coming on with us.
Rebecca, PT, DPT 37:41
Yeah, of course, thanks for having me, Maggie.
Maggie, RNC-OB 37:45
Oh, I just love that conversation with Rebecca and really appreciate all of her time coming on here to share more about her work and to educate all of us. So we can be more aware as we go to care for people and as as we examine our bodies ourselves, and figure out where we could use more support and recovering from birth and really embracing our bodies as a transition in the postpartum period, as long as that may last. So thank you so much for tuning in. We love to learn and grow alongside with you. You can find us at Your BIRTH Partners across social media. And we’d love for you to join our Facebook group, Your BIRTH Partners Community, where we have a chance to dig into some of the topics each week and a space for more conversation. You’ll also find more information in our show notes. We’ll leave more to Rebecca’s work and some of the other resources we found really helpful as you go to learn more about pelvic PT and kind of what is what is normal variations are normal and things that need to be treated in the postpartum period in particular. So we hope you find this helpful as you’re going out and changing your practice in the real world as we all work together for more collaborative, inclusive and equitable care. Till next time!
040: Supporting Birth At Every Size
Maggie, RNC-OB 0:06
Welcome to your birth partners, where our mission is to cultivate inclusive collaborative birth gear communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation. As we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome to this week’s episode, we’ll be exploring supporting Birth at Every Size, which is a play on the term Health at Every Size, which is often used to just talk about creating more inclusive health care. So how do we celebrate body diversity? And, you know, honor the fact that we all come in different sizes? So how can we kind of challenge those biases that we have about, you know, weight and larger sizes? And how do we help those in our care to really just embrace the body they’re in and exploring health and nutrition, outside of just a focus on weight and size. And I think this is a really important conversation to have around birth, which is already just a time that so many people are hyper conscious of their body, and how it’s changing. And then the role that we have, as you know, birth professionals as providers, in terms of how we either kind of, you know, reinforce that focus, and, you know, really make it central to care, versus considering overall health and nutrition, and how the person feels in their body, rather than examining BMI and recommending weight ranges to you know, stay within and less one size fits all nutrition counseling in pregnancy, and really caring about the person who’s in front of us and what their body needs. And I am excited to have Ray Rachlin, and Sarah on to talk about this, and share a little bit more about their experiences supporting nutritional counseling, and books of all sizes, who are having babies. Onto the show!
All right. Well, welcome. I am so excited to be having this conversation today with Ray and Sarah and just really diving into all the ways that we can show up and support everyone in our care and making sure that we’re creating size inclusive communities and not letting you know, weight be something that brings stigma and bias and shame into pregnancy and birth. So if we can just get started, Sarah, Ray, do you want to just tell our audience a little bit about yourself and what brings you here?
Ray, CPM 2:41
Sarah, you want to go for it?
Sarah, RDN 2:42
That sounds good to me. My name is Sarah. I am a registered dietician and diabetes educator primarily working in gestational diabetes, working within the prenatal and postpartum nutrition world over the past 10 plus years.
Maggie, RNC-OB 2:59
Awesome.
Ray, CPM 3:00
I’m Ray Rachlin, I’m a certified professional midwife in Philadelphia, my practice is Refuge Midwifery, and I do home birth number free care as well as fertility care and home IUI and like the greater Philly and South Jersey area, my pronouns are she & they.
Maggie, RNC-OB 3:15
Thank you so much. Alright, so yeah, so I wanted to maybe start, I feel like this conversation, this could be an entire podcast that just constantly discusses it, because I think there’s so many different angles to this and how it really shows up in our care. But I wanted to maybe just start by kind of laying some groundwork about how we can talk to clients about weight, if there are ways that you have found in your practice, that you can talk about it, they really avoid a lot of the you know, body shaming and fat phobia and a lot of things that are just so rampant in kind of typical medical healthcare when we talk about, you know, weight and nutrition.
Sarah, RDN 3:47
Yeah, so for myself, you know, one of the areas that a major area I work in is medical nutrition therapy. So by the time I see somebody, it’s usually because of a diagnosis, and often that diagnosis is gestational diabetes, right. But I’ve also worked with individuals who are referred for one reason per their request for general nutrition discussions during pregnancy. And for myself, the focus obviously is not on weight, or if the scale is moving. So we know that weight is often the driving force in conversations and during pregnancy or can be and then how is that message of weight I, in my experience, it’s not often a positive message regarding weight is often comes with a warning or work guidelines or restriction or with pause. And what’s been really interesting for me during the pandemic is the shift away from the scale. So as we’ve transitioned over to telehealth and the movement away from in office to appointments, especially last spring, and over the summer, it was really great to see the shift in conversation away from the assessment of how or if the scale changed when somebody went to see provider.
Maggie, RNC-OB 5:01
Mmm.
Ray, CPM 5:02
Yeah, so I think for me, I start off as like a weight neutral provider, there’s not evidence that weighing people in pregnancy changes how much they gain. So it tends to be like this cultural, like, I think it’s a lazy assessment tool, I think what people are putting in their body matters so much more than the number on the scale. And talking to people about numbers, just kind of feeds into diet culture where they don’t, people want to know how to like nourish their, their self and their baby. And you can do that by like talking about what they eat, and what they’re craving, and how to, like get nutrients, and how to get movement in how like, those two things together are really great at preventing complications in pregnancy. And like, none of that has to do with the number on the scale. You know, correlation does not equal causation, you know, and so these things that are associated with like, higher BMI, and pregnancy, like doesn’t mean that you’re a high risk pregnancy, because you’re starting off, like at a heavier number on the scale. And so I treat my fat clients like I treat all my other clients, you know, like, I assume health and well being and I provide appropriate screenings. And when we’re in certain categories, I talk about the difference of how the medical model assesses and manages and how the midwifery model of like, assesses and manages and like ways that, like if they want to use the tools and the medical model and the risks and benefits of those, but otherwise, you just do normal care, and you treat problems if they come up and not treating people like a ticking time bomb.
Maggie, RNC-OB 6:24
Mmm.
Sarah, RDN 6:25
It doesn’t have to be complicated, right? Weight inclusive care is not complicated. In fact, when weight gets involved, it’s complicated. So I find it’s the least complicated when that’s absolutely not the driving force of any compensation.
Ray, CPM 6:38
Yeah, it’s like you can just treat people like people and what I mean, I think, like, the times that weight matters to me as a midwife is like if someone’s not gaining anything, or if we’re seeing like a really sudden jump, like, extreme to the time that like, indicates a problem, but it’s not a nutrition. It’s like indicating like another health problem, like hyperemesis, or possibly preeclampsia, but like, you know, things that are moving within the range of normal is typically that stuff that just is like used to like body shame, pregnant people, which just sucks like it’s a vulnerable time as it is.
Sarah, RDN 7:14
Absolutely, like those-that trend. So like you said, is that at least opportunities for some dialogue to support the person. It’s good to hear that is your model! You know, I think it’s common for us to connect through like minded people, right? It’s but it’s, when I remove myself from Instagram, or for the people I’ve met in like minded spaces, it’s absolutely not what I’m hearing. And it’s you know, and that’s the frustrating part. So these will be these are great conversations, and then it’s getting the message across.
Maggie, RNC-OB 7:48
Yeah, I agree. I mean, obviously, it is, it’s, we add in weight, and that adds a complication. It’s like, there’s just another variable that people think that they’re supposed to be tracking, or, you know, keeping an eye on and I think there is the piece of it in, you know, the medical model that often just likes the black and white-ness of numbers, right? You know, like, I’ve been having conversation this week about like the VBAC calculator, all these different things that we really like to have, like, there’s a percentage, there’s a statistic, so the BMI, you know, like using that as a tool, even though the BMI was never created, it was created as a population health measure, it was never created for individual health, we use it like that, because that seemed all of a sudden, that seemed easy to someone like, “Oh, great, I can just make these categories and have this really firm line to measure everyone.” And that takes away that piece of actually being able to have like conversations with someone. Because we know that there are certainly people at higher weights who are very healthy. They’re eating with a great nutrition, they’re metabolically very healthy, they’re confident, they’re feeling great with where they’re at, just as there are people who are perhaps lower weights, who they’re not actually very healthy. They’re not getting good nutrition to fuel their bodies for any number of reasons. You know, they have different issues that are creeping up behind the scenes. And if we’re only if we’re not ever talking about weight, if we’re not engaging in a conversation about nutrition, if we’re not asking them what they’re craving, and we’re just saying like, yeah, oh, yeah, your weight falls in a “normal range,” check. Right? We lose that opportunity. And I think one of the things too, I wanted to talk about this and I don’t know if you could speak to a little bit of like how you do nutritional counseling with clients, but they think they’re, it’s easy for us to fall into just that, that weight category. And there’s also a piece about like food access, and what is considered nutrition “healthy food,” because I think that the diet culture piece has just it’s warped so much about how we think about what food is going into our body and what the purpose of food is.
Sarah, RDN 9:49
Yeah, yeah, sure. So I’ve also worked with WIC, so I’ve worked at the community on the state level with the WIC program. So when you mentioned food access you know, it definitely connects when we think about for the WIC program and general nutrition. So taking a step away from somebody coming with a medical nutrition diagnosis in general nutrition and still it’s, again, it sounds very similar to what you both have mentioned is whether somebody is coming to me for a diagnosis or if they’re just seeking general advice it’s pretty much the same you know, there’s not much of a change it’s: How is their appetite? Are they do they feel hunger? Are is their consistent intake or food patterns? What are their cravings? It’s not a situation or environment where we I have never thankfully witnessed and nutrient analysis during pregnancy and it’s just not something you know, we have prenatal vitamins that can cover a possible deficiencies. So when we look we are guided more by the person what they’re stating what they are interested in, how their appetite is, are they feeling hunger? And looking at it’s so nuanced? As mentioned before? Is there a hyperemesis? Are they having food aversions? So it’s it’s not clear nutrition guidelines because of food aversions alone during pregnancy? Right? So we it’s not a food focused at all it’s patterns and variety and how they’re feeling overall and what they you know, what their goals are.
Ray, CPM 11:28
So when I start nutritional counseling, I usually do in the first visit, I love to kind of just ask people like how they like to feed themselves, like what their life looks like, you know, where, like, are they eating at home, are they eating out, my typically I start with, like, my counseling is like, my hierarchy of needs, and pregnancy is protein and water at the top, and then calories, and then nutrients and fruits and vegetables and probiotics and everything else for that. Because most, you know, people who are assigned female at birth in our culture, do not get enough protein in their diet. And for me, it’s like the thing that’s going to keep your blood sugar stable, which helps prevent gestational diabetes, it’s the thing that’s going to be the building block of your baby, it’s going to help your liver function as you like, make more blood, it’s gonna help you make more blood. And sometimes it’s like a pretty doable switch. Like I really like nutritional counseling that’s about adding and switching things out. And so giving like a lot of different tools, I have handouts on, like, how to get protein rich foods in your diet, how to like easily get 20 grams, and starting off with like, you know, having people do a diet diary for like, you know, five days or so and checking in at the next appointment and then being like, okay, like, yeah, you’re kind of getting this or like, okay, let’s strategize on protein first. And then like, after we get protein, then we move on to other things. And just kind of keep checking in. And also using food as a tool for like when things like heartburn come up, or constipation, because a lot of pregnancy issues can be treated nutritionally. And also like, sometimes people have like issues with appetite or nausea. And those are also things that can be managed nutritionally, but it’s just about like asking a lot of questions. And then like, having some strategies and tools coming back to me if they work or not, if they don’t like reevaluating, and the more that I learned how my clients eat, the better recommendations I can make, because you know, if I tell somebody to eat hard boiled eggs, and they think eggs are disgusting, I’m like, that’s not useful for either one of us. So like, if I know how you’d like to feed yourself that I can make recommendations that are in line with that, and then like, help you like, make changes that feeling doable and empowering. And I know like, I forgot where I learned this, but I never make more than three nutrition recommendations, like ever. It’s just like, there’s a cap of like, three total that like in the new I try things and reassessment, that doesn’t work, then you just try those same three, again, like really trying to make things like doable, manageable and empowering because you’re able to make the change.
Sarah, RDN 13:42
Absolutely. When we’re looking at somebody the same whether they have a diagnosis or not, I look at very similar I look at fluid, fiber and protein. So those also help with blood sugar stabilization, right, but they also can help with constipation. You say for protein add in, like, absolutely the message often is restrict, avoid decreased, oh, it or they’ll be, oh, no, we want you to have everything, but just the small amount. So same exact approach, the add in takes off so much pressure when the message is excellent. And you know, what can you add, and I call him sometimes defensive foods, when we’re talking about blood sugar stabilization, which is usually protein, nut seeds, nut butters. You know, having that just that shift in conversation and language of add-ins, like you said is exactly something that can remove this where people assume that we’re going to ask them to cut down or eliminate or avoid other foods. So that’s great to hear. Again, it’s not common for me to hear people even talk about nutrition mess.
Ray, CPM 14:53
Yeah, I think it’s one of those things that like, it’s not just midwifery model care. It’s also being a home birth provider and being outside the system. You know, as a certified professional midwife, I did get a lot of nutritional counseling training, but also, because my clients do not have good insurance reimbursement, and they’re just paying out of pocket for their care, right, I can do hour long appointments. And if you can do hour long appointments, you can do really good nutritional counseling and get to know people in their diet and have continuity of care. So you can also do really good follow up. And there’s, you know, I think more and more conversations I’m having with other midwives are just like, probably part of our poor outcomes is like has in our society have to do with like the insurance payer system. And like if you HAVE to do such a high volume, and see so many people that have a hospitalist model, because that’s the only way you can get paid to do your job, then all the things that are preventative care are going to fall through the cracks, because you cannot do nutritional counseling and a five or 15 minute appointment very well. We’re not care that’s going to be like motivating and empowering and like help you make like positive change.
Maggie, RNC-OB 15:56
Yeah, absolutely. It’s so hard to find that, that time and like you said, that’s a system issue. That’s not just on, you know, one provider and obviously some some try and you know, manage to squish some in but it is hard in that sort of model to just to have enough time to actually do it to review someone’s the, you know, food diary. Like that’s gonna take time for you to go, you know, go through it with them and then and have a whole conversation. I wonder, Sarah, in your, your work? Do you hear when when clients come to you? Have they had any, like any nutritional counseling, or like talking with their provider? Usually up till that point, or pretty much like nothing?
Sarah, RDN 16:33
Nope, they’ll get the standard, here are the foods that you need to avoid? Right? There’s even somebody who’s had type two for 20 years, it’s just not common so many times. So I start off with what have you heard or read or been told, you know, about nutrition, just to see, you know, where they’re coming from? And so No, absolutely. What I’m hearing tonight is just, unfortunately, not the norm in my experience. Yeah, and having a consistent message of support to a pregnant person is just fantastic to hear.
Maggie, RNC-OB 17:09
Yeah, I know, I’ve certainly seen more of it in in providers or hospitals that offer like Centering Pregnancy classes, or that kind of like group prenatal care, that then allows for more talking especially like earlier stages, you know, of appointments, you know, kind of intake eight weeks or 10-12 weeks, anytime in that frame, you’re first coming in, you’re kind of just assessing that overall, like pregnancy health, what are some of the things we’re in, you know, interested in? And I think, outside of that type of, you know, group model, and or, like you said, people who are, you know, kind of getting private care homebirth, you know, care outside of it. It’s just, unfortunately, really rare. And I think another thing I would just, you know, you both touched on the piece of focusing on what we’re adding, you know, instead of taking away and I think that’s a really simple shift that providers in any of these settings, though, could make. So instead of having a handout that’s just lists of restrictions, or you know, some sort of weight gain limit or range that you’re handing people instead, can you just focus on that? Could you have another handout, instead, that focuses on like you said, you know, protein, water fiber, and really encouraging that you only have a minute to talk to someone about their nutrition, that you start with something like that, instead of starting from this really, like stigmatizing restrictive standpoint.
Sarah, RDN 18:27
When they do receive information for nutrition is gestational diabetes. And just last week, one person said, Well, the first provider said, avoid pasta, breads and pizza, and then then subsequent appointment at a different provider stated, don’t even worry about that. Just follow keto. Because then at least with keto, you’ll be able to find some keto breads and so so the a lot so the nutrition information, there’s a lot of undoing so you know, just having a conversation, first of what have you heard been told, not just by providers, but by family members and peers or their partner, so to see if there’s some information that can be undone, because I can tell you, you know, the amount of people who cry during their appointment because of the stress and the worry, the guilt, the shame, and then feel like they have to hyper focus on food also can revisit, you know, previous poor relationships with food at a time when their body is being assessed and examined. So it’s really a challenging time for people last thing that any provider should do is play shame or guilt. And we all think as humans, that that’s a simple basic expectation. Yeah, I hear it every day.
Ray, CPM 19:43
Yeah, also, I think it’s kind of wild that you know, the time that people typically get international intervention to larger systems is if they get a gestational diabetes diagnosis. You know, I’ve definitely had the experience of like carrying people with previous gestational age. Diabetes diagnosis is that we were able to prevent the second time around by doing dietary interventions earlier, where people who require medication, their first pregnancy is not requiring it. And the second because we just did a lot more things earlier and had the support and follow up to kind of do that. And it’s just, you know, like preventative care versus like, yeah, system.
Sarah, RDN 20:21
Yeah, I have somebody that I’m working with right now. And this is her second gestational diabetes diagnosis within about a year and a half. And the only thing if so has been self monitoring all along, just out of curiosity, all beautiful, but then 1 hour glucose tests elevated, but that all of her self monitoring is beautiful. So because she kept with the, the approaches, the, the changes the movement in her life. And that’s another thing. So when we talk about movement, right, so movement, gentle movement, meditation, dancing, you know, as part of the picture, it’s, I talked about stress, sleep movement, what do they enjoy doing? It’s not just, it isn’t just fiber, protein and fluids, even though you know, that’s something that I enjoy talking about for add-ins so much a part of their health is not just that,
Maggie, RNC-OB 21:10
a lot of it, there’s that desire to control, right? So being able to, like control someone’s weight, and to stay on that, instead of again, looking at the overall picture of health and movement and engaging in a conversation around that. And I think you touched on as well, in terms of when we’ve talked to people about nutritional, you know, concerns or their approaches? And I think that kind of leads us into like, the, the why piece of it, like when and why are we caring about weight and size and nutrition. And it feels like what I heard, you know, from a lot of people is that they, they come into pregnancy, they’re at a higher weight. And right away, the kind of first thing that gets talked them with their providers about their weight. And then sometimes it feels a little bit like, somewhat like the ship sailed, like, here we are, we’re already there, we’re pregnant, we’re at a higher weight, and that there is still this kind of picking at that piece of it. Which at that point, we’re not expecting anyone to to lose weight, we know that everyone needs to continue to gain weight in their pregnancy to to maintain a healthy pregnancy to grow a healthy baby. So I also want her to but just like, why are we doing that assessment at that time? And what do we what do we possibly think it’s really, that information is giving it that we that we couldn’t get in a different way?
Ray, CPM 22:27
I mean, I feel like I just want to say fat phobia is lazy medicine, you know, like, using BMI to assess health is a way to lump large groups of people together, instead of asking them questions about their diet, their life, doing health screenings, like blood pressure, or, you know, lipid panels, I think it’s you know, we have a lot of fatphobia in our society, you know, the diet industry funds, a lot of medical studies. So there’s like this is these kind of these two institutions just kind of keep bouncing off of each other and creating a system that’s really hostile to, like pregnant people and bigger bodies, and like anyone and bigger bodies, like the stories of people who like, got mis diagnosed with like, major issues, because they were fat, and were just told to lose weight or pretty horrific and also pretty common. And it’s Yeah, using BMI as a tool to assess health is just like really a good way to like not see the person in front of you and not care for them well.
Sarah, RDN 23:29
Right, like what? So are they taking the same approach for a different size body? So is their approach for treatment or care the same regardless of body size? And that’s where it’s really always I’m curious about because when somebody comes in, for example, with hypertension, the weight focused discussion versus absolutely no discussion regarding weight based on unfortunately, incorrect measure regarding BMI. So when that is leading, you know, the discussion. It’s harmful.
Maggie, RNC-OB 24:02
Yeah, I think I mean, this whole season, we’ve been talking about biases, right. And the ones that we hold that we picked up from, from training, from society, just those things that we haven’t really, maybe thought enough about. And I think this is one of those pieces where there’s obviously a ton of information from like every major kind of pregnancy or birth resource, talking about weight and pregnancy and, you know, potential risks and all of that, and I with all those in reading through the research, and there’s just that piece of it that absolutely sure some people at higher weight might have some of these complications. They seem to have some more rigorous, you know, information that show that okay, yes, in this population, they were studying the higher weight did have, you know, higher incidence of complication. But there’s just that the devil’s advocate piece of me that I just really wonder how much of that is about the actual higher weight itself and how much of it is the bias that the provider already has about taking care of someone at a higher weight and how that impacts the care that they then provide. And we’ve talked about this with other subjects, but I just think it’s one of those things that like, we need to continue to be self reflexive and thinking about like, okay, right now, what am I actually looking at? Am I really concerned because of this higher higher weight in its own, like as its own entity? Or am I actually looking at like the clinical picture in front of me, because it really seems like in some of those cases, so many of birth care choices are very dictated by the provider, both in terms of when they just act on their own without really consulting or waiting for it, you know, informed consent or anything like that, and in the way that they talk to risk about, you know, patients. And so, if you have someone, you know, in front of you, and you really leading them down this like very high risk path. I don’t know, I wonder then and how, in terms of how that actually impacts, you know, these results? I, I guess I feel like what I know, when one of my pregnancies, I, my one hour glucose test was high. And at the time, I was like, reassured by provider like, oh, it happens, we’re going to do the three hour like, you’re probably fine. I know multiple people, though, who are at higher weights, were told by their provider, like, let’s not even bother with the three hour glucose test, like, let’s just call it GDM. and move on. It’s not the same provider, who knows, maybe they tell everyone within one hour that, you know, but they they felt that that like stigma piece and that question that like, I don’t know, is that Is that normal? Why are you recommending that for me? Is it based on something more than just a higher number on the scale?
Ray, CPM 26:37
Yeah, I think like, I mean, statistically, like, that people who are pregnant, like have more testing done, they have more evaluation, they have more inductions, they have more c sections. And I don’t feel like we can trust the data. Because the data like that people gathering data have a lot a lot of bias around high BMI. And so we don’t see great literature about blood pressure issues that Yeah, kind of stuff that like low risk and high risk like, same with a BMI like we just don’t, we don’t see like a separation. And so it’s really, really hard to interpret. And for someone to like, try and see like, is my baby safe or not, like, based on all this research, there was a really, like, decently done study that just came out, around like birth center birth, with high BMI that like found, like, people who are in bigger bodies have like the same transfer rate and same vaginal birth rate as people who started off pregnancy at like, like an average BMI. So we’re like, oh, we’re seeing like, actually similar data with like, low risk pregnancies for people in bigger bodies that we are for people who are like, you know, straight size bodies, but how that’s going to correlate to like, general practice? Who knows, I always send my clients to Plus Size Birth, there’s a really, really good breakdown, or about like, what would be normal to expect having care, you know, in pregnancy, what would be like abusive care or like, kind of fatphobia in your healthcare, kind of like questions to ask and how to find a size friendly provider, which I will definitely say like, there are not size friendly providers available in all areas. But just to like, start understanding, like, you know, like, yeah, we summed like, sometimes may see like, a little bit more of this, like, so maybe like, like I can say, as a provider, like, it might be a little bit harder for me to feel your baby’s position. But that’s like a me problem. It’s not a huge problem. But we have tools, you know, to try and like figure that out, like ultrasound, and maybe a grow scan at 32 weeks, like a little bit more appropriate in this population, just because of ways that our assessment tools with our hands are, like less helpful, and that’s still like a provider problem, not a patient or client problem. But, but yeah, like, there’s just like, Where’s the line of like, you know, appropriate for like, possibly, like, possibly getting more information is going to be helpful and what’s just like, bias and fat phobia. And I think probably the majority of it is bias and fat phobia, unfortunately.
Maggie, RNC-OB 29:01
Yeah, I really like how you said that piece of it, where we’re taking the onus on us as like, as a professional as a provider, that if our tools are limited, okay, what other tools are available to help aid that, you know, assessment, I think, you know, working in a hospital setting, you know, there are a couple of things we can do to make people with large BMIs feel more comfortable when they come in. So like even from when they first come in to be admitted? Like, are we encouraging them to wear clothes that are comfortable for them, that they brought that they they already are able to move in well, and that don’t feel constraining? Or you know, if they need a gown? Are we making sure that there’s one that’s available that doesn’t make them feel uncomfortable? are we offering monitoring tools? If there’s someone who’s a candidate and needs to be on, you know, external fetal monitoring continuously? Do we have tools have we gotten, you know, the Monica monitor or you know, some of the other monitoring tools that they’ve shown work equally well for people with different sized bodies like, there are steps that we take as, as providers as institutions, to create a better experience for those in our care, rather than somehow feeling like, put off that someone in a larger body, it, you know, is seeking care with you. And somehow, I think this is one of those pieces, like you were saying, read that we have to kind of take, there’s an ownership for the care we’re providing, that we need to be responsible for. And certainly having any conversation, you know, it’s a dialogue, you’re caring for someone, and they, you know, they really the birthing parent should be the one who’s making those kinds of care decisions, and that you’re talking about this, and you’re having these, you know, informed conversations, but that we are the ones who are bending, we were the ones who are trying to figure out, Okay, how do we make this system that there’s so many things not? Well, how can we make it work a little bit better for you right now, instead of putting so much the onus on on them? There’s another piece of that, too, when I know, Sarah, you’ve talked to kind of the shaming that can happen around, you know, a GDM diagnosis. And I know, we talked about this in a previous conversation, I wonder if you just kind of speak a little bit more, we touched on it already. Kind of that, you know, when someone received a GDM diagnosis, what are the ways that they are treated? If they are, you know at a lower BMI? How is that kind of acknowledged by a care provider? What are the things that that you kind of see? What do they what story are they told, versus the story that they’re told if they have a diagnosis, and they’re at a higher weight?
Sarah, RDN 31:37
Yeah, so just recent experiences where we had somebody who, where weight was not the focus of the providers concern, and the the person with the diagnosis of gestational diabetes stated, I’m an active person, I’m not overweight, I’m surprised to even have this and the affirmation from the provider is Yeah, me too. You know, so that messaging right there of affirmation of were surprised when absolutely, I am sure both of you can stay, there should be no surprise of any person and having the diagnosis of gestational diabetes, I, if I was a betting person, I every single time I would get it wrong, like you may be if they have a history, a strong history of gestational diabetes, right. But when you look at the physical appearance of a person’s body, it should not be like that person received affirmation of surprise that you have it because you’re physically active, and you’re in a body size that we would not expect this. And on the other hands. Food is brought up more and often food like, including like sodas and juices, and pizzas and cakes for people where the provider might be more focused on their weight, where then they go into the canned conversation have an initial diagnosis. But fortunately, where I am, we have most of the time, we have the conversation before the provider. So they have the diagnosis. Unfortunately, they receive that messaging of, quote, unquote, you failed right over the phone from the providers office. But when we get them within 48 business hours, so we can lay the groundwork and the foundation and prep them and some anticipatory guidance, and we know who their provider is, of what to just kind of filter out or prepare them for of how the compensation will go. So that’s, that’s a fortunate part is when we can have a conversation with them pretty immediately after diagnosis.
Maggie, RNC-OB 33:43
Yeah, and then the other thing too, and I don’t know, Ray, if you can speak to this for how you kind of see this happening and, you know, otherwise low risk. Birth community, I think there’s also a piece where I’ve heard people who are being turned away from care, because they have a higher BMI. Because they’re, you know, not at a, I believe, quote, unquote, trauma center was the the term that was used to deny care. Someone was sharing a story recently…
Ray, CPM 34:14
Yeah, I mean, the birth center in our area, which is the only birth center has a BMI cut off. A lot of states, who are the states that have newer midwifery regulations also have BMI cut offs. So like, in Maryland, if I had a Maryland license, I believe the BMI caught off is like pretty ridiculous, like 35. So there are places where you are legally not allowed to at home or for because of weight bias and weight stigma. And yeah, so I think like yeah, fatphobia is really ingrained in our medical system and that really shows up with obstetrics and therefore like hurts people who are not necessarily sick. They just need care. You know, I think there’s this, there’s assumption, they make a lot of assumptions about bigger bodies, which could be true for some people, but aren’t true for other people. But when larger systems try to standardize things to try and protect providers systems, overall well being, and they do it from a place of bias, like, yeah, harm is done.
Maggie, RNC-OB 35:19
Yeah, I know. And I think like we said, I think that’s just one of those places where we have to interrogate that in ourselves, you have to be aware of it and recognize, see all these threads for how it shows up in our healthcare system at large to start to dissect it a little bit. And like you said, realize the parts where it’s, you know, it’s appropriate to perhaps offer different monitoring or, you know, additional tests or when is it really just another one the constructs, we’ve, you know, that we’ve just decided that this is something that, you know, we have to care about, and that you know, weight is inexplicably tied to health. And then we’re going to put all these, you know, regulations on on top of it. And I think there’s hard parts like that, where you’re fighting a system that might be like legally telling you like, Oh, you could lose your license if you care for this person, because they’re, you know, at a higher BMI, those of us who are operating in like bigger, you know, health care systems and hospitals, like having these conversations, addressing them on, you know, a broader level to see how are we using, how we’re using weight? Why are we using it that way, and seeing where we can start to make some of those changes that happen little by little to make it. So everyone gets just everyone has access to good care, the care that they want and care that doesn’t make them feel bad, just for existing in their body? Is there anything else that you all want to share on this topic, as we wrap up?
Ray, CPM 36:48
Maybe I want to add on. So something I’ve definitely noticed and experiences, my clients who have bigger bodies would experience a lot of discrimination, by time they come into prenatal care, and learning how fatphobia like leads people to avoid care, and can make you feel really small. But learning how to be your own advocate, and like learning how to be a consumer and client instead of a patient, I think is one of the most essential skills for finding safety in your body. And also like, having a positive like healthcare experience, where you’re a partner with someone in care versus like something that’s being done to you. And that involves shopping around and involves interviewing providers and practices, asking if, you know, there’s, you know, things that that would be required of them because of their BMI, or even asking what what’s the section rates are for bigger bodies versus not, and like, learning what answers people give, and if you don’t, if something is unsettling to like, to run, you know, or leave and shopping around. And like finding a provider that like, sees you here as your respect, who is going to change your experience of care dramatically, because then you can have more nuanced conversations, and you might want all the things that are, you know, often like, you know, recommended to people in big bodies, but like, just having someone that like, respects you and sees you as a person will make a really big difference. Absolutely. I mean, yeah, plus size. birth is like such an amazing resource page. They have a blog, they have, yeah, a podcast, like there’s a lot, there’s community of people who are just like, I’m pregnant, I’m not ill and like, just like, I’m just like, let me live in my body. And you know, so you don’t have to start from square one. There’s like lots of people to learn from.
Maggie, RNC-OB 38:32
Great, well send people there in the show notes. Everyone can kind of reference that.
Sarah, RDN 38:37
So I can share some there’s a couple of social media accounts, I can send them over to you. So if you want to link
Maggie, RNC-OB 38:42
Yeah, absolutely. And we’ll link those for every one of them on social as we’re sharing about this episode, so everyone can follow along and learn with them. So thank you both so much for coming on and having this conversation.
Sarah, RDN 38:55
Thank you for having the conversation with us. It’s needed and let’s get it out to as many people right to have them listen.
Maggie, RNC-OB 39:02
Thank you!
I hope you really enjoyed that conversation with Sarah and Ray and that it helps you to just think a little bit more about the way we view weight as a society. And you know, how that impacts the the care that we provide to folks and and how it impacts the way that we think and talk about health and you know, weight and size and BMI and just that we’re turning a critical lens to it. We’re not trying to abandon the idea of health or helping our clients to make choices that support their overall nutrition. And, you know, certainly we want to you know, be aware of potential complications that can come up along in pregnancy. But there is so much of the how we do that, that matters to those in our care and I hope in this conversation, you’re you know, prompted to just explore a bit more about how that shows up in your practice and you know what you can do to create more size inclusive care practices so that everyone ends up feeling supported. We would love to hear from you about, you know, if you’ve thought about these principles before, if you’ve applied them to your practice, if you think it wouldn’t work in, you know your population, we would love to dive into it. You can find us across social media at Your BIRTH Partners, or join our community group on Facebook, which is Your BIRTH Partners Community. We would love to connect there and you know, talk more about this week’s episode and, and hear from you. So you can also tune into the show notes. We’ll be linking to some interesting articles to read about this plus as birth and some other social media accounts that you can enjoy following to learn a little bit more about this, that we hope you’ll enjoy those resources. Till next time.
041: Navigating Homebirth to Hospital Transfer
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
In this week’s episode, we’ll be talking about navigating the transfers from a planned home birth to the hospital setting in a number of different contexts. I think this is one of those topics that certainly, like all the ones we’ve been highlighting the season, really draws us to question what we believe about birth and risk and safety, and evaluating our role within birth. My hope in creating this podcast last year was to draw diverse perspectives together, and to get a chance to talk with people who don’t agree with each other, to get outside of the echo chamber, to question and explore what we’ve learned and why we learned it that way, and what we continue to believe and how that impacts our practice. And this topic is really one that’s near and dear to my heart. As a labor and birth nurse, I’ve had the opportunity to support birth, in hospitals and at home. And I’ve always found myself kind of toeing the line between where I fall within these communities. Personally, I also had a baby at a hospital and I’ve had a baby at home. And so when I think about care transferring and how we do that, well, I think back to when I was having my home birth. Ultimately, everything went well, and I ended up having my baby at home. But there was a time when due to my baby’s position pushing was just taking much longer than I anticipated and was much more difficult than I was expecting. And in the back of my mind, I kept thinking, Okay, well, if we need to leave home, if we need to transfer, what would that look like? What would that mean? What other services can I get from a hospital that I can’t get here to help with it. And in the midst of kind of weighing options and thinking about what’s available, I was cognitive, just how emotionally challenging the decision and process of transferring is. And I say this as someone who lives five minutes away from the hospital, and it’s a hospital where I work at, where I have wonderful co workers who care about me and my baby’s well being and who, you know, would receive us with open arms. I think about how much more challenging considering a transfer is, if you’re finding yourself in a community that doesn’t have good relationships between home birth and hospital providers. And a place where the person who’s having a baby is also trying to weigh if they’re gonna be received kindly and treated well by the hospital staff if they choose to transfer prob with hospital. Because the other side, I’ve also been in the hospital as a nurse, when we’re receiving a transfer of a client from home who you don’t know anything about. And you’re concerned to see what situation is about to walk through the door, and you’re worried that you might not be able to support them, or maybe an emergent situation. And there’s a tension and stress that comes from that. And in experiencing some of the sides of this conversation, I’m just reminded of the complexities of birth, and my desire constantly to remember the human element of it and of us. I’m really grateful to have two people join this conversation whose practices I respect immensely, even though we all practice in different ways. Those who’ve been listening the podcast for a while, are both familiar with midwife Ray Rachlin and Dr. Abby Dennis, who’s an OB GYN. And so as we share this conversation between the three of us, I hope we’re able to highlight some of the challenges that we face on all sides of this discussion. And as we navigate the parts where there are issues, where we don’t necessarily agree on a solution, I hope we’re able to open up this dialogue and continue with you all so we can find better ways to function as a system and to support each other and provide better birth care onto the show.
So this week, we want to talk a little bit about the home birth to hospital transfer process and, you know, ways that that can go well, challenges that can come up during that and, and really speak to how can we both as you know, as birth workers and providers working in and out of the hospital system? How can we make that a just a smoother process as it possible? How can we minimize trauma? How can we help people to still have birth experiences that you know, match up as closely as we can to, you know, their values and their goals for birth? So, I am really excited to dive into this all. Ray and Abby if you want to just maybe introduce yourself to our listeners just remind everyone who you are and kind of your positionality within birth.
Abby, MD 4:29
Ray, wanna go first?
Ray, CPM 4:32
Sure Ray Rachlin, she they I’m a certified professional midwife doing home birth, midwifery care, in like the greater Philly area and South Jersey also do home IUI and Fertility Care, as well. And I guess I’ve now been doing home birth. I’ll be a midwife for like five years next month.
Maggie, RNC-OB 4:50
That’s so exciting.
Abby, MD 4:51
Yeah. I’m Abby Dennis. I am an OB GYN practicing in Baltimore, Maryland. I’m board certified in family medicine and OB GYN and practiced in a lot of different settings and formed some strong opinions over my years of practice. Period.
Maggie, RNC-OB 5:06
Haven’t we all? [laughter] Maybe we can just kind of start a conversation by kind of framing the fact that you we do anticipate that there are planned home births that will end up in the hospital for a myriad of reasons. And if we could just start by kind of covering that piece of it, because I think often we picture that any transfer to the hospital from a planned home birth is like an emergency and that there’s going to be a poor outcome. And that’s, that’s just not the case. So I don’t know if Ray if he would start with that?
Ray, CPM 5:36
Sure, I can start I have a transfer conversation with a lot all my clients and many, many times, and, you know, the vast majority of homebirth transfer, I would say at least over 90% in my practice are for a long labor, you know, the most common reason to go to the hospital from a home birth is a first baby that’s maybe in a funky position, or it’s just taking forever. And you just like run out of tools at home, the parent has run out of steam, the contractions have run out of steam and like either a nap or like more, more oomp with contractions with pitocin is just like the next best step to make a vaginal birth happen. And you know, those transfers are not emergent. It’s usually a decision that’s like made over many hours and is a car ride and a call to the hospital and faxing over records and usually like kind of a stressful hour or two before someone gets an epidural. And if they’re super tired, that’s like very welcomed intervention and then a lot more waiting, you know, and then managing like a fatigue labor and there’s definitely an art to transferring the like transferring for long labor as well that can preserve a vaginal birth that if you go too late, it’s less likely to so there was kind of an art of like trying to figure out how to transfer early enough that you can typically preserve that option, but and not tire the person out as much. And then you know other homebirth transfers like people tend to risk out of home birth care at the end. So I think sometimes birth that are more likely to have emergencies like people risk out for blood pressure stuff, or malposition babies. So we tend to have like less emergencies associated with like abruption, because we don’t have risk factors for abruption at home, those people have already been risked out of home birth. But you know, the other 10% of homebirth transfers are for medical indications, you know, and statistically about 1% are urgent medical indications. But you know, things like this person is developing a temperature, you know, an infection is not for home birth, or water breaks, and there’s a lot of meconium getting a few high blood pressures, excessive bleeding, and you’re just, yeah, this is like not a good medical picture for home. Or we’re hearing things on the baby’s heart rate that we can’t correct whether it’s, we have kind of like heart tone criteria at home. So like what level of variable decelerations we can tolerate and what we don’t. And then if we ever hear late decelerations, and can’t correct it within 10 minutes, you know, we go in, you know, typically when emergency transfers happen, it’s for heart tones, which also could be associated with bleeding. And then emergency transfer always happens by ambulance, because we want access to surgery, or just like we need to not be home now. And that’s a more stressful process where, you know, midwife calls 911. And we also call the closest hospital, let them know we’re coming. I have electronic health records, I can like fax records from my phone, like while I’m in an ambulance. And then we’re transitioning really quickly and in a way that I think can sometimes be scary for hospital providers that don’t know us to suddenly like feel like they’re getting something that’s scary that they don’t, they couldn’t, didn’t predict.
Abby, MD 8:29
That’s interesting listening to those numbers because I feel like on the hospital side of things, we remember the transfers that haven’t gone well, or the transfers where, in a short period of time, we’ve been really unable to establish trust with a patient and then an outcome that hasn’t been ideal has been blamed on us as sort of the end of the line care involved. It’s interesting to think about like one, you know, 1% being an emergent transfer, because certainly if you asked me those numbers, and I don’t know those numbers, I would have guessed very different numbers in terms of what I’ve seen in the hospital side of practice. I have thought a lot about transfer of care. It’s interesting, you have electronic medical records on your phone, like you’re calling people on the way to the hospital. That’s amazing, right. And I feel like that’s much more consistent with, you know, a model of care that is European or elsewhere, not in the US. I think one of the issues, there are a lot of issues around home birth transfers, but I think one of the things that I think a lot about is is why that whole process is so broken in the United States specifically where there aren’t always good relationships and those adversarial relationships have led to some really bad outcomes. And I always come to women’s health care from a point of autonomy if somebody is well educated and they make the best decision for themselves and their body. That’s the right decision. I should be clear in this conversation that I mean, I remember sitting with Maggie several years ago and talking about her plans for her birth and homebirth. It’s probably important for me to state my bias that I can’t imagine ever, ever choosing and out of hospital birth just because of what I’ve seen over the years, and I was also older when I had my kids and I had complications. But in the past couple years, a couple people who are really close to me chosen home birth, which very much has as just caused me to dig a little deeper and think about what we need to be doing differently, both in terms of home to hospital transfer. And in terms of just the hospital care we provide, that we’re not driving people away so much.
Ray, CPM 10:32
Yeah, I think you just mentioned like the kind of key thing, which is like the integration or like lack of integration and hostility, because I think for me, you know, like, in other countries, the date, like other similar countries, the data is really clear on safety in the US, it’s really unclear. And it seems like, the thing that causes worse outcomes for babies is the lack of integration, and then hostility, and then the clinical decisions people make on both sides of that, because of the lack of trust. And so for me, as a home birth midwife, I see it as like my responsibility that like I must build relationships of trust with hospital based providers, and I must transfer well, in order to be able to do my job, you know, like, if I don’t feel confident in my ability to transfer, well, I shouldn’t be doing that birth at home, and not that I will be received well, in every setting, like I have, you know, a primary hospital, I do backup care with which like, I know, all the midwives that can like really facilitate like, great relationships and transfers, and like, not all the, you know, obese or residents are on board with that. But I have like advocacy from the midwives that like really helps have smooth experiences. But I said, for wide radius, I can always go to that hospital, you know, and so that I have to, like, interact with all these other health systems that like, you know, have only maybe experienced like one or two homers, and they like went badly because, you know, like, I know, if I go an hour north of the city, like I’m pretty scared to transfer, I’ve had very bad experiences. And I’m still gonna do all those things where I’m like, I’m gonna practice like I am, you know, a legal fully integrated, perfect part of this healthcare system, and just expect the same thing. And if I like, you know, treat myself as a fully integrated part, and I’m like, asking you to also be this fully integrated part with me like, and do this as a partnership, like, maybe I’m gonna get better results. And sometimes I do, and a lot of times the most confusion and hostility, but I’m still gonna keep trying, but also like, the more negative experiences you have over the years, like maybe the way it like changes your decision making too.
Maggie, RNC-OB 12:16
yeah, there’s so much to unpack there, I appreciate both of you, just the transparency, that you’re speaking to your experiences, because I think there’s often this perception that like people on either side, out of hospital based providers in hospital based ones, like they’re just they’re deeply entrenched in this and that there’s no way to like, possibly move towards, or forge your bridge across. And like you said, certainly, there are some people out there who there are some out of hospital, you know, midwives who have absolutely no interest in ever interacting with the medical industrial complex at all. And there are absolutely some ob gyn who are not ever going to be welcoming or looking to integrate with community based midwives. But outside of that, I think there is an opportunity, there is a place to continue to forge those relationships. And you know, like, both of you are saying, you know, Ray, you just, you keep trying, you keep showing up as like, yep, here I am. I am trying to maintain safety, by being professional by sending these records right over by calling to let you know, coming by showing up with my, you know, with my client and keeping everything kind of in this like aboveboard feeling. And, you know, to your point to Abby, it’s I think it is hard when so much of your experience has been in hospital settings where we have just higher risk, you know, patient populations, and that there are just these, a lot of these other things that can go awry, if a lot of your experience is in that it is hard to consider homebirth as a safe option, have always been in like a high risk kind of place. And you’re used to seeing a lot of complications that do happen, because not every pregnancy does go smoothly. There are plenty of things that can happen in birth, if so much of your experience is that it’s really hard to make like a mental shift to ever feel comfortable with, you know, out of hospital birth. And if you if you hold on to that piece of it too tightly. Each time that you meet someone who’s playing at home birth, each time you meet with a provider who practices outside the hospital, you just immediately have this little bit of a wall up, because it doesn’t feel safe to you. But there is a reason that we have homebirth midwives there’s a reason that Ray you chose to practice in that environment like that aligned with how you want to provide care to birthing people. In the same way Abby, like you have chosen to practice in a bunch of different you know environments, but in environments that allow you to kind of work your muscles that you enjoy in handling complex situations. In dealing with high risk pregnancies on helping people to safely get through those situations when that’s how their birth is unfolding. And I just feel like obviously, because I admire and respect to both of you so much I feel like there is, there’s way more ways to try to help, like, bring that together. And like you said, there are so many model of collaborative care between midwifery and OB GYN around the world that works so much better than what we have here. And it’s really easy, I think, to get like deeply entrenched in kind of either side of the coin here and feel like there’s no, there’s no way through. If either of you, both of you, maybe we can speak two ways when you’ve had that good collaborative relationship and a little bit more deeply about, like what that looks like.
Abby, MD 15:43
I had a really beautiful, my last job before my current job was as a hospitalist. So I was really just working in the capacity of supporting both midwives and obstetricians on labor and delivery. And it’s interesting right around the time that one of my closest friends really opened my eyes and, and really made me think about home birth in a new way, because that was her choice. I was contacted by a local home birth provider who contacted me and basically said, you know, they had somebody who as breech, persistent breech presentation, first baby. And this is somebody who, you know, called me was so just her presentation of the patient and the case her knowledge of the patient, her knowledge of outcomes when you attempt to Singleton breech delivery in a home environment. She knew her stuff. And she was really thinking about her patient in such a wonderful way. And also was really committed to her patients sort of psychosocial situation, and the fact that she was terrified about a hospital situation than a hospital birth, in that case turned into an unfortunately unsuccessful attempt at version. And you know, one of the first, really truly like family centered or gentle c sections, whatever you call it that I did in hospital setting, we’re now pretty much doing those universally. But I do remember walking away from that birth, just thinking, gosh, if we had this kind of communication and respect all the time, this could work really well, this could work like it does in Europe and other places where we’re able to overcome that competition or negativity, or I think that a lot of the homebirth movement is driven by the way that women have been treated in hospital settings, particularly like in the 1940s, through 60s, when suddenly obstetrics became, you know, a very, unfortunately male driven but also a very interventional field, like it went from birthing came into the hospital and then suddenly became very much a medical procedure. And that culture in that dogma have really driven a lot of sort of the things that have come sense, even when I think there are a lot of us in hospital settings, who are very committed to actually delivering babies in a way that’s still patient centered and respectful and beautiful.
Ray, CPM 18:08
Yeah, I really like the story you just shared, where it’s just like if we could both like, hear and see each other and respect, like, patient autonomy and like, do things collaboratively. Like I’ve been in those care situations, and it feels wonderful to like be able to extend like, the hand of like home birth and referee and also, like, provide kind of like this, like all around safety, like I think about a few years ago, I had a client so the midwife that I use primarily as backup, I used to be at a different hospital and I had a client who had a previa, and you know, and I was doing co care with the midwives were doing follow up ultrasounds, you know, it, like became apparent that we were going to have to, like do a C section, like the previa wasn’t going to move. And you know, like, I was able to schedule my clients c section and the midwives arranged for me to like, be in the C section with them and like, and kind of like checked on my client cuz they, you know, the baby went up at the NICU and just like, it was a really like, it was a challenging experience, right client and also like, a really well supported one. And at the end, she was like, that could have been so much more traumatic, but it was like, yeah, you know, like, and it was just because, like, you know, I had relationships with the midwives who then like helped me build relationships with the OBS and the residents. And there was like, mutual trust that like I was a good care provider and also we were all like making good clinical decisions together. And there are places I think sometimes where like homebirth midwives like will push boundaries on like, you know, things like VBAC or you know, in some places breaches in twins or for other places where are like going past 42 weeks like these places that are more firm rules and hospitals that people wanting more autonomy sometimes seek out of hospital for, some midwives, some comfort level with and some don’t. And I think there’s like when there’s trust, there’s like the ability to push that and when there’s not trust, it’s like, a flat out like this is dangerous and wrong. And I know for me like a lot of a lot of homebirth is done by a Certified Professional Midwives. And we don’t train in the medical system, we train outside of it. And I think one of the things I’ve really come across is that people within the system, like don’t understand our skill level or our training. And so part of me being able to do collaborative care as me being able to build personal relationships where they like learn that I’m like, actually, like a competent care provider who like went to school and like draws labs and reads labs and like a lot of like real basics. And I do that by like, participating in the ACM chapter. And I do that by like, going to study groups that have doctors at them and just end by like reaching out to consult with small things. So they like understand that I’m like, trying to make appropriate clinical decisions and like seeking help when something’s outside my scope, it still takes time. And there’s also, you know, I think there sometimes is more trust with like the providers trained in the system as nurse midwives. But there’s really significant barriers to nurse midwives being able to do home birth, like one of the main ones being their malpractice costs, and also like some of their licensure regulations, like there’s only like one nurse midwife doing calmbirth. And like my city right now, and, you know, their malpractice cost is over $20,000 a year, which is like, could sometimes be like a third of a homebirth salary. And that’s, you know, one of the reasons that, you know, like, this other model of care and this other kind of provider are the ones doing the majority of homework, there’s just a lot of ways that like, the way the financial insurance system in our practices are set up that like, doesn’t work for people within the system, and then plus making different choices around malpractice, or not actually having access to malpractice, then makes hospital or med OB’s that are just like, What do you mean? Like, you don’t have malpractice? And I’m like, “Yeah, I actually can’t get malpractice, like doing homebirth in Philadelphia is considered uninsurable.” And they’re just the idea of like people practicing without that is like, so yeah, is really intense and like, like kind of unconceivable. In other countries, the system is better set up for home birth integration. And here, the way that obstetrics developed, and then the way the midwifery movements developed, and also, like home birth was kind of crushed and then had a resurgence and has really exacerbated the lack of integration. And like the system, I don’t feel like the gulf has gotten any closer. I mean, there has been movements around like licensure. But I think a lot of the more recent licensure wins, like on the East Coast are like, don’t actually help with integration.
Maggie, RNC-OB 22:13
That piece of it is so challenging. And I think, like you said that when we’re not integrating like that, like it is directly at the safety issue, right, like it is, it’s a safety issue. If one like midwives don’t feel comfortable reaching out to talk about issues to see if something is going on to initiate a transfer, when, you know, it’s appropriate, because they’re worried that they’re going to be sued for practicing midwifery if, you know, they’re worried that they’re going to be received poorly by the people that they are trying to consult and collaborate with. And I feel like this is like so many things. It’s not. It’s not that there’s one right way, but I think there’s, I think part of my issue, my question around all of this is, you know, my belief and again, as like, I’m a labor and birth nurse who’s mostly practicing hospital, I’ve also supported home birth, I’ve had both births myself, like, I think there is a power imbalance at play between out of hospital providers and hospital providers that a lot of the power rests with hospital systems, you know, because that is this other level of care. And I think there is a piece of it that that means that those of us who are based in the hospital, like we need to create welcoming environments for whoever seeks care with us. So whether that is someone who is sitting here, they’ve been seeing this ob their entire lives, and now they’re having a baby, and of course, they’re going to have the baby at this hospital, or that someone’s coming in at 40 weeks from their home birth, that for whatever reason, they now need to receive care at the hospital. I think within that there, there has to be an awareness for us as you know, hospital based birth workers that we that we just were focused on that care provision piece of it, like hospitals are supposed to be a place where people come and receive care. And I think there is a lot of fear that is created around transfers, you know, on both sides and and I think it’s important to call out that like OBs are not the bad guys. They are not practicing just to try to ruin people’s, you know, birth plans or go against people’s wishes. And obviously, that doesn’t speak for everyone. But I think there’s a piece of it that when we talk about these conversations, there’s always just this a ton of fear that goes into how people will be received when they go to the hospital, which is valid because like we said, we know, oftentimes there are issues that come up where people do not have good transfers, but I also think we need to hold the humanity of everyone who’s involved in it, in recognizing that, like, obstetricians are also facing a kind of unique set of circumstances when they go to receive the home birth transfer. And I don’t know if you know, you all can kind of speak to that piece of it. And that that dynamic there.
Abby, MD 25:20
I think, you know, it should be implicit in any patient provider relationship, that as a health care provider, I’m there to respect; accept, respect my patient without judgment, I need to meet them where they’re at. And I need to provide the best compassionate and evidence based care, it’s I can’t, I see these home to hospital birth transfers is an area where providers I work with every day who I watched, and I watched them able to do that so beautifully, suddenly, that respect and sort of patient provider relationship really breaks down. And I’ve thought about a lot about you know why that is, and I’m not sure I will, I will say, and you touched on this as an OB practicing in this day and age where malpractice is a real fear, it is really scary for somebody to just be dropped off at the door of my hospital. You know, if somebody is coming from home to the hospital to have a birth, it’s because things aren’t going well, things aren’t going right. Although it’s interesting, because Ray touched on this earlier, actually, maybe maybe most of the time is just because labor is obstructed and not progressing the way it should and, and we do have time, but it’s really hard to suddenly have a patient that you’re meeting for the first time you’re figuring out what’s going on, and you’re trying to figure out if it’s a situation where things are happening really quickly, because in obstetrics things can turn and you know, although these situations are rare, there are situations where you do need to act really, really quickly. You’re simultaneously building a relationship with a patient, you’re simultaneously asking this patient to trust you and they don’t know you, and they don’t know what you’re, you know, ideas are about their choices about their birth. And then I think for a lot of people you throw in that there’s a lot of fear, I think I see providers in the hospital end of things feel very threatened by home birth, which is really silly, because it’s fewer than 1% of births. And if done the right way home births should be for patients who are low risk, but I think that providers in the hospital side of things feel a little threatened and there is a judgement that happens, overt or not over when these patients hit the door, I think, you know, in the US where the system of homebirth to hospital transfer is disintegrated. You know that there’s a two fold increased risk and perinatal death in patients delivering and home birth setting and risk of neurologic complications, I think is threefold. I mean that that data in this country does not mimic the data in Canada or in Europe, or in places where there’s an integrated model of care transfer and where it’s just more regulated in terms of providers and the patients are taking on and those kinds of things. So I think people in the hospital side know that and then they get angry at the patients, which has absolutely no, it only serves to hinder things even further. But I but I see this like anger coming from certain providers at patients that they would have, but they’ve chosen us, they would have made this decision that you know, potentially puts their baby at risk or at higher risk, we need to fix the system, we need to fix the way we communicate with one another. And we need to be able to drop that judgment at the door. Like when a patient hits the door, we need to be respectful and provide the best care for them and include their midwife in the process and include their partner in the process. And if we did that, I think a lot of these situations wouldn’t seem so scary to us as providers.
Ray, CPM 28:46
Yeah, I definitely have a lot of sympathy for the feeling of like, you know, when I know when I’ve done emergency transfers in areas where I don’t have relationships in the hospital, how scary it could be to have an unknown midwife. And then this like client that you don’t know, and you’re getting records, but it’s still like a chaotic situation that you don’t know how to integrate in and that like, leads to bias. And I also know that on the homebirth side of things, like the lack of integration sometimes causes midwives to make choices that, you know, to delay transfer, and that can lead to a worse experience for everyone. And it’s really hard to build trust. And I think something like we’ve talked about is just that like, I mean, I guess for me like one of the main barriers to like, how do we get integration is just that like being a for profit medicine and that like the ways that like hospitals are set up around meeting the needs of insurance and malpractice in the wait like homebirth isn’t like outside and I think sometimes it’s like easier to like be mistrustful and and fight them. They kind of organize against the kind of common enemy that’s making it harder to provide good care and every health care setting provided like more like if you have to do really high volumes and like you can’t do more individualized care. And the things that people want from home birth that like they maybe are not the best candidates for and that like, there’s so much room for things to improve and like have moments of it, but it’s definitely not consistent. Also, I do want to push back on the data you mentioned, because that data comes from birth certificate data. And birth certificates are really unreliable because they, they don’t include people who had midwives versus not having midwives. And then there’s also the other places where like, the data about like home birth is very unsafe in the US comes from the wax meta analysis that didn’t include the largest study on home birth. So I think like, the answer is yes, the data is still unclear. And also like, is there a two fold death rate?Like, I don’t think so.
Abby, MD 30:38
Like there shouldn’t be if we’re doing things the right way.
Ray, CPM 30:40
Yeah. And I think like, I love the MANA stats data. It’s imperfect too. But there was this like, really large study on home birth, and like 2014. That was like 14,000 home births. And it’s just like, Yeah, when we have a single head down baby between 37 to 42 weeks without high blood pressure, gestational diabetes, like VBAC breach, we have equivalent co outcomes to the hospital. And when we start…
Abby, MD 31:03
You also have more parous patients, right and more patients who are committed to their health during pregnancy. So I think we do you can’t do a randomized control trial, right? You can’t do that. And we’re never going to do that. So rather than and I actually had a day where I pulled all these papers, like, Yeah, all the data on homework, because I really wanted to figure it out. And every single day, every single study I pulled, has some margin of error, which which I think really boils down to the fact that homebirth is done in its best capacity, if the right patients are choosing homebirths. Like you said, like, term, healthy, uncomplicated births in patients who haven’t sought that out for reasons of fear of hospital fear of medical, right. I’m sorry, go ahead.
Ray, CPM 31:58
No, no, you’re right. Like, I think I think we had this like clear dataset of like, who were really good home birth candidates, and like, it’s challenging, because sometimes people were scared at the end. And it can be like, really expensive change of plans, in addition to like, you know, emotionally challenging. And also, like, Why do people who have increased risk factors go out of hospital? Like, is there a place for more complicated shared decision making? And is there a place for more complicated shared decision making, you know, with the ability to have good backup, my comfort level is not other midwives comfort level? Like, I am very uncomfortable with twins at home… And also, like, why are people seeking that out? they’re seeking that out, because they’re having a really difficult time having a vaginal twin birth in the hospital.
Abby, MD 32:37
So that my favorite thing to do, by the way, no, like, as long as you don’t take my twins, I’m fine. [laughter]
Ray, CPM 32:45
I would love to attend someone in the hospital, like as like yet, like, be like, I was like, did some prenatal care for you, and then like, got to witness your twin birth? Like, I never got trained in that, like, because, like, it’s really risky for the second twin at home. And also, like, should people be able to, like, make that choice about their body and their babies and like, you know, be able to, like, have really complicated informed choice conversations, like, “Yes, I don’t personally want to be their midwife.” But like, I’m theoretically glad that there’s someone who is willing to hold that for them. But it does make trust more complicated. And we do have the ability to do really good informed choice out of hospital because of the relationship in a way that, you know, also, like, you know, like, because we don’t have malpractice, like, you get me you don’t like that, like, you don’t like the outcomes like you get my car, like, it’s just can have like, an hour long conversation and talk about what that looks like. And like how people like hold the nuances and the unknowns of like, have a really good shared decision making. And also that doesn’t necessarily mean will make us my clients and I will make a decision that a hospital system would agree with, and also like, I have limits too as a provider, and like, someone might want to make those decisions. And I’m like, I can’t make that with you. Like, I’m not that midwife, and that’s okay. It can it can feel bad to be like, sometimes the gatekeeper of home birth in that capacity, because there’s Yeah, because there isn’t as good integration, and it can feel like, yeah, like you’re being dropped off somewhere that you didn’t want to be dropped off, which is not true. It’s like, the ability to transfer is essential to the safety and longevity upon birth. You know, like I need to be able to transfer well, like, I, my practice is like had between a 10 to 12% c section rate since I started and I’m like, that is a good c section rate. That means I’m transferring appropriately that is like along the line, what’s World Health Organization. I think people have a really low transfer rate, like for me, like gives me pause, because I’m like, why aren’t you transferring more like, just statistically, like, 10 to 15% is like, where we see like the best outcomes, you know, worldwide. So like, that’s what we should be aiming for, you know, and that’s what we should be aiming for together. And it’s not a battle like we, you know, like homebirth midwives need OBs, we need c sections to be able to do our job safely. But the mistrust and the money just like keeps, keeps us from forming this relationship that like allows us to provide good care for everyone and also like, have smoother transfers, so we can like get people who are not great to be at home that like not at home from the get go.
Abby, MD 35:02
It’s funny too; you touched on this earlier. But I think the other really interesting thing is that all this for me is sort of, after you’ve done all this informed consent, and a patient has decided that the best choice for them is to have a home birth, and then things don’t go as expected and they landed in a hospital setting, how can we best help patients continue to feel okay about the decisions they’ve made about their health care? Because I think that’s one of the other really interesting sort of dynamics, particularly in the transfers that don’t go well is like where is the patient?
Ray, CPM 35:35
I think so much of that falls on the midwife. So like if, if I do a good job of framing, hospital transfer in like a positive light and like as also like a normal, like variation of normal, then that homebirth is a model of care and not a place of birth. And like I set people up well for that, like, yes, like I once I’ve had a client who experienced retaliatory care in a hospital, but I’m fortunate that I’ve only had that happen once. But I think I really would say like, midwives who frame hospitals as the enemy or like combative, like are setting people up for having a bad experience.
Abby, MD 36:09
Yeah. And really suffering mentally about like, their experience after the fact, you know?
Ray, CPM 36:14
I mean, some people will have a lot of mourning and others won’t. And I don’t know if there’s a way to save people who like, like, the bad experience, but I do think a lot of it has to do with like, you know, the midwife like the way the midwife frames transfer and frames safety. And, you know…
Abby, MD 36:31
And the way we accept, I mean, again, if on the accepting side of these transfers can just look at a patient and be like, I’m so sorry, this isn’t going the way you planned. Let’s move forward together. And still, you know, just, I think communicating to patients that we’re we’re there for them, and we’re okay with their decisions, we’re going to change things now because they’re in the hospital, but we’re not there to punish them or give them a horrible no birth experience. Like that is not what we do.
Ray, CPM 37:01
I think sometimes just acknowledgement being like, we know, this is what you wanted, like, what are the things that are important to you for this birth? Because like I tell people, I’m like we are, like, when you write a birth plan, or like birth preferences, whatever, it’s like you get everything you want at home, great. Choose your big three preferences if you had a hospital birth originally, and then like, what would be like your two or three preferences? If you had a C section, like think about like, what are the things that are important to hold on to because like, you’re going in, you’re getting an IV, we’re probably getting pitocin, an epidural, you’re going to have a bladder cut, you’re going to go, you’re going to feel like a marionette puppet like these are going to change a bit. And also like we’re like, like, we need those tools. Like we don’t have them at home. Like these are great tools that are being appropriately, very appropriately used right now. It’s not this, like overuse of intervention cascades here. So but like, Is it the way that you get to meet your baby? Is it like, kind of like, Is it a quiet? Is it the skin to skin? Like what are the things that are like, important for the homebirth that we can kind of hold for you here and like the hospital providers also, like, we know what you were planning? I’m sorry, that like, isn’t working out for this baby. But like, what are the things that you want to hold from that? And that do that? And sometimes it’s quiet, sometimes it’s like, pushing, standing, you know, it’s like, it’s doable?
Abby, MD 38:09
Yeah, it is. And I think, you know, it’s funny with birth plans, I often tell patients in the hospital, I’m like, if I start doing interventions, I’m usually doing them to help, you know, get you a healthy outcome, and ideally prevent you from having a C section. Like, that’s how I try to think about interventions in the birth setting. In general, a birth plan is a great opportunity for somebody to think about all the things that could happen in their birth. Right. But it’s not birthing is also your first exercise as a parent, things are going to be out of your control. Like, it’s, it’s you can’t plan it, and you don’t know how it’s gonna go. And that first birth sets a lot of tone about how things are gonna go the next couple weeks and, and moving forward and then with other children.
Ray, CPM 38:50
Yeah. And I think the main thing is that people feel respected and heard, like, you can feel respected and heard and have like a crash the section but if you like, if you like, felt heard and understood and like, understand, like, why things happened the way they did, like, you might have sadness about it, but it’s like, I think it’s sometimes it’s the feeling like you’re not heard or respected. And that like, that leads to like, some of the tension. And it’s like, those are like, you know, I know that there is like, it’s impossible to communicate everything with birth, but like, those are things that like, yeah, relationships, trust, like slowing down on possible, like, very homebirth II things that also can totally happen in a hospital. Yeah.
Abby, MD 39:24
And I can be rolling somebody down the hall who’s abrupting, and I know, I have like five minutes to get their baby out. I could still hold their hand, look at them in the face and be like, I promise I’m going to take good care of you. Are you okay? What do you need? You know, like, you actually can…I do struggle when I see that breakdown in the hospital setting?
Ray, CPM 39:42
Yeah, I mean, I think like, you know, for me at home, it’s like, there is me and one other provider like, when we’re in an emergency, it’s like, we actually have to keep things calm and have to explain things like it’s a part of like maintaining safety, like I had a shoulder dystocia on Monday, and I was you know, I was trying to help the grandma catch and that did not happen. And then I was like, your baby shoulders are stuck, I need you to flip now. And just like was able to communicate that they followed along. Got the baby out, flared my tendinitis, you know, and, you know, afterwards I was like, Did you understand what’s going on? She’s like, yeah, like, Yeah, I got it like you did what you had to do and I was like, great, you know, and it’s just like, cuz you know, shoulder dystocia has a lot of hands in vaginas. And also like, if you’re like, understand why your providers doing something, and that it’s an emergency and like all that stuff. It’s like you feel cared for and not like, why did someone put your hands on my vagina?
Maggie, RNC-OB 40:36
Yeah, yeah, something happening with your permission understanding is very different than something happening to you. Like, yeah, just it is. And I think that communication piece with transfers is huge. Like, that’s, we have that opportunity, like you said, on both sides, both on, you know, the home birth midwife side in terms of prepping prenatally about the, you know, the possibility that a transfer could happen, what might that look like? And then like you didn’t like on the receiving end, acknowledging, hey, I’m so sorry. Like, it’s, it’s these like the humanism piece of birth here. It’s not hard. This is not the complicated stuff that we needed to go to school for years to do. Like, this is just treating people like a human right in front of you. And just responding in a human caring way and acknowledging when things don’t go the way we wanted them to. And not and just not being a jerk about it. Like, it’s really that simple. Like the retaliatory care, like it’s inappropriate like it is that it’s always the wrong thing to do. Even if you think this person or you made a series of terrible decisions, doesn’t matter. It doesn’t matter at all right? Now, what matters is that they’re in your care, to take care of them, like, leave the rest of the stuff later. Like if you feel like you need to process that later, as a birth worker, as a professional to like, try to wrap your head around it and understand it. Absolutely. And there are avenues to do that later, after the birth, when you’re off shift whenever to like, process and reflect and understand was there something you could have done differently, how could you have helped the situation a different way, but like, in that moment, just support the person who’s in front of you, like, Don’t let your own stuff overwhelm.
Abby, MD 42:20
Yeah, totally agree that if I am stressed, if I am angry, if I am screaming, if I like, I’m not doing my job, my job is to take a breath, and deliver baby and do that in the best way I can. Like, it’s funny, one of our nurses recently said to me, when I can actually hear your voice, I get really nervous, because I have a bad tendency to mumble and be really quiet, but I just don’t believe in…. And you said it really well. I like all those external emotions. That’s not part of my job. My job is to be professional, and be compassionate. And then, hopefully practice evidence based medicine and be technically sound and do all those things, too.
Ray, CPM 43:05
I think one of the things I want one of the challenges I do want to mention on the like home good hospital challenges is that like, is sometimes not being believed, as a provider. And I’ve had this happen two times. And actually I was just with a client who’s become a friend. And I told her about the podcast, and she’s like, you need to tell my story. And I was like, Okay, sure. Basically, I had a client last year who had retained placenta, and I called… My protocol, so if I don’t get the placenta out in an hour, I go to the hospital. And I called it an hour. And at that point, we were at, like, 1200ccs, and we went by ambulance. And I called and was like, I’m coming in for a retained placenta like, this is our blood loss right now, like, she’s in compensated shock, like, you know, we need to remove all and we got there and it took over an hour for her to be brought back. And it was just like, that’s stuck in the ER for a little while. And then we went up, and then they were kind of doing things slowly. And then a resident is like, oh, let’s see if we get up here. And then like, and then they did a spinal, and then she was no longer in compensated shock, she was in uncompensated shock. And the total EBL by time their removal was done was about 3500. And, you know, was on pressors. And like, you know, hospitalized for a little while. And like, I feel like we could have saved 1000 CCS if they had, like, you know, I called, I faxed records. I did, like all the appropriate things. And like, I remember when I did like peer review on this, something like one of the midwives is like, yeah, like, it’s just sometimes it’s harder to believe the blood loss if you don’t see it, but because I like wasn’t believed they like didn’t act as quickly. I’m, like, you know, made it a worse hemorrhage and worse recovery as a result. And I also had a time where I transferred a baby for respiratory distress and wasn’t believed and they’re like, Oh, just observe him until he got sicker. And at that point, like it was an intervention that happened earlier, and I was believed, like, intervention would have been done better and they might have been hospitalized for less time. And that’s another challenge of just being like, Oh, yeah, like, if you like don’t see the problem over there. A few hours and maybe like you don’t have relationship with a provider to be like, Oh, yeah, like I trust this person taking it seriously. Yeah, we also that’s another part that leads to worse outcomes.
Abby, MD 45:10
And it’s hard on the provider side walking in and trying to figure out how sick somebody is or how much you need to do, you know? Yeah, it doesn’t make me think that relationships between hospital and home birth providers like that, that is the like, we’re gonna fix this, that’s gonna be the key. Like, yeah, you and I in a community, knowing each other. Knowing our skill sets, yeah, communicating effectively going to trainings together. I mean, that’s, that’s what needs to happen for this to work.
Ray, CPM 45:40
Well, like, yeah, it’s like, it’s a 1200. And then we’re continuing to lose blood. I’m just like, yeah, this should be happening quickly. And I was like, is this because they have more resources that they aren’t intervening as much, but you know, just like, just like pouring clots, like, while we were waiting, and there wasn’t a sense of urgency, and it was, yeah, like, it was, like a positive transfer in that like everyone was like, treated really well, and respectfully, but like, especially during COVID, but also like, it could have gone a lot better.
Maggie, RNC-OB 46:08
It’s interesting, like you said, there is a, it just comes down that relationship piece, like, obviously, I have a different role. But if I was to call a provider, and say like, Hey, we’re having hemorrhage here, we’ve already lost this much blood and they were to come and have to like, Alright, let me like really wait and see for a while by myself. Like, that’s causing a delay in care anything, obviously, that piece of it like as a nurse, when I’m calling a midwife or a doctor and saying, like, Hey, this is what’s happened, we have a relationship, they we do we have mutual trust that like, Okay, if Maggie is saying that, Oh, she went in, and they already have 1000 out on the pads, they’re gonna act right away that what I said was, like, was accurate, was truth. And we keeps going in an integrative process, instead of this kind of, like, stop start fashion where you feel like there’s a transition of care that then if we’re taking so much time, in our like assessment piece, because we don’t have that trust established, which I get it like, that’s for the for that receiving provider, like, they don’t know you, right? And so they’re trying to figure out like, Ah, what did happen? When are we overreacting? And maybe there’s especially if they think that they’re trying to be like, protective of not being over interventional? Like, it’s kind of this whole piece of like, like, almost like, you’re…
Abby, MD 47:21
That’s an interesting point.
Maggie, RNC-OB 47:22
Like you’re going beyond in an attempt to be like, no, yeah, we’re doing everything above board here, that you’re trying to be almost use, like, again, that we’re not then ready to react when, like, when it’s necessary. Like when you actually like I came here the transfers, because we need some sort of intervention like that is why a transfer is done. It’s because a, an intervention is needed. And yeah, cascade of interventions is a problem. But like intervention, when used appropriately, is a good thing.
Abby, MD 47:49
Somebody very wise told me once that if somebody is coming from the home to have a hospital transfer, it’s either because their home birth midwife is really bad and they need intervention, or they’re really good, and they know they need intervention. So either way, you should be ready to provide intervention. And I actually like thought about I was like, Yeah, I guess that sort of makes sense. And, again, that was the respect piece, the communication piece as an OB, I don’t want to have to prove to anybody that I know how to do a low intervention birth. I actually do, I actually can do my job well, and I hate a situation where somebody is coming to me. We joked about this, you said this earlier, I mean, when you asked me to be part of this podcast, I was like, Okay, I get to be the supervillain of Maggie’s podcast, like I don’t want to be perceived as somebody that’s always gonna do the most interventional thing. If I’m doing my job. Well, that’s not what I’m doing all the time. But again, if there was better if there were better relationships and communication, that it wouldn’t feel that way when there was transfer, and perhaps energy could be focused more on the patient, and the outcome.
Maggie, RNC-OB 48:54
Absolutely. And that’s what’s so important. Like I could keep talking to both of you about this, like, all day, it’s such a, it’s such a passionate subject for me personally. And I think it’s saying that we need so many different levels to kind of help to move things forward. That said, I think we will wrap up here with that piece of just respect, because I think that if we had that if we had respect and good communication across the board, like birth care would look completely different in our country. And that’s something that, you know, we all can have a hand in different ways in helping to get it there. But I just want to thank both of you were speaking just so clearly to your experiences. And I know this is like a very intense conversation, trying to figure out how to balance out and keep that focus on, you know, the birthing person and what they need and protect birth as much as we can. So I appreciate you both.
Abby, MD 49:38
Thank you. Okay.
Maggie, RNC-OB 49:40
Well, thank you so much for tuning in and sharing this conversation with us. You know, in talking with Ray and Abby and preparing for this episode, we were all just really cognizant of how multi-layered this is. And, you know, my hope is and having these conversations in all of our podcast episodes, but you know, particularly here, that, you know, we just have the opportunity to think of different perspectives to consider just all of the complications that are present in birth. And, and as always, these are system issues, these are things that I believe collectively, we can create something different, we can create something that helps everyone to feel respected, and taken care of. I think especially with this conversation, you know, there are so many pieces in within transferring there, there’s sometimes this fear and, and shame and guilt. And there’s that piece where if we’re not, if we’re not being honest with ourselves about what’s going on, if we’re not recognizing the pieces of our own stories that are showing up in how we take care of people, if we don’t have enough trust, and we’re not, you know, sharing accurate information with each other as providers, when we go to make these transfers. unsafe, you know, the whole cloak and dagger routine of, you know, some of these transfers where information isn’t, you know, accurately shared or people aren’t being forthright about, you know, what’s going on and what their concerns are like, that has no place in, in collaborative care. And, and that’s what I believe birth has to be so that we can all function to the best of our abilities. So we can all use the skills that we have, when they’re what’s needed to support the working person and their process. And so I hope that you enjoyed this conversation. I hope it gave you something to think about, we would love to hear from you and your feedback on it and what it brought up for you. You can join our Facebook group, Your BIRTH Partners Community, you can find us all across social media, we’re Your BIRTH Partners, and you know, we’d love to engage in more dialogue with you and learn more with you. So we’ll also be sharing some relevant articles and posts in the show notes. So you can tune into some of the data that’s out there around over safety and transfers and all of that and we look forward to continuing this conversation more with you as you digest and reflect. Till next time!
042: Holding Space for Perinatal Mental Health
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies, and step into the future of better birth care.
Hey, everybody, and welcome back to the podcast, we are just thrilled to be coming back with season four. And we’re excited to dive into a new theme for this season. So we are going to be exploring what it means to hold space through the complicated pieces of pregnancy, birth and postpartum. We know that so often in our trainings as birth workers and providers that, you know, we’re kind of focused on getting from point A to point B. And a lot of times in our efforts to support someone, we are problem solving, and thinking mostly about the solution instead of about the journey. And so we’re eager this time to explore a little bit more about what it means to just hold space, how do we be there for people? How do we understand complexities that come from pregnancy, birth and postpartum, outside of what we think of in the textbooks. And so as we continue this topic, we felt like the first thing that needs to be addressed was perinatal mental health. So we’ve talked about that before on the podcast, but especially as the COVID pandemic continues to rage on globally, and we recognize the holes and the gaps that are present in our postpartum care delivery. The ways that we need to change how we show up for those who have questions about their mental health, for those who are trying to navigate just an abundance of trauma, and hardship, and transition. We want to dig into how we can best be there for our loved ones, and for those in our care as they navigate these waters. And so I am really thrilled to have two therapists joining us today to dive into all that Allison Lieberman and Yvette Osorio. practice together and supporting families, and particularly those who are in the newly postpartum timeframe. And I’m thrilled to have them here to share their insights with us for how we can be better support. So without further ado, on to the show!
Well, welcome back to the podcast. We are so excited to be diving into a new season and kind of a new framework for how we’re looking at topics in this one. So I’m really excited to bring two guests on, if you will want to introduce yourself to our audience, and we’ll start get into questions.
Allison, LMFT 3:14
Yeah, definitely. My name is Allison Lieberman. I am a licensed Marriage and Family Therapist and a certified perinatal mental health professional in California, and Yvette and I have our company Rooted in Harmony Counseling, and we work with, I specifically work with women postpartum. And then Yvette also works with couples and parents and children can dive into that a little bit more.
Yvette, AMFT 3:40
Yeah, yeah. So nice. Nice to be here. My name is Yvette Osorio. I’m also an associate marriage and family therapist. I have experience working with postpartum moms, but I do more specifically work with couples and parents.
Maggie, RNC-OB 3:55
Yeah, that’s awesome. That’s a perfect framework for really digging into all this. So with this season, we are kind of framing all these conversations around the idea of holding space through the complicated. And one of the ways that we were kind of pushed to do that for this one is I think, so often, as medical professionals involved in supporting births, were used…the medical model has us fixing things, right. We’re not often trained to hold space and allow things to kind of exist and process in that way. And so we’re starting off by just asking all of our guests if you could kind of just give us off the cuff. What does it mean to you to hold space?
Allison, LMFT 4:30
Yeah, that’s a good question.
Yvette, AMFT 4:32
Yeah.
Allison, LMFT 4:33
I think about this a lot, actually. I think holding space, at least for me is being able to be that one person in this person’s life, whoever it is that seeking treatment for whatever the issue is at hand, to be able to sit there and be okay with sitting in whatever their emotions are, whatever their feelings are, whatever they’re experiencing and not trying to fix the problem. And just be being the person that they need you to be in that exact moment. And even as therapists, I think we struggle with that sometimes because we too, want to fix things. But I think really just being able to sit in that and let that person experience that is a big piece of that for me.
Yvette, AMFT 5:17
Yeah, yeah, I kinda have to just go on on what you’re saying, Allie? I think part of that also, is this just being there to witness what’s happening for the client, right. And sometimes that’s a mom, sometimes it’s a dad, sometimes it’s a couple, someone who’s going through something that has no one else, to be that support for them. And so that I think that’s kind of very much the role we try to take on whenever we’re seeing our clients.
Maggie, RNC-OB 5:42
Hmm. Yeah, I do. There’s so much power around just being heard. And I think we maybe as like a American society, kind of have like, downplayed that I don’t feel like that’s something that I like was aware of as a concept until, like, later on. I mean, obviously, the people who raised me did a great job, hearing my concerns, and we talked and all that. But I think until I was out of college, kind of starting to navigate more different like, kind of like circle communities and stuff, just that idea of just like someone can tell you something that’s just hard and overwhelming. And something that you feel like this is you’re obviously upset about this, this is this is not going the way you want it to, and that you’re allowed to just get responses, like, you’re heard, like, yep, I’m here for you, like I’m listening in it, you don’t have to automatically go into that, like, fixing piece of it. And I think this comes up a lot. And it’s come up with conversations we’ve had before about, you know, postpartum and that just that whole timeframe, really, for when you have a baby till 40 years later. But yeah, in the postpartum period, you know, in that first those first couple months, that first year. There’s so much going on, there’s so much transition. And I think again, as as like a larger society, we we believe people are happy to grow their family, we see babies as a blessing. And so I think sometimes that makes it hard for people to sit through when someone is sharing something uncomfortable with them or something that sheds a light that is not like positive and glowing about this transition that you know, they’ve gone through that their family is going through. And I think a lot of times when people like you as therapists, people as like healthcare providers, especially people gonna work in non clinical roles, like you know, doulas, other birth workers, lactation consultants, they end up kind of being the one who’s like a safe space that they can just talk about what’s going on without that pressure from family or friends to be a certain way. And I didn’t know if you all could kind of speak a little bit to, you know, in that relationship, if, you know, most of our audiences are workers who listen and so you know, what is it? What are the things we can look out for, to kind of know, maybe when the differences are pick up on when someone just kind of sharing those, those things we need to get out of our system? versus what are they sharing so that we need to kind of like, tune in and be ready to help them navigate maybe reaching out to a therapist or you know, getting assistance from someone else?
Allison, LMFT 8:02
Yeah, I think that’s a great question. I think on our end, it typically is like the the phrasing around it is like what is like baby blues versus like an actual, like, diagnoseable, postpartum mental health issue, right? Because there is so much of this like transition into this post part of world and I think you guys also talked about this on the postpartum failures podcast, which is like, you sort of have to like grieve the person that you were, in order to be okay with this transition. And some people have a much easier time doing that, and some people don’t, but those first few weeks are really hard no matter what. You’re not sleeping, if you are breastfeeding, then like you’re just totally drained of pumping schedules and feeding schedules and all of that and if you’re formula feeding, there’s a whole other bottle situation with that, you know, and, and it can be stressful and so there are like the typical like, not sleeping, overwhelmed, crying, all of that is a natural reaction to having a baby. I think when we start to see it shift, I always say like, I have like two pretty like big indicators and one is when the baby goes to sleep at night, if you are not sleeping, that is like a giant red flag of you’re not getting the sleep, your mood, your anxiety, your functioning is all going to drop. The “sleeping when the baby sleeps” during the day. I’m not a big supporter of that statement. I think that it’s not realistic but at night definitely should be sleeping when the baby is sleeping. And I think another one is like this idea of intrusive thoughts which nobody really talks about, which is like in the range, right? They can be like more on the lower key. I guess side of Have an intrusive thought, which is like, Oh my gosh, what if I fall down the stairs with the baby in my arms? Like I’m really scared, right? versus like the intrusive thoughts that lead to the suicidal and homicidal thoughts. Right. I think those are the two bigger indicators. I think intrusive thoughts are a lot harder to pull out of people, especially as a birth professional. I think people aren’t just sitting there saying, Hey, I thought about my baby falling down the stairs last night, you know, but I definitely think the sleep piece is a big one.
Maggie, RNC-OB 10:33
I love that I think that’s just a really helpful way to cuz i do i think that whole sleeping baby sleep is so like, tongue in cheek like, okay, I’ll do laundry, when the baby does laundry like short what you know, like, it’s hard to like wrap around it and how that is actually like realized. But obviously sleeping at nighttime, when you know, whenever is your typical rhythm to like, be asleep, that’s a really great, like, quality care. Anything else that you see.
Yvette, AMFT 10:53
I think it just kind of in addition to that, for those new moms, who maybe do have a partner or somebody else who’s very much involved, they can also be kind of a witness of what’s happening. And so you probably have a good idea of how your partner was before becoming a mom and having this baby, right. And so you might be the one to see some of those changes, right. And in terms of their mood in terms of, of what they kind of are wanting to do or not wanting to do, I think for for a lot of couples, we see that or for even just, you know, moms who maybe have, they live with family members, right. So like, they live with other loved ones that are not necessarily their partner, or the parent to the child, but they are also a big source of who can identify what’s happening for for the mom and changes in not wanting to go outside. Right? really being fearful of going outside that happens a lot being outdoors trying to you know, I think right now that we’re kind of like in this still COVID age, it’s, it’s a little bit trickier to identify, you know, because it you might think like, well, what would I have been like this if we weren’t in COVID? Right. So it’s a little bit trickier to navigate now with, you know, thinking about what what health could look like, for the baby, for the parent and for the family members, if we leave the home, if we go out to the you know, the market if we go to the park. So really, it can be you know, something to look out for,
Maggie, RNC-OB 12:33
You know, elephant in the room like COVID and a pandemic living. It’s, it’s not what we’re used to, right. It’s not what other loved ones have navigated before, it’s not what healthcare you know, providers as people who are trying to help people figure out how to do this, like we don’t have this great lived experience to pull from to say, like, “Oh, these are the best ways to get through” something that has just, you know, completely turned people’s world upside down. And, you know, as a result, obviously, we’re seeing just skyrocketing rates in terms of, you know, perinatal mood and anxiety disorders, PTSD, like that piece of it is, it’s really overwhelming, I think, for people to try to clarify that. And I say, as someone who’s not newly postpartum, I have had to think that like, right, is this a normal response to like living through a pandemic? And I’m wondering about this? Or is this like anxiety getting the better of me in this, you know, situation? Can you speak a little bit to how you’re helping clients navigate that?
Yvette, AMFT 13:31
I think part of what, what I like to do with my clients is to encourage them to come from a place of curiosity, whenever they have some anxiety. And, and not try to just brush it off, or ignore it, or put it to the side, but really ask themselves, like, why am I feeling like this? You know, ask a lot of questions, and explore what’s happening for you. without judgment, because like, you know, like you said, I guess a lot of this, you know, it’s difficult to separate the anxiety that comes with COVID. Right? We’ve never navigated a pandemic before. I don’t, I don’t think I know anyone who has navigated a pandemic outside of COVID. So what what is the right way to do it really depends from family to family and their own comfort levels. But I think that exploring it from a place of curiosity can help you find what you’re comfortable with.
Maggie, RNC-OB 14:28
Mmmmm.
Yvette, AMFT 14:29
What do you think, Ally?
Allison, LMFT 14:30
Yeah, absolutely yeah. And I think just to add to that, you know, I, I have a pandemic, baby. So I have gone through this. It’s definitely been an experience, but I think what I asked myself and I also encourage my clients to do is like, small basic things that would not normally stress us out or stressing us out now. And is this we sort of have to re establish our baseline right, because everybody’s baseline has increased in terms What is your baseline anxiety? And then Am I making this more than it needs to be in the situation? So like an example I’ll use myself as an example is like grocery shopping is stressful, and it shouldn’t be. But like, I spent so long not taking my kids to the grocery store and having to plan around, like, how do I go grocery shopping without them that like, it doesn’t even cross my mind anymore, that I could just take one of them with me. You know, and then it creates so much stress. And so then that increases the the baseline of your anxiety up than it already was and increases and increases and increases. And then I think on top of that is reminding clients that like if you’ve had a traumatic birth, which I think anybody that’s giving birth right now could argue that it’s traumatic in some way or another. But it’s like, did your birth happen the way that you anticipated when you decided to get pregnant or found out that you were pregnant? And like, when you are experiencing these heightened awareness moments, are you giving yourself the kind of credits the right word, but the grace to know that, like, you’ve experienced something really traumatic, and you have to process that, and understand that that is what you are experiencing right now. It’s not just a panic attack, you’re having a response to something?
Maggie, RNC-OB 16:36
Yeah, absolutely. I think like you said that, that idea of credit, just recognizing the source of it, and it’s not, you know, it’s not, you’re not, you’re not creating it out of some desire to make things more difficult, or it’s not, you know, your body, your mind aren’t going against you, you know, in any way here. Like you’re, you’re living through something really challenging. I think one of the pieces too with that. And, you know, I’ve heard this from a couple people who’ve had pandemic babies, that they had some people just make kind of, I think well meaning, as are many comments, but dismissive comments about, like, “Oh, well, like, but you’re so lucky. Just got to have your baby during this,” like as if, what’s what’s a better use of your pandemic time than like, raising a small child? And this has happened to like several people.
Allison, LMFT 17:19
oh yeah.
Maggie, RNC-OB 17:19
So I know, it’s not just a one off person who’s making these comments, but I’m trying to understand maybe how that then is making people have like, more reticence to seek help with mental health, because they feel like they have just more people telling them like, well, what else would you be doing right now you would already be stuck in the house with a baby. So like, what do you want from life and everything? And obviously not said that way. But that’s how it’s received. And I wonder if you I don’t know if you’ve had that seen that in your practice? Or, you know, how can we as as family members, as loved ones, as friends help to kind of support and acknowledge how difficult this has been for people and him pandemic, maybe instead of just trying to be trite in our commentary?
Allison, LMFT 18:06
Yeah, I think that’s a great point. I think it was the New York Times that came out with that article A while back about how moms are just having to like, do everything, and they’re so burned out through this pandemic. And I think that that just like contributes to all of it. Right? It’s like, you’re supposed to be grateful that like, you’re working at home, you have your kids at home, you have your baby at home, you get to breastfeed at home, you don’t have to go pump, you don’t have to. And it’s like, what if I’m not grateful for that, then Am I the bad person, because I liked the escape of going to work. I liked feeling more productive with my time, it made me feel good about myself. And does that make me a bad mom, a bad employee, a bad wife is like, I just want to be away from all these people for a period of time to, to feel like myself, again. I think it kind of goes back to that identity piece we were talking about a little bit earlier, right? Like you’ve you’ve essentially lost an element of your identity, and then you’re being told that you should be okay with it, because you get to be home.
Maggie, RNC-OB 19:09
Oh, yeah, we put we just we put so much pressure on each other, you know, try to make people feel a way about Yeah, about how they’re generally supposed to handle early Parenthood. You know, like, obviously, we were doing it before the pandemic, but there’s just so many other pieces of this that have just really magnified it for people and, you know, I know, a piece of your work Yvette that you’ve talked before about how, you know, you kind of work with communities to decrease stigma around seeking help for mental health, you know, concerns and have you seen, are you seeing more people seeking out less people like you feel like there’s more awareness at the same time that like, oh, the pandemics been hard and everyone it’s okay to get help or do you feel like people are kind of batting down.
Yvette, AMFT 19:57
I think it’s kind of been a combination of both, but what was I think like when the younger generation is a lot more open to seeking mental health than the older generation? And I don’t know that, you know, that’s something that will change overnight, right? But but it’s doing the work and really bringing it to to awareness that look, this is something that none of us have ever lived through. So yeah, it’s gonna bring up a lot of emotions, it’s going to bring up a lot of conflict, it’s going to bring up a lot of things that haven’t been resolved, because now we’re all home. And now we’re all around each other all the time, kind of like what Allie was saying, There’s no escape, we’re here. Right. So, you know, I think that that part of the work that we’re doing is really trying to be detigmatize mental health, because it’s not really something that’s often talked about. And I think we have a blog coming soon about, like, the stigma of mental health and the BIPOC communities. And we, I mean, really, I’m really looking forward to that kind of coming to fruition, but it’s really something that that impacts, you know, the BIPOC community. And so, really working on that is something that I’m really passionate about
Maggie, RNC-OB 21:14
the reality of structural and systemic racism that has existed, and the BIPOC communities being impacted so much more by the pandemic, in terms of rates of COVID, and how they’re impacted by jaw, you know, job security, and so much more. And we already know, the abysmal mortality rates associated with it. And it’s easy to be overwhelmed by how much is going on there. And in a culturally humble, you know, framework where we know that there are each person, each family, each culture has different ways of kind of navigating grief and trauma and and just generally working through the postpartum period, have you found that there are certain things that can help, like from a broad stroke to help increase comfort for, you know, members of historically marginalized communities who haven’t had the same access to mental health resources to help them feel comfortable accessing it?
Yvette, AMFT 22:07
Yeah, that’s a really good question. You know, I think that there’s a couple of ways to go about it. And part of that is that there isn’t enough access for these communities, to receive services from people who look like them. So already there, we kind of encounter an issue, right? Do I feel comfortable working with someone who doesn’t look like me? Are they going to understand me? Do they speak the same language that I speak? So I think that part of that is really, you know, as the service provider coming in, with an open mind, being understanding and really checking your judgment at the door, you know, there, there really is no space for judgment when you’re providing any of these services, whether you’re a mental health provider, or you’re, you know, helping moms and families. And, you know, I know, earlier you were mentioning like doulas, and birth workers and things like that, and even healthcare providers we see. So we hear so much about that, right, you know, BIPOC will come into a doctor complain of an illness complain of ailments, and maybe complaint is not the right word, right. But they’re informing them of what’s happening to them, and, and they’re dismissed, you know, brushed off, it’s not something that, oh, you’ll be fine. It’ll be okay, I think but I don’t know if it was like, sometime this year, or last year, there was a couple of celebrities who were talking about, and I’m terrible with names, but they were talking about their experience of going from doctor to doctor to doctor, providing them the list of symptoms that they had been experiencing, and every single doctor was not taking them seriously. And so they kind of had to end up doing their own research, they had to end up finding other doctors who were willing to take them seriously until they got the appropriate diagnosis, and then the adequate treatment that they deserved.
Maggie, RNC-OB 24:06
Yeah there’s so much so much to improve and the way that we connect people with the health care that they need. And again, what you know, no matter what, what part of you needs, assistance, whatever you’re looking for, and, and I’ll link there, there’s a couple different like therapists networks and like counseling networks that work particularly to help like communities, you know, around the country, and luckily, sometimes I know sometimes the way licensing works for you know, counselors and therapists are able to see virtually people who were not, you know, immediately in their area, and that helps to increase access, you know, sometimes but yeah, I think that that piece of receiving people openly without judgment, and, and also, you know, recognizing if you’re not gonna be the right fit for them, and helping them to find someone who is who isn’t gonna be dismissive, if you can’t find yourself able to be compassionate, then you’re not the right fit, you know.
Allison, LMFT 24:55
Also, the perinatal mental health certification. It’s not like something you have to have to work with the community. However, I do think that it is a specialized field. And I think what we’re finding is that like insurance companies and medical providers, they’re not, like, emphasizing that. And it’s just a lot of people who are generalists are approaching this perinatal mental health framework, and they don’t have any training. And I think that that’s the piece on the mental health side that we need to be better with. And like, identifying like, this is outside of my scope, just because I’m a woman doesn’t mean that I can be supportive in this, I have to actually have the training.
Maggie, RNC-OB 25:44
Yeah. Oh, absolutely. Yeah, I think there’s, there’s a huge piece of like, knowing, knowing our limits, having that awareness about what we, you know, what we can do what we can support. And that’s, we’ve talked about that in a couple of different topics, just as you know, as birth workers, and you know, whatever, like, we are not gonna be the right fit for every family. And that’s not stuff that doesn’t need to weigh over you. That’s why you have a referral network. That’s why you know, your boundaries, and you know, you find the people you can best, you know, support that that same for those who are giving birth, those who are newly postpartum, when they’re looking like if someone isn’t a great fit, you don’t have to feel some obligation to take it out. You want someone who can actually, like connect with you, and, you know, help you along towards meeting your goals, not their goals, or whatever they’re able to help you do. What was the word you lose earlier, Allison, like you’ve kind of found your re equilibrium, like, you’ve kind of got yourself back to a place where you feel like okay, yes, this is me. If you all could speak maybe a little bit to how do you see like history of perinatal mental health, anxiety, depression, any of these things have gone on in a previous pregnancy? How does that impede people then as they’re continuing on in Parenthood, as they’re continuing future pregnancies, cuz I think it’s a conversation. As a nurse, sometimes when I’m caring for people who have a history, it’s still said in report, maybe as like some hush hush, like, Oh, they have a history of this. And they’re on this medication as if it’s as if it’s any, like worse, or it’s a secret or, you know, something that couldn’t be talked about as much as their diabetes, or hypertension, or hypothyroid, or whatever. And so I think sometimes we kind of push that stigma back on to those in our care as we want them to kind of have like, arrive to a certain point to like, have another baby or, you know, to keep parenting and I don’t know, if you see that happening with with clients as well, or kind of what we can do better, on our end to help people to feel like coming into a pregnancy on an antidepressant is not bad that it’s fine, that’s where you’re at. And how do we kind of help them navigate that transition?
Allison, LMFT 27:48
Yeah, that’s a great question. And I could probably talk about this particular topic forever. We don’t treat PMADs as though they are… I don’t want to say illness in like the sense that there’s something wrong with you, but an illness in the sense of like, hypertension, right? Like, you’re not going to treat that as like some hush hush thing or blame somebody for having hypertension throughout multiple pregnancies, right, that’s just the way that their body works. And I think there’s an element of like PMADs, that that is the case, there is definitely a hormonal aspect to some of these disorders, and the impact that these hormones have on your body. I think, in addition to that, like the amount of trauma that people carry, that we have no idea about, especially as a nurse or a doctor, even as therapists, Yvette and I have talked a lot about how, you know, it takes a long time of seeing somebody before they’re willing to share their trauma with you. Because they have to know that you’re going to hold the space for them, and that it’s going to be a safe place, and you’re not going to be dismissive. And so when these women who have experienced a history of PMADs come in with another pregnancy, of course, they’re at higher risk of experiencing it again. And, like, I think that they are dismissed, because if the woman who struggled with postpartum anxiety comes in and is anxious about something, they’re going to be dismissed because they’re probably overthinking it. Right? Or maybe they are feeling like they’re calling their OB too much. So then they just don’t call and then they’ve now missed something important. Right? And I think that there’s a lot of questions that are being asked. And even if you know that somebody that you’re seeing has a therapist, we love talking to other providers, as therapists. And if somebody’s OB called me and wanted to understand what I was working on with their patient, I would be happy to have that continuity of care. And I think that is a huge piece that’s missing. But yeah, I just think questions asking questions, like the Edinburgh is not enough.
Maggie, RNC-OB 30:13
Yes. So the bare minimum that we act as if it’s some like giant stamp that you’re all set, then yeah, you were 26 hours after having your baby and “Nope, sounds like you’re good to go, you’ll be totally fine. You’ve passed this.” And now we’re not going to talk about it again until maybe six weeks, eight weeks out to see like how things been. And then after that, it’s right, when is the next time you’re gonna have contact with, you know, a health care provider to even have that conversation.
Allison, LMFT 30:43
And even if healthcare providers had a printout that they could give people after that, like if they just want to do the bare minimum and do the Edinburgh and that’s it, like, fine, but have something to give them I’ve had clients that are like, yeah, my OB gave it to me. And they told me to talk to my pediatrician. And then the pediatrician gave it to me again, they told me to talk to my primary doctor that my primary doctor told me I need to look for a therapist. It’s like you’ve had four touch points, and no one has actually given you anything useful.
Maggie, RNC-OB 31:16
So disappointing. We can do so much better.
Allison, LMFT 31:19
Yeah, yeah.
Yvette, AMFT 31:21
I think you know, I think that’s all like, it’s all very true. And even going maybe a little bit. Before we even get there right before having the baby. How can we even include this information in like thinking about Lamaze classes. And I think Ally and I have talked about this too, where all of the focus is on the baby and how to, you know, keep the baby strong and healthy and growing and, and how to survive keeping your child alive, right once there. But how, how come there is no information on how to keep yourself alive and strong and healthy? Yeah, and, and that is such a big piece that so many moms, including myself, have missed, where there was just no focus on this is what you might feel like afterwards. This is what’s gonna happen to you, potentially. Yeah, physically, mentally, emotionally. You know, there we go through so much after giving birth, whether it’s, you know, vaginal or C section, right, each one has its own element, and some overlap, but there is no discussion on how difficult that recovery is going to be. And so, for some moms, it takes them by by complete surprise. Yeah, can there be some information that’s given to to expecting moms about what to look out for in yourself? Once you give labor?
Maggie, RNC-OB 32:53
Yeah. Oh, absolutely. And we, I know we presented before because I think it might have been in that postpartum episode like that, that sense that we just, you know, the baby comes out, and then it’s all about the baby. Right? Like that was that was the whole purpose of the pregnancy. So then the baby’s here, and it went from being like, Oh, you know, you’re, you’re glowing? Or you look great. How’s everything going to, like, kick to the side? How’s the baby? Is the baby doing X? Is the baby doing Y? And you’re like, Hi. Still here? You know me, right? That’s how you’re connected to the baby? Yes. Yeah. Like and people, I’m sure I’ve done it. Again, because you’re just you’re excited, and you know, whatever. But that piece, I think is huge, preparing people when they’re pregnant. To have just a little bit more awareness. So I think I mean, almost everyone I take care of, you know, postpartum, especially if it’s, you know, their first child, they’re just like, wow, like, I had no idea it was gonna be like this. And that’s, that’s like, again, that’s like a huge way we’re, that we’re letting people down by not addressing some of those concerns. And helping them to know what might be again, variations of normal. There’s some challenges that come, you know, during that piece, and then letting them know that like, they’re not that they’re not alone in this that like, it is hard, but, but it also like, these are the ways we can help make it better help it to transition instead of just feeling like you’re slogging along here your own and that all of us to like, afterwards, when we have all these touch points with people in our lives, whether we are we know them in like a formal kind of clinical context, or they’re our loved ones, that we can ask them those questions and like, and be there to hold space for them and listen to that answer. Like, and if it’s, if it’s like, yeah, I’m great, actually, like, I’m sleeping. Well, like things are going great. The baby’s growing. And you can just be like, That’s amazing. I’m so glad it was just really wonderful. And if it’s not that, that we’re proud to be like, Wow, sounds pretty challenging. How can I help? Could I do this? Can I kind of put some laundry over? Can I hold the baby while you take over? Like, all of those things we can do that are not like they’re not hard. They’re just being humans caring for us. And then recognizing when it’s like, oh, this is beyond my ability as a friend or you know, family, I would like to participate in helping you through this.
Allison, LMFT 35:03
I feel like there’s like two things. Because I think, as with a lot of things in this category, people don’t know what to do. Like, they’re just like, I don’t know what to do to be supportive. They’re not asking me, right. So I think one thing for people to understand is like, it is really hard, especially people that come from trauma and self sufficiency, and all of that, to be able to say, like, I need help, I need you to come over, I need you to take the baby so I can do something that makes me feel normal. Like that is a hard thing for moms to do. And I think that people miss that. It’s like, well, they didn’t ask me for help. So they don’t need my help. And then, in addition to that is like, I cannot tell you how many times in a very non clinical way, someone has said to me like this, this, this and this, and I’m like, “wow, like, that sucks.” And it’s just like tears. Because it’s like some semblance of validation that like, it doesn’t have to be better. You’re just holding that space. Like that sucks.
Maggie, RNC-OB 36:09
Yeah. Mmmm. Well, as we’re like, wrapping up this conversation, is there anything else that you any other things are on your heart to share with our audiences, we’re helping to navigate and support mental health with, with our family, you know, the families that are in our care, because, as you know, we’ve touched on like, it’s not just the person who gave birth, you know, there’s a whole interplays with has impacts, you know, another parent if there’s someone else involved, but most other caregivers, like, it’s a huge transition that families and you know, groups are put through?
Allison, LMFT 36:40
Yeah, yeah, I, you know, we obviously focus a lot on the mom postpartum. and rightfully so, I also think that there is an element where like, the partners could also benefit from extra attention and care and compassion and, and being a part of that postpartum checkup and asking the partner the same questions that you’re asking the birth partner, because postpartum depression in a non birth partner, is also something that happens. And they’re also a very neglected part of the population in a different sense, in those moments. And so I think, also providing space for that is important. I don’t know you probably have more to add, Yvette.
Yvette, AMFT 37:25
Yeah, no, I think you touched on a really important piece. And that’s just really like navigating this know life, postpartum life with a lot of compassion, and grace, and just allowing yourself to recognize that you’re, you’re human too. And I think at the end of the day, we really forget that. And parents, especially moms even more, so we forget that we’re just we’re also human, right? And this idea of being a supermom, and doing it all by ourselves without asking for help. It’s, it’s not real. Something that we see in the movies, and we watch in funny shows. But in real life, it’s not that way. And I think that we have to just be gentle with ourselves and remind ourselves, you know what, I’m also a human. And I need to sleep. They do.
Maggie, RNC-OB 38:19
I love it. Yeah, I think that is so internalized. Yeah. Yeah, yeah, we do. We totally just internalize that like primary caregiver, well, then that’s your thing. Like, that’s your whole purpose in life. And then if you’re a good one, if it’s what you wanted, then voila, then you should be able to do that. And you’re supposed to have some herculean ability to just slog through whatever and it’s not, it’s not real. That is completely like constructed, we’ve decided that’s like a badge of honor. And it’s and it’s not, it’s okay to let that go. And I think that’s, like you said, that’s one of things we can just help to remind ourselves and remind each other. Like, it’s okay, because you’re human. Like that is such a powerful like, right? That’s right. And again, especially like during all this time, like and it’s okay, because this is just really hard. Like, yeah, being able to hold space around that, I think is a powerful gift that we can give, you know, ourselves and everyone else’s within our care. Well, thank you both so much for coming on. And digging, I feel like there’s like so many more ways to take this and like there’s so much to unpack. But I really appreciate you both being here and with us.
Allison, LMFT 39:22
Thanks for having us.
Yvette, AMFT 39:23
It was a pleasure being here.
Maggie, RNC-OB 39:25
I so appreciate Yvette & Allison coming on to share their wisdom with us about how we can be more responsive and aware about perinatal mental health, and both those we take care of and any other loved ones in our lives. As we go to continue processing this information, I invite you to check out our show notes. We also would love for you to join us on social media. We are Your BIRTH Partners across all platforms, and we appreciate your feedback. Please give us a shout out there; share this with your friends, your colleagues, we would love to hear what is happening in the world of perinatal mental health, especially as the COVID pandemic continues to create additional complexities to postpartum healing from birth and moving into parenthood. We look forward to hearing from you as we all work to grow and expand our practices and create more collaborative, inclusive and equitable care. Till next time!
043: Supporting Parents on a NICU Journey
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth care communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back to the podcast. As we continue our series on holding space around the complicated parts of pregnancy, birth and postpartum. We are excited to be able to highlight NICU Awareness Month, which runs through the month of September, as we share more here about NICU journeys, some of the challenges and the complexities and the joy that’s found along that process. We are so delighted to have Tracy May on; Tracy is a mother of two micro preemies and is going to share more about her own personal journey, how she has worked as an advocate for families in the NICU, and encouraged us on ways that we can show up for those in our lives who are experiencing a stay in the NICU, and how we can hold space for them as they process all that comes along with it onto the show.
All right. Well, welcome Tracy I am just so excited to have you on here and in honor of NICU awareness month and just sharing a little bit about you know, who you are, and your story in the NICU. So if you want to start by, you know, telling your audience a little bit about you know yourself what you do, who you are, and kind of how you how you came here to be here talking about this topic with us on the podcast.
Tracy, NICU Coach 1:43
Awesome. Thanks so much for having me, Maggie. You know, my journey with prematurity really started 25 years ago when I became a first time mom. And I live in central Iowa with two boys. And I’ll kind of share my story about my prematurity journey. But I was I was sitting at work one day, and it was on a Friday and I started leaking a little bit of fluid and not having been through this before, I just thought maybe the baby’s just pushing on my bladder. And I called my ob, and they’re like, we need to see you. And so I went down and I was dilated three and a half centimeters at 19 and a half weeks. And so there was no going home, I went straight to the hospital. They weren’t even going to let me drive but I did get myself to the hospital. And I had an emergency cerclage and put on strict bed rest. I couldn’t walk for really three and a half weeks. But that’s what ultimately saved his life was that emergency cerclage and just keeping me solitary and quiet and off my feet. And then he arrived at 22 and a half weeks. And he was one pound three ounces. He was still, his eyes were still fused shut. In fact, I was scheduled to do a tour of the NICU so at this point on my bed rest I had not even toured the NICU to know what we were even facing to see how small these babies were that were fighting for their lives. So it was kind of thrown into that he was born at 1033 at night. And because I had had spinal, I had to be able to walk and stand before I could go see him. So it was 130 in the morning before I got to see him and that first glimpse and tell you there really isn’t anything that can prepare you for that. I mean, I saw a little bit of his chin, but his whole face was covered with you know, to keep him under the bili(rubin) lights. But all of that, you know, obviously he had to be resuscitated and on a ventilator and, and you know, antibiotics and whatnot that were being pumped into him. So that was really what started my journey with my first son. I wasn’t an easy stay, from the get go. Even the second day had the neonatologist in saying he’s got an E coli bacteria in his blood. So we’re going to do a spinal tap and check for meningitis. I’m like, “Oh my gosh, this one pound three ounce baby with translucent skin who’s fighting for his life doesn’t need you know, something like that.” But ultimately, you know, it came back that he didn’t have meningitis. But that just really kind of started the the ups and downs that were the NICU. We ultimately were there for six and a half months before he came home. And that left us with being on a ventilator for four months to the day almost that he was on a ventilator needing support. During that time we were discharged and he was flown to Chicago for emergency eye surgery due to severe retinopathy of prematurity. And so ultimately that surgery left him blind in one eye; the retina was too far detached to be able to be repaired. But it did leave him with functional vision in his left eye. So like I said, After six and a half months, we were able to come home and that that kid is an amazing little miracle and he’s 19 years old today, but he will have challenges throughout his life due to his early birth. My second son then was born in 2004. So two years after my oldest son Jack, and because I knew that I had an incompetent cervix, the OB were on top of that from the get go. And I had the same cerclage that I did with that I had with my first son. But I had that at 13 weeks, and really closely was monitored, and I ultimately had to go on bedrest at 22 weeks with him. But I was able to get him to 25 and a half weeks. So he was born, obviously, very early, still was one pound, 14 ounces. And his stay was, was much easier than Jack’s. But any stay in the NICU, you you could argue is not an easy stay, even though it was night and day different from my oldest. But Nathan today is a 16 year old who has absolutely zero complications from being born so early. So that’s really what started my journey with prematurity with my boys.
Maggie, RNC-OB 5:42
Oh, my gosh. Oh, well, thank you so much for sharing that story and being so vulnerable with us about everything that you know, your family went through. I think, like you’re saying it is a you know, I think any stay in the NICU has challenges. Absolutely. And, you know, when you’re there for months and months and months, it’s a defining part of your life’s, you know, trajectory up till then. And I wonder if, you know, one of the things we’re doing in, in this series for the podcast is really talking about how we as, as birth workers, as you know, people involved in birth care, how do we hold space for these really complicated situations to come up? And so we’re just asking all of our guests to kind of share a little bit about what does it mean, for you, for someone to just hold space for you?
Tracy, NICU Coach 6:27
Yeah, I think probably some of the most pivotal moments that allowed me to get just, I mean, there’s a heaviness on your heart that you can’t describe. And if I think back to, you know, some of the NICU workers, and nurses and doctors too, that held space, it was really just that it was every baby has their own timetable. And they do things differently. But it was just, you know, I can remember vividly just sitting at their bedside and this was before, our setting before private rooms. And so it was all out in the open room. So when you were having a bad day, everybody knew you were having a bad day, when you’re having a great day everybody knew and but just having nurses come over and just you know, placing a hand on your shoulder, and there and not even saying anything, but you knew they were there. And that allowed you to just almost have the sense of calmness come over you to the point you felt like sharing, like, here’s what I’m struggling with today. Here’s what I don’t understand, here’s what terrifies me. And then that can open the dialog, but rather than you know, just having somebody come in and starting that conversation, and maybe it wasn’t where I wanted to start the conversation or a conversation I wasn’t ready to have, but that holding space just allowed. Just it’s just that sense of calmness come over that really, you know, finally started letting some of those bottle of anxiousness feelings, kind of letting them loose a little bit.
Maggie, RNC-OB 7:53
Huh, yeah, I think that’s just such a powerful reminder, as caregivers that, you know, so much of what we have that power to, like, share of ourselves with people is just our presence, and that it is not always about getting from A to B, you know, as quickly as we can, as efficiently as we think you know, we should be and just being able to, to be there with people. And it’s it because it’s challenging, like it is it is hard to be with people when they are when they’re struggling. And especially you know, it like you’re saying, especially with, you know, your first it’s such an unknown, you know, there are so many pieces that you just you have to keep waiting and seeing, and then waiting some more. And you know, so much to that. You don’t know until I mean years later. And so I think there’s a lot that you’re you’re kind of weighing, can you speak a little bit to what are some of the ways that you found helpful for coping, during that?
Tracy, NICU Coach 8:48
I would say probably the biggest thing for me, and this wasn’t a practice. So journaling was a practice that I started from the get go. And I think there’s something so cathartic about just journaling, and especially when you’re you know, obviously electronics weren’t as prevalent then as they are now. So all my journaling was by hand and I still have those journals, and I can look back, but I think I think for me, that was a big way in which I just was able to get out out some of that pent up just anxiety and nervousness of what’s happening. What I started a little bit later was a gratitude practice. Because even the hardest days, it’s finding there you can always find something, something to be grateful for whether you’re on the NICU or not, I’m a big advocate for gratitude. And just you know, having that be part of your day, but I would say by far journaling was the biggest probably release of some of that anxiety for me that that I started really early on and there were some days where you could tell I mean, I wrote page after page I just needed a lot and there were some days where you know what, that he was he was stable, he was okay. And that was all right. I didn’t have a lot to say but it was there and it was a tool that I used when I needed it. The most.
Maggie, RNC-OB 10:01
Mmm, what do you think is one thing people maybe misunderstand about being in the NICU?
Tracy, NICU Coach 10:08
Well, one of the things I end so I’m going at this from a patient perspective initially, and then I’ll kind of go to kind of an outsider’s view, I think the misunderstanding that I have in in so many preemie moms that I talked to have, it’s just what your rights are as a parent, and you know, if something doesn’t feel right, it’s okay to question it. Right? You’re the parent. There were times when I walked in, and maybe his oxygen level was up a little bit. And I even had to push it a little bit with some of the NICU nurses that I just felt like, okay, he was fine. Yesterday, there was no issues or even fine earlier today. And now all of a sudden, he’s needing 80% oxygen. And I think, you know, we feel like, oh, they’re the doctors and the nurses, they know, I just need to just sit back and let them do their thing. And yes, that’s true to an extent. But as a parent, you have every right to go have a conversation with a charge nurse and say something doesn’t feel right here. I don’t understand this. Why aren’t you listening to me? And I, you know, I think I got more comfortable with that. But when you’re thrown into that world of the unknown, you don’t realize, well, you do have that you do have that ability to speak up when you need to, I think from an outsider view is, you know, I didn’t know that, NICU even existed before being thrown into that, right, all these life saving measures that go on. And while you know, they see these small babies, I think people that are embedded in that journey, don’t understand one the severity of it, just all the internal struggles that you’re going on, you know, with with whether or not your baby’s going to survive, or what impact is this going to have on my marriage. And just, you know, sometimes they just, you know, I felt like they didn’t respect boundaries and misunderstood when, you know, moms or families were setting boundaries, to say, you know, now’s not the right time for a visit, or we need some time as a family. And sometimes, that’s a big struggle I see with preemie families is just, you know, sticking to those boundaries and, and family members not wanting to stick to those boundaries, because they don’t understand there’s a reason why I’m saying no visitors today, or there’s a reason why I’m saying, I just want it to be my family today. And that’s all I can do to get through this day. But you don’t it’s as an outsider looking in, it’s really hard to say, Well, you know, it appears like everything’s going well. Yeah, well, and we all know, a lot of times things are going well. And then you you take two steps forward and one step back. And and so unless you’re just in in that journey, that it’s really hard to understand and and get comfortable with. Yeah, boundaries and what your rights as parents are.
Maggie, RNC-OB 12:44
Oh, yeah, you touched on so many important things there. I feel like that piece of just respecting boundaries is something we’ve talked before about just kind of generally, during the postpartum time that you know, as a broader society, you know, often times everyone’s just they’re so excited about the birth, they want to be there, they want to be involved. And that’s for them, right? Like, we think we’re doing that for like, the loved one, Oh, of course, I’m going to come see you and the baby. But really, that’s more like to satisfy our desire often, to like, be involved in the process and get to see because people love babies, and sure you want to see you know, your, your friend, or your family member that just had the baby, but that sometimes we need to really take a step back there, and just ask, what would be helpful for you right now? Would it be helpful for me to come over and hold the baby? Great, I can do that. And I think, you know, certainly when you’re dealing with health challenges, and the NICU just adds a completely other element to that, that, you know, we just have to be that much more conscious, and respectful of those boundaries, and really just asking people, what they need, and what they want. And then listening to that, instead of deciding that we actually have a better idea. And we’re going to do that anyway. And I’ve heard that sometimes from other people with family members, like grandparents, especially that it’s hard for them to have that kind of transition of roles, especially when in the NICU setting.
Tracy, NICU Coach 14:04
Yeah, I think that that is a very valid point in that asking, you know, what can I do for you because we all would want to just dive in and help I think conversely to that is when it’s something I learned, and it’s taken years and years for me to get here is being okay, asking for help. Right? We want to be so strong, we will be strong for our baby for our marriage for our families. And I kept I that was one thing that I really struggled with early on. Nope, I’m good. I’ve got this. No, we don’t need meals. Well, you know what, I realized that people want to do that. And I’m that person on the other end when it’s other people going through it, but I had a really hard time receiving that when it was us needing that support. But yeah, I think when people just ask …”It’s okay,” and it’s hard to tell people no sometimes or no, now’s not a good time to visit. But I think those are easier conversations and when people just insert themselves in and assume it’s going to be okay. And so just having that open dialogue i think is key.
Maggie, RNC-OB 14:59
Yeah. Can you can you speak a little bit to since you had to kind of different NICU journeys with both your boys? In the first one it was your first child, there’s probably a little bit of difference in terms of time that you were able to be at the NICU you can you speak to them? How did that come across, especially second child, when you have a child in the NICU and you also have medically complex child at home? Kind of a little bit about that dynamic and what we can do to help families who are you know, who have other kiddos at home?
Tracy, NICU Coach 15:26
Yeah. So with the first one, I mean, I spent pretty much every waking hour there, I could I remember when they kicked us out after I’d had jack a couple days later and said, okay, you’re being discharged. And I told my husband, I said, Well, I’m not leaving here until 1159. And we stayed till 1159 in the NICU just to be with him. And then, you know, I spent every waking hour and when we got into, I had to go back to work after six weeks. So I have my sixth week where I spent every pretty much every day and, and he evenings home a little bit with my husband after he would come and visit jack when he went back to work. But then when I went to work, so I had a decision to make, I either took the full 12 weeks when I had him or took the first six weeks, and I took the other six weeks when he came home. And so that’s what I chose to do. Because we at this point, we didn’t know how long that journey was going to be. And so we had a lot of you know, once we got into a routine and after I went back to work, then we would my husband would go after work at if he got off work earlier. And then I would go and I would stay until like seven or eight at night and I would go home. And that’s just what we did. And every weekend you know, we had the most amazing NICU nurse. And this is one of those things where I think, make it fun for the families or caregivers no matter who it is, is we had bath night every night. Like I didn’t get to hold Jack until he was one month old. And even then on Saturdays, it wasn’t necessarily even before that I would get to hold him. But I could be that you know, we could do the wipe and kind of do a sponge bath. But we took pictures. And you know, one of the things that has always struck me is I’ve worked with preemie families, some families, they don’t want to take pictures because they’re too hard to look at. And I have the complete opposite. Like this is a memory. This is what we’re dealing, you know, this is our life in 2002. And I didn’t want to lose sight of that. And so we I have probably 1000s of pictures from that time period. And that was just something I looked back up on that our NICU nurse made it fun. And it was family picture night, every Saturday night. And then when he came home, you know, we came home on oxygen. There were therapists in our house from day one that worked with him multiple different types of therapists. And so again, that was our life for two years. And then when I found out I was pregnant with Nathan and I have a two year old now who’s you know, still on oxygen now has a feeding tube has to be fed around the clock. And then when I was on bedrest, it was that was really hard because I put all that on my husband to do all of that. And I hated that I couldn’t be there. But I knew going through the first time with Jack, I’m going to backtrack just a little bit, too.. When I went it was went in on bedrest with my oldest. You know that first week of that three weeks I was I went through a period of almost like depression, like I wasn’t ready for this. I’m a planner, I hadn’t planned to be gone. I didn’t have a backup at my job. It was all about me. And then finally something clicked like how selfish I felt I was being like, this isn’t about me right now. This is about saving his life. So fast forward to when I had to go on bedrest with my second it was a much different, like, I just did what I had to do. I was on magnesium, which was much different than the first one. So I felt like I was out of my head a little bit. But when he was finally born, it was a balance to balance you know, a two year old so that first six weeks, we had, we were fortunate that we had, a home health nurse come with Jack and so we had her since he was young, like six weeks old. And so there was that comfort in that, you know, I knew she was very diligent in her care with him that made it easier if during the days then for me to be at the NICU with Nathan, but it was this constant tug on my heart like okay, I feel like I should be home with Jack because he’s got all these medical needs. But I need to be here with Nathan and I didn’t want to lose sight of that how much I needed to be there with him. And so we just we spent a lot of time on weekends balancing Okay, kind of a balance of family time and at that point I learned that it’s okay for me to walk out and not feel guilty that I’ve not spent 24 hours here in the NICU because I’ve got very capable care workers or caretakers that can take care of him. Always have all that time when I get home. But I also wanted to make sure that we bonded and that you know, I felt that connection with him. So it was a constant pull. But I think that’s to where care workers and NICU nurses, were like Tracy, it’s okay, and almost give you permission to go and take care of yourself. Go see your son, go see your husband, go spend time as a family. You know, we’ve got him now. You’re going to have the opportunity when he you know, is ready to go home. And I didn’t, I didn’t have that as much with Jack the first time because he was. So there were so many days where we got called back and said, “You need to get this way.” Nathan, like I said it was night and day different. So I didn’t have that critical: “Okay, is he going to make it through the night?” And that was just a blessing that allowed me to not have that constant guilt feeling of am I spending enough time here? am I spending enough time at the NICU? But it was just people giving me permission and just saying It’s okay. Don’t forget, you know, you don’t need to feel guilty. And that was a huge, it released a huge burden I was putting on myself.
Maggie, RNC-OB 20:43
Yes, that guilt is so powerful. And thank you for speaking to it. Because I do think it’s a huge piece I think of, especially in that early postpartum time, there’s so much pressure, you know, on like, every moment counting for bonding. And that absolutely, there’s, you know, there’s, that’s real, we absolutely need to bond with our infants, and we need to also, like you said, you know, you need to come back into yourself, you need to process what has happened to to you you need to bond with your family, and having that trust and that relationship with your caregivers that you’re able to know Okay, yes, yeah. Okay, right now, you can kind of pass the baton to them and having that and I think so many of the, you know, NICU staff like, they are absolutely incredible about creating that safe and warm and very, like home like environment for those babies. And, you know, they take care of them as much as they can for anyone who’s not their own. And, you know, like you said, all those special moments that we can still create for families because they’re, they can’t be there all the time. But the special pictures and the bads, and those moments that make it still feel like okay, yes, the time here, it’s it’s quality time you’re having those snuggles you’re getting to do care, all of those can really help families to still feel really connected, even when they’re not now and I know, obviously different than when you had, you know, your voice I know a lot of Nikki’s now have like the angel cams and those different, you know, systems that kind of help parents do feel like they are, you know, able to kind of check in on their phone or, you know, different apps to kind of keep aware of what’s going on, which I’m sure it comes with pros and cons, like everything, but lets people feel like at least they’re able to be a little bit more connected, even if they can’t be at the bedside right there.
Tracy, NICU Coach 22:22
Yeah, there was we were during this part of our NICU stay with my oldest when he had to be flown to Chicago. We had to buy it. We did make a stop in Iowa City where this is a major hospital here and they’ve got an amazing I department. But there wasn’t technology at the time and in central Iowa to do an eye ultrasound to really confirm that his retinas were detaching. And so one of the neonatologist made sure that on his call that my son got transported by ambulance to the hospital two hours away. And then my husband and I drove and you know, years later, I don’t think I appreciated the impact of this one particular Nikki nurse had on our family. But when you were mentioning, you know, pictures and doing special things with families. We were only there in that, NICU from probably Saturday afternoon until Monday morning, because on Monday morning, they flew him by intensive air to Chicago. So really, you know, 48 hours at most, and this NICU nurse, I mean, I still have the pictures today. She just knew that we were battling, you know, just all the internal like, “okay, is he gonna go blind?” just that uncertainty. And what that meant for him was gut wrenching, but she made, her name was Myrna, and bless her heart, I will never forget Myrna because she just we would come in from, you know, we would come in in the morning after being gone at night. And you know, she had goggles on him and like he was sunbathing, right. And she had all these fun pictures and beats with him under the bili(rubin) lights. And it was just, you know, I look back at that. And it’s this little small little things like that, that just means so much that she just took time because he certainly wasn’t the only baby that she had on her care that day. But I mean, and shame on me for taking so long to try to find her. But we’re kind of involved with that hospital now in other ways. And I wanted to seek her out and tell her what an impact she had on our family. And she’d retired a month earlier. And that was a good lesson to say don’t wait to tell somebody the impact they’ve had on you and your family until it’s too late. Tell him when it happened. Right. And so I hope that Myrna’s read some of my post or I’ve tried to connect with folks that are in her circle and let them know, to tell her, but it’s just things like that, that are just priceless and just can relieve so much. You know, she had to know how much that was weighing on our hearts. What Monday’s test was or what that test on Monday was going to show but it just made it a really hard situation that much better because of her caring pneus and just wanting to make it light hearted for us as best she could.
Maggie, RNC-OB 24:53
Yeah, yeah, I love and I’m sure, I am certain knowing you that you that she understood how grateful you were, even then as you know, as she was doing that, but and I think that again, it’s that, you know, that power and she couldn’t, you know, she couldn’t fix anything, or she didn’t have power over this test results, but she still had power to connect with you all and help you to find, you know, kind of the little silver lining moments. And that’s beautiful. I wonder kind of on the on the flip side, I know you touched on earlier, as you know, as family members, if you are concerned about something that’s going on, you know, with your baby, absolutely, we talk a lot about, you know, kind of patient autonomy and how you know, you really are, you are in charge of your care, you know, it’s a relationship that you have with your care providers. And I think that is still like, it’s hard for people to push back against that sometimes when they’re, if they’re concerned. And there’s a lot of terminology in the NICU, that it’s completely brand new to people and it’s overwhelming. You’re dealing with really like complex issues and concepts. Are there ways that like information was explained to you that you found pretty helpful a different techniques that you found helpful that like we can do as providers when we’re in that situation? Or was it kind of case by case?
Tracy, NICU Coach 26:06
I think one of the things that again, you know, the internet was, was not as prevalent as it is now to look things up, right? My sister, bless her heart, and I still have this book over here on my bookshelf, but it was a preemie book that was like this thick, and it was probably my Bible to me at that point. So every time, you know, we, the doctors did rounds, and I was there, or I read the rounds later, and I had something I didn’t understand or wanting to better understand that, gosh, I’ve pulled out that book. And lo and behold, yes, I could usually find what I was looking for. But I know I spent a lot of time talking to the nurses like can you just help me understand what does this mean or, and the doctors, the neonatologist, no matter where we were, were very, very helpful and making sure we understood. So in terms of, for our particular situation, I guess I don’t feel like there, there was a lot that was left that, you know, I needed more clarity on, certainly that that preemie book was a resource; nowadays, it’s different because you have to have access to and it can be a blessing and a curse so many resources on the internet. But one of the things that I probably relied too much on on that book for were the things that were top of hand right there in the moment. So for example, you know, he had a less than 5% chance of surviving my oldest and his stomach ballooned up to the point where he was three pounds within like his third week of life. And part of that, you know, I was like, “Okay, well, what is this do? Is this NEC? Is this something I need to be concerned about?” The doctors called us at one point said,”Hey, we think this is NEC, where do you want him to go?” Because that hospital couldn’t do the surgery. And so that I relied so much on that part of his what was going on in the moment, that kind of overlooked everything that was going on that was already going on with his eyes and could go on with his eyes. So once we got through the stomach issues and the distended abdomen, I thought, “okay, we’re in the clear.” And we weren’t; part of what’s hard, though to is, and again, NICU nurses we had some that, you know, shared statistics or, you know, babies of this gestation, usually struggle with this. And the hard thing about that is parents you want to know is you want as much information as you can get. So we can process it. But sometimes that information and every baby’s different, that information may not even come to be to come to fruition in your baby. And but but it causes undue worry, right, so I’m worried about something that may not ever happen. And so while I wanted to know like, Well, typically, what are babies of this gestation? What does that look like for them? I didn’t do that the second time around with me then because I felt like all that does is a wait for it to happen before I need to worry about it. Right? Because that for the first time around, I think I’m worried about everything, because I had all this information coming at me, like, well, he’ll probably this will probably happen, he’ll probably get this. And it just cause worry in some of those things didn’t ever happen. And so I just think sharing information is good. But I’m also, I am also very guarded, and how much I share when people ask me and or always caveat it with every baby is different. You know, all of those things. So I kind of couch it, like I’m happy to share. But that doesn’t mean that will happen to your child, or at the same time. And so again, my resources were, you know, kind of what had been shared that those had walked before me and my preemie book that I really kind of carried everywhere with me.
Maggie, RNC-OB 29:31
Yeah, there is; it’s a tricky balance just information overload that can happen in that time. And at the same time, I think, like you’d said, you know, for those of us who are planners by nature, it’s hard to not feel like you feel like you want to know everything that could happen. You could try to somehow map it out as if that’s how it would work, even though it doesn’t fall out that way. And I think that’s just a good reminder for us and how we’re, how we’re talking to people about those about just continuing to reiterate about that, you know, it’s individualized, there’s certain things we look out for babies in this situation, but we aren’t seeing that or we’re seeing signs of this. So here’s something you might want to look into a little bit more. And just kind of creating a little bit more of like a container to hold all of that that information.
Tracy, NICU Coach 30:09
Yeah, we even had, you know, because we were married for six years, we were together for six years before we got married six years, before we had my oldest so had a really stable relationship. And that was probably on my very first day in the NICU ith him was that statistics on marriage on families with premature babies. That just created an undue worry, like, okay, now you’re telling me my baby might not survive, but my marriage might not also survive either. And I that was not even something hadn’t even crossed my mind, quite honestly. So again, it’s it’s being you know, knowing that stuff is one thing, but couching and how you present that information is totally different. And that was probably information I didn’t need to hear, because then it was constantly a worry, like, “okay, am I doing enough with my husband?” right, “is my marriage gonna suffer as a result of this?” And that, then that guilt, it really felt like even more of a balancing act that I had to kind of try to figure out where, and obviously, it all worked out fine. But that was just as an example of where I didn’t probably need those statistics. And that evolution to cloud kind of where I was already feeling
Maggie, RNC-OB 31:16
heavy, huh, yeah, it’s a very apt reminder. And then can you tell us a little bit more about kind of your, your current work, and I would love to hear a little bit about what led you to write your book and what you kind of hope to see as the impact from that.
Tracy, NICU Coach 31:30
Yeah. So back in 2016. At that point, I’ve been involved with the March of Dimes about 13 years and had, you know, met some great families due to the great work the March of Dimes does, but I had a health scare. And it really caused me to do some really deep introspection on you know, what’s important to me, what’s my purpose? You know, what, what, what am I trying to get out of our journey with having two boys being micro preemies. And what it really led me to do is really create almost a deeper connection with families and help them really where they need help the most is that is processing those those days in the NICU. And I’m not going to make it sound like after you get out of the NICU life is all hunky dory, because that’s not the case. There’s a lot of stuff in in my own personal experience that travels years and years, due to being born early. But the NICU time is pivotal. And so one of the things that just again, God putting it on my heart to do something more than what I’ve been doing with the March of Dimes, and that’s really what led me to create my premium journal. And it really is a guided journal to help families through through the NICU and beyond to an extent but really, it’s not just a journal where it’s a freeform journal, that was certainly a component because that’s where some of really a lot of what were my healing came from was just writing things down in a freeform style. But it also really has a place to keep track of all the medical information that you don’t want to lose sight of every day. And you can look back over that and just look at how far they’ve come. And certainly you’re going to see a setback, but really is really a place to chronicle and look back on how far your child came. As well as just ending every day with gratitude. I think I just realized how important that was. And so that’s every single day you end it with gratitude. And write your day, how was your day and sometimes you’re gonna have a bad day, and you rate it and you know what, then you look forward to having a better day, the next day. And then also sprinkled throughout or some of the most inspirational quotes that were really I’ve read those and just there, they’re uplifting, and it tells me “Yep, I know. Yep, I know.” And so I wanted to make sure that there was some inspiration sprinkled throughout. But I’m actually using the journal myself even though it’s we’re well beyond our next few days, and that there’s a section at the end for milestones beyond the NICU. And there’s just it’s there’s a series of pages that are freeform, whether it’s overcoming a feeding tube, which is something I didn’t talk about, but my son had a feeding tube for 10 years, and we tried multiple feeding clinics and we were able to overcome that now are our challenges really the eyes and making sure we keep his vision stable. But it really is it’s a place for families to just get everything on their heart out on paper and just be able to just have that story to tell these stories families go through they matter and my hope in doing this this journal was I would love for this to become a welcome packet, part of a welcome to the NICU when families are admitted to the NICU they automatically this journal is something that they can start with day one. And not five days in 10 days in a month into their journey. It’s right there waiting for them when they’re admitted.
Maggie, RNC-OB 34:48
Yes. Oh, I love that and I’m like flipping through my copy of your book right now which I was so excited just to check it out because I love the balance between like you said the kind of the freeform journaling to just get those thoughts out on paper and it’s just very cathartic to, to just write and not have, you know, a purpose to it, per se. And then I also I love how at least kind of keep track of all the medical information, the gratitude, I think those are just really helpful to kind of like anchors in your day, if you reflect on something that was really overwhelming, having a chance to kind of process some of that and put it into thoughts. And I also think that’s like a way to, I can totally see, you know, I can imagine if I was in the NICU you need to like take a picture of that page the other day to share it to my family as like an update, if you don’t have like the energy to sit there and like, explain it all again, and write out a long text and do all that like that there’s just a way to kind of have a snapshot of what happened. And I do I love the quotes I’m looking at this one that you know, “there’s no footprint so small, does not leave an imprint on this world.” Like there’s just a really like, thoughtful places for pictures and everything. And I love that I think it is such a beautiful idea to have it be part of that welcoming gift. And I would love to know, we’ll be giving away a couple copies on like social media when this podcast airs. So if you’re listening in, check out our Instagram for that giveaway. But I you know, I would love to partner and in the future and know how us or how many listeners can help defend us support and get, you know, get this journalist resource into their local NICU. If you have any, you know, insight for us in that.
Tracy, NICU Coach 36:17
Yeah, I’ve been partnering with like the Neonatal Nurses Association, or the perinatal social workers association to I know, they have an annual conference, and they’re always looking for resources, and this year was virtual, but also trying to see where where I can, you know, have those resources available for like NICU nurses and whatnot as well, the tried to try to explore multiple avenues to get this out in the hands of those and COVID was hard. Yeah, you know, as this was, this launched during COVID. And so it was really happy that that this was a resource available to families, because this was unprecedented time were limited, you know, visitors and the new queue. And I can’t imagine being told “Oh, either you or your husband can go into the NICU, but not both.” And because that was some of the memories I cherish most about our next Tuesday was having us all there as a family. And so yeah, it’s just getting it out to the hands of those that need it. And the end care workers and NICU nurses as well to know the resources there for families that needed as well.
Maggie, RNC-OB 37:19
Mmm, that’s beautiful. Well, we are excited to share about that. Are there any other resources you would like us to to share, you know, with our audience, that they might find helpful if they’re, they’re navigating the NICU journey themselves? Or if they have, you know, a loved one who’s going through it? Or, again, if they’re kind of professionally involved in this?
Tracy, NICU Coach 37:35
Yeah, so I think, you know, just to kind of talk about the journal again, is is a great option for families that you know, don’t know what to get to get somebody, because I remember getting a baby book as a gift. And that’s another reason why I my kind of heart went to doing a journal is because, you know, I got that baby book. And as I started to fill it out, I couldn’t fill it out, none of the things were relevant. And so again, you know, I think this journal is going to be great for families that are looking for something or friends or family members, I’ve had a number of friends reach out to me and say, “Hey, I have a friend who had a baby early, how do I get a copy of your journal?” And those are in that’s kind of when I was creating this, my where I was thinking that that need would be somebody looking at how do I support them, I don’t know how to support them. I don’t know what to get them. And so that that’s a great resource. You know, March of Dimes is also another great resource. There’s the premium book that I have, I think is still in existence. That’s a great resources, as well as, you know, just all the things on social media, that there’s a Preemie World on Instagram that are always highlighting different things for families. So that’s where I gravitate towards if I was looking for resources now in our state where I was limited back in 2002, and 2004.
Maggie, RNC-OB 38:55
Oh, that’s perfect. And we’ll link all those in the show notes. For everyone who wants to kind of check them all out at a quick glance. But well, thank you so much, Tracy, for sharing your story with us and giving us an insight into how we can better support folks who are going through an acute journey.
Tracy, NICU Coach 39:07
Awesome. Thank you so much, Maggie, really appreciate you taking the time to talk to me about our story.
Maggie, RNC-OB 39:12
Absolutely. Have a great one. Well, I am just so grateful for Tracy coming on and sharing so much about her personal story and how she has become just an incredible advocate for families who are dealing with a NICU stay, who are navigating the uncertainty of raising a premature baby. And I really appreciate her sharing so much insight into how we all can show up better for those who are in our care for our loved ones as they navigate this journey as well. I really look forward to connecting with you all about what struck you about this episode. We love to do that on social media. So find us wherever you like to consume. We are Your BIRTH Partners across all platforms. And we would really appreciate it if you share this episode with friend or colleague, and give us a shout out on social media so we can know what you’re thinking. As you continue to process this information, we invite you to visit our show notes where we can, you can see all the resources we shared here. And we really are so excited about the potential for Tracy’s book, My Preemie’s Journey to help families to hold space during this time. And so we’ll be doing a giveaway for that later this week; so find us on Instagram to be a part of that. And we look forward to hearing what you think about it. Thank you so much for being part of this community, as we all learn together, how to provide more collaborative, inclusive and equitable care. Till next time!
044: Birth Nurses: Unique Position & Power
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth care communities, rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Hey, y’all, welcome back to the podcast. So we are continuing our series on holding space through the complicated. And when I was considering different topics for this, one of the ones I knew I wanted to dive into was how we as professionals hold space through the everyday and I thought about how, as a nurse, this was something I really had to actively cultivate. And I didn’t necessarily find that it came up explicitly in my kind of official professional training as a nurse or orienting on units. There is a piece of nursing culture that is often focused on still that kind of antiquated, handmaiden role, where we’re there to be helpers and to get stuff done more quickly, and to make sure that the providers have everything going smoothly for them, which is fine. But I really feel that nurses have a unique power and position in hospital birth. And I think it’s really important for us to dive into some of the ways that we can use that power and that opportunity to hold space, to create moments where we are more tuned into the person who is in our care. And if we don’t do that, otherwise, we’re just contributing to the harm that is often within our modern birth care system. And this is something that I’ve been thinking and talking a lot about recently with two friends and colleagues, Mandy Irby and Paul Richards, and I am just thrilled to have them come on the show and share their perspectives and their experience as we explore the roles of nurses in holding space and creating a future of better birth care. On to the show!
Oh, I am just so excited to have two of my favorite labor and birth nurses on today to dive into everything around power and positions and holding space as nurses. So Mandy and Paula, if you would like to just tell us a little bit about yourselves and kind of where you’re at in this work. That’d be great.
Mandy, RNC-OB 2:27
Hey, Maggie, thanks so much. I’m Mandy Irby and online I’m The Birth Nurse. I’m a labor and delivery nurse as well and and nurse and parent educator and also a trauma informed birth strategist. And hey, hey, friend. Hey, Maggie. Hey, great to be back. Thanks. Thanks for the invite.
Paula, RNC-OB 2:49
Hi, guys. I’m Paula Richards. I guess again on the internet, you can find me at Nurse Brown Girl on Instagram. I’m a labor and delivery nurse as well and nurse educator. That’s about it.
Maggie, RNC-OB 3:02
Well, there’s a lot more than that, but I’ll let you get away with that for now. So I have these two fabulous nursing educators on here. And I want to start out this whole season we’re talking about holding space through the complicated and so we’re actually asking each of our guests if you could just tell us what does it mean for you to hold space as a nurse? Get in there Paula!
Paula, RNC-OB 3:20
Okay, I was gonna say leave it to me to not know how to answer the very first question that’s like super important right? It’s the kind of thing where that even that phrase holding space is something that I’ve been familiar for quite some time and not not to sound like a doofus, but it feels kind of like a vibe, right? And so being a vibe it’s you know, how does how is that defined? I was gonna use that term in a class of primarily nurses and the person that I was collaborating with actually put me on the spot analysts like “Dude, not everybody knows what that means. So I’m gonna need you to break that down.” So I guess to me, like without, you know, cheating and looking at notes and being beyond like, I think I’ve defined it before, off the cuff, I would describe holding space as presence or presencing another human. And as a labor nurse, holding space means being present for an individual patient or you know, maybe it’s the whole family unit through that birth process and transition from you know, maybe a family with no children or family with, you know, a few kids to like, what a family with more kids looks like, right? Because those dynamics are always changing. So yeah, it’s kind of being present for them and meeting people where they are in that capacity.
Mandy, RNC-OB 4:50
Oh, I like that, Paula. I also like it’s a vibe, because I think it is a vibe, but I think when you say it’s a vibe, I feel like Maybe I’m not in. I’m not in the know, am I doing it right? I’m not. I’m too old for a vibe. But a vibe is like, Oh, wait. I think it a vibe give space for everyone’s unique, one way of holding space and two person you’re holding space for. And with a little bit of background, Paula and I are friends. Well, we’re all three friends outside of this recording. I think Paula, you and I have been practicing holding space for each other incredibly intentionally recently. And it’s opened up my understanding of what holding space for me means. And I think that’s helped me have a better understanding of holding space, how I can do that for others and show up for others. But it is kind of something that I’ve been learning outside of the hospital and outside of my labor and delivery nurse role. And then bringing it back to the bedside when I was at the bedside, was challenging. And not everyone knew what that meant. They thought it was like a vibe,
Paula, RNC-OB 6:14
some “witchy woo,”
Mandy, RNC-OB 6:16
yeah, some woo, right? Exactly. Woo. But it really was just being curious, and confident not confident, but comfortable with whatever came up. So whatever came up in that person’s journey, whatever information they disclose, to me, this is holding space for my patient, assuming there’s one, even though the room is kind of the whole, another vibe, right? Yeah, family, the family, right? whomever they’ve brought, whomever they’re wishing was there, you’re kind of getting curious and comfortable with whatever comes up, which is, I think, I think kind of like lame compared to all of the going and running and pseudo emergencies slash real emergencies that go on in our work. But the holding space part felt really challenging for me, because I had to be I had to be still and quiet, to allow for all of that uniqueness to unfold instead of interjecting any sort of plan or feeling into it.
Paula, RNC-OB 7:17
I call those like the factory settings, right?
Maggie, RNC-OB 7:22
Yeah, sure. I find it interesting to like both of you as you’re talking through it. I feel like for listeners, we think like, of course, like that feels very a part of nursing, right like that. You’re just you’re sure you’re being present with someone, you’re there at the bedside, you’re like taking it all in. But I think there’s a huge discrepancy between that as like a vision and maybe even how we thought we would be as nurses going into nursing school. And then like, how we learn to be nurses? I feel like maybe we have some theory classes early on, in, like nursing education that we learn about, like, Oh, yes, this idea of like nurses role, you know, within the patient’s lives. And then, so much of our, like, nursing training, and so much of nurse residencies and, you know, getting on the unit and orientation is really focused on those like, kind of hard skills and giving medications correctly. And that’s important. And understanding the policies, and you know, all of those things, they matter, too. But I feel like we get pretty far removed from kind of that baseline of just being there with someone and then responding how they like with what they need in that moment. And I don’t know if you could speak a little bit about like, Where do you think you have learned best how to cultivate this idea of holding space for people, and maybe it came up for you in your, you know, in your more formal education than it did for me?
Mandy, RNC-OB 8:44
Well, where did it come up for you?
Maggie, RNC-OB 8:47
So…Mandy, you trickster! [laughter]
I mean, I can answer first is that no, that’s good. Yeah. So I know, I came into holding space more as I was, I mean, it wasn’t that it was it wasn’t non existent in my life up till the end. And you know, it came up in nursing school, I think in probably, maybe not using those exact words. But certainly that idea of it is very much a part of who I want to be as a nurse, how I want to show up, but I don’t think it was until I was out of college and had been a nurse for a couple years and was trying to get involved more in like community spaces and sitting in circle with people and holding that and then as I went into my Master’s in nursing education, I was involved in like circle leadership and how that works from faculty show so I think it got me started on that road more about like, Oh, yes, holding space has its own full thing. You know, like that is, that is enough. But I don’t think I recognized it was enough. And I think it’s doesn’t it’s hard for me, we were talking earlier before recording about like enneagram types and all that and I’m very much a helper a type two. And it is hard for me to hold space for people. When there’s a like piece of me that desperately wants to help and there’s part of me that has to understand the difference between like helping someone the way that I want to help them and helping someone the way that they actually want to be helped. So that’s also been like a huge personal distinction for me and something I’m still, like actively working on as I support friends and loved ones and, you know, clients through difficult situations.
Mandy, RNC-OB 10:12
Yeah, for sure. I was just thinking, Paula, imagine if there is a competency, a holding space
Paula, RNC-OB 10:19
holding space competency? I know, right?
Mandy, RNC-OB 10:22
What would we? What would we do to check that off the box? Would we just sit with each other?
Paula, RNC-OB 10:28
Right? Describe your vibe. or know a competency? Would it be written more like, is able to demonstrate vibing?
Mandy, RNC-OB 10:41
Exactly adjusting to appropriate vibe missed?
Paula, RNC-OB 10:45
Yeah, yeah,
Mandy, RNC-OB 10:46
with each changing patient. And I think in nursing school, they would say like, Listen to the patient, and we’re assuming the patient, the birthing person, the pregnant person, like can identify what they need and ask for it. And in my mid 30s, I am just learning this and trying to get comfortable with asking for what I need and not apologizing for it and identifying it. And I can’t imagine being an expert at that, in labor and birth. I mean, I definitely, I know that some folks get there and they’re like, I need this, I need that. I just need this off. But they’re not really always able to identify what they need. And they may not know the option. And I think that’s where the labor nurse, I’ve always thought and I’ve always said the labor and delivery nurse has one of the most important roles in the world. And we have so much information on how to be creative, how birth, how creative birth is, how unique it is, how many things we’ve seen and done and tried. And all of like all of the options, not all of the options, but many of the options that may be supportive for someone that I think we can listen and identify and kind of get curious about maybe what someone isn’t saying, maybe offer some ideas that might resonate, or they might throw that back. And then we have more information. And that comes from only started for me after many years at the bedside, where I was like, I just do not the what you call the factory settings are just not working. They’re not working for me, and they’re not working for everyone else I need to get I need to get more clear and asking the patient and listen to them is not it? Usually, I think it’s more right vibing like, really sitting with someone and being still and asking and sitting with tough questions and with tough answers and tough emotions and and then the challenge is not taking it home. So then you have that whole like, shut it down. Yeah. So you, you have to walk into something it with that vulnerability, but then also try to practice the skill of not letting it in too deep and not letting it in forever and not letting it take over your personal life and your day and take it home with you. I think it’s been in my trauma informed training, especially with sexual assault survivors, or folks with a history of trauma and loss. And then outside of the hospital on like community education settings, childbirth Ed settings, where we could kind of practice this, and then take that back to the bedside. And that’s what I found that information. And I found it to be really helpful. But it also takes a lot of time. So it’s also difficult, at the bedside.
Paula, RNC-OB 13:43
It is difficult at the bedside, because I feel like so much of that involves humility on our part. Not only is our training focused around heart skills, but I would say I would take it one step further. And they’re hard skills in service of productivity. Right? And so then what gets praised as a labor nurse is you know, the fact that like, you can bang out deliveries and you can you know, like, yeah, go to without IVs those IV sticks you
Mandy, RNC-OB 14:16
30 minute admission. Done. Yeah.
Paula, RNC-OB 14:19
Or, you know, an admission when you should probably not leave your active patients. That’s right, yeah. But you know, like, we somebody’s got an appointment for their induction. So you know, we need to get in there and get started. And then how do you make decisions about prioritization of care, right? So I think that for me, I learned to be a labor, a labor nurse, surrounded by mentors who were very intentional about continuing to ask questions. So one of them I mean, 30 years a labor nurse, and was still Bringing in articles or talking about a panel at a conference and made her think, you know, rethink an approach to care. So seeing that role model, I felt like was really important. And it’s still kind of important. Maggie and I were talking about role modeling before recording, but just, you know, like how key that is, to our professional development to like to see those kinds of behaviors in action, especially when they’re pretty scarce, right? And if your unit culture centers around productivity with no with nothing else, right, then a lot of us, I feel confident in saying, then only learn about birth happening in one particular way, which is kind of cool about the spaces that we have found ourselves speaking in, because well, there’s a lot of shorthand and a lot of thoughts universal about our experiences, as labor nurses so much about the particulars or you know, how well you function within a unit gets down into how, how well can you acclimate to that particular units culture, right, and their own way of functioning? For me, I started so holding space for me, and how I see that practice of kind of observing what people need, I think comes from way before from my life, because as an immigrant, you have to like a lot of your safety depends on keen observation, and then, you know, astute understanding of what is acceptable behavior in order to assimilate, right. So that’s kind of something that I feel like I’ve just practiced throughout my life, my initial approach to any new any new situation is kind of to take a step back, and kind of observe for key players, right? Like, who are your leaders formally and informally? Like, who would you go to to whatever, but that also, I guess, allowed me to see what behaviors by other clinicians and I started as a nurse directly into ob, so I learned to be a nurse, and I learned to be an OB nurse. Because this is what I wanted to do. I started noticing the difference between you know, like, a good outcome, and then a satisfying birth experience. Right? Because those two things, I mean, they don’t have to be, you know, they certainly don’t have to be mutually exclusive. But we, as a whole, like clinicians, as a whole, certainly aren’t taught to prioritize the birth experience. Right, as opposed to, you know, like, they can like the heart outcome of, you know, like, where you’re at cars, good and gases.
Mandy, RNC-OB 17:58
Man, so I feel attacked. Oh, I mean, gosh, good outcome. I wrote it down verse satisfying birth experience, of course, we sometimes think that they’re the same, right?
Paula, RNC-OB 18:12
Right, right. And then you know, so you kind of start noticing that beyond the confidence that comes with competence in the heart skills. I was definitely left asking like, this can’t be all that there, there is. And my first hospital, I was really lucky to have a wide range of private providers and physicians and midwives. So you know, it’s kind of it’s just nice to see a variety of practice styles and approaches and then you know, you get to you get to see that number one, you know, it’s not just one thing that works. And two, with the different types of patients, some of them brought their doulas with was just fascinated by again, just how satisfied with the birth experience are patients appear to be in the way that maybe others did not. And so I don’t know maybe it’s my brain that listens, like starting to dissect and tease out like, Okay, what is it that you’re doing right? And initially, it’s easy to pinpoint, like the you know, like, what is the hip squeeze thing that you’re doing? Teach me and then it’s like that hands on hard skill, comfort measure, right? But as you adopt comfort measures…here’s where holding space comes into play. What’s more important is knowing when to deploy those things. Right? Because you don’t have to, I see I am definitely I definitely do this. Like I’ll attend a workshop and I’m like, I’m gonna use it tomorrow and…
Mandy, RNC-OB 19:52
I actually don’t want to be touched ever.
Paula, RNC-OB 19:58
Go away. Exactly. Right. Yeah, yeah, yeah, we’re good here, or like, just sit there. Right. So it took me many years. And still, just as you were saying that the natural inclination to be like, actively physically doing something to help, right kind of gets in the way of getting to the heart of what our what our patients want.
Maggie, RNC-OB 20:22
Yeah, we have a unique position, right, you know, kind of within the staff who’s available to support her, you know, particularly in the hospital, I, you know, obviously labor and birth nurse, you know, we, we have the greatest numbers, there’s a biggest quantity of us compared to midwives, physicians. And so I feel inherent in that, then, like, we, we have this ability to really set culture, like you said, and that it is obviously, it’s also it happens in teamwork, it’s dictated by things that are outside of their control. But by and large, the way that we as labor nurses show up at the bedside, the way that we support people, the way we listen, the way we tune in we, we vibe with them, the way that we hold that space has a huge way of impacting that piece of how is your worth experienced by you compared to like, yeah, and what were the numbers we’re putting up on a bulletin board this month for outcomes? Like, yeah, we have a lot of potential there to create the space we want to exist in, like, we have the ability to make a culture where our patients come in and feel safe and supported, and that they are able to tell what they want to need, even when that’s something that works for us like, and that I think it’s not, it’s not common, and I feel like especially in labor and birth, when there is something that like, absolutely, it’s natural and beautiful, and people have been doing it for millennia. And there’s also complicated parts of it. And I think we learn as nurses to focus on that complicated part.
Paula, RNC-OB 21:50
I could go on a whole tangent about like, fearmongering nursing education, that kind of, like feeds into that, right?
Maggie, RNC-OB 21:59
Absolutely. Yeah, I feel like that’s like there’s like that huge piece of it, that we tend to cling on that and that that’s what we I guess maybe that’s what we worry about when we come on as nurses to OB. People, when you talk to non labor nurses, they’re like, terrified by the idea of “oh my gosh, like so you have to take take care, you have to take care of, you can’t see or touch or…”
Paula, RNC-OB 22:18
Yes and in clinical it’s all about like emergency potential emergency. So you have to be prepared for right. Yeah, remember the blood as opposed to Yeah, the pressure to approaching pregnancy and childbirth as a physiologic process. Right, like what’s inherently normal, like how its approached? Yeah, from a nursing perspective, in the, in the United States in particular, because I like to do my homework. So when I became a labor nurse, I mean, I was looking to work as a midwife. And so that resonates with me, Maggie, what you were saying about kind of like the power that we find in birthing rooms what I noticed in my area is that you know, the job markets not great but also still 15 years later get super excited about you know, being in labor rooms, right? Like even if it’s like sitting and charting, sitting and charting, right, like that doesn’t sound like it’s not doing anything for the patient. And yet you’re with them in a way that you’re not if you’re you know, watching a monitor from from the nurse’s station, right? Yeah. But when I did my so so then I decided, you know, I wasn’t in any position to like move regionally to a place where you know, midwives might be doing more labor sitting in that fashion. And also, I thought about the patient population where you know, 98% of the people in this area are going to birth in the hospital than when I’m what what am I doing, like not attending that right? in a hospital space I still have to remind myself of that you know, every time I’m like maybe it’s time to let this go. But also right until we can fully divest right where are people going to go to birth while they’re still going to come here and whatever the quote is about like highly developed skills in that you know,
Mandy, RNC-OB 24:26
Right? It’s that fix it culture like right you’re so concerned about what could go wrong because then we can fix it and then we can save everyone from all of the hard stuff and that’s how people have been dying from childbirth and we can save them.
Paula, RNC-OB 24:42
But that’s all you know, like that. To me that’s all born out of how obstetrics was developed in this country right? Ever in most other, what are we calling them like “high resource” countries I don’t know everything seems problematic when that like words leave my mouth, but in places where Yeah, them. It was model of care predominates which is like literally everywhere else, right? You know, what we do as labor nurses is the worker of midwives, who don’t necessarily train as nurse because the approach is totally different. Right? We are trained as generalists. But we’re also trained, even though like what you know, like the prevailing theories of nursing, that makes it different from medicine, is what that our job is to help like patients attain their, like, the best version of themselves. So they want to attain right, like, so it’s still very, like patient centered. And so in helping people achieve that we end up learning about, you know, like, medicinal approaches or surgical approaches, or, you know, therapeutic approaches, but it’s still subservient to the centering of pathology, right. And so, and so when our, the very foundation of our education is grounded in pathology first, right, as opposed to like, whole human burst. What a contradiction, right? Like, yeah, I feel so hard. And I could teach nursing theory, like, I love that I love that nerdy shit, you read the words. And then again, in theory, or like, academically, a lot of has been up and written. And, you know, there’s a lot of discourse around nursing versus medicine, but the two are so entrenched here, as nurses trained in this fashion, in which we’re preparing for every, you know, emergency, and it’s gonna, it’s hard to unlearn, right? It’s hard to divorce that, and then, you know, put a significant amount of time in learning about like, basic birth physiology, right, our training, just not encompass that, right, like, you have to go to grad school. And if you get lucky, like, you might understand some of that. And that, like, we really just sound like clowns, right? Like, how’s your labor nurse not gonna know, physiology at the end orientation,
Mandy, RNC-OB 27:14
I know. Right? Yeah, yeah. It feels like a huge chunk is missing when we’re like, our patients have really great questions. And why am I not able to really readily explain that in like a full way?
Paula, RNC-OB 27:27
Well, and I think the problem is that, in my experience, I felt comfortable in answering questions by not with a full understanding that that was based off of one particular like, set a routine. Yes. And so it was more about again, like those factory settings as opposed to like a true underlying understanding of pregnancy and birth physiology. Right. And so for me, the lightbulb started going off when having, you know, too many children to know what to do. I needed like, a little bit more job flexibility. And I started teaching childbirth classes for parents who have these questions, right? How does the body work? Like, how is how are you supposed to function? You know, and I had to, like, hit the books. And I was five years in, right to like being a labor nurse and feeling pretty, pretty good about the job that I did, and still finding huge chunk of missing information, right? Or misinformation. And you’re just plain information that yes, makes you want to scream because, yeah. And that gets like it’s continuing to be perpetuated. Right?
Maggie, RNC-OB 28:47
Yeah, I feel like that. That piece of it, where we’re just, we’re falling in line with whatever we’ve learned, right? Whatever. We’ve been taught whatever they’re saying, whatever. You know, when you’re sitting there, and you’re talking to someone, if the provider just has explained in one way, yeah, you’re like, oh, okay, I guess that’s like the framework we’re taking for this. So I’d also really love to dive into like the idea of like nurse power, and like, how do we show up as like powerful advocates. And I think some people think of power is like a is an aggressive term that feels at odds with this idea of like, holding space for someone and being there. But I’d love for you to share a little bit more about like, how do we see nurses acknowledging their power, acknowledging this unique position we have at the bedside, and taking all of those to really be that that advocate to hold space for their patients through all of these different things that we’re helping them navigate from physiology and childbirth choices and all of these things that that come up. How do you see that as like a part of it?
Paula, RNC-OB 29:51
Can I say something?
Maggie, RNC-OB 29:52
Yes.
Paula, RNC-OB 29:53
Potentially controversial?
Maggie, RNC-OB 29:55
Yeah!
I mean, I don’t know. I think most of us don’t have the language. To describe what power looks like, because in my again, my lived experience, power looks like making sure like the wheels of the machine are like greased and functioning well, right again, because that’s what gets praised. And if you’re if you’re working, it’s so it’s so it sucks.
Mandy, RNC-OB 30:21
You’re right, though. Yeah.
Paula, RNC-OB 30:25
And it’s not, it’s not like power in and of itself, but you have to look at the power dynamics of the whole, right? So if you walk into a unit, where it’s not the done thing to call physicians or providers after a certain time of night, right, like, you better figure it out, we have to do a pretty significant, like root cause analysis who like where does the Okay, what, what is happening here, right? Because we know them to have something bigger, right? And that’s what’s going on and like, who holds, you know, or seem to hold the ultimate power? And so I see nurses in those kinds of spaces, reclaim power, and kind of what feels like manipulative ways if you frame it in the negative, because it’s subversive, for safety reasons. And so like power comes from power comes from calling somebody eight centimeters until they’re a plus three station. Right?
Maggie, RNC-OB 31:32
Right.
Paula, RNC-OB 31:33
You know, like power comes from,
Mandy, RNC-OB 31:35
wait, you can do that. That’s a sneaky shit, that’s sneaky
Paula, RNC-OB 31:41
Power comes exactly like learning who you need to, like call somebody “four” when they’re “six,” because when they recheck, you know, like, when they come in to recheck them, you better be showing that like cervical change has happened, right? And so you better be stingy with that exam to buy you time, right? I didn’t know a lot of things that I had learned to do were powerful, like, it had never been framed in that fashion, until I started talking to other birth workers who were like, I still don’t believe it. And when I, you know, I couldn’t like off the top tell you specifically, like, what I said, that, you know, had that kind of a response. It was like, okay, so like, my whole existence, I guess, is powerful here. What the hell is that? When did that happen? Right? I learned that as a charge nurse. I could say “no, we’re not starting that induction because everybody already has a labor patient. And this is not emergent.” And that’s powerful. Right? Like, patient flow is powerful as a preceptor saying, you know, “my Oriente and I need this particular learning experience,” and like prioritizing that is powerful, and scary, but we’re not taught to call it powerful, right? Or like, or, like, feel like there’s power in in those kinds of approaches or statements.
Mandy, RNC-OB 33:17
You’re using your power for good when you talk like that.
Paula, RNC-OB 33:21
So that’s why like, my, my initial inclination is to say, you know, like, I feel like most nurses that I work with be like what power you know, right? I’m just, I’m just here and kind of like told what to do. And a lot of the job can sometimes feel that way. Right? And so then you have to, I mean, I have to think about Like, who do I who am I here for, I do still have to pay bills, right? And I work several per diems just so that I can have like the privilege of say, you know, like, if I piss somebody off too much and I won’t be back for four weeks and they can get over it before like pick up another shift right? Like I’ll go find hours elsewhere. So for me personally, like power comes from that flexibility. It also comes like my own homework. So it’s kind of like if I know guidelines really well and can read them right to back at you. Come at Come at me, right? Like when I give patients a particular piece of information, because we do so much patient education, right? Like from the moment we meet them. I feel like almost anytime I open my mouth in front of a patient in the back of my mind, I’m like, Who’s gonna come at me?
Mandy, RNC-OB 34:35
I’m so glad you say that.
Paula, RNC-OB 34:36
And am I am I ready? Right?
Mandy, RNC-OB 34:40
Because when they repeat this Yes, it’s gonna come back to me. Yes, because it sounds like me.
Paula, RNC-OB 34:46
But Mnady said that I could, right? Exactly, Paula said, and my evolution was, you know, like, let’s take like eating and drinking.
Maggie, RNC-OB 34:54
Right? Yeah.
Paula, RNC-OB 34:56
Nurses have the power to enforce bad policy or orders. When you know like when they set the tone until the patient Now don’t be eating anything, right? And even that tone is like so patronizing and condescending and infantilizing. Right? Like, just line up all of those, like bad words.
Mandy, RNC-OB 35:19
Yeah, the fact that people listen to that bullshit means that you have some power, right? Otherwise, they should be like, um, no one talks to me like that.
Paula, RNC-OB 35:28
Yeah,
Mandy, RNC-OB 35:29
Right, we should all feel like that cringy.
Paula, RNC-OB 35:31
I’m gonna need you to strip down to this gown. Okay, right, like no questions asked, right? Like super powerful as like an agent of, again, the MIC (medical industrial complex).
Mandy, RNC-OB 35:43
Right? for evil or for good.
Paula, RNC-OB 35:45
Right, right. Yeah. And so it’s just like, when I, for example, I decided at one point that I was going to take all of the gowns out of triage when I do triage, you know, like, everybody has their own set up. And I don’t even remember, it’s been a few years. So I don’t know, what was the impetus for this, specifically, but I was like, Nope, not everybody needs a pelvic exam, or to be like, Fully undressed? Like, there are many different chief complaints. And I can hand them a gown if they ask one or if they really need one. But you know, like, that’s not going to be the default. Right? I wasn’t waiting for a policy to tell me that. But then also, like, at that point, you couldn’t have told me that that was like, me exercising any kind of power. Right?
Mandy, RNC-OB 36:35
Right.
Maggie, RNC-OB 36:35
Right.
Paula, RNC-OB 36:36
Because I personally didn’t feel like I had any agency.
Mandy, RNC-OB 36:41
Yeah, we definitely talk to each other like that. Like, who said we could do that? Or did you ask so and so?
Paula, RNC-OB 36:49
Where’s the study? Right? Like, the amount of conversations online with other labor nurses are like, um, do you? Can you cite your source for that, because I know that somebody’s going to ask me. And like the last time I remember things we were talking about, like the source material is from the abs, and the data has not changed. But we just refuse to believe that, you know, you can turn pitocin off when labor is achieved, or like, whatever rail workout, and you don’t have to wear a gown or, like you can keep your underwear on or whatever.
Mandy, RNC-OB 37:25
I think I realized my power as a nurse, when other birth professionals, other birth workers told me. I usually have to get knocked over the head with stuff. And they were like, Oh, my gosh, you’re a labor nurse? Oh, my gosh, you can affect so much change. And I was like, I don’t think you know what I mean, when I say I’m a labor nurse, I am a worker bee. Like I literally told them, I’m a worker bee. And then they were like, Oh my god, so there’s no hope for change. And I was like, Oh, no, I don’t. I’m just learning. I don’t know. But they, but they were like, Oh, my gosh, you’re a labor nurse. And then I started to see my power, or our power collectively as labor nurses. One in the negative, like, someone could easily just say, No, you can’t eat any food. And people just do it. Yeah, oh my gosh, and learning trauma informed care. I was learning like how you know, the ins and outs of our memories, and our trauma and trauma memories and our body memories, and really wanting it to be really important and meaningful positive, I wanted to be a part of a positive forever impact. And I felt an urgency around that. And then I felt very strongly inside in my body. When my power was used against me, specifically, this is the hardest, and I’ll just like, touch on it for just a moment and then mute my mic. But when someone would say when a provider would say or a resident would say, “well, we need to break our water, we need to break their water. That’s what’s next. And they just won’t do it. And they just don’t want to. And they’re just prolonging this” and all these awful things. You can insert your own experience with this probably. And they would look at me and say, “You need to talk to her about breaking water.” And I would get confused. And they would say, this is what needs to happen next. “Do you think that she’ll agree? If you talked to her about it?” That I was like, “This feels like the ugliest thing I’ve ever felt.” And you know, inside I’m like you want me you right now are acknowledging this hard work. In this relationship that we have done, my patient and me have done together to trust each other and form this relationship between two strangers during the most intense, memorable time in someone’s life. And you’re telling me to manipulate that person with that. I was like, oh, okay, so I’m going to Stand a little taller for a second and say a bunch of stuff in my head back And then decide for myself if I’m going to do that. And I felt really powerful. Once I realized what that was, and saw it and looked around, and no one thought that that was disgusting, or no one, you know, said, “Hey, back up. That’s manipulation. We don’t do that.” No one said that. So there was a very obvious and collective like, this is the culture. This is accepted. And this is powerful.
Unknown Speaker 40:32
Oh, my gosh, yeah, like, and I mean, you both just touch on something. So like, if we have the power to enforce bad policies, we have the power to enforce good policies, to make change happen, to be the leaders of what we need to see happen in birthcare.
Paula, RNC-OB 40:49
And call bullshit on policy. Oh, yeah, that’s kind of been part of my journey is that I had one point was the nurse who would be like, “I’m gonna leave the room. And then you know, like, you do whatever you want in terms of for like, eating and drinking,” right? Yeah. And I’m now at the point where I’m like, so data on eating and drinking and fast like that data and fasting and labor stupid, we shouldn’t be doing it. But the policy is this, I just have to inform you, and this is what we’re concerned about. And you can just tell people that you know, Paula said that nobody can tell you what to put in your mouth. So you’re just gonna go ahead and eat right? Like, more recently it is. It’s not just like, I hope that this doesn’t get back to me. Or if it does, like, Do I have the evidence to back it up? I’m full blown just like, “FYI” exactly. And like the next the nurse behind me might come in or an SDM might come in and say like, “Oh, no, no, no.” And so like full disclosure, this is actually what the ASA says. And this is what you know, like, what they might be concerned with, by you do whatever you want, because you’re the boss, and you know, just kind of like feeling powerful enough to give that power back to the patient. Right? Because people who lack who are disenfranchised and lack agency can really then promote that in somebody else. Yeah. Like, it’s part of those, like, the, like, systems of oppression, right? Where if you’re feeling, you know, like, super down, or like, you don’t have any power to make a difference, what, what’s the point, it’s an echo of that. You do need to own some of your power in order to start, you know, like moving that needle and making those changes. And then saying, like, you know, like, guess what, I got you in case of emergency. So here you go, what do you want to do?
Mandy, RNC-OB 42:56
That’s right, yeah, I could take that power straight from the resident and say, Oh, thank you very much, you have now lifted me up, I can go into the room and say, “we really need you to do this.” Or I can go into the room and say, “Here’s six options, you have three no one else is going to tell you. I’m never leaving your side. I’ll back up whatever you want to do. This is what it may look like, or I can give you a minute. But when so and so comes in. It might look and sound like this. Look at me. And I will confirm your choice.” Yeah. And then you’re sweating and shaking and everyone comes in. And they’re like, Oh, shit, they just like repeated it.
Maggie, RNC-OB 43:36
When we’re standing firm in our power and our knowledge of our role and what we have that that lets us feel confident in the patient’s power. They are the one who gets to choose what happens. Yeah, like we just give space for their power to be evident instead of hiding behind. All these are things that we think we have to couple behind the provider preference and the policies and the way we’ve always done things and yada yada yada, like if we all stand firm, and what we know, our role is as an advocate for the person in our care, that lets them shine out you know, I always hate that like voice for the voiceless, because that’s not it. We’re just stepping back and letting their voice be be strong, be heard, and making sure that we’re amplifying it, instead of trying to crush it with the policies voice. That’s not a real thing. Policies aren’t people and they’re definitely not more important than people. But oh, well, yeah, I we could just sit and talk about this forever, which is what we do mostly, we sit here and we refund all this stuff all the time. And that leads me to the last thing I wanted to cover and share with you all is about the program that Paula and Mandy and I have all been putting together as we’ve been talking through all these issues and recognizing the way we want to see this change from this standard of helping whatever that means, which is usually inadequate to standing in this trauma informed standard. of advocacy that we want to see all of us feeling comfortable and confident doing as labor and birth nurses. And so we have created the Trauma Informed Birth Nurse program. Yeah, so and movement would maybe be a better term for it, because we really want to see this be a community of changemakers who are coming together and recognizing trauma informed care. as something that happens with every client. In every care interaction. It’s not something that’s reserved for special populations. And that trauma informed care lets us really see people with a heart, it helps us to gain those skills to hold space, it creates a way a lens for us to view everyone in our care more holistically, and really tune in with them. And so I would love if you all just want a shout out kind of whatever you’re most excited about. for that program, we’ll be sharing everything in the show notes, we’ll link to everything. And we’ll be pumping it up on social media. So you can look for stuff there too. But I’d love to just hear as we kind of close out what you’re kind of most excited to see, kind of as like the future of us taking this this power and disposition we have and bring it forward.
Mandy, RNC-OB 46:07
Well, I’m, like sizzling with excitement. What a weird word. I am so excited about all of the parts, mostly excited that it’s being created by these minds that are here on this podcast, Maggie and Paula just the way Maggie explained it, I think it’s perfect. I’m most excited about everyone that’s involved. We have what do we have, like 15? People? Yeah, we have so many people involved, it’s really nurse education, like I’ve never seen it before. And I wish I had 10 years ago, because it would have shortcutted a lot of this learning, I think we’re learning from so many different genius minds and experiences, voices and stories, that we really get a lot of expert information without having to live it without having to go through don’t have to become a childbirth educator, you don’t have to have a traumatic birth. You don’t have to get burned out before you get this information. And it’s I’m excited for the radical change that it’s going to bring to the standard of care of labor and birth nursing. Alright, Paula!
Paula, RNC-OB 47:17
hey, I’m excited about the application of concepts. So I feel like recently, you know, trauma and trauma informed care as an approach. I have heard people call those buzzwords, right, like they’re all of a sudden everywhere and why it’s the why is this important. And so I feel like most people going in might have some idea about what trauma informed care means, or at least like the theory of that, you know, approach that is person centered, we do get stuck on the like, Okay, what does this mean for my behavior, right for my participation as a labor nurse in the system, to shift my own practice, which is like when I have control over to to be trauma informed, right? Like the embodiment of that. So I’m, I’m super excited about how the way that we’re building this program, is working towards giving people a blueprint for their own process of that embodiment of a trauma informed approach to care. I mean, and labor and delivery care specifically, which is it. So I mean, it’s just so nuanced, just from our conversation, right? It doesn’t feels like one of the things that I’ve been missing. And, you know, my own, like research and study is that is our voices that are speaking directly to that. And like that, that role of the labor and delivery nurse.
Maggie, RNC-OB 48:47
So, yes. Oh, I’m just so excited to be doing that with you all. And thank you for coming on, and just sharing more about your experiences and helping us to all just think more critically about the way we’re showing up and holding the space for those in our care.
Mandy, RNC-OB 49:02
Thanks, Maggie.
Paula, RNC-OB 49:03
Yeah, thank you.
Maggie, RNC-OB 49:05
Well, I hope you enjoyed that conversation with Paula and Mandy, as we’re just sharing a lot about our personal experiences and kind of how we’re traveling this journey as nurses, trying to do better, trying to improve the care that is needed by the person who’s actually seeking it, trying to expand our horizons. And if you loved listening to us go on about this, you will absolutely love the new course we’ve created. I’m really proud of what we are cultivating in the Trauma Informed Birth Nurse program. And I will be sharing more about that in the show notes, as we said, and you’ll see it posted up all over the place. So we’d love for you to let us know what you’re thinking about that or what you would like to see from more trauma informed care. As we all continue to hold space. We love to connect on social media. We are Your BIRTH Partners across all platforms. So find us there. We really appreciate it if you’d give us a shout out there, share it with a friend or colleague and let’s get talking about this and seeing how we can shake stuff up and create a better world that is more inclusive and collaborative and actually leads to equitable care for everyone. Till next time!
045: Honoring Pregnancy & Infant Loss
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back to the show. This week, we are diving into a really heavy topic as we explore how we can best support families experiencing perinatal loss. October is the month for awareness around pregnancy and infant loss. And October 15, in particular, is the Remembrance Day. Of everything around topics that deserve our attention in this series about holding space, we knew that we wanted to address the realities of perinatal loss, and how we show up for our patients and our loved ones as they navigate something as challenging as losing your child, losing a pregnancy. To help us navigate this conversation. Our guest this week is Lola Brognano. And she is a licensed clinical social worker. She does a lot of work supporting families with perinatal mood and anxiety disorders, and particularly work around supporting perinatal loss and grieving process. And so I welcome you into this conversation with Lola as we explore how we can best support both during an immediate loss, and as the grieving process continues thereafter. On to the show!
Well, I am just really eager to dive into this conversation with you, Lola and share with our audience a little bit more about supporting parents through loss. So if you want to just share with our audience, just a little bit about yourself and kind of how you came into this work.
Lola, LCSW 1:57
Thank you sure. I am a licensed clinical social worker. And I’m currently in private practice. And I mostly work with perinatal mood and anxiety disorders. I am certified mental health professional. And I do a lot of birth trauma and perinatal grief and loss. And so I have a lot of community involvement. And I’m just really happy to be here today. Thank you for inviting me.
Maggie, RNC-OB 2:24
Thank you so much for joining us. So this whole season, we’re really exploring what it means to hold space through complicated pieces of perinatal care. And so we’re asking all of our guests to just tell us kind of give us your own definition, your own feeling of like, what does it mean to you to hold space for someone?
Lola, LCSW 2:38
You know, that that’s, that’s a lot, you know, holding space, I kind of find it to be similar to kind of like companioning, right, having that that compassionate presence, physically, emotionally, spiritually, and being willing to go down whatever road you might be going down with that person, you’re willing to go there with them on that on that road, and it’s it’s holding space wholly, holistically, right?
Maggie, RNC-OB 3:05
Yeah. Oh, absolutely. Yeah, there’s so many pieces of ourselves that kind of get lost easily, I think in the healthcare shuffle. So it’s beautiful to think about it from this holistic perspective. So you know, as we’re thinking about how we best support folks during a loss, one of the things we want to talk about how do we help cultivate trust? As someone who has not necessarily been involved with, you know, the person who’s experiencing loss, I think, particularly for, you know, a lot of our audiences, I know healthcare workers, nurses, OBS midwives, you know, especially for those of us who work in hospitals and don’t have a pre existing relationship with someone who experiencing a loss, can you speak a little bit to what you find helpful for cultivating trust there?
Lola, LCSW 3:45
That’s kind of complicated, right? Like you said, if you don’t already have a pre existing relationship, or it’s short term, right, like this kind of is coming in at that part of something at the end, would really, I think, would really rely on a lot of empathy and validation and normalization, I really do believe right that health care workers birth workers especially really should have an educational background of trauma, trauma informed care, and, and grief support care, that even if you’re only briefly with someone, you might be the first person during that, that very vulnerable, raw, painful moment and, you know, there’s really, I don’t think there’s any words that make it better, but when someone’s companioning, and having that supportive presence and validating and using certain positive language and acknowledging and validating the loss and not kind of shuffling out because it’s uncomfortable or we have another bed, but coming in at the end of someone’s painful experience could really rely probably more on the validation that the loss occurred. Um, that, that we’re sorry for the loss and have an established program in place that the hospital can absolutely connect no matter who the worker is connecting with that parent, the loss parent, that the resources are known. They’re universal. And everyone knows, right? You can’t just stop here. We need to validate them while they’re in our care, but help them get to the next step in their healing care.
Maggie, RNC-OB 5:28
Mmm. Oh, so important. And I take you on a little bit of a tangent there, perhaps but you know, we were talking a lot about language we use to help validate. And I would love it if it’s possible for you to maybe give us a verbiage scripts kind of that work that actually feel validating, I think a lot of us have learned things to say that are actually end up being hurtful and inappropriate with the best of intentions, but that doesn’t, that doesn’t change the impact of them. So if you’d have a little tell us some things that works and things to definitely avoid.
Lola, LCSW 5:57
Right? You’re right, you touched on that, you know, intention versus impact, right, that a lot of what we say intending for it to be helpful or supportive might not come out that way, you know, saying things like, “well, you’re young, you can always have another one” that’s very insensitive, and might not even be true, and the person might not even be there. And that’s not supportive, and companioning in nature. The majority to me kind of is like acknowledging transparently, genuinely, that there aren’t really words. So acknowledging that, to me, is positive language saying, and “I know there’s nothing I can say, but I’m sorry for your loss.” And I’m here for you to talk about anything you want to talk about. But acknowledging that there aren’t any words, but I’m here, and I’m sorry for your loss. And I care about you, how can I be with you in this moment? How can I support you in this moment? It’s to me is much more validating and a lot of women have expressed that through their journey somewhere, to another nurse, maybe or to their postpartum doula that someone who allowed them that moment to to be heard in that way. Because later, right, sometimes people really, they do say a lot that they don’t mean, and people stop talking. And so I think if we Front Load it positively, with just very, “I’m sorry, for your loss, do you want to talk about your baby?” A lot of people think that that might be scary to do. And why would somebody want to do that in that moment of loss, but it is real, what happened. And when we kind of shuffle out and don’t acknowledge and then the expiration date for grief, right later shows up with friends and family, we’ve got to start trying to get it in every part. And that includes that brief intervention, where someone can let them know open up the lines. “Do you want to talk about your baby? What were you going to name your baby?” It puts people in the realness of it, instead of the shame and secrecy that can happen with perinatal loss.
Maggie, RNC-OB 8:09
Oh, yes. Oh, but that is an important reminder. I do I think, unfortunately, in our efforts to we think we’re making people feel better by like breezing past it. Instead, we’re just promoting this, that shame. And that’s, that does nothing to help you know, that person. And I love just the reminder, just be open to asking what, again, we’ve talked a lot about, you know, that as we explore these topics around holding space, but so much of it is really just letting ourselves be with that person and asking what they want, instead of trying to come up with something, you know, pithy and moving, that feels like a Hallmark card. Right? We can just be there with them and, and in the emotions that they’re having.
Yeah, absolutely. My Long, long ago, in the ancient times, when I was a new social worker, my first job was in hospice. And I learned about being present and holding sacred space. There’s no words for loss and we have a social construct that is so uncomfortable with death and grieving and loss, let alone on top. miscarriage or neonatal loss. Any kind of perinatal loss is even more isolating, you know, but yet, it’s one in four, one in four women have miscarriage and there’s two of us right here. Right, right. I mean, we’re already half it. Yeah. And so it’s common yet. So isolating, how’s that? We need to get in there in every way we can. And it includes at the beginning of, you know, the loss.
Yeah, like we’re doing really, we’re where are there like maybe some of the gaps that you see in the way that like typical kind of birth care addresses the grieving process for parents following pregnancy and infant loss.
Definitely that connection to the next step. The validation. There’s gaps there, right there. Oh, Ways of not everyone’s getting the same emotional support, ending on who the provider is right? Then getting them to the next step of connecting to resources beyond your part if it’s ending, right. And that’s how we kind of, kind of look at it as as like a village, right of going in. And every part of that, that to glue in the gaps after a loss is really when a lot of the gaps start kind of really showing is if if they weren’t, the birthing parent was not connected to resources, informal support outside, they’re kind of free floating. And it’s there’s just a huge gap to everything at that point, the system, friends, self, because you know, the death or the loss is really the primary right loss, but their secondary loss, it’s a ripple effect, some get stuck in their trauma, and their relationships suffer and their health in terms of, you know, mental health and, and loss of identity. And so the gaps that start occurring because of the isolation from the beginning, we really want to approach where we have to somehow as a social society get over in my opinion, that construct of the expiration date of brief, there is where the phone call stopped coming in, and the check ins, the meals that were so helpful, right, I mean, just a meal from someone preparing it is so supportive, and really hits home, you know, in that you get a warm belly, you didn’t have to do it, you don’t have to worry about it, the little things that really keep us connected and where the glue is keeping us held, or being held by our village, it starts to fall apart, when that’s not there. Okay, and if it started from the beginning, by the time, right, someone’s here in the gaps have become so much, you know, it can be a spiral. At that point, the ripple effect can be, you know, a spiral. And so hopefully the goal becomes every single point of entry, the pediatricians, you’re part of this, right? So the lost parent goes back out into the community and has their postpartum and pediatrician checkups coming. And we know that she’ll show up to the pediatrician visits, she might not go for herself. Yeah, that is another way right of filling in the gaps is that pediatrician should have training and grief support in you know, postpartum mood and anxiety stuff. This is absolutely it’s affects so many people and so we’re missing the boat. And there’s a lot of gaps.
Hmm, that’s great. We talked a lot about collaborative care on the podcast, and I, that’s a huge, that’s a huge gap there if we’re not having good, you know, inner collaborative chats about what’s happening with our patients and making sure that they’re aware that there was this loss be able to support like he talked about more holistically be able to be able to show up in you know, as a pediatrician of course, you want to know if, you know, one of your families is going through this, right, and making sure that we have Yeah, exactly that, you know, they don’t end up isolated that you’re aware of, you know, look out for red flags, you know, all of that there’s so much more that we need to do to keep that connection amongst, you know, kind of ourselves as healthcare workers too. I think from from there to one of things you touched on a little bit, and I would love to just hear kind of I know, this has been a big part of your practice. Where do you find the roles of like, perinatal loss support group fit into this whole dynamic?
Yeah, you know, that’s interesting, right? Because the support group, you know, kind of has its own dynamic, right? So, you know, a lot of people when they hear of stuff like that group therapy or support group, which is not therapeutic in nature, right? It’s supportive. People typically have an initial reaction, they’re like, Oh, you know, it’s not, that’s okay. You know, they don’t want to, they don’t embarrass themselves or they don’t want to talk that kind of, you know, normal reaction one might have if they haven’t done it, but we’ve found that when it comes to postpartum moods and anxiety issues, and all of the motherload of stuff that goes with that, right, and any kind of perinatal loss, a lot, the majority of people who decide to go that route for some healing, they really really come out the other side with a very different story. They get to write the end of that part of their story in a different way because a lot of them find the universality right of i am not alone. Look who’s here with me, and I’m not crazy for feeling this way, you know, and how beneficial that can be. But I also found amazing in a beautiful way, that the healing also happens symbiotically back the other way, when you are able to share your story and have your voice tell your truth, that might help somebody else besides your own healing, right. And that’s really where we need to really be doing it. The gaps that we just talked about are also that we don’t talk about any of it really, what did you expect motherhood to be? And when it’s not like that, what do we do? Nobody talks about that. Nobody talks about what it’s like to have loss. And those are a lot of the things that happened in support groups, because we didn’t have the holding space partner. You know,
yeah. I love the imagery you shared about that, you know, you get to write your end to your own story, instead of it’s just kind of like trailed off, and it’s out there. And there’s, there’s not that closure, you have, you know, insights that you found helpful for how you explain the process to folks who are maybe they’re reticent about attending particular tips are? not that we want to pressure anyone into it, obviously….But, you know, for someone who’s hesitant ways we can explain it, maybe that helped to get that idea across better?
Yeah, you know, I think, um, I think when you try to explain, right, the benefits and stuff, when it comes to support groups, is again, right kind of giving autonomy of ownership to that person that they can decide right later if they don’t like it, but to, or it’s not really meeting their needs. Typically, when, when we allow someone, right, say, you know, give yourself permission to decide this on your own when you go, if you feel support about something like this. And I typically if I’m working with someone, in any kind of manner, even maybe on a personal level, I would probably approach it the same way saying right to, if you trust me, right, whether it’s my friend, or maybe your client, if you trust me enough to be here today, can you trust me enough that I think this might help? And, of course, as an autonomous, competent adult, you know, you’re going to be the one to determine that you’re going to be the one how you want to finish what your you know, your story is, because I really, it comes back to the story, the language that we create, telling our story, you know, and that, you know, we want to be the authors of that in some kind of way. And a lot of times when you take away the fear of what the group is, right, it’s, it’s meant to be a way to move from the stigma and the shame and the secrecy of it. And coming out the other side, and realizing, right, that there is healing, there’s post trauma growth.
Hmm, yeah. So powerful. On that note, do you find that there is a time that join a support group, you know, if your your six months after last year, a year, I’ve lost your three years after a loss? Is there a time when it would be less appropriate to join, you know, apparently, the loss support group or are there kind of different rules for each group?
there, there’s kind of different rules for each group. And they set that up after the fact realizing that some people do are more comfortable in certain groups and the dynamics and, and it does make sense, you know, we do know that it can be 40 plus years, it can be 70 years later, loss is always something that we learn to live with, we don’t get over it. And perinatal and infant loss is a sort of loss that is completely unnatural to what we know to be it is considered the worst loss when a parent loses a child. And that is definitely something no one gets over. It’s not a destination you’re ever going to reach. It’s going to be “Can I experience joy to in my life after this?” you know, and so 40 years down the road, there should be support groups if there’s not for that. And it’s because we know that Parenthood is not defined by gestational period. There are probably different rules and requirements and whatnot. And so just check with that and you will find a group and then of course, we say if not… then start one, huh?
Yes, yes, I love that. So, you know, as we’re, as we’re walking alongside folks in, you know, in their grief and in their parenting journeys, I think one of the issues that I’ve run into as you know, a labor and birth nurse, when we have folks who are they’ve had a loss, you know, in a previous pregnancy, they’re looking to become pregnant again, they are pregnant, and they’re having a lot of very understandable concerns and anxiety about that. Do have tips for how we can help to navigate the reality of what we know about, you know, pregnancy and infant loss without being fearmongering? Or, of course, being dismissive of these really valid concerns?
Lola, LCSW 20:04
Yeah, yeah, absolutely. That’s tough. That’s hard, because it’s totally understandable. And, you know, what wouldn’t somebody worry, right? But where’s the line, right of when, you know, it’s, it’s, it’s too much for a person to carry, you know, and that’s definitely, you know, individual, one of the ways that we kind of work on that we try is to work on distress tolerance, right? That grief is always going to be a part of our lives, we’re always going to have loss in some kind of way, we got to try to normalize it not catastrophize about we can work on, this is something we’re going to experience and like, it’s not going to stop, and this could be one of them. It’s a form of like radical acceptance. And we try to balance if you can think about it that way, trying to balance a lie, which is what anticipatory anxiety and fear is, is lying, it’s trying to Chicken Little something, right? I tried to say, you know, drown it with a truth. Hit it with something that’s a truth that can overtake right, the lie that it’s trying to send us the message, because you know, anxiety lives in that…anxiety lives in shallow breathing, and it lives in false lies, things that haven’t happened, things we believe, right that aren’t here. And so when we kind of put those together, they seem to work well to where we get someone to be in a manageable place, we might not ever get to zero. And that might not even be a realistic number. People are gonna worry, especially if they have a history. I mean, that’s how we are as humans, right? So it just makes sense that they would be there. So we’re going to validate, right that you have every right and you don’t need to explain, defend, or apologize, feeling worry and fear about this, but let’s try to get a hold of this so that you can also experience joy and excitement for your next chapter. You know,
Maggie, RNC-OB 22:04
ah, yeah, I thought that’s just such a it’s such a hard line, you know, right to balance it out. There’s a there’s a tightrope piece of that as we’re, you know, you’re validating that and then also wanting to help people be able to experience that joy and you know, be able to, to live in where they’re, you know, where they’re at right now. Have there been things that their healthcare providers did like during a follow on pregnancy or did during like their labor and birth care that really helped them to feel like supported and honored in that piece?
Lola, LCSW 22:32
it’s less of that, and more being unheard, but the ones that do actually feel heard and validated and supported? Usually, it was someone who was doing something that we talked about saying, I know there’s nothing I can say to make this better, but I’m here with you, how can I support you was definitely something they reported a lot of nurses stepping outside, you know, of labor and delivery, men stepping into that almost that bereavement part that could be considered somebody else’s job if we want to play that right, but remaining in their remaining with them, which is what holding space means.
Maggie, RNC-OB 23:13
When I ask those questions, you know, I always I love to, I love to highlight things, we can do that, that work, right? Because so many of us tried really hard at this work. And, and it’s at the same time, it’s important to have that reality and the knowledge that so many times people are feeling let down by the care that they’re kind of the standard birth care. And we talk a lot about the flaws and the holes in you know, our, in our birth care system. There are many. And I think having that support, you know, knowing knowing where to turn knowing where to refer people acknowledging where you have these, the gaps when if the only thing you’re able to do is offer reassurance and validation and the fact that I don’t know enough to go from here. But here’s this list of referrals, here’s a therapist who can help. Here’s a perinatal loss group, here are the ways we can connect you with other resources that are outside of that, you know, acknowledging that we’re not I think a lot of times we have internalized the idea that we have to be enough, we have to be all for the people who are in our care that we have to know everything that we have to be able to cover all these bases and that’s false, we we literally can’t do that. It’s not true and no one else expects that from us. So I think remembering where we can turn to community to support to have this you know, full range of services for the people in our care.
Lola, LCSW 24:30
That’s really it. I agree bouncing off of that, I think right? Like if you’re really not able to have anything beyond that really brief interaction that we’re gonna have there in the hospital setting. It is it is vital, right that either the hospital has something running through them. A specific social worker trained in this can be bouncing between these departments that are going to have this or run The monthly or weekly support group, I mean, we need a NICU support group, you know, it’s all kinds of stuff, too. If not, then we definitely should know where the next step connection is going to be right and filling in those gaps. That’s how we can start to do that in those kinds of ways. You know, and, of course being I would say, you know, challenging that even further is in some kind of way, having representation as a stakeholder in the other community places like other perinatal collaboratives, we’re gonna want a hospital presence, so that we can figure out is there actually a bigger gap going on at this point of service that we could fill? Right with things? And that’s kind of how we learn right, that our entire hospital is missing the boat, or the department is or the providers are? or all of the above?
Maggie, RNC-OB 25:55
Yeah, hmm. One of the one of the questions too, that I had for you is, I think gets complicated as we’re sometimes working through this. And I’ve seen it before where, you know, when you have a mismatch with the client in your care, whether it’s they have a different cultural background, religious background, just coming from a different worldview, which you know, we all do. And wondering, maybe what are some of the ways that we kind of can best support that when we were not familiar with their religious customs, or, or they have ones that are very different than our own. And so we’re feeling that kind of in between about how to best support that in hospitals that are often rigid and don’t have as much negotiation room as we want?
Lola, LCSW 26:35
Yeah, really, really good question. That’s a big, big factor and how people report their experiences, you know, how they interpret something, it’s the same as whether or not someone interprets whether they had birth trauma, it’s not automatically A Yes, if there was an emergency in there. It had to do with how they felt how they were treated, right. And it’s the same kind of way with this, it’s, it’s how this person in interprets their support that they got, whether or not they’re going to say it was positive or negative experience. And this is one of those ways that we have to start being sure that we don’t miss the mark, right. And the best way I found as a clinician that taught me how to do it in my personal life, is to stop making assumptions and just ask, Hi, can you please let me know what your culture or your religion might have me do about this with you? Is there a certain ritual that I can help you get started? Because, you know, we don’t want to assume, and there actually are other cultural rituals and things that really needs to be taken into consideration. The Jewish culture has their own ways of dealing with loss, there are certain Middle Eastern descent that have their own rituals and cultural things that should as much as possible, be right, supported and encouraged, actually, because imagine, if your own cultural heritage and ritual that you are supposed to be able to experience was you were robbed of that, basically, that experience, there’s no way you’re going to view that positively. No, wow. Right. And so we’re, we’re sending them out with already the wrong way of going about this. And so to me, the being genuine and saying, Can you let me know, what is the right thing for me to do here? You know, educate me on what you need for me to support you. And they’ll tell you, they’ll tell you. And the biggest one is to not make assumptions and also to check yourself out the door, right? I might do something this way. I might have my own feelings, but I’m not in. I’m not supposed to be taking space. I’m supposed to be holding space. I can’t hold space if I’m taking space.
Maggie, RNC-OB 28:57
Oh, yeah, that’s a good one. I think sometimes we we don’t do that in a fear of being invasive, you know, or kind of like we’re, we feel like we’re twisting the knife by asking. “Okay, so now what am I supposed to do to to help you?” but we need to do that. Otherwise, we’re going to miss the mark. Anyway. So, um, yeah. And then, you know, as we’re trying to kind of close this discussion out, I was wondering if you can, you know, speak to maybe some of the ways you found helpful for staff to support each other, you know, as we’re dealing with losses on, you know, the unit as nurses as midwives, doctors and doulas, all of us who are involved as you know, birth workers?
Lola, LCSW 29:35
Yes. Y’all have an amazing job, but it’s also really heavy. You know, like it can be full of joy one moment and literally, heartbreak the next and so, nurses, doctors, doulas, y’all have high risks of secondary trauma, okay? And it’s not just trauma, that you’re being traumatized. With, okay, it’s also the grief and loss that you’re witnessing and experiencing with them as well that there’s no support for y’all for sure. I mean, for the most part, you can walk into a hospital and ask, what kind of support groups do you have here? And they’re going to be all for patients. And then when you say, what kind of supportive services do you have for your employees, there’s not going to be a support group for that. There’s, there’s not for the most part, okay, you’ll find an exception somewhere, someone who’s hip, you know, to the thing, but I say, when we start reaching out individually to someone is when the ripple effects takes effect that way that when we start reaching out to our village and saying, “Hey, I’m feeling this way, you’ve got to be feeling something, what is it? Can we hold on to each other? And are there other people that we can hold on to through this, and maybe we can start off with social things to keep us connected? And then maybe we can start our own thing?” Right, which should either be informal, or perhaps bring it to management about wanting some kind of program. Right? where perhaps someone comes in from the outside that can do you know, consultation about how do we take care of ourselves? And what can we put into place about what we’re going through? So that not only can we be okay, that helps us make sure that we’re going to have okay patients. Yeah. Right. Because we cannot be present with them and give them our all if we are having compassion, fatigue, and some are on healed stuff. Huh?
Maggie, RNC-OB 31:38
Oh, yeah. So a shout out to everyone who’s who’s thinking like nodding their head right now and feeling like oh, that’s me. Like, this is your your loving reminder that like you are worth getting, getting help for yourself, you can be healed so that you can help heal others and be supportive to them. And it’s not selfish to take time to deal with that, that stuff, this heavy secondary trauma that follows us through this really important work like it also needs to be addressed.
Lola, LCSW 32:04
Absolutely. Yeah, I say it’s not selfish. It’s like self preservation, right? Taking care of ourselves.
Maggie, RNC-OB 32:10
Hmm. Well, well, as we wrap up, is there anything else you’d like to share with our audience about, you know, this work this topic?
Lola, LCSW 32:18
No, except, you know, basically, I think what you said was great, right? We deserve to take care of ourselves, and we deserve to feel better and to heal from some of this stuff, right? And to support our village were a part of that village. And reach out for support. There’s a lot of places that have formal and informal support regarding pregnancy and infant loss. You know, a few of them right Postpartum Support International has some groups and, and some other ones, Star Foundation. So start the healing journey, right? And you can be the author of that. I love him.
Maggie, RNC-OB 32:54
Yes. Thank you so much for coming on here and sharing your expertise with us. We really appreciate it.
Lola, LCSW 33:00
Thank you so much for inviting me I had such a great day. Thank you.
Maggie, RNC-OB 33:06
Thanks for tuning in. I so appreciate Lola coming on and sharing so much of her experience and her insights with us. As we figure out how to do a better job in holding space around loss, how we get through some of our, you know, society’s impulses to to ignore and try to just brace through grief, how we show up for our patients so that they know that we’re here for them that we care about their loss as well, and that we want to do everything in our power to support them as they cope and find ways to move forward and find joy and navigate future pregnancies and parenthood and everything else that comes along with it. But we would love to hear what struck you about this episode what you have found helpful in your experience in supporting perinatal loss. Please give us a shout out: we are Your BIRTH Partners across social media. We would love for you to share this with a friend and let them know what you got out of it as well. We look forward to continuing our work together to create more collaborative, inclusive work your communities rooted in equity. Till next time!
046: Preventing & Processing Birth Trauma
Maggie, RNC-OB 0:07
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth care communities, rooted in autonomy, respect, and equity. I’m your host, Maggie Runyan, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back. As we continue our series on holding space through the complicated pieces, pregnancy, birth and postpartum, we knew one of the topics we absolutely need to talk about was birth trauma. And this is such a deep and heavy conversation. As we dive into what we’re seeing in terms of trends in birth trauma, how is trauma being experienced by folks, how is the pandemic and living through such a huge upheaval over the last year and a half plus? How is that impacting folks? How is that changing birth care, we want to dive into some of the dissonance around how birth professionals providers in the hospitals see birth and perceive how birth was and how it’s experienced by those in our care. We know that there’s a lot of harsh realities about standard birth care right now. And we want to figure out how we talk with our clients and support them in navigating this without fear mongering and causing shame and contributing to anxiety. And so to help lead us in this conversation, we have the incredible Krysta Dancy coming on, who is a therapist and doula, she wears many hats, and focuses much of her work in her research around birth trauma. So we invite you into that conversation.
Well, Krysta I am just so excited to have you in here and be able to dive into this really important topic around birth trauma. So if you want to just remind our audience, we’ve been lucky to listen to you before, a little bit about who you are and how you do this work.
Krysta Dancy 2:12
Yeah, thanks for having me. I’m a licensed trauma therapist, that was my original sort of expertise coming at that I’ve been doing that for close to 20 years now. And it makes me feel old to say it. And you know, early in my career. And during my internship, I was just really fortunate in that I ended up attracting a lot of veterans to my practice and working with them specifically on like combat related PTSD. So trauma was the specialty that really initially just found me. And as I started to develop the specialty, also just life would have it I became a mom for the first time, and started to also attract a lot of new moms to my practice, you know, they wanted to be with somebody who they felt like understood the life stage they were in. And so it was really neat, because my waiting room was often filled with combat veterans and new moms with newborns. And it was just like, my favorite happy place, I loved it. But an interesting thing started to happen, where I would see these new parents that would start to have symptoms that in some ways mimicked the PTSD that I was seeing elsewhere. And at first I thought that was my bias, right? I thought, “Oh, I’m just seeing that because that’s what I treat, you know, if you’re a hammer, everything’s a nail.” And so at first, I really didn’t trust that because at the time, we weren’t being taught that that was possible, we were taught a very strict definition of what PTSD could be in birth didn’t really fit in it, unless we almost died. So it sent me on a course to try to find better resources for them to try to find books or other therapists I could send them to or anything around the subject and at the time, I just came up completely empty handed. I learned later that other amazing people like Dr. Cheryl Beck were doing research on it…I didn’t have access to that at the time so I was just left feeling like I guess I’m gonna have to be the one to figure out what to do with this. And that became the secondary specialty that chose me which was traumatic birth. And so that’s how I found my way into this field but since then have gone on to become a certified birth doula have attended births myself, and more recently, in more recent years and now provider and professional educator on the subject of preventing traumatic birth, healing, treating birth trauma for mental health professionals, and then also now more moving into even professional trauma that they encourage. care they give so all the way around. Wraparound trauma, mental health, birth, that’s that’s my jam.
Maggie, RNC-OB 4:27
Yes. Oh, there’s so many layers to it, right? Like it’s all it is all connected. Yeah, I love it. And I like so privileged take different of your courses and like the way you explain all of this is just it’s such a gift. So we’ll be linking everyone who wants to dive into this a little bit more and some of the resources that Krysta has. With this series, we’re talking about holding space through the complicated pieces of pregnancy, birth and postpartum and so we’re asking all of our guests if you can just tell us what does it mean for you to hold space?
Krysta Dancy 4:54
I when I knew that we were going to talk about this I was like, “oh asking a therapist, what holding space right? I have a master’s degree in holding space.” You know, for me, holding space is a lot about it starts with believing people. And I think there’s a really important first step, which is I may not relate, I may not understand, I may not know what I’m looking at. But I start by believing you, I start by believing that you’re having a human experience and that you are the expert on what that experience is. And the default is I believe you. To me, that’s a really important foundation for the rest of holding space. Right that I just start with the assumption of, I believe you. And then from there, it has a lot to do with therefore I believe you’re the expert on this, therefore, I believe your truth is what matters here. What matters is your perspective and experience and not mine or my take on it or my interpretation of it. Not that you know, how I’m feeling is completely absent. But if I’m holding space for somebody, it’s centering their story, their experience their needs, being held, right with empathy. For what? Yeah, yeah,
Maggie, RNC-OB 6:01
Oh, I love that that foundation in believing we just, we don’t trust people enough. We don’t, you know, healthcare professionals, we tend to kind of believe our, our training first, right, we tend to believe like our education and what we’ve learned about something, and we, a lot of u,s default to that, instead of believing the person who’s right in front of us. And that’s a huge like, transition to make.
Krysta Dancy 6:21
Sure and I relate to that somewhat as a mental health professional, because when I’m being taught in, you know, higher institutions of learning, first and foremost is like assessment diagnosis, right? So that I can treat, and that’s even more so for a medical provider, right? And so like, you’re being taught to come at it with an evaluative lens, and that’s just on its face, at odds with holding space. Because if I’m coming at it with an evaluative lens, then right off the bat, I’m parsing right I’m yeah, I’m triaging, which are important life or death skills. These are not bad skills. These are good skills, we want providers and professionals to have these skills. But it’s the opposite of holding space.
Maggie, RNC-OB 6:58
Yeah, yeah, there’s so much tension there for how we’re how we’re showing up and what people actually need our role to, to provide in that moment.
Krysta Dancy 7:05
It is and, and that was part of why I started, you know, training professionals, because my, I realized, Oh, my gosh, of course, your professionals aren’t getting told any of this. Because, obviously, right, you’re being taught life saving skills and clinical skills and really important skills that are that are necessary for the for the care that you give, but where’s the section that’s about like, you know, anything, any of the how to give care partners?
Maggie, RNC-OB 7:29
Yes.
Krysta Dancy 7:29
How would you? There’s no space or time for that for the average person who’s trying to learn to become a provider a professional?
Maggie, RNC-OB 7:35
No, there isn’t. There isn’t. And that’s like that. If there’s one thing I want to change, it’s that like, we need to change the way that we are learning to actually provide care and apply all of this knowledge and the skills that we’ve we’ve gained. So as we you know, as we look at birth trauma specifically, can you just give us kind of a little bit of a overarching, what kind of like, what do we see in terms of birth trauma statistics? What trends are we seeing?
Krysta Dancy 7:58
Birth trauma, you know, it depends on how you define it. And part of what’s tricky is that the sort of diagnostic statistics manual criteria for PTSD changed over the course of like my work with this. And so there’s a little bit of people don’t even realize in the literature, there’s a little bit of a before and after that happens and how we define it. And there’s been some attempts at measurement tools, some more successful than others have, like a universally agreed upon way of measuring it. So all the way around, I want people to know that if they dive into the literature, they’re going to get different answers. And that can sometimes cause people to believe like, “Oh, well then this is not real or this is not happening or this you know, this person over here says it’s not a big deal,” or it makes it easy to just sort of get overwhelmed at the you know, discrepancies and say, Okay, forget it. But what we know is that if we really drill down to so what I like to look at, as opposed to getting really hung up on like, here’s where the cut off is, for instance, with this tool, is I like to say, when we’ve gotten to a point that the trauma symptoms are impairing function, which a lot of people don’t realize that in the DSM, the diagnostic statistics manual, your trauma symptoms can be impairing your life function and not qualify for PTSD. And so that’s where it gets a little tricky. So for me, I just say forget it, I’m not going to worry about it, I’m going to say if their trauma symptoms are impairing their function significantly, and what that looks like is difficulties bonding with baby, can’t sleep, flashbacks, nightmares, interpersonal difficulties with partner, avoidance of medical care, which is a really big an important aspect of this because often people have traumatic birds have complicated follow up and they become avoidant of that follow up. So these kinds of things, what we see is like hyper vigilance, which can look like anxiety, insomnia, agitation, overreaction, or avoidance, right, which in some extreme cases, it looks like avoidance of medical care or avoidance of talking about it with friends and family, but it can also even look like avoidance of baby depending upon the particulars of the trauma and more extreme cases. So it can look like a variety of things. But what I’m teaching people to look for is some combination of what we call hyper vigilance, which is like the nervous system has switched into fight and flight and really having a hard time turning off and or avoidance that, you know, for clinicians, sometimes they say like, when in doubt, just ask them. Do you feel like your experience was traumatic? Because usually, you know, they have, they can give you a pretty accurate answer, and that we don’t have great quick cross cutting tools for that yet. So that’s another way to do it. But what we what we see to get back to your question about statistics, it depends. So pre pandemic, we were looking at fully diagnoseable, PTSD would be in the six to 8% range. So 6-8% of people come into birth without PTSD and would have PTSD as a result of birth, we screen out people who have pre existing, what we’re seeing now is that some statistics are if you can believe it, like in the 20-30 percentile range, if we’re comparing apples to apples. And so we take people who have trauma symptoms that are clinically relevant. So like, maybe they don’t hit all the criteria for PTSD, but they’re avoiding, they’re hyper vigilant, they’re not sleeping, they’re agitated, whatever it is. And it’s relevant enough that it’s causing impairment in their life that’s really distressing to them. We, before the pandemic, we were looking at upwards of 30% of people were experiencing that after birth. And now it seems to be again, the measurement tools are the problem, but I would guess a minimum of 40%. But probably more than half was what I’m guessing, as a result of like pandemic changes and protocols. Yeah, it’s so it’s just astronomical, that people are leaving birth with clinically relevant trauma symptoms at this point.
Maggie, RNC-OB 11:37
Yeah, you know, we’ve talked a couple times, you know, obviously, throughout the, the podcast has existed primarily during the pandemic. And so, you know, several times, we’ve had to realize, like some of the things that we thought we knew and understood about birth and birth care, they’ve been completely changed by functioning in a pandemic, which I guess you would expect, right. But some of it we’re aware of, perhaps, and as you know, birth professionals, there’s parts of our jobs that have changed that we’re very in tune with. But then I think some of the pieces were because of the nature of living through a pandemic, and the way that it is changed our connection, and the way that we are able and accessible to our patients. I am concerned that there is a disconnect there, and that many of us as refreshable probably aren’t aware just how deeply the pandemic is changing and impacting the experience of birthing people.
Krysta Dancy 12:35
Right? Yeah. And I also think that a lot of professionals are just I mean, in my office, my experience with them is they’re just overwhelmed. I mean, they’re just completely overwhelmed. Being a professional during a pandemic is a monumental thing in and of itself, to then also be told, hey, by the way, the people that you’re sacrificing to care for are actually doing worse and worse and worse. I just felt like some of them just get to this place of like, I just have no more capacity. I don’t know what to do. It feels too big, you know, not a lack of compassion, but like a lack of capacity.
Maggie, RNC-OB 13:06
Yeah, absolutely. Yeah. I appreciate that clarification, because I do I think it’s just that we’re limited, right? Like, we’re limited in how much and and how much some of this because it is these are big, their system issues there. They are out of our control. It can be really easy as birth pros maybe to kind of crumble under that. We just, we just keep failing those who are in our care. And then we feel worse ourselves. Right? You know, it’s not that us versus them thing. It’s just that everyone ends up suffering who is working in the birth space right now and trying to navigate all of this?
Krysta Dancy 13:44
Yeah, I think I mean, there’s so many. There’s so many systemic factors that in and of themselves are like their own podcast episode. Yeah. The pandemic just exacerbated. It just added to right like, pick an issue a topic and trauma informed care and the pandemic added weight to it. Okay, understaffing, policy changes based on liability, lack of access to adequate supplies, adequate staff, adequate train, I mean, just like pick a topic and the pandemic made it all heavier. So we already had cracks in the foundation, and then we added weight. Yeah, it’s just, it’s created a space where I think it’s totally human and totally understandable if you’re in a position of care providing to be like, I’m just gonna get through this shift. Right. And that is a completely valid human response. What’s tricky is, maybe that would work if you were like, you worked in, you know, post op, where your job is just to like, make sure that you safeguard people. Yeah, right. And so you could just do your safeguarding and get through your shift. But the issue is that birth is so much more than just safeguarding and it is hard work, which is what pulls people into it. I find that the warmest, most compassionate most lovely people Pick birth work, right? Right. More than safeguarding because it’s, it’s relational because it’s important. And likewise, it’s like sacred and it’s a privilege. And so I find that because people are drawn to birth work because of the fact that it is more than safeguarding. Those are the very same people that feel the weight of these changes more acutely. Like, it’s hot, they can feel it. What does that make sense? Like, if you were somebody who’s fine with just sort of doing the mechanics of medical care, you probably would have picked a different specialty. Yeah, one that would have been easier on your body. But you picked one that was like you were in it for the heart. Yeah, right. And so to have that barrier there between you and your patient, and then also, to know that your patients are feeling it as well, I think that I see a lot of people going I just throw my hands up, like I just don’t mind, you know, I’m just gonna get through the shift.
Maggie, RNC-OB 15:52
Yeah, yeah, absolutely. Because we do you know, you we talked a lot about how expectations versus reality of you know, so many of us who get into birth work, especially those of us who operating primarily in, you know, hospital health care spaces, we think like, yeah, this is gonna be great. We’re helping we’re supporting people through birth, like, Sure, I love families, I love babies is such like a magical transition to be a part of. And then we are just inundated by all the ways that the birth care system is not actually like set up to do that well. And it just keeps hitting like, over and over and over again. And the way that the pandemic has put so much extra strain on everyone who’s involved in that system, like the it’s easy to maybe get overwhelmed, and then to start being protective for us, as birth pros. Start being a little callous about what is going on for individual people. And I don’t know if you can speak a little bit to maybe tools. And if there are tips, we can do recenter, that piece of ourselves. And then as we go to approach each individual person, each new birth that hasn’t already been traumatic, even though we’re already feeling traumatized by the potential. How do we kind of work that out?
Krysta Dancy 17:08
Yeah, well, that’s such a good question. And it’s deserving of a huge answer. So you’ll have to forgive me if I just summarize here because I know that I’m only on the tip of it, there’s just a lot to that. I think you’ve already touched on one important part of it, which is the internal recognition of the separation from the system versus the person in front of me. Right? One of the many attributes of breathing within a system that we were all aware of keenly before we came to the pandemic is that a lot of what’s happening in terms of policy is based on fear. And that that, again, is at odds with a heart connection. And so you know, what we know through like psychology, I talk about this all the time on my pages, because I just nerd out on the brain science stuff. What we know is that, you know, when we’re in a space of fear, the parts of our brain that connect to empathy actually are compromised. Other parts are too like our language centers of our brain are compromised for instance, like our ability to communicate our ability to empathize gets compromised when we’re afraid and this is easily you can easily demonstrate this this is just like pretty basic if your pulse goes over 100 beats a minute, your ability to empathize and understand others just greatly compromised so what we know is that when we are surrounded by fear then immediately we lose touch with our ability to empathize with the person in front of us and so we know that a lot of systems already operated under fear and then we added other elements of fear and very real fear for the professionals especially early in the pandemic when there’s a lot of unknown like how deadly Is this? how does this spread? How can I keep myself safe? Right…didn’t have a vaccine didn’t have like these tools that we have in our this understanding we have now there’s just a lot of fear and regular policy changes the providers in my practice would come in and be like well this week it’s this thing next week
Maggie, RNC-OB 18:57
Oh constant.
Krysta Dancy 18:58
every time I walk into my shift I’m briefed on the new policy today that I’m supposed to remember that’s different than how I’ve always done it right so yes, that’s like we just added that that was a big tear of connection and so what you’re saying which I think is so important to slow down and highlight is there is a moment when you walk into the birth space where I think professionals who are able to connect with patients and reach outside themselves take a moment in the physical space to become present again. Right they mentally through I’ve seen like ritual through breathing exercises through you know whatever works for them as they walk through the door to that room. They in some way mark for themselves. Those things are outside this room. Yeah, boss is outside this room that policy is outside this room, the fears outside this room, and they do something inside themselves to bring themselves back into the present. And it’s there’s infinite ways to do that based on what your personal perspective disciplines faith background, you know, Whatever, whatever works for you is fine. But what they all have in common is that they take a moment to slow. And what I think they’re doing is actually probably slowing their heart rate, slowing their breathing, which we know brings the empathy parts of their brain back on board. And I’ll actually teach people if you for one minute, and I know this isn’t always a luxury that people who are professionals have, but if you have one minute, and for one minute, you breathe in for three out for seven, just for one full minute, i for three or four, out seven, the trick is that elongated exhale, the elongated exhale actually counteracts fight or flight in your system, you will slow your heart rate, you will bring not only your empathy centers of your brain on board, which is a huge incentive, but also the rational logical decision making parts of your brain work better. That’s the thing is that we’re operating in fight and flight, we think that what we’re doing is protecting safety, but we actually make poor decisions. When we’re feeling under stress, right, we make better decisions, we’re feeling clear headed. So if you won’t do it for your own mental health, do it for the fact that you will be a better clinician a better co worker, to slow that’s so I mean, again, there’s infinite techniques for this, and I teach a lot of them. But what they all have in common, and we’re just going to summarize them is, let’s take a moment to walk into the space and become present in that space. Smell it, see it, hear it, breathe it, I’m here. And recognizing which we all know, and that’s why we signed up for this work that a day at the office for us is the day that they will remember forever. Yeah, no pressure. this weekend’s the story of the birth of their family. Right? And so let’s like, take a moment to be like, Okay, I’m entering into this, to leave those things outside. And that requires a lot I don’t say this lightly, I don’t say like, Oh, just take deep breaths, and you’re gonna be all better. But part of what goes into this is like, all the stuff you’ve done before this to take care of yourself, but in a moment when you walk into the room.
Maggie, RNC-OB 21:59
Yeah, yeah. That’s so helpful, though. Just I think honing in on that piece of like, this is an intentional practice. And it’s something that we cannot always sure you’re gonna have days and moments and situations that don’t just simply don’t allow for it. But that if you’re having you’re feeling that tension rise, you’re feeling your pulse go up, you’re feeling that instinct that like, this isn’t something emergent is happening, something is wrong, that we do have an option to pause. Yeah. And to just and even if it’s a five second pause to realize, like, is this a real emergency? Okay, and maybe I really need to act and it has to be very decisive, and every second counts, or is this like, Uh huh. There’s a point of tension something potential is going on and said, I have a minute to compose myself, I have a minute to make sure I’m showing up in the best way for the patient. Like that is a really powerful reminder for all of us in that the control we have over that piece of it that often just feels outside of us.
Krysta Dancy 23:01
Totally. And I love I mean, birth is just I love it. Obviously, I’m a big birth nerd. And one of the things about it is that it has all of these reminders in it. And so you might have to charge into the room and immediately assess it immediately talking to me, that happens that happens for safety sometimes, right? But assuming there’s nothing that requires an immediate action, which is the truth, the majority of the time, nothing requires the immediate action, often just that between contraction pause is such an amazing reminder. There’s 60 seconds, you can just breathe, they’re breathing, you’re breathing. There you go, right. And as a as a doula as a birth attendant. I love watching the providers that I see do this nurses, I mean, you can be holding a leg and breathing, you can be watching the monitor and breathing. You can be you know, gearing up and breathing. And so what’s nice is this realization that often it can’t look like this sort of perfect like Zen. You have to, but berserkers are excellent at that they’re excellent at multitasking and excellent at working out on the fly.
Maggie, RNC-OB 24:04
Yes. Oh, I love that. And then you know, Krysta, I think one thing that’s been really challenging for me as a birth professional, walking alongside folks, whether that’s in you know, in the hospital as I’m labor nurse at someone’s bedside, or when I’m talking to a loved one who is you know, texting and trying to figure out like, “Okay, how do I how do i do birth right now, because I’m concerned about a lot of these things.” I have worried that I found myself as I’m carrying all of this tension and all of these concerns and all the ways that things are changing. It’s been hard for me to maybe provide details oradvice in a way that I feel like doesn’t end up fear mongering or increasing anxiety when I really just want to be presenting reality in a way that prepares people.
Krysta Dancy 24:48
Yeah. I love this question, because I think it’s important to highlight that this is a question pre pandemic because it’s like, you know, I run support groups, and sometimes there’s just like, “Why didn’t anybody warn me birth could be like that.” On the other side, it’s like “stop telling me your trauma stories,” right?
Maggie, RNC-OB 25:02
Exactly, yes.
Krysta Dancy 25:04
Like this is already a line that I think I continually asked myself when I’m educating, like, at what point is it helpful? And at what point is it hurtful and I don’t know, I can’t pretend to like that’s always easy to know. But here’s one of the things that I recommend to professionals that I do think is worthwhile, which is, we know from literature, previous to the pandemic, that one of the big predictors of PTSD later, is shock, psychological shock, not medical shock. What shock demonstrates psychologically speaking, is that there’s an overwhelm happening to the central nervous system, and it’s, I think of it, unscientifically is like a log jam. It’s like, what shock tells us is like, too much input can’t process and it starts to backup. And that is a precursor to PTSD later on. So one of the things that we know protects people against this is preparation and information. This is we knew this before the pandemic, and so I believe that it is good evidence supported care, to give people accurate information, even if that information is something you wish weren’t true. Yeah, right. One of the things that is not true probably everyone in professionals care, but it’s true of probably more of them than they expect is that they’re hearing horror stories on the internet, about infant parent separation, about NICU separation about, you know, quarantine type separation that’s happening or forced course of care, etc. And so they’re not coming off into your care as a blank slate, they have unspoken fears that are happening. And so what you can actually do is give them very clear information about what they can expect coming into your facility. And that sounds like “so when you arrive partner will be here you will be here, these tests will be given this is how long it will take to get the results back. This is what PPE is going to be used…” this kind of information. The way that I distinguish it from fear mongering is fear mongering is when we add our own our own emotional load to it, right. This is terrible. And it’s horrible. And I wish it wasn’t that way. And I’m so upset. And this policy is stupid, it doesn’t make any sense. And I don’t agree with it. And I want to quit my job. And none of that makes any sense to me anymore. Okay, so that’s fear mongering, yeah, by saying, here’s a step by step. And what you can expect when you walk through the doors, not only helps them start to get a mental image, it also allows them to ask questions. And while that conversation might feel heavy in the room, what you just did is prevented trauma later. Because when things are unexpected, our nervous system is more likely to experience them as shock and eventually trauma. Right? So I walk in the door, and I didn’t expect the test, I didn’t expect the PPE or I didn’t expect to be separated from my support person, or whatever it is that that not having a clear expectation, each one of those compounds into creating a heightened Nervous System state, right, it’s just like the cup that finally overflows, like each one of those unexpected things. So if you as a professional have the opportunity, whether it is in prenatal or even bedside. So from here, here’s how the hospital’s handling this issue. It looks like this, this and this. I actually think that providers and professionals can feel good about the fact that what they’re doing is evidence supported protection, even if what you’d rather say is I don’t like any of that. Yeah, yeah. I don’t want it to be true.
Maggie, RNC-OB 28:25
Yeah, I think that isn’t like you said, it’s it’s certainly pre pandemic, it is just that feeling of like, I don’t want to tell you this, because I want there to be a different I would like the answer to be different. And so sometimes we think people hedge that answer, but that doesn’t end up. That doesn’t change the answer. We just haven’t given it to someone. Right? And then they’re, they’re kind of left with half information or misinformation and not being prepared; that’s an important clarification.
Krysta Dancy 28:49
I think that it’s okay to say like, “I would like the answer to be different.” You know, I think that as a doula, I love those professionals who kind of give us the look and say, hospital policy says, right, I am required to tell you and they just kind of give us a look. I’m like, thank you that I feel that human connection there and I feel that honesty I think it’s okay to say what the hospitals doing right now or what the facilities do whatever it is, you’re not you don’t have to speak as if you think it’s a great idea when you don’t but but we can do is just give accurate expectations. And we can even say like “I’m doing this because I want you to when you come through the door, like feel as comfortable as possible, because none of this is a surprise to you.” And how much better for them to have four weeks to absorb that information and make plans versus be in the throes of labor and be caught off guard. Yeah, yeah. Yeah. And truthfully, most of them I find Well, I wouldn’t say most of everybody who gives birth but the people that I see who tend to be like more invested in the process and doing a lot of like, you know, reading and googling and childbirth and whatever. I think most of the time it will actually decrease their anxiety overall because they there’s just so much unknown of what they’re reading is happening. That You’re just afraid to even ask about.
Maggie, RNC-OB 29:13
Yeah. I bet there’s like there’s so many ways I, I could go back and have this conversation with you, Krysta all day. I’m wondering as we start to kind of close out, if there is maybe there’s two things that we all as, as a society, whether we are professionals, working parents, loved ones, what we could understand about birth trauma, like if you could have something on a billboard, what do you feel like you would share with us?
Krysta Dancy 30:30
That’s a good question. I would love for everyone to understand that birth trauma is a central nervous system response. And it’s not an absence of gratitude, not an absence of strength, it’s not failing to look on the bright side, it’s not a lack of positivity or faith, that you can be grateful that you can be strong, that you can be optimistic, and you can still have trauma. It’s just a central nervous system response. And so therefore, it is very common, and it is highly treatable. And so those are the things that I most want people to take home to remove the stigma because the stigma is causing people to not get care, and actually, it’s incredibly treatable very quickly. Yeah. And you can be all of those wonderful things you can be. I mean, for crying out loud, remember, I worked with combat veterans, like you can be really tough and positive and optimistic and strong, and have grit and fortitude in all of that, and have trauma. These things are not mutually exclusive. It’s a nervous system state. And so there, there’s so much reason to be optimistic, both for patients and for professionals who have a high degree of trauma as well, there’s so much reason to be optimistic. Because every year that we learn more about trauma, we learn how to treat it more effectively. It’s, it’s, it’s a really good time to seek care on this. And it’s really, there’s so much reason to be positive about the future on
Maggie, RNC-OB 31:59
Ah, yes, that is that is lifting in something that feels so heavy and so hard and can feel really overwhelming to process by yourself. And so a shout out to everyone out there who has been on the fence about seeking care and getting resources that there is really good help out there. And we’ll be sharing some favorite resources to kind of help lead you on that way in the show notes. So please check out there will be shout it out on social media, too. But well, Krysta, thank you so much for coming on and having this conversation with us. I so appreciate you.
Krysta Dancy 32:30
Thanks for having me.
Maggie, RNC-OB 32:36
I know talking about trauma and thinking through the ways that it shows up in our in our lives and in our work is it’s always really challenging, right? I so appreciate the note that Krysta left us on with kind of her billboard for understanding birth trauma. You know, there is so much hope that comes with knowledge. Right. So as we all think through the topics from today and process, the reality of how birth trauma has been exacerbated by the pandemic, as we think through ways that we can alter our practice to be more supportive, more trauma informed. I hope you feel that thread of hope coming towards us that when we see this when we know when it could show up when we’re more aware of it, that that also gives us power to act to act differently, both personally and to show up for those in our care by making systemic changes so that everyone out there has a better chance of receiving trauma informed care. that minimizes their risk of birth trauma. And then when birth trauma occurs, we are ready with resources, and support and hope to share with those who are suffering and struggling so that they know where they can reach out to for resources will obviously be linking a bunch of those in the show notes so you can turn there. And we would love for you to give us a shout out on social media we’re Your BIRTH Partners across all platforms. And we would just love to hear what what struck you about this episode. Like Krista, share that with a light bulb moment for you. And how are you going to take this and go out and create the practice that you want. That is trauma informed, that centers the birthing person and that also creates the kind of environment that you want to operate in and practicing as a birth worker. So we look forward to hearing from you next time.
047: Managing PCOS: Fertility, Nutrition, & Beyond
Maggie, RNC-OB 0:07
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive, collaborative birthcare communities, rooted in autonomy, respect and equity. I’m your host, Maggie Runyan, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Hey, everyone, and welcome back to the podcast. This week, we are digging into kind of a different track than what we’ve been talking about. Lately, we are talking about holding space for those on a PCOS journey. So PCOS or polycystic ovarian syndrome, is a metabolic condition that impacts roughly 10% of folks in their reproductive years, which is about like 5 million people, we estimate. So this is something that undoubtedly you have seen in your work or in your personal life. And so we want to turn our attention to, you know, how we hold space when it feels like our bodies aren’t working the way that we want them to, and how we support folks to meet their individual needs and desires and how we make sure that our practices reflect what they actually want to get out of their care whether that’s we’re helping them along a, you know, fertility journey as they’re looking to get pregnant, whether it means we are supporting them through hormonal changes, and whether that means we’re helping them to understand what their body is going to look like postpartum and figure out ways to manage PCOS so that they feel as good as they possibly can. So joining us in this conversation is Sam Abbott, an incredible nutritionist who focuses much of her work on PCOS and helping folks to navigate that…so let’s head right on into that conversation.
Oh, well welcome, Sam. I am just so excited to have you on here on the podcast and share a little bit more about your work with PCOS. So if you want to just start by sharing with our audience a little bit about yourself.
Sam, RD 2:02
Yeah, thank you so much for having me. I’m excited to be here. My name is Sam Abbott. I’m a registered dietitian. And I specialize in nutrition coaching for PCOS. So I run the Instagram account pcos.nutritionist where I give a lot of free information about PCOS. And then I also have a group nutrition coaching program. I have worked in the field of nutrition for 14 years and just super passionate about helping people with PCOS improve their quality of life, have a healthy relationship with food in their body. And just know and feel like PCOS is not going to stand in their way of living their fullest life.
Maggie, RNC-OB 2:45
Oh, yes. So good. See, I found you on Instagram the power of social media. And just love the the tidbits you share on there. If anyone is not following you already get on that because there’s a lot of great information there. I wonder if maybe you could just start by kind of laying the playing field for us in terms of what what PCOS is and is not.
Sam, RD 3:04
Yeah, PCOS is a metabolic, endocrine and reproductive disorder. It affects 10 to 15% of people born with a uterus, we think that up to 50% of people who have PCOS really don’t even know that they have it. PCOS is characterized by a lack of a period or regular periods. Some other symptoms can be acne here, hirsutism, which is excessive hair growth, hair loss, especially like around the top of the head. And then many people do experience unexplained weight gain. We were talking about this before we started recording that PCOS it is the leading cause of an anovulatory infertility. But it’s also so much more than that. It’s a metabolic conditions are really affects the entire body and long term health. pcls is associated with increased risk of type two diabetes, sleep apnea, endometrial cancer, fatty liver disease, it’s also associated with anxiety and depression. We don’t really know what causes PCOS. There’s a lot of misinformation out there about that. But we think there’s a genetic component and we think there may be an environmental component as well being exposed to environmental endocrine disruptors, or maybe someone’s mom was exposed to endocrine disruptors when they were pregnant.
Maggie, RNC-OB 4:36
Hmm. There’s so much there. Yeah. I feel like that’s one of the things that we when we were forming this whole podcast season around the idea of holding space, PCOS came up because I feel like it is not just this moment around fertility or getting pregnant, which I think a lot of us, we’ve unfortunately, that’s kind of what we’ve taken in is that like, “Oh, great, okay, yeah, people who are of reproductive age with PCOS. That’s the concern is just kind of get pregnant if they want to.” And then once we’ve done that we’re kind of it’s over. We don’t seem to think about it that much. Can you tell us a little bit we’re asking all of our guests tell us what does it mean for you, as you’re kind of walking along with clients who are experiencing PCOS? What does it mean for you to hold space for their journey?
Sam, RD 5:19
Well, I think for me really recognizing and understanding that how someone experiences PCOS is going to look different for each person. So the things that they’re concerned about the symptoms that bother them, how the things that they’re worried about long term, you know, for some people, their focus and fears are around fertility. For others, they are exhausted, and they just want someone to help them have a little bit more energy. Some of my clients really, really struggle with disordered thoughts around food and poor body image. So really holding space when I’m working with a client for their own personal experiences, and also understanding that their own experiences are valid. You know, we, shockingly, don’t have a ton of research about PCOS, outside of fertility. And I think it’s really important to remember that our patients and our clients experiences are valid, you know, when they’re sitting with us in a room and sharing their experiences, they’re not lying, or being dishonest or exaggerating, that is actually how they are experiencing this syndrome.
Maggie, RNC-OB 6:28
Yeah. Hmm. Yeah, I think, obviously, we just in, in healthcare, and you know, even in birth care, we’re we’re, we should be very focused on individual desires for this huge transition. I think it’s just, I don’t know, it’s very easy for us to dismiss people’s experiences that are not similar to our own. And, you know, I think, especially with PCOS, because it’s, it’s relatively common. People have, everyone knows someone, right? Like, you can write yourself have PCOS, or you know, your best friend, your cousin, your sister. So you feel like you have a sense of what maybe what PCOS means to someone else. And then you’re kind of missing, checking in on their individual concerns and actually understanding it. Do you see when you’re talking with clients about either kind of navigating PCOS? And if they’re in this space, where they’re looking to become pregnant? Do they talk about kind of like gaps that they’re seeing from there other healthcare providers, medical providers on this?
Sam, RD 7:28
Yeah. Yes, I would say it’s actually a really difficult part of being a dietitian, is that there are so many gaps in healthcare, that I think that clients are turning to other people to get that medical information. And it’s really frustrating, because I want to say, you need to take these concerns back to your doctor. But then at the same time, I know they’re having a poor experience trying to get, you know, appropriate screenings or testings and things like that. So yeah, we do see a lot of gaps. One would be telling a patient or a patient’s been told, you know, “just come back when you want to get pregnant. PCOS is really mostly about fertility.” And we know that PCOS affects the entire body and long term health and patients are now Googling things and reading about that on the internet. So they’re very aware when they’re not receiving, you know, the full picture of education around their pcls diagnosis. So many times patient’s concerns are dismissed, overweight, or blaming things on lifestyle and nutrition. So someone may be requesting a lab or sharing that they’re experiencing something that’s really affecting their day to day life and how they function. And they’re just told, “You know, I think you need to exercise more, I think you need to eat less, or I think you need to cut out carbohydrates.” And we’re really missing a huge piece of the conversation. We’re giving people nutrition and lifestyle and medical advice.
Maggie, RNC-OB 9:08
So frustrating. Why do you feel like why do you think we have so much conflicting information between OBs, midwives, nutritionists, everyone?
Sam, RD 9:19
I could probably rant about this all day. Right now. PCOS is only classified as a reproductive disorder within the NIH and that is how certain medical conditions get funding and we really need Congress to vote to reclassify pcls as a metabolic condition. And when it falls as a metabolic condition, it would get so much more funding for research and then with that research, there would be a lot more awareness around the condition but right now there’s such a lack of awareness and even you know, I feel like I learned so much by being involved. pcls advocacy and being able to listen to some of the lead researchers or specialist or pediatric endocrinologist who are really in the weeds studying pcls, and all of the newer information that’s coming out that just hasn’t really been published or trickled down to other doctors yet. And I think that that is really that’s really the biggest gap right now is it all starts with the research funding, if pcls were reclassified as a metabolic condition. I mean, if you think about other metabolic conditions, like heart disease, or diabetes, or things like that, that end up affecting like long term health, I think that the experience of having PCOS would just be completely different.
Maggie, RNC-OB 10:49
Hmm, it’s fascinating. And it’s, it’s shocking to me that it’s still misclassified like that within the NIH like…
Sam, RD 10:58
yeah, and it, you know, I’ll be honest, I was a little ignorant to this before I got involved in PCs advocacy of how political this topic is, because pcls is kind of falls under the umbrella of women’s health, the primary treatment for it is birth control. So you know, if you have a politician that doesn’t want to touch that topic with like a 10 foot pole, they’re not going to say that they’re not supportive of changing that classification. They’re just going to say that they were prioritizing other things, and they’re leaving, they’re leaving it to the NIH to kind of deal with. Yeah, it’s frustrating.
Maggie, RNC-OB 11:43
Yeah, I, you know, just the reminder of like, how messy this all is. So much work to be done in terms of advocacy, and helping people to understand that more. And, you know, for those politicians who, out of their own ignorance about the issue and how it’s impacting it, that they’re not willing to give it the attention that they need, like, that’s incredibly frustrating, and huge disservice to everyone who experiences pts.
Sam, RD 12:10
Yeah, definitely. It’s really frustrating.
Maggie, RNC-OB 12:13
Okay, so everyone listening, we’re going to tune in there and check in with our politicians and see if they even know that this is something that they could be impacting and making change on.
Sam, RD 12:24
Yeah, there’s a really great organization called PCOS Challenge. It’s a nonprofit organization, and they organize a PCOS advocacy day where you can actually talk to your representatives, and because of everything with the Coronavirus, that event was virtual last year, I would guess it’s going to be virtual this year. So it’s a lot more accessible to people to participate.
Maggie, RNC-OB 12:48
Fantastic. Well, we will obviously link that in the show notes and everyone who wants to get access to that. I guess one question, too. So we’ve certainly talked a lot on the podcast before about the impacts of sizes and fatphobia. And relying on the BMI. And all of the ways that that impacts birth care. From your perspective, I think, as you touched on so often with PCOS, we think of this as, okay, well here you have to control your weight to deal with it, or that it’s just about how you eat. How do you approach that front as a nutritionist?
Sam, RD 13:24
Well, I think it’s really important to remember that when we look at weight, Well, two things. One is that bodies come in all sizes, they always have, and they always will. So you know, even when we look back in history, that has been the case. And so much of diet, culture, and the diet industry. And even I don’t know if you’ve talked about this on your show, but how influential the pharmaceutical industry was, in getting the BMI to where it is today pharmaceutical industry, meaning companies that had weight loss drugs. I mean, I think this should all be really concerning to us when we are talking about using BMI and weight as an indicator of health. So bodies come in all shapes and sizes, and then also weight is an outcome. It’s really not a behavior. And when we look at research around weight loss studies, they’re mostly short term. And when we look at the research past a two to five year period, we don’t really have much that shows that intentional weight loss efforts are maintainable or realistic long term. What we actually see is the opposite that people who diet and weight cycle are more likely to experience negative health impacts; dieting is associated with increased inflammation, worsening blood pressure, higher aim on see all things that people with pcls struggle with anyway. So I really like to focus on actual behaviors, we know that elevated circulating insulin levels and increase inflammation are really at the core of PCOS. So, obviously, nutrition and lifestyle, you know, do play a part in that. But you know, to what extent and how much are we asking our patients and clients to sacrifice their emotional health and mental health in this pursuit of weight loss. So I think it’s just really important to remember that our patients and our clients are individuals, and I find that my clients have the best experiences and the most positive health outcomes when they have a support team that says, Let’s not focus on your weight or your body, let’s focus on other symptoms, let’s focus on you honoring what’s important to you and taking care of yourself.
Maggie, RNC-OB 16:02
Hmm, that’s so powerful. I just want to say again, what you said that weight is an outcome and not a behavior because it shows up over and over and over again, because that is not what we have internalized as a society, obviously.
Sam, RD 16:15
Yeah, yeah. And I think that we all have some sort of internalized fat phobia, some sort of internalized weight bias, where if you see someone at a higher weight, you’re automatically making assumptions about that person and their lifestyle, and what’s important to them. And I think that if you are in a role where you’re providing care to someone else, we really need to work hard to break down our own weight biases, because I think you really, I have had clients in larger bodies who were marathon runners, and I have had clients who were very thin and were metabolically unhealthy. So when we’re judging someone when they walk in the door, we’re really not providing the best care that we could be. And that, you know, when you asked about gaps in care, that’s probably the biggest one that stands in the way of my clients, when it comes to nutrition and lifestyle is that when someone’s in a larger body, a lot of times, they feel like it doesn’t even matter what they tell their provider, because they’re just going to be told to eat less and exercise more, they’re just kind of going to be facing the assumption that they don’t care about their health. And it’s not a good starting place for someone who’s seeking medical care.
Maggie, RNC-OB 17:38
Yeah, that’s crushing. And I question how much I think we’ve talked, we talked at length about a lot of the holes we have in our healthcare system, and how you know, it’s really not, it’s not set up for individualized care, you know, it’s set up to kind of factory gets everyone in and out and moving along. And so I think part of it comes from our internalized biases. Part of it comes from the way we’ve set up workflows, you know, that you come in, and it’s everyone just gets their their weight. And boop, boop, boop, boop, boop, and you have to put that in the chart. And that dictates so many, so much of care, I can remember now who, someone who just shared that, you know, they went to the doctor, they declined having their weight taken, they didn’t need to, and then they were unable to proceed with their appointment, though, because of the way that the medical documentation system was set up, it made the nurse put in a number before they could move on to any other concern. And there are just so many ways that we continue to give legitimacy to weight as a measure of health, like we need to systematically cut out of the way we’ve designed our healthcare workflows and being really critical of ourselves. And this isn’t for operating in to move past that, because it’s has such a detrimental effect on the people in our care.
Sam, RD 18:58
Yeah, I completely agree. And I think that I think anybody who, who goes and researches the history of BMI, or kind of reads about how weight became the center of medical care, or one of the main points of medical care, I should say, it’s really bothersome.
Maggie, RNC-OB 19:20
Yeah, yeah. Oh, and I know I will be sharing resources, you know, in the show notes for this for everyone who’s kind of hearing this and it’s like, you’re maybe feeling uncomfortable, you’re questioning this because this has been really very ingrained in our medical education, nursing education. So we’ll share some information about that for those of you who want to dig deeper and gain a little bit more of a holistic view about weight and how it has operated within our healthcare system.
Sam, RD 19:46
Yeah, and I think I do you think that if you’re someone who’s practiced from a weight centric approach, when you when you hear a conversation like this, your first reaction is like, this is ridiculous. I can Google, so many studies about weight and health and things like that. And I think a good first step in kind of exploring this topic is understanding that in most cases, focusing on weight with clients and patients tends to not help them improve their health in the long run. Even if you still center your thoughts around weight and health, you know, a direct cause and effect relationship there. Just knowing that focusing on that with a client tends to not really help them or the patient has not really helped them. It’s a good, it’s a good stepping stone.
Maggie, RNC-OB 20:41
Yes, thank you. Once we’ve kind of moved beyond that, and you know, we’re able to kind of get past this weight centric approach. And we’re looking to really dive into people with what their goals are around PCs, for those who they really are focused on fertility, they are anxious to become pregnant, do you have some some tips and some ways that we can approach this with them with kind of holding the realities of what we know from research around PCOS without necessarily being like fear mongering about their chance of getting pregnant or adding to kind of anxiety that they have there, which isn’t going to help towards their fertility goals?
Sam, RD 21:17
Yeah, I think a great way of explaining it. For most people who have PCOS, what’s standing in the way of fertility has to do with elevated insulin levels, which can cause our body to become resistant to insulin, and then that can cause the body to produce elevated androgens, which are male sex hormones, and that can stand in the way of population from a fertility standpoint, as well, we know that pcls can affect egg quality, increase the risk of miscarriage as well, too. So I think that that’s a really great way of explaining it. PCOS is also an inflammatory condition, which is associated with elevated androgens as well. So anything that we can do to improve insulin resistance, and decrease inflammation can definitely improve chances of more regular oscillation and decrease the risk of miscarriage. And another important thing to bring up is that we don’t really know what causes pcls. And what causes this underlying insulin resistance. And so I think communicating with the patient or client that you know, you didn’t cause this your lifestyle and causes your this, your nutrition did not cause this. But of course, nutrition and lifestyle can play a role in how it’s managed.
Maggie, RNC-OB 22:48
Yeah, yeah, I think that’s where we, we start to kind of slide into some of those, the negative behaviors we’ve taken around food and body image.
Sam, RD 23:02
Mm hmm. Yeah, and I think that in the medical space, we tend to lean on research about adiposity, and inflammation and insulin resistance, when in reality, we also have research that, you know, walking can improve insulin resistance, even when weight loss doesn’t occur. So I think this is really where backing off of the focus on weight, and instead, centering the conversation around the individual, in their own nutrition and lifestyle habits, and what’s important to them can be the most beneficial.
Maggie, RNC-OB 23:44
Yes, I love that. And then, you know, as we’re walking along, folks to this, once they’ve, you know, they’ve gotten pregnant, they’ve had the baby. I know sometimes when we see people, you know, postpartum often body image, it’s just coming back into play, people are very conscious of how their body has changed through pregnancy and birth. And, you know, as they’re feeding their baby, are there ways you have found it helpful to talk to folks about body image and understanding that transition that also acknowledges just that this is part of their lives, that PCOS is there, it’s not necessarily going away? And that they’re going to need to kind of continue to be aware of it and make change this transition?
Sam, RD 24:26
Yeah, yeah. So I think making sure that anyone who has carried a child and has given birth, making sure that we really normalize the experience of body changing throughout that, throughout that time, you know, bodies change during that time, bodies change during menopause we need to really normalize this and make it really clear to, to the people that we’re working with that we shouldn’t expect you to have a “pre baby body,” because that’s really not how bodies are designed, I find with my clients that throughout pregnancy, their symptoms actually get better. And then in the immediate postpartum period, they tend to feel pretty good, and their symptoms tend to be better. But then as time goes on, things kind of go back to where they were. And it’s just kind of a reminder that PCOS is a lifelong condition. And, you know, keeping in mind the, the metabolic aspect, and how it can affect you from day to day. You know, unfortunately, that doesn’t really go away after pregnancy.
Maggie, RNC-OB 25:44
Yeah, I know, personally, I know, that was only my experience, as well with PCOS. During pregnancy, and can even really afterwards I like it felt like so many of the symptoms that had bothered me, had improved a lot. And then it was a little bit challenging to find that my body was kind of returning to its kind of standard operating procedures afterwards. And that felt frustrating, after having kind of experienced how much better I felt with the way my hormones were working during pregnancy.
Sam, RD 26:16
Mm hmm. Yeah, I could totally see how that would be frustrating. And, you know, I wonder, how would someone’s experience be different if they were kind of told what to expect?
Maggie, RNC-OB 26:29
Yes. Yes, yeah. I think that’s totally something we can I think for, you know, all of us as we’re talking with clients, who experiences preparing them for that speaking in these realities, and really educating ourselves on the way that these hormone shifts impact so much and moving beyond kind of our our narrow view about PCOS as a fertility, reproductive condition, would help so much as we kind of pair folks for navigating PCs for their entire life, even once they’re beyond their reproductive years. Yes, definitely. Oh, well, thank you so much. And it’s been such a great conversation. Are there any other kind of tips you want to share with our audience any resources that you really recommend?
Sam, RD 27:12
Well, definitely follow me on Instagram, I try to give out a lot of awesome information there. I really love PCOS Challenge is an organization that’s, you know, they have advocacy day, and they have their annual symposium in September, that’s pretty inexpensive to attend virtually. I would also say, for anyone listening, you know, if you feel like you haven’t had a lot of training around nutrition and nutrition coaching and Lifestyle coaching, feel free to partner up with a registered dietician, we, we are the ones who spend four to seven years in school, just studying nutrition and lifestyle. And so that can be a really great resource, considering how impactful those factors can be in PCOS Management,
Maggie, RNC-OB 27:58
Mmmm. Yes, yes, absolutely. When we’ve talked about, you know, kind of nutrition, dietary concerns in the past, I feel like that’s one of those cyber care gaps that we would love to see filled, is really that everyone who is you know, pregnant and postpartum, that they have access to a dietitian to talk through their individual concerns, their goals, and not just feeling they’re kind of awash in the sea of misinformation about nutrition and what our bodies are supposed to be doing.
Sam, RD 28:30
Yeah, definitely. And then from a nutrition standpoint, for just giving some basic nutrition advice of really making sure first of all that, that whoever you’re working with knows that nutrition is not the only thing that affects insulin resistance, like stress management, and sleep and how you’re moving your body plays a role as well. That’s especially we’re recording this during a pandemic. And I think it has such a stressful time and we normalize stress so much. And pairing carbohydrates with protein and fat can really slow down the digestion of carbohydrate. So I think so many times when someone has insulin resistance, we are telling them to eat low carb or cut out carbohydrates. And that’s not really necessary. And it can also make nutrition feel really overwhelming to people. So just encouraging them to add in fats and protein. Fiber is great as well. We know that people with PCOS tend to have a less diverse gut microbiome. So doing what we can to help support gut health is really impactful as well.
Maggie, RNC-OB 29:39
Oh, those are awesome tips. And yeah, for everyone listening when you check out Sam’s Instagram, you share a ton of great imagery to help understand like what a plate looks like when you’re focusing on carbohydrates versus once you’ve loaded in some more fat and protein and those are really helpful for if you’re looking for kind of like quick tips to be able to give to the clients to help them out.
Sam, RD 30:00
Another tip, just PCOS-wise, this topic is a little confusing with actual clients and patients. But I find so many people I work with are told that they don’t have insulin resistance because they have a normal fasting blood sugar, or they have a normal A1C. And what we really look for is what’s going on beneath that we see underlying insulin resistance, really fostering for a long time. And this is this was a topic a big topic of conversation at the last PCOS Symposium that when someone develops elevated liver enzymes, or high blood sugar, or even high blood pressure, or cholesterol with PCOS, this isn’t a new issue, this is something that’s probably been going on for a really long time. So being proactive with checking labs, ordering an oral glucose tolerance test with fasting insulin levels can really give you more information there.
Maggie, RNC-OB 31:04
That’s so helpful. Thank you.
Sam, RD 31:06
You’re welcome.
Maggie, RNC-OB 31:07
Oh, well, Sam, thank you so much for sharing all of this with us. And just helping us to provide better care for everyone was PCOS. Appreciate you.
Sam, RD 31:15
Oh, well, thank you so much for giving me the opportunity to come on here and chat about it. And I really appreciate the opportunity to have a conversation around a lot of these topics. Because I know it can sometimes feel like an uphill battle. When we look at how weight centric a lot of things related to patient and client care are related.
Maggie, RNC-OB 31:38
Yes, absolutely; so much.
Sam, RD 31:42
Thank you.
Unknown Speaker 31:43
I just so appreciate Sam coming on and sharing. So much of that. And I I learned a lot listening to just how all of these things, we constantly are realizing how everything is connected, you know, how politics dictate our healthcare system, and what gets researched, and ultimately, what ends up being treated and who ends up being cared for? Well, by our health care system, we’ll be sharing information in the show notes so that you can look up and see what is happening with PCOS and the legislature, where are your representatives at something you can contact them about if this is something that moves you and just exploring a little bit more about some of these biases that we have around weight and nutrition and we have a lot of great resources lined up in there for you. So we look forward to hearing what struck you about this? What surprised you ?How are you gonna be changing your practice based on something that Sam shared today? So please give us a shout out on social media we’re your birth partners across all platforms, we love to hear from you and be inspired as you create your practice to be more inclusive, collaborative and equitable. Till next time
048: Power of Reflection for Birthworkers
Maggie, RNC-OB 0:07
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth care communities, rooted in autonomy, respect, and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Hey, welcome back. In this episode, we are continuing our series on holding space, as we dive into the power of reflection, and processing what we can do as professionals to gain greater insight into our work to figure out how we are processing our own feelings and making sure that they don’t get pushed into future clients’ birth spaces. This is such a needed topic. And I think one that ends up being minimized. Often, when we are in kind of typical training spaces. So much of it is focused on the people who are in our care, which is very valid and necessary. But often we don’t acknowledge the humanity that is within each of us and what needs to happen for us to show up whole to everyone else. So we are excited to have Cheyenne Scarlett come on here and share some of her research and her work and what drew her to really focus on reflection as a crucial element of birth worker practice…on to the show.
Oh, well, alright, Cheyenne, I’m just so excited to have you here on the podcast and sharing a little bit more about your work as a birthworker and what you kind of want to see happening with us as birth pros. So if you want to just tell us a little bit more about yourself and your work and what kind of brought you to this place?
Cheyenne, Researcher 1:52
Sure, yeah. My name is Cheyenne Scarlett. I am childbirth educator and doula in training. [inaudible noise] Sorry, that was my three week old baby. You can always hear her, but yeah, I didn’t I never intended to actually be in the birth world I’ve always been interested in, in birth and children and families. And my formal education is actually in like child development. And I sort of came to the birth world from the perspective of children wanting to advocate for better birth experiences for them. You know, I’m sort of wondering, does that, does itmatter how we come into the world and how we’re born? Does that? Does that mean anything? But now we’ve sort of arrived in this place, we’re realizing it’s more about supporting the parents in order for them to be able to support their children.
Maggie, RNC-OB 2:45
Yeah, ripple effect, right? Yeah. So in this series, on the podcast, we’re talking a lot about holding space, and how we kind of cultivate that. So we’re just asking all of our guests to kind of give us a little bit of like, what is holding space mean to you? How is that part of your practice?
Cheyenne, Researcher 3:00
Yeah, I think holding space can be, like, literally creating a space for someone to talk or creating, you know, an opportunity that didn’t previously exist, sort of, you know, just allowing, allowing people to share their story, or, you know, share something that’s important to them. So literally creating a space for that to happen, or just figuratively, you know, just being open to listening and, you know, taking in information that, you know, you might be hesitant to, to listen to, either, you know, usually it’s for personal reasons that people don’t want to sort of feel attacked or feel threatened by what somebody else is saying. Even if that is their their own truth. Right. So, literally creating opportunities and spaces, and also just figuratively, just being quiet and listening to somebody.
Maggie, RNC-OB 4:00
Oh, yes. Yeah, actually power switch power in both those approaches, right, like, depending on what’s needed. So do you can you share a little bit more about kind of how you really like, went down this birth work path? And like, what would pull your attention there and made you really feel like that’s what needs more attention?
Cheyenne, Researcher 4:19
Sure. So like I said, my formal education, diploma are early childhood education, a diploma degree in child development, and a master’s in Early Childhood Studies. And I felt like, you know, we really leave out birth in the conversation when we’re talking about children. It’s always in pregnancy, you should do this this way. And you should avoid this and you should make sure you do that. And then, you know, when we’re actually parenting children, raising children, it’s make sure you do this. Make sure you don’t do that. And then in birth, it’s just this like, thing that we don’t talk about. You go into the hospital and you come back out and you don’t talk about what happened there. And that’s all not to say that we need more lists of things that people should or should not be doing. Like there should be more conversations about things. I think, you know, people acknowledge that they have choices and things that they can or prefer to do or want to do in pregnancy and in parenting, but that birth is just, you know, leave it to the experts and do whatever they tell you. It’s not something I agree with. So I just felt like there should be more conversation around that. And then even just looking into how the mental health of parents matters for their children, and how, how they’re parenting their children. And we talked about, you know, trauma and anxiety and depression and what the effects of poor mental health have on parents and child relationships we’ve ever talked about, where those traumas could stem from, and if that is a birth trauma, what does that mean? Going forward? Right. So I just felt like that was just this huge gray area. So for my master’s research, I really wanted to incorporate something with birth, and I would really want to, you know, usually when you’re doing research, you kind of have to pick a really small group, because you can’t, you know, reach out to too far, especially in graduate school. So I decided to pick just Black parents, Black mothers, and see what their experience was. And I was going to, you know, look up, what is their experience? And then, you know, study beyond that, you know, if if it is more likely to be negative, what does that mean going forward, but there was no research, there was no foundation to bounce off of. So I kind of had to do that study itself. So I did an interview 30 moms who have given birth in the GTA [greater toronto area] in the last two, three years, and heard their their birth stories and their experiences. So listening to those made me want to, you know, actually work with people and, and help them have better, better birth experiences. Because, you know, it is the fault of the medical system, that people are having such poor experiences, but there are some, some things defensively, that birthing people can do to sort of protect themselves in the meantime, while we work on fixing the system.
Maggie, RNC-OB 7:28
Yes. Yeah, that’s such a hard line, right? There’s this whole piece of how much of it is like personal control and preparation that we can do individually, whether that’s as a parent or as, you know, a birth pro who wants to things change, and then how much of these elements of like, have a systemic nature that needs, you know, huge sweeping changes, whether that’s, you know, from legislation or professional organizations that, you know, herald change, like, there’s so much that has to happen on all of those different layers to come together to really see actual change finally occur in birth care. And then in through your, through your research, is that where, where did you kind of start to focus on, you know, birth workers and kind of the power of like reflection as part of their practice?
Cheyenne, Researcher 8:16
Yeah, so my whole thought process was, you know, do the thing you’re supposed to do go to school, go to graduate school, get a “good job,” and everything…But the problem with that was that I graduated from my master’s program in September of 2020. Like, in the height of the pandemic, and there were no jobs there was, especially in you know, working with children and families. People weren’t doing face to face services, they weren’t hiring anything. At the time, I had found a childbirth educator training and decided to take that and when I still couldn’t find anything, decided to take doula training, and then ended up working for them-Birthing Advocacy Doula Trainings, which was fantastic. And then just in that in engaging with their teaching content, with them just getting more and more into the birth world. And in a new way, I was realizing that there’s so much to be done. And there’s lots that that, you know, doulas and childbirth educators can engage with but there’s definitely a lot that healthcare professionals need to engage with because, you know, engaged with my research, I was realizing that a lot of these women were having experiences that it felt to me that the healthcare provider had no idea what they were doing, they weren’t actively trying to hurt somebody. So it’s clear that there’s a disconnect that people are not purposely going into work every day thinking I’m gonna traumatize some people. I’m going to ruin some relationships today. I really don’t think people are doing that, but it’s still happening. So there’s a disconnect there. they need to, to reflect on, you know, what we’re saying? How we’re saying them and, and make more like modifications to that?
Maggie, RNC-OB 10:10
Well, yeah. Where do you see when you were, you know, doing your research? Where did you see maybe some of the biggest gaps in terms of like, using maybe like the birth care standard, what people think they’re providing and how that actually ends up being perceived by those in their care?
Cheyenne, Researcher 10:26
So yeah, there’s two areas that I think are lacking. One is negative, like more actively negative, and one is good intentions, that could go poorly. So I’ll give two examples from from stories that I heard one active, actively negative experience was a mom who had an experience with a nurse who was telling her that her baby really needed to have formula and scared her into agreeing by saying that her baby would have mental problems if he didn’t, which is obviously, especially like the baby’s like a day old, you know, it’s, they were okay. And they had a really traumatizing experience with this nurse cup feeding the baby. And the mom was like, you know, why can’t we even give a bottle or something? And the nurse said, well, we don’t want the baby to have a nipple confusion. So it’s better we use a cup instead of a bottle. So it’s like, I’m confused. Because that sounds like you want them to have a good breastfeeding relationship. But then why are you you know, lying to them and force feeding the baby and creating a traumatizing situation right at the beginning of their breastfeeding relationship together. So disconnect there. Yeah. So it’s like, that person clearly had no idea that they were being aggressive and forceful and creating a problem here. And then another example of someone doing a good thing that could be hurtful. One mom had a really difficult birth experience. She hadn’t been on a long labor episiotomy, and, you know, the whole nine yards, and the nurse just said, “Hey, do you want me to take baby to the nursery so that you can rest and relax?” But because of Canadian history with, with Black and Indigenous parents of deeming them as unfit parents and the birth alerts in the hospital system, mom felt very, I don’t want to use the word threatened, but just sort of like a heightened awareness of, “Should I say, yes? Can I say yes? Is she gonna think that I’m a bad mom? Because I’m asking for help. You know, should I agree to her taking taking the baby?” So obviously, that nurse did nothing wrong, she was trying to be helpful, had the mom you know, become defensive, or, you know, a little bit what was potentially perceived as aggressive things could have gone south, and you know, that nurse could have thought, “oh, you know, just another angry black woman” kind of thing, but not realizing that disconnect of why would would she be having this reaction? Right? So there needs to be some self reflection of, what am I doing? Why am I doing it? Do I need to do this? And also, how do I approach? You know, anybody? And not even just Black and Indigenous people, but anybody from like a trauma-informed lens of if there is a reaction that comes up? Why might this person be would be reacting this way? Again, you know, what is the history and the thought process here?
Maggie, RNC-OB 13:46
Mmm. Yeah. Oh, that’s so good. I do. There’s so much like, you know, the future is trauma-informed care, like that needs to be standard for everyone in every interaction and not, you know, kind of not saving those tactics for people who we deem you know, especially deserving of it, who very obviously have identified something that we think is is traumatic, really recognizing how, just how complicated life is, like how complex each of us are, as human beings, we can’t just, you know, we’re not gonna look at someone and know, their whole history, but being aware of, being curious about that, instead of, you know, jumping to conclusions and being we need to be more thoughtful, you know, as, you know, as a labor and birth nurse, I, there are so many ways that like, kind of typical education prepares us to approach client situations and just use it there like that nurse out there have been very helpful, right? They thought like, sure you would like to do this. Instead of having a conversation maybe? Or like, what would be most supportive for you right now? How can I..? Okay, do you want… and if they volunteer, yes, I Yeah, actually, I could use some time to rest myself or actually, yeah, it would really help if you could help me get the baby situated in the bassinet nextto me or whatever it is that they want, or actually, yeah, could take a picture of me cuddling with the baby right here, cuz I want remember this moment, like, whatever it is. Having that instead of I think so many of us, we feel, we’ve talked a lot about like that holding space versus the fixing, and how that is challenging. So many of us like, we want to be helpful. So we think we need to just like jump in and do something to make it happen, rather than being curious and just asking, like, what do you actually want me to do right now? What would be helpful? And that’s hard, you know? As you’ve, as you’ve kind of thought more about, like this reflection and the role that it has for birth pros, what do you feel like? What are some big takeaways you’ve had with it?
Cheyenne, Researcher 15:35
I think, yeah, there’s a lot of defensiveness that can come up for people. And I think it’s important to just like, label those and name those. One of the chapters in the, in the reflective journal that I wrote, is just about listing out stereotypes that you have for people and different groups of people. And just, you know, trying to figure out where did these come from and addressing? are they true? Are they you know, where did this stem from and, and finding the root cause and sort of squashing it from the root? And I think that’s something that’s really hard for people to engage with, because especially in Canada, when we’re like, “we’re not a racist country.” That problem, right. So, you know, we’ve we gaslight ourselves into believing that that couldn’t possibly be true. But I would rather you know, people, label it, write it down, put it out in the open and address it rather than pretending that it’s not there.
Maggie, RNC-OB 16:43
Yeah, like, that’s how that’s how we grow. Right? You know, like, we have to call that, that out. Instead of being silent and just letting it sit there. Can you tell us, share a little bit more about my deep dive and kind of like the process for that?
Cheyenne, Researcher 16:58
Yeah. So I kind of just rapid fire wrote out a bunch of questions that I felt like are lacking. It really started after I wrote a post about TERFs and, you know, just getting really frustrated with people saying, Oh, I’m a I’m a feminist. And it’s, you know, I support and protect women. And then even still, by excluding trans people, they were also excluding other women and girls. So for the example of, of using inclusive language, I saying birthing person rather than mother, like, there’s still women who are surrogates who are not mothers, so you’re excluding them to? Yeah. And then when you say, women, you know, you’re excluding the, the younger girls who are giving birth who are definitely not women, because they’re 13-14 years old, right? So it was just really frustrating to me that, in this quest to exclude trans people, which should be included, they are also just blanketly, pushing a lot of other people out of their lives. So I just felt like, there needs to be a little bit more reflection here, because you’re saying one thing and doing something else. So that’s not the case. And then, yeah, so I just started writing out a bunch of questions that I felt people need to think about how they, how they formed the opinions that they have. So this book does not tell people “oh, you should think this way about something, you should think that way about something.” It’s just like, What is your opinion on religion? If you have one? Where did it come from? You know, how did you get there? And a lot of the questions actually have absolutely nothing to do with birth, are more about our own personal views on things and thoughts, and really just evaluating how we arrived to that place.
Maggie, RNC-OB 18:58
Yeah, that’s so powerful, because I think so many of us like, right, we just we take on others opinions, right? Like we’ve heard something once we just think that that’s, that’s how we have to go forward with it, instead of taking time to reflect in question and realize, like, do I actually want to even think that way? Like, am I just parroting something that I have heard before? How do you see, you know, because I think there is there such a part of this bigger piece of you know, life anxiety, like in the reflective piece? Because many times like that’s just that isn’t as common maybe, in you know, in the ways that we approach birth care. We think like, yes, we are attending to someone’s birth, it’s going to be about this moment without a pregnancy is coming to a close or having this baby. And then you talked about how like some of the questions in your book, like they have nothing to do with like birth or birth care specifically, how do you feel like some of those kind of play into these other opinions other ways we’ve learned to feel about stuff like how does that end up showing up? In the first place, if we haven’t attended to them, and like reflected on them?
Cheyenne, Researcher 20:05
In my opinion, birth workers are there to support the person giving birth, they’re there to be an aid, you know, an extra set of hands, someone described it as the maid of honor at a wedding, right. And I agree with that, let’s, you’re the right hand person for for their experience. But I find a lot of people say, Oh, I got into birth work, because this bad thing happened to me. And I don’t want that to happen. Anybody else? Oh, yeah, let’s say that is, you know, a traumatic C section. And then they’ll say all well, when they’re, you know, when they’re actually working with a client, their own personal experience comes into it. And then they’re not actually, you know, helping the person giving birth, you know, form a truly unbiased opinion, because they’re adding their own trauma about C sections into, if that makes sense. So when we look at these other areas, it’s more about your ability to remove yourself from your work. So you need to include yourself and remove yourself. It’s kind of a strange paradox here, but sort of like if you think so one of the questions was, you know, what are your opinions on? People who are poor? Right? If you feel like, if you personally think that people who are poor shouldn’t be giving birth? How does that and you know, play into your work? And is it really your place to even say anything? Should you just be there supporting the person giving birth regardless, or, you know, if that’s their race, or their age, or their marital status? Or like any of those other factors? Can you remove yourself from that, and just be able to respect that, you know, they know what they’re doing, and be able to, to trust that they can, you know, be in charge of their own life, and that that’s not part of what you get to have an opinion on. Sort of. So it’s a bit of, can you, you know, empathize. But also, can you trust that this person knows what they’re doing? Even if you, you know, have an opinion? opposite to what they are doing?
Maggie, RNC-OB 22:25
Yeah. Oh, yeah. Then there’s that whole idea like the the maid of honor references, that piece of it, I think so many of us, like, we feel like we’re the experts, right? Coming into it. And so we have to be like, putting all of our our stuff into it. And it very easily crosses over to even with the best of intentions. But we know that that impact often ends up being where people feel really like they feel bowled over. Like they didn’t have an opportunity to say what they actually wanted. Because it all became about what we as the, you know, the person there to help guide, we can very easily focus on our own stuff instead. Do you feel like you know, you started about kind of trauma informed care practices? Where do you see kind of like, taking care of ourselves as professionals taking this time to reflect how does that play into kind of trauma informed care practice?
Cheyenne, Researcher 23:19
I really feel like two things. So modeling, how we care for ourselves and care for others can all can be really helpful for clients, I think, you know, if you’re, if they’re feeling, you know, caught up in that, oh, my doctor knows best than I don’t get to have an opinion kind of thing. When you say to them, Well, what do you what how do you feel right? Without saying, Oh, well, doctors are terrible. Don’t listen to them. Like just creating that space to say, hey, well, what? What is your preference? Right? Like, that can be really helpful. Just that you You also cannot fill from an empty cup if you’re not like taking care of yourself and, and, you know, avoiding burnout, the best you can and and taking care of yourself first. How are you supposed to be effective at helping somebody else through through something? But yeah, I think we also don’t really take a lot of time to just be like we’re always doing something that was even one of the anxieties I had about being on maternity leave right now because I was doing a million things before and now I just have two kids at home with me which isn’t adjust it’s a lot, but it’s less before, so I feel like we often just busy ourselves, and we don’t take time to slow down. And just like what you said about you know, taking on stuff and not actually evaluating where that thought come came from and just repeating what we hear that that can be harmful to ourselves to hold certain opinions either about ourselves or about the world. Of course, if you’re perpetuating that with as well, but not helpful to anybody there.
Maggie, RNC-OB 25:12
Yeah. In your as you’ve been like sharing my deep dive the journal with birthworkers have you been like surprised by any insights that have come from it?
Cheyenne, Researcher 25:23
No, I think people are taking it slowly. I don’t think anybody’s really gone through the whole thing yet. At the very beginning, I do put like, some stuff about what you should or shouldn’t should do with it. And one of them is to, like, take it very, so even if that’s like a question a week. It’s, it can be really hard to face yourself. Yeah. And I even you know, when people do meditation, or grounding, or reflective things at the beginning of stuff, I have a hard time participating myself, like I had a hard time just sitting there quietly with my own thoughts. I can’t, I can’t do that. So it’s really hard work to, to do that. And face stuff, especially when you feel some of these thoughts and opinions and feelings came from people or places that you already have relationships with, right? Oh, it’s often it’s connected to family or parents, which is why I want to make another book very similar, but for parents to evaluate how they were parenting and how they would like to parent. Wow, sort of make some adjustments and decide what to keep and what to get rid of. Right?
Maggie, RNC-OB 26:52
Oh, that’s, that sounds so powerful. And like such a helpful tool for understanding that, like, there’s so many moments, speaking personally, as a parent, that you’re going along that you didn’t even realize, like, Oh, this is gonna be an issue like, oh, it turns out, I have some feelings about this. And like, what a powerful tool to be able to do like, especially as you’re navigating early parenthood and coming up for that to, to just have more intentional prompts around that to hopefully help you to prepare before you’re in that situation before all sudden, you’re at like a tense situation with your toddler and you’re realizing like, oh, how do I actually want to show up right now? Maybe it’s not the way that’s been modeled for me before? Like, that’s, that sounds incredible. As you’re kind of looking forward for you, like, what comes next? Where do you want to see like happening with like, your research, you’re looking at, focus more on birthing families are more with with birth workers?
Cheyenne, Researcher 27:46
I don’t know, I’m struggling with that. Sometimes. Some days, I’m like, Yeah, I want a PhD, I want to continue with this research and actually, you know, help create some numbers to work with, because we all know that, you know, the people in charge, don’t put money anywhere, if there’s no numbers to prove. Also, you know, academia is not the greatest place to be, especially for black women. And I really want to continue with, you know, sharing actual stories of people because, you know, we don’t even know what infant mortality or maternal mortality rates are in Canada. We don’t have those numbers, we really, yeah, they don’t exist. So it’s tough, it’s hard to say, to you know, governments and local, local governments, hey, there’s a problem here, if there’s nothing to present to them, but at the same time, it’s like, we shouldn’t have to do that, we should just be able to say, we’re saying there’s a problem, do something about it. So I’m on the fence there, but I really would prefer to just work with, with people with parents and families, but also, you know, it’s, it’s both it’s like I said, you know, there there are some things that parents and families can do to, to have a better experience, but at the same time, like, shouldn’t necessarily be their responsibility. And there needs to be more more done so that they’re not getting traumatized in the first place. Right. So yeah, there’s lots of things.
Maggie, RNC-OB 29:27
Oh, yeah. Oh, and I just I so incredibly frustrating about the lack of data, and how that then impacts legislation and how it comes I think there’s such a the whole different, you know, quantitative versus qualitative research, like there’s always that push pull and like government, big organizations tend to really do they want those hard numbers like that’s what proves that something is is real and exists, which is fine. But also when you have like such rich, quality data like these are lived experiences. These are people’s actual stories and for them to not be To not be willing to accept that at face value, and take that and instead have to jump through so many hoops to prove what is literally happening like in front of their eyes. It’s incredibly frustrating.
Cheyenne, Researcher 30:17
It is, and you know, things take time. And, you know, do we have enough information that we know, like, what would be helpful, you know, increasing the amount of midwives that are out there, making just making things more accessible to people, especially in northern communities where people are flying for, you know, a few weeks away from their families, to have babies and there’s so many things, there’s lots of things that we already know, mean doing. And I guess the those other studies would be about, for how many people? Or how much money do we actually need to execute these things? But the problems are definitely there.
Maggie, RNC-OB 30:59
Oh, yeah, rich territory for you to explore as up like going on that path. And like you said, there, it’s when we were at when I was thinking about like this topic, and I loved seeing like you were sharing my deep dive, and the image like how it is interconnected, like the you, like you said, you can’t just focus on birthing families necessarily, because we are a society, like, you’re all working together. And if we are able to connect with the people who are providing care, to make personal changes to how they’re approaching folks, but also standing up and working within the system, they’re in what you know, whatever, whether that’s organizations, you work with hospitals, you’re, you know, a part of like that, then we can really have like systemic change that makes it better for each family, instead of kind of that that piece where we put so much pressure on to individual families to make their experience what it needs to be, and satisfied taking that ownership for the system.
Cheyenne, Researcher 32:00
Exactly, exactly. Because there’s, there’s some things that are big, like the example I gave with the nurse and the formula feeding, like, that’s not something that you can prepare a family for, or that right, you know, they could possibly sign stuff, but it’s more like things like, just birth education. And the best example I was given that, you know, C-sections are not inherently traumatic, it’s usually the circumstances under which they happen that are traumatic. So, you know, helping people understand what the process would be like, should that happen and the circumstances under what that might, what they might happen. And just getting a better idea of what that looks like. So that if things happen quickly, it might be difficult to process, but they wouldn’t be totally blindsided, right, they would be like, Okay, I know, these are the steps and, you know, this is what I can expect things like that.
Maggie, RNC-OB 32:55
Oh, yeah. Once you get work to do to get like, birthcare, where we actually want to see it, is there anything else as we like, wrap up anything else, you want to kind of tell two out there to professionals as they’re thinking and like reflecting on on their practice, and how they can be a part of that change?
Cheyenne, Researcher 33:13
I think number one is really just like, lean into that discomfort that’s gonna come up, like, I promise you, it’s not going to be easy. And just lean into it. Find a trusted person to, to talk about stuff with and take care of yourself on that, on that journey as you as you process that stuff, because things will, will come up and you know, you know, you might think, Oh, this belief came from my, my dad always talking about, you know, people of color in this way. And then you’re like, Wait a second. He’s, you know, that’s racist. And then you’re like, Oh, my God, my dad’s a racist. And you know, it just keeps continuing, right? So it might not be just about your own thoughts and beliefs, like you might realize things about people around you, or, you know, your community or your government that you thought was totally high before. And that can be hard to process. So lean into it, and take care of yourself.
Maggie, RNC-OB 34:21
Yes, yes, that is totally we all can we all have that power to to reflect in and lean into those hard spaces. That is that’s how that’s how we grow. And that’s how we’re gonna end up giving better care to everyone and to ourselves. Well, thank you so much for coming on and sharing about your work and I’m just so excited to see what what comes next for you as you dive into all this.
Cheyenne, Researcher 34:44
Thanks so much for having me. It’s nice to to chat and to talk to an adult. [laughter]
Maggie, RNCc-OB 34:53
Well, thank you so much to Cheyenne. I just so appreciate her coming on and sharing a little bit more about her work and inviting all of us to reflect on our practice to reflect on how we form our values, how we practice, how we parent. And you know, just think more critically about the systems that we’re in, what we’re upholding through our actions, how we’re showing up for those in our care. We will be dropping in Cheyenne’s “My Deep Dive” ournal and workbook for you to walk through as you are doing your own processing and reflecting on the whole of you, and how that shows up as you care for folks during births and those who brace yourself. So we’d love to hear what struck you about this? Give us a shout on social media. We’re Your BIRTH Partners across all platforms. We would love to hear what inspired you from Cheyenne and her work. We appreciate you being here in community with us as we strive to create more inclusive and collaborative birth communities rooted in autonomy and equity. Till next time!
049: Holding Space for High-Risk Pregnancy
Maggie, RNC-OB 0:06
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Hey, y’all, and welcome back to the podcast. This week, we are continuing our series around holding space as we talk about holding space for those experiencing a high risk pregnancy. And you know, I thought of this topic, because it highlights I think so many of the struggles we have where we as healthcare workers, as birth professionals, work to hold in the one hand, all of our medical knowledge and our understanding of like complex situations, and physiology. And then the other hand, we are trying to hold space for the emotional and mental upheaval that is happening sometimes to those in our care as they navigate these complex situations. And I think this often puts us in this push and pull where we’re not sure what skills we’re supposed to be using, what the person in front of us actually really needs for their care, as we try to explain what you know, is potentially going on with a high risk pregnancy as we work through and walk with people alongside their journey as they navigate a situation that is complex, and that we don’t always know what the outcome will be. And so as we hold all of these complicated pieces together, I am excited to have an expert come on Parijat Deshpande has experienced her own high risk pregnancy and now works as a high risk pregnancy specialist and supports pregnant folks to navigate this experience to make sure that their questions are answered to give them tips and tools to step into their own power and maintain their agency in a situation that often strips of it. So without further ado, I will bring you on to the show and this conversation.
Yeah, well, Parijat, Welcome to the show. I am so excited to have you on here to have this conversation about high risk pregnancy and how we can show it better for those in our care. So if you want to just tell our audience a little bit about yourself and your work and what brings you here.
Parijat, High-Risk Specialist 2:27
Absolutely. I’m so excited to be here to and chatting with you again. So my name is Parijat Deshpande, and I’m an integrative health strategist for women who are going through a high risk pregnancy who are trying to conceive after high risk pregnancy. A lot of my clients like 99%, my clients are trying to conceive and are pregnant after late term loss or preterm delivery. And so, you know, they’ve they’ve been through it, they they’ve lived the, the risks, they have lived in that one to two percentile part of the curve, they know that it has it can happen and they’ve they have lived experience of it. And you know, the the honestly, I would not have known to do this work had I not been that person myself, to be very honest. I didn’t know anything about this part of the world. I didn’t know anything about what this was like. And interestingly, I often think back to, you know, my training was in traditional clinical psychology, and I was teaching psychology in undergraduate courses here at UC Berkeley, Go Bears. And I remember so distinctly when I would teach developmental psychology to the upper division undergraduate students in the psychology department, there were elements and parts of those lessons where we would talk about preterm birth, and I would, it is so funny to me now, looking back going, I knew nothing about it beyond what was written on a page or the studies that I was reading. I didn’t understand the gravity of it, and the nuances of it and the lived experience of it. Until I became that person. I was the person who experienced infertility, multiple losses, a very high risk pregnancy with multiple complications. And a baby who was born in the second trimester. He was born at 24 weeks and five days, I was on hospital bedrest for 15 days, we were in the NICU for months after he was born. We were very fortunate that he came home to us. But it was that experience of actually being the patient and realizing I can now see what the gaps are in the medical care that I’m receiving, even though I was very fortunate to have exceptional medical care. And if I we were to ever do it again, I would handpick that team all over again. I would just be a more informed patient is what would be different about it. And so I could experience the gaps in the medical care and I could experience the gaps in my training on what to do with a patient like me and there was a moment It’s probably like 15-16 weeks pregnant, I’d already developed a few complications by that point. And I was terrified. I remember being at home alone, I wasn’t working anymore. You know, all the doctors are saying, “take it easy, and don’t do a whole lot,” because it was just a very precarious situation already, I’d already lost one before this pregnancy. And I was terrified of losing this child. And I remember thinking, if I reached out to me as the professional, or somebody like me, I know what I would say, as the professional. And now as the patient, I know, that’s not at all what I need. I need somebody to teach me what I can do to help me stay pregnant. And I know my anxiety, my worries, my stress, whatever we want to call it, is affecting my health. And I need that gap to be filled, too. And so between all of those and that experience, and knowing that I was able to affect and change my health, and modulate my health in a way that nobody was telling me, I could do really create this lightbulb moment for me that I don’t have any superpowers. I’m nobody special on this planet. It’s not something about me, it’s about the human body. And if I can do this, anyone can do this. And so it was two days before my son was born, I remember making that vow literally to him out loud. I said, If we both survive this, I’m changing my career, I’m quitting everything. And I’m coming back, we’re going to work with women who are trying to bring these babies home and teach them what they can do to impact their health their bodies to in addition to all the medical care they’re receiving, how can we give that power back so they know what they can do to help bring that baby home?
Maggie, RNC-OB 6:44
Yes, oh, my gosh, thank you so much for sharing so much of your story, there are just so many. So many parts that I’m sure are resonating with our audience from you know, we have mostly birth workers professionals in here, which obviously, some of us have experienced our own complications and pregnancy. And you know, there’s always something different than once you see it on the other side, it’s something very different about, you know, what we learned, technically, from a textbook, even in clinical experience, you learn one way, and you’re like, yes, you’ve kind of got like a cerebral level. And then you experience it in your body on the other side, as you know, the patient the client, and you’re just like, well, I don’t know what I learned about that, wasn’t it? It’s so challenging to know that… one of the questions we’ve had for everyone during the season is, what does it mean to you, to hold space for someone, when they’re going through a complicated experience?
Parijat, High-Risk Specialist 7:38
I think it means leaving literal space. So time, energy, attention, you know, all of those things, leaving it empty, for them to fill, I think we’re very quick to want to fill in gaps in the story. If we here, I think we all as patients, for any number of reasons, have gone to a medical professional and said I have XYZ thing happening, and they fill in the gaps for us. And we lose the ability to express our lived experience of it, right. So if I’m living with chronic pain, and you’re living with chronic pain, our actual experiences of of that can be very different. And that can be very important for us to be able to convey. And so I see that as allowing the ability to leave a vacuum that the client or the patient fills in for us. And our job then is to be able to #1 tolerate that vacuum, which is a skill that has to be learned because we’re very quick to want to fill that it is uncomfortable at first. And then the second piece is to then be able to without judgment, accept whatever they fill it with. And I think when we can do that the person on the other side can feel so seen, and oh validated simply in just knowing they have that space to fill it with whatever they need to fill it with.
Maggie, RNC-OB 9:06
Oh, that’s so beautiful. And that second part about like, then whatever they filled with is like valid and we have to accept that. I think that’s where like it, it hits us we want to be able to like provide this space, but we’re also maybe hoping they’re gonna fill it with like a particular way that we could still kind of step in and help to guide. I don’t know if you could maybe expand that was maybe some of the examples you’ve seen in your practice. I think we’ve talked a lot through this season about kind of like this, the juxtaposition of like that idea of holding space, letting people have their own experiences, and how in many ways, like just antithetical that is to like medical nursing training, right? How do you see people navigating that piece of it? Well, because that feels just like really hard to put all of those pieces into like an actual clinical practice.
Unknown Speaker 9:50
Yes, it is. And I want to fully acknowledge that when you are working inside that medical model, it is very difficult to do because in some ways, one or both of your hands are tied by any number of factors. And so even if you want to, I fully recognize that it is not always simple and easy to bring that into your practice. And so I think there’s a lot of really tiny ways that you can inject that in really simple ways, I think include having very direct eye contact with with the client, even if they’re looking away, by allowing them to yours is you’re essentially showing them I’m here with you, and I’m physically showing you, I’m here with you. But for a client who’s living in a traumatized body, they’re not going to be able to make that eye contact back or sustained that eye contact, that doesn’t mean they’re done. That doesn’t mean that they want to move on, it doesn’t necessarily mean that they don’t want to have this conversation, their body is trying to regulate itself. And one of the ways it’s doing that is by removing eye contact, but knowing that you’re still there, right? So you’re not filling that space, you’re letting them step away for a minute in whatever way they need, and then allowing them to come back and let you know what the next step is, is so important. I found that to be super, super helpful. I think other ways that I think it conveys really nicely is asking very open ended questions. I think we think we’re asking open ended questions, but they’re often leading questions.
Maggie, RNC-OB 11:18
And especially easy to do, right?
Parijat, High-Risk Specialist 11:20
So easy to do that. Absolutely. And so really kind of checking, especially outside of that client interaction, if you can go through the list of what do I ask my clients or my patients? And how do I ask and just doing a little inventory to say, is this actually an open ended question? Or am I trying to guide them to a particular answer? Or a particular number of answers that I know I can answer very quickly or address very quickly? Those very open ended questions again, create that speaks that vacuum, that allow the patient to come in and fill it with whatever it is that they need to fill it with at that moment.
Maggie, RNC-OB 11:57
Yeah. Yeah. And that, you know, those are those are essentially, they’re, they’re theoretically easy, right, like maintaining eye contact, asking opening questions. And I love that just that prompt to like, think through how we usually ask those questions and be critical. Is that really what you’re doing? Even if that is your 10? Is that how it’s going to be received from from someone else? And taking a few minutes to like, walk through that? Because I’m sure all of us, I know, I could find ones in my practice that fall into that realm? Sure. Oh, that’s so good. You mentioned it kind of how you you saw different gaps on the patient side than when you had kind of been practicing? Could you tell us maybe for some of us, who are maybe still operating kind of within those gaps in the healthcare system, when we’re navigating a high risk pregnancy with someone? Where do you see some of those?
Parijat, High-Risk Specialist 12:40
Oh, my gosh, how much time do we have? No. I think the biggest one is challenging the words we use. And so I knew going having kind of been in a similar field, having worked with health complications before, but through a different lens. The term high risk pregnancy to me did not scare me. But when I started doing this work, that is the number one question that we receive, probably on a daily basis of Oh, my gosh, my doctor, my nurse, my whoever just called me high risk. What does that mean? And there’s so much fear, right? So and, and again, so we’re talking about leaving space and letting the patient fill in, in in this case, the patient is filling in with horror stories and their imagination, and whatever they’re reading online, and it’s scary. And so in some ways, we as the practitioners, and providers actually need to fill that space for them in this way. So that what they’re taking away from that conversation is only what applies to them, and not a general kind of, here’s a big term that has heavy implications that we’re not going to get into yet, and letting them fill that in for them. So I think, you know, that’s just one example. But a lot of the medical terminology that we use is filled with judgment, or it can be perceived as judgmental, even if it’s not intended to be judgmental. And so having the conversation in a way that the patient can hear again, without judgment, right, that this is not your fault. You did nothing wrong. And even when you say that I work with a lot of clients who have a hard time believing that even when they hear that, and so if you can have this conversation to ask them again, opening that space up, what is it that essentially getting the answer to the question of what is it that is difficult to believe about this? What is it that you’re hearing when I say XYZ think, right? Because you want to understand where that translation is, is getting mixed up? Because what we have in our lingo, is very different for somebody who’s never heard it before. And they only have kind of the point pop culture media version of what that might mean, for example, I think, you know, when I was in the hospital and this is a really tricky one, I landed in the hospital at 22 weeks and four days. And I it was at that point where you know, even on the phone, the on call OB was saying, maybe just wait it out and come, go talk to your doctor tomorrow, because there’s nothing we can do. And I chose to go in anyway, because of being in that peri-viable stage. I knew there was nothing they could do. And so the next morning when everybody came in, and they gave all the horrible statistics and all the terrible things that could happen if the baby were born within the next couple of days, I think that was a perfect example of they said it as compassionately as they possibly could. They also, I understand for their sake needed to be very direct to make sure we understood what was happening. And I think the piece that was missing beyond that was the question, What did you hear? Because not only was it an onslaught of information, right, we had the MFM come talk, the OB talk, and then the neonatologist came soon after, it was just like horrible news after horrible news, which again, was very real. It’s it’s, it’s reality. And also, what we were left with once they all left the room was our own narrative of what that meant for our family, what that meant for each of us as an individual or culture, all of that. An understanding that context, I think, can be so powerful in knowing how to say the very same things, but in a way that can land more impactfully we think, for each patient.
Maggie, RNC-OB 16:48
Yeah, gosh, I feel like that is that touch. That is like the line where we’re trying to be truthful and clear. And like you said, we don’t want people, we don’t want people guessing, because that leaves a hole. I think we go between either, often. And I recently was talking to a friend who is experiencing high risk pregnancy. And she received a very vague sort of explanation and this idea that like, well, we’ll follow up later to check into this…which is fine. And understand that is what has to happen. They do not know right now. And they will have to do that. But it left her feeling just incredibly like in the lurch. Yes. In terms of like, well, what what does this mean, now? Is there something different? Like she just felt very in the weeds? And I think sometimes we do that, though, when we try to be kind of like, vague. And we have to see and check about this because we don’t want to like fearmonger Yep, we don’t want to add more stuff to it. We don’t want to onslaught of like these the 85 things that could go terribly wrong. But maybe they won’t, because that also doesn’t feel good.
Parijat, High-Risk Specialist 17:47
Obviously, it’s such a hard line to walk like in between these two is a really hard line. And this is if you don’t mind me sharing this is where I think the work that I do with my clients pair so beautifully with the work that you all do with with the patients in the room is that then those patients call me and we schedule a call and we go over “Okay, what did you hear? And where are the gaps?” Because then I can see what I know, you probably told them, but they didn’t retain because they were scared. And you know, working memory doesn’t quite work so well when we’re terrified. Right? And so there’s a little bit of that extra health education that can happen outside of that room to booster that up. And then additionally, what other questions do you have now that you’ve had a day, a few hours a week to think about this, that we can then cultivate to take back to your provider and say okay, but what about these scenarios? And then in addition to that the good question, honestly, as you mentioned, is, what do I do now? Right? You just told me this whole thing? What can I do? And I think from my perspective, because I work as a somatic trauma professional as well. A lot of what I do is trying to prevent trauma and giving them actionable things to do is a fantastic way to maintain agency for the patient. And it is a powerful tool to help protect them from trauma through the pregnancy.
Maggie, RNC-OB 19:13
Yes, I was just talking with a trauma therapist, Renee who was sharing how like trauma happens, one of the reasons that happens is when we’re unable to take effective action. Yep. Right. And so thinking about how we, you know, apply that and bring it into how can we provide an action, something that our patient or client can do that helps you to step back into that agency like that it’s so powerful for, for helping that piece of it. Can you also expand a little bit like on your on your role? It feels to me like there should be way more of you accessible for folks who are experiencing complications? Is it all like private practice folks doing like the type of work you do? Is that something like do you get to meet up with like Doctor practices? Is that something we could see in the wave of the future? I’m always dreaming about like a more collaborative future for birth care, how we could have these different like roles all playing together to our strengths to actually like meet people and provide the services they need. Can you tell us a little bit more about like that background piece of it?
Parijat, High-Risk Specialist 20:06
Yeah, absolutely. So the the work that I do pulls from my training and clinical psychology, my lived experience with being that patient. And then the additional training I received from somatic trauma approach as well as psycho neuro immunology, the impact of the nervous system, endocrine system and the immune system, all three together on pregnancy health. And so I have actually not yet found somebody who does this kind of work in this way. Yeah. But my vision also is to actually make this available in some way. And that’s actually what I’m working on for next year is how to get this to doctors offices and clinics and hospitals and get this to the antepartum units, and how to train providers to do their jobs from this angle. So that it’s not like anybody has to replicate what I do. It’s just there’s elements of it that are brought to the work of providers who patients need to see anyway.
Maggie, RNC-OB 21:03
Oh, yes. Well, I, I will be ready and waiting for that as you continue to develop that because I do think that’s like, just it’s so needed in this space to provide that extra layer. You know, as your as you know, one of the things you mentioned was your experience, as you kind of got to labor and delivery. What do you think are helpful tips that those of us who work in, you know, in the hospital setting, what are ways that we can help to, like, cultivate that trust, established connection for folks who are coming in in such a like, very high tension timeframe?
Parijat, High-Risk Specialist 21:36
Yeah, I think, kind of looping back to what you started this with as a holding that space is so important. I understand there’s the technicalities of getting somebody just stirred in and then their beds and monitored and all that all that has to happen. But if there’s a way in that kind of what it feels like chaotic experience, as the patient, for somebody, anybody on that team, to be completely focused on the patient, and say and ask the very basic questions, how are you doing right now? What do you need right now? What’s happening right now? Just to bring them to the present. And for you to understand what’s happening, what are how are they experiencing everything that’s happening. I always think back to the moment that my son was born. And it was such a blur to me. And my mom was in the room. And so she remembers it differently than I do, of course, but she said, there were a lot of people in the room. And I asked her one time after he was born, like years later, I asked him, like how many people were in that room. And she’s like, Oh, maybe maybe seven or eight people or so. And I was like, it felt like 45 to me. And so getting to understand what that experience is like for them, I think is so important, because I know those seven to eight or 45, however many there were actually everybody knew their role, and everybody’s doing what they needed to do. And it was very clear to them. And it was very unclear to me what was happening even though we had prepared for that moment before. And I think in in line with that it is having somebody whose role is to always explain what is happening, make sure that the patient is hearing it, and then registering it and is able to tell you back because anywhere in there that that chain is broken, consent is gone. Right? And if we’re trying to protect the patient from trauma, all three of those steps has to be there. So who can that person be? And how can they explain that? And how can they? You know, be sure to have that communication with the person? Is this okay? Are you comfortable with this? Would you like us to continue? Or would you like us to begin are really getting that verbal consent back to, again, maintain that level of power and agency for them as all of this is happening?
Maggie, RNC-OB 24:04
Oh, that’s a great one. I think I know, you know, as a labor and delivery nurse, I think so often that responsibility sort of is assumed it’s going to fall into the primary nurse, you know, whoever had been taking care of the patient. Yeah. Which is fair. And I’m, I’m thinking through like, what are the ways that we can better support that then so sure this person has been with the patient for, you know, hours days, however long has a relationship great, they’re the ones to walk them through what’s happening, ask those questions, keep affirming consent. You know, is there a way for another person, it’s the Charge nurse, it’s the other you know, their buddy, nurse, whoever however their unit is set up, who then they’re going to step in and do the piddly charting, hang the medication, you know, the other kind of more technical nursing skills that are happening at that time, because I know that that often is having we feel very disjointed as we’re trying to like typing here and hang this and also make eye contact and and that doesn’t feel good for us as healthcare workers. It doesn’t feel good for the person who’s sitting there like watching a flurry of activity happen. I think that’s a great idea. for how we can, like think through our labor processes, when we’re dealing with that, just like how sometimes we have like a recorder in a code situation, yeah, if you need that other role, like the, the opposite side of that, like someone’s writing notes are happening and someone who’s sitting there and helping the patient in the family to understand what’s going on which sometimes those are sometimes like built into processes. And I feel like that’d be a really good one to have for high risk experiences pre you know, very preterm birth, where we know there’s gonna be like a lot of action happening, something we could think of to be prepared for in advance.
Parijat, High-Risk Specialist 25:30
Absolutely, absolutely. Yep.
Maggie, RNC-OB 25:34
I’m wondering too, after birth, baby goes off to the NICU. What did people do or not do during that time, that helped you to kind of feel like supported as you adjusted to this huge postpartum transition, and then we’re also still very conscious about the risks for your baby.
Parijat, High-Risk Specialist 25:50
Sure. That is, that is a tricky, tricky time. So in my case, I was I had been on magnesium for 10 days. And so there was that, I had been in Trendelenburg, for 15 days. So I hadn’t been upright in over two weeks. So it’s, I mean, I think it starts at that basic level, which is why I’m sharing that is talking them through I had my nurse that I had, I’m still friends with her now, it was in the hospital long enough that I’m friends with most of them, I got to know a lot of them there, you all are wonderful people. And, and she was very good about explaining, okay, we’re going to lift you up to zero now, and you let me know, this is how you might feel. And she was like predicting for me, this is the this is what you could feel if it doesn’t feel good. And this is what it could feel if it feels fine. And so she was showing me kind of the whole range. So again, we’re not filling in for the patient where, you know, she was giving me what that whole range could look like. And so I can come back and say, hey, it’s somewhere in the middle, or something like that. And she was I know, and I imagine this was probably the hospital policy for situations like ours, where she didn’t leave the room. Or if she did somebody else filled in immediately, I did notice that very clearly. Like once the 45 people left, there was always one. Yeah, who was helping, and who was there with us, because I it was such a shock and emotional time for us. I think, in our case, because I had such a long lead time until this my son was born, there were a lot of conversations about what that moment would look like. So we were generally prepared. I think even in the situations where it’s spontaneous delivery, if there’s any moment to describe, okay, baby is going to go, this is how they’re going to get there, we’re going to take you when and fill in those gaps, wherever they can, you’re kind of predicting for them and kind of making that map for them. I believe it took a while for me to be able to get to the NICU, but the nurse also wheeled me over my husband was walking me over. And she stayed the whole time and then wheeled in. In that time. I think the staff and my family had cleaned out the labor and delivery room and moved us over to mother baby. And so I don’t know that side of it. But I appreciated that that was part of the process, I think it would have been helpful for me to know that I was not going to go back to that room because there was a very symbolic shift that happened of Oh, my pregnancies over room. And now we’re on the other side. So just having that conversation they you know, this really, really tiny things. And and then beyond that, I think this is probably hospital hospital. But once the baby was born, and I got to see him the first time we and then the nurse, we’ll be back to the new room, the conversations and switch to the NICU team. And so there wasn’t a whole lot of conversation between me and the delivery team anymore. That was kind of done. And that transition, I think is always very difficult when now we’re handed off to a bunch of people who don’t know us. No connection to our history. I mean, they’re wonderful people, but we didn’t know that at the time. They were strangers to us, you know,
Maggie, RNC-OB 29:17
oh gosh, I like on the nurse side of that, like that is hard. It’s hard when we’re wheeling like these folks who like spend time with antepartum and you know them or even during, you know, a regular you know, labor experience and you feel like you know this connection and then you do like we’ll move on, you’re like “Well, hi, these other great person is going to come in in a minute and they’ll be fabulous and take care of you.” But it is like this weird, like transitional like disclosure piece that has to happen.
Parijat, High-Risk Specialist 29:39
Absolutely. So even having a conversation, I think, even if it’s you know, 30 seconds a minute doesn’t have to be long, but I love that use that word closure of really closing out that relationship and having just that moment together. Now we’re getting to the next phase.
Maggie, RNC-OB 29:55
So maybe like thoughtful and aware of as we’re like doing all those busy tasks that So we’re happening behind. Absolutely. And then switching gears just a little bit, when you have clients who like this has been a previous experience, they’ve had a high risk pregnancy before they had a preterm baby before they’ve gotten pregnant again, or they’re approaching a pregnancy again, you know, are there any tools you can give us or guidance for how we help to kind of hold space for the reality of their previous pregnancy? Without knowing how this will be, you know, sometimes people have certain conditions that we know, okay, likely this pregnancy will also be complicated by x, but often not as well. And we know like this next pregnancy actually could be, you know, “normal,” and everything could go very, you know, typically, and there could be now these issues. I feel like that’s a, you know, we run into just so many very understandable anxieties around that. And how we again, kind of like have those conversations that don’t feel like falsely toxic positivity, but are also allowing like space for how things can be different in each pregnancy.
Parijat, High-Risk Specialist 30:55
Yeah, absolutely. I think I love this question. Because it really speaks to the wide range of experiences that my clients have had, as you said, All of them come in with a tremendous amount of fear, and they begin to work with me to start healing the trauma from the previous pregnancy, a lot of it is tied to medical trauma, in addition to the birth and pregnancy trauma, there’s a lot of that that we’re working through. And once they’re ready to try to conceive, you know, there, there’s a lot of mistrust of not just the medical field or the system or anything like that. But there’s a mistrust in the feedback that they get so and what I especially see is when the feedback is positive, hey, everything’s looking great. Your blood work came back really good. Babies growing well. And in a body that’s still living with trauma, that translates to Okay, so that means something terrible could go wrong. Next, it’s not now it’s coming.
Maggie, RNC-OB 31:54
Always waiting for that other shoe to drop, right?
Parijat, High-Risk Specialist 31:56
exactly. So my role with them is to get rid of that shoe so that they can tolerate the positive feedback. But I think in the room, as you mentioned earlier, what would be super helpful as again, checking in to, in whatever fashion feels most natural and doable. What did you hear? What are you hearing? When I say this? When I tell you, you know, you your previous pregnancy wasn’t IUGR. You had an IUGR baby, I’m telling you right now baby’s in the 80th percentile of growth. What do you hear when I say that? Because some patients will be relieved, and they’ll just be thrilled. And some patients will be terrified. Because what they’re seeing then is 80 to 15. That gap is what I’m now calculating. Right? And how long is that going to take? And when is that going to happen? And so I think it just goes back to leaving that space for each patient at a time. And recognizing that even and I even would say, especially when you give good news, making sure that they really hear that. And it’s not something else, because if it is something else, then you can have a different conversation with them about it. Oh, yes.
Maggie, RNC-OB 33:10
Oh, that’s such a good one. So helpful. Well, as we you know, wrap up this conversation. Is there anything else you’d like to share with our audience? Anything we haven’t touched on yet? That would be helpful as we as we contemplate taking better care of our high risk patients.
Parijat, High-Risk Specialist 33:25
I would say one other thing, which is, as you probably see it, frequently is the anxiety, the high levels of anxiety, the overwhelm, the worries, if there’s one thing I would please ask you not to do is don’t tell them to relax. And don’t tell them to take a deep breath. It’s from this the trauma-informed lens. It won’t work, it won’t work for them. And what they hear when they hear that is, oh, well, I should be over this. This shouldn’t feel so bad to me. Oh, gosh, yeah. And so instead encouraging them to find their safety anchors. And that’s, you know, something that I am happy to go into details with something that I teach actually in our trauma professionals.
Maggie, RNC-OB 34:15
Yeah, absolutely.
Parijat, High-Risk Specialist 34:17
but it you know, helping them to figure out what do you need right now. And for some people might be glass of water, for some people might be fresh air for some people, it might be I need you to leave the room so I can be with my partner, or I can be alone. Again, giving them back that agency, just to really identify and maybe they don’t even know and that’s okay, too, but you’re creating that space for them to tell you that.
Maggie, RNC-OB 34:44
Yes, yeah. So, so needed. And again, that’s one of those like, that’s, that’s easy. It’s it’s very ingrained right beside each other, you know, like, who wants to be none of us have ever in our lives wanted to be told to relax You know, I mean, right? No one like that is not a good feeling with you are feeling really activated in your body for somebody to tell you like, Hey, calm down. Yeah. Oh, okay. You know, I mean like, that’s just that’s not, that’s not a helpful invitation into how to settle your body and what you’re feeling. But I do I just love that that ability, just remember to say like, wow, I’ve just given you a lot of information, what would be helpful right now? And then letting them fill that in? Yeah. And then offering you know, if they don’t seem to know what you’d like me to give you a moment? Could I get you a glass of water? Do you want to step outside for a minute before we have the conversation? Like any of those things we can then offer if they aren’t sure kind of what to grasp on to totally. Oh, beautiful. Oh, well, thank you so much for coming on. And having this this talk with us. Can you just let our listeners know if they want to follow along with your work? If they want to do some your trainings? What’s the best way for them to get access to you? Yes, absolutely.
Parijat, High-Risk Specialist 35:52
So I typically hang out on Instagram. So you can find me at healthy high risk pregnancy on Instagram. And all of my links to all the things are on my website, which is ParijatDeshpande.com It’s my full name calm. And specifically for birth professionals. I have a training on birth after trauma and how to support your clients and patients who are preparing for birth after a previous birth trauma experience. So I would be more than happy to offer your listeners a discount promo code. Oh, it’d be amazing some savings on that workshop. So I can send you that link. Perfect.
Maggie, RNC-OB 36:26
Yes. And I’ll put that up in the show notes for everyone. So you can get that and then we’ll put that up on social media when it’s allowed. Perfect. Oh, that’s amazing. Well, thank you so much for coming on, and sharing all of your wisdom with us. I really appreciate it.
Parijat, High-Risk Specialist 36:35
Thank you so much. I love chatting with you. And I really, I know we’ve talked before, but I want to say again, you all do such important incredible work. And I really mean that both as a professional who works closely with professionals like you and also as a patient who deeply relied on my labor and delivery nurses to keep me alive and safe and functional, and have even moments of joy and laughter and those really difficult 15 days I there’s some of my favorite people, you all are amazing.
Maggie, RNC-OB 37:06
Thank you so much. Obviously I am so always just so honored to be involved in this work, we talk a lot about the things we want to change and fix and improving the system. But you know, I’m in this work because I believe deeply in our power to have a positive impact on folks life and to support them as they work through the transitions. And so I’m just I’m really grateful for like the community that we find that is connected to this work and wants to keep creating these spaces where we take just really excellent care of people. So thank you so much for being part of it. Yeah,
Parijat, High-Risk Specialist 37:33
thank you.
Maggie, RNC-OB 37:34
Oh, well, I hope you all enjoyed that conversation with Parijat as much as I did. You know, this is such a complicated topic. And I appreciate how much she continued to break it down into kind of bite sized nuggets, things that each of us can do when we feel understandably overwhelmed as we’re navigating these really difficult situations. And these are just heart wrenching experiences with those who are in our care. So I hope you found those tips helpful. We would love to hear from you about, you know what struck you particularly which piece you’ll be bringing into your practice right away. Give us a shout out on social media. We are Your BIRTH Partners across all platforms. We would love to hear from you on there. And we’ll be sharing more information, more resources around high risk pregnancy and particularly the course that our job teaches around helping are professionals to know how to better navigate this with their clients. So we will put all that information there notes for you and we look forward to hearing from you as we all work together to create more inclusive collaborative birth care communities rooted in autonomy, respect
050: Inclusive Care for Gender-Diverse Birthing People
Maggie, RNC-OB 0:07
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care. Hey, y’all, and welcome back to the show. In this episode, we are continuing our series on holding space through the complicated and you know, with this, I wanted to dive into some of the ways that we as a birth care system, and as birth care workers can create complications for those in our care, and particularly thinking about how we make it more difficult for trans and non binary and gender non conforming folks to access our care. You know, we talk a lot about being inclusive in our language, in our practices, in the way that, you know, we treat everyone who reaches out for birth care. And you know, with that, we certainly talk a lot about how that shows up in, you know, in our language and our awareness about how we reflect on what birthing people need during their care, but also so much that goes, you know, beyond language beyond pronouns. And so to dig into that I have invited Jennifer Molina on the show who is a birth worker and the founder of United in Birth. And United in Birth is a collective that is based in NYC and works to center the needs of trans, non binary, gender nonconforming and queer people in their practice, so that they’re able to access services that truly meet their needs, and are prepared to help them navigate these complexities within our birth care system. And so I’m excited to welcome you into this conversation as we dive into more of how we show up and hold space and create better care systems that offer inclusive care is respectful of trans, non binary, and gender non conforming people. On to the show!
Awesome. Well, I am just so excited to dive into this with you, Jen, if you want to just share a little bit about yourself and your work with our audience so we can get to know you better. That’d be great.
Jen, Full Spectrum Birthworker 2:29
Yeah, so my name is Jen. I am a full spectrum birth worker based out of New York City. And some of the things that inform my work is that first generation, I am queer, I’m also you know, my family’s from the Dominican Republic. So I am a person of color as well. I started United in Birth, which is a birth worker collective, based here in New York City in September 2020. At it is a collective of birth workers, the goal is to serve gender and sexually diverse people. It’s people who hold those identities themselves. So right now, it’s just me. My dream is for it to expand. And also, when I’m not doing birth work, I have two plants that I spend a lot of time with, I like to cook, I write, and I spend time with my partner. Yeah, so yeah, so that’s a little bit about me.
Maggie, RNC-OB 3:33
That sounds like a beautiful life! Well, thank you for sharing with us, you know, within this whole season, we’re kind of basing all of our conversations around that concept of holding space. So we’re asking for all of our guests to just share with us a little bit about like to you what is what is the idea of holding space? What does that mean to you?
Jen, Full Spectrum Birthworker 3:50
Holding space, for me, means just kind of being there for people in however they want to show up. So this is something that I reflect a lot. Because I work closely with king yaa, and I feel like they are very good at holding space, in terms of like facilitating and things like that. It’s just sometimes literally just like, kind of pausing. And seeing, like, the things that that people bring up and stuff like that. And so, so I think for me, like at this point in time, that’s kind of what that looks like. There’s a lot of listening, and also fighting the urge to like, fix and like give people advice on like, whatever it is that they’re talking about, you know, because most of the time people don’t want that, you know? Yeah, so I think that for me, that’s kind of like well, holding space looks like is just is just as simple as that is just kind of like being there and seeing like what comes up for people and like, not judging them. For like, whatever it is that they may be feeling or however it is that that like things may be presenting themselves and validating people in whatever experiences or feelings they may be having.
Maggie, RNC-OB 5:18
Oh, yeah, so much as someone who has been in, you know, in spaces that king yaa facilities, I totally agree with you like, there are some people who certainly just have an art to holding space and carrying that, and king yaa is definitely high up that list. I also think there is that piece of like fighting to like non fix and not offer advice. It’s something that personally, I constantly have to like, fight back, because I know that that’s not really what most people…sometimes do is literally say, I would like advice on it. “Okay, great. Thank you. I’m happy to put in my advice cap,” but most people are just sharing, and it’s really hard. And I think it probably is something that some of us, you know, whether it’s we grow up with or you know, what circles we run into, we’re, that’s like, kind of ingrained in us or a personality quirk. And so it is like it’s a process in being really intentional about that. Can you share a little bit more maybe about how that shows up with your work as as a doula as a birth worker? How do you see that showing up when you’re with clients?
Jen, Full Spectrum Birthworker 6:15
Yeah, yeah, I was thinking about that about how like, you know, so much of the like, that, like, desire to, to give feedback comes from a place of like, of like, oh, like, I’m an expert in this or whatever. And so as like, as like the doula, you know, and have supposed to be that person who’s like the “expert: in birth, and like, you know, postpartum and like all things like babies, and like, all this stuff, you know, it’s like, it’s almost like an impulse to be like, Yeah, I have all this information I want to share with you. And so the way that I have shown up for me when I’m working with people is I guess giving information like when people ask for, I’m thinking of this one person that I worked with, it was one of the first people that I worked with, and she was on the younger side, it was like her first baby. And she was a student. And I was like, I was like volunteering my Doula services. And just like, when I kind of look back on like, my time working with her, I can see this like, just like our interactions felt different, because I felt like, there was more of, like, power dynamic at play with like, you know, the fact that it was like, free doula services. And like, it was like, I was referred to be her doula through the clinic. And then she was also younger. So it’s, so I felt like when we were talking, a lot of it was like, I felt like she was she was kind of treating me like advocates at the health center or whatever. Like, if I was like, working with the health center versus like, working with her, you know, and working for her. Yeah. So I found myself in this position of kind of telling her what to do. And coming from a very like patriarchal sort of frame of mind of like, this is like, what you should do, this is like how your breath should go. And like all these things, these are the things that you should think about, versus just like, kind of being more of a conversation, different factors in that, like, you know, I was like, she was she was my first client. Yeah. So. So it was also like, kind of a learning experience as like a newer doula. I kind of had to like, learn, like I learned later on about, I guess, like how to hold space in a better way. But yeah, so that’s kind of an example of times when I haven’t held space. Yeah.
Unknown Speaker 8:44
Oh, yeah. Interesting. It sounds kind of like you were falling into, like, almost like a tutor role. You know, like, you’re kind of like, Yep, okay, this is like the way to do it, which I know, certainly, with my background, as a nurse, it’s very easy to like people often expect, you know, certain things from their healthcare, you know, providers, and people will ask like, “well, what would you do? You know, you see this all the time,” and you’re like, Oh, well, I know what I would do. But that’s not necessarily the right thing for you. And it’s like, hard to catch yourself in that moment, especially when someone kind of falls into that different like that different power dynamic shift. Mm hmm. You identified like, there’s several different factors and identities that people can hold that kind of shift that power dynamics so that they feel like they’re being maybe a little bit more like kind of subservient, or they’re supposed to be like under it, instead of feeling like they’re able to stand strong in like, Yes, you are powerful, what you what do you want to do, and it’s easy to like, slip into those. So I mean, obviously, you’re definitely in good company. I don’t know a birth worker who looks back now at their practice and says like, Yep, I’ve been doing exactly the same the entire time. You know, because obviously we do like each experience, we learn more about ourselves, how we need to show up, we learn more about the experiences of birthing people and realize like, oh, there’s way more to this. So I think that’s like there is just like a huge piece of learning to hold space like with each client that we get, and, you know, finessing all of that.
Unknown Speaker 10:06
A lot of is also reflecting on like, I just think it’s a very, like, kind of white supremacists type of thing where it’s like, have this like always this thing of like, okay, like, I know best, like, I am the professional, like, I know, things are whatever. And then like, you listen to me, like sort of like white savior ism to, that’s actually the word that I was thinking of, like, “Oh, I am going to save you like, I am going to save you from yourself.” Like, I know what’s best for you. I’ve had to unpack that a lot. Because I was really deep in that, you know, like, I was volunteering from a very young age. I like all these like food pantries, and like, all these things, and like community service, and I was in the Peace Corps, and like, all these things, you know, and so I like once I started getting into birth work, it was just like, like, I was just like, repeating the same like patterns. And so now I’ve like really, like, that’s one of my, like, struggles and kind of things that I that I’ve had to unpack my desire to, like, save people and like, what does that even mean?
Maggie, RNC-OB 11:17
Oh, my gosh, yes. Because what you’re saying that I think that it personally is a huge thing I struggle with as well, I think, shared background in terms of a lot of that like kind of volunteer work and how you’re looking at, you know, sharing of your time and talents and what you have with someone in a way that actually supports what they want and what they’re asking for versus like, what you want to give or what you think they should want. And like, there is so much to unpack and reflect there for how we keep showing up. And I think we’ve talked about this with a couple other guests on, you know, other episodes about the ways that saviorism creeps into birth work when we know that there is so much wrong with our healthcare system. Yeah. And that as someone who has that, like inside glimpse behind it, we feel very aware of it. And very activated. When we see things happening that we realize, like, “Oh, this is probably headed down this path….”
Jen, Full Spectrum Birthworker 12:13
Yeah.
Maggie, RNC-OB 12:14
And learning how to know that share that information with your client, make sure that they are aware of what’s going on and then be okay with whatever they choose with that information is like, really challenging and I don’t know, it’s certainly not something that I have, like, settled in my spirit yet. You know, like, I think that keep actively like feeling that push and pull against. Yeah. It’s like, it’s a big one. Yeah. So maybe like on thinking about that one of the things you know, with this season, we’ve talked about all things like things that are complicated in pregnancy, birth and postpartum. And, you know, one of the reasons I had reached out to you with your work with United in Birth is thinking about how our system, our birth care healthcare system, you know, particularly working in hospitals, but also in the community birth space, has just is so cis/hetero-normative, in a way that creates creates huge complications for anyone who desires birth care, who doesn’t like fit neatly into that package. And I think that is something that we are continuing to have an awakening around. And at the same time, having like, huge push back against as, and again, in both both we see particularly in some ways, I think in the ways that like hospital birth spaces are created and some of the like, just like paperwork and the ways that we work with folks. But there’s also a huge part of it. That’s like the personal attitudes and biases in the ways that we function within birth that extend far outside of, you know, the hospital space. So yeah, I was wondering if you could share a little bit about like, what inspired you to create United in Birth and how you’re centering your practice?
Jen, Full Spectrum Birthworker 13:51
Yeah, um, so it basically my life [laughter] because So like I mentioned before, like, I am queer, I am, you know, Latinx. I am like, first generation. And so for me, I wanted to create United in Birth because I felt like it wasn’t something that I had seen, like, while I was kind of training to be a doula. So the things behind it are like, there’s a bunch of like, queer birth workers, the number gets lower if you’re talking about trans birth workers or like gender non conforming birth workers. But there’s a huge community of us and we aren’t all in like conversation with each other. And also, I don’t know that like, other people know that we’re out here, if that makes sense. When I’ve talked to like other birth workers, like what they’ve said is that there’s like a lack of awareness or maybe it’s not a lack of awareness, but like from our end, a perceived lack of awareness of doula support And like birthwork support, and also how it can be like accessible. And like a lot of us want to be working with people like us. But it’s hard for us to find the clients, you know. So with the United in Birth, like some of the things that I’m trying to do is center the experiences of queer trans and gender nonconforming people. Because a lot of like, birthwork doesn’t. Like you were saying, like the default a lot of the time, it’s like, cis-het-white. And so there is like, part of part of who I want to focus on is like Black, Indigenous and other people of color, or the global majority as king would say, Yeah, I also not only want to support queer trans gender nonconforming clients, but also other birth workers, because I think that I’m still like, trying to figure out how to do it. But I think that there is like something that we haven’t thought of yet, in terms of sustainability for birth workers doing this work, right. So like, there are a bunch of collectives out there that are doing like amazing work, and are able to kind of support each other. And I would like to replicate that in terms of like, all kinds of support, like, you know, so I say that I’m like a full spectrum doula, which means that I support people through abortion, loss, pregnancy, birth and postpartum. But I would also love to include in that gender transition support, death support, or like end of life support, things like that. And things like abortion, loss, and I would argue, like gender transition support as well, are things that like, typically, people don’t really charge for, just because it’s like, people already have like, kind of a lot of expenses or like, it also just seems like kind of, like fucked up to charge people to support them through an abortion, but that’s just me, I’m sure that there are people who charge and like, you know, that is in your right to do that. But I want to find a way to be able to, like do those things. Where like, if someone is like a primarily abortion doula, right, and like they are, they are like, providing their services mostly for free, that they still like can support themselves, you know, from all the work that we’re doing. I’m not entirely sure how that’s gonna work yet. So if anyone has any ideas, I welcome them. But, but yeah, that that is kind of like my, my intention with it of like, I want it to be like a community for like queer, trans and gender nonconforming birth workers, you know, have, like, you know, we are supporting each other. And like, it’s just like, a hub that people can go to of like, okay, like, like, I am the center of this, you know, not like, I don’t know, not like an afterthought, like, a lot of times it feels like an afterthought of like, oh, yeah, I know how to support like, where people I know how to support trans people, I know how to support like, non binary people. But that’s like, not really like the main focus of the work. It’s just like, oh, like, if people come my way, like, like, I can do it, but like, I really wanted to make it the center because, like, that’s what I would want, like, I would want to go to someone that like, that, like, really knows what they’re talking about, you know, that they’re not just gonna treat me like, another birth client. Because like, I’m not, you know, like, I would need someone to, to talk to me about like, second parent adoption or like, different things like that, that like that. They’re like, considering if you’re gonna refer me to someone that it’s not like someone who’s like overly heteronormative you know, and and makes me feel bad. And just like different things like that, you know, and that’s one of the most important things to me with United in Birth is that people feel like seen and that they’re like the center of of like my business and me and like my company, that they’re completely supported that they don’t have to hide any part of themselves.
Maggie, RNC-OB 19:38
Yeah, oh my gosh, that was like so many powerful things and everything you just said I want to break it down. So it first off like I think that everything you were talking about in terms of like just supporting the like, full spectrum of human experience, you know, and how that is so needed, and also we run into like that rub between like, Okay, how do we provide that support. And then you’re trying to think about like pay, how do I sustain myself financially was provided support and obviously I think are in very good company about. We all know, birth workers in general significant undervalue their service, most people are charging far less than there really are, like owed for what they bring to it, but it is hard to like, push back against oppressive payment structures and live and also still feel like you’re still able to survive in the world. And so I think I mean, there’s obviously like such a need for figuring out how to how to balance it out between, you know, between birth workers within the collective between clients, you know, within that, who are accessing services who have different, you know, access to financial resources, like there’s such a, there’s so much there that like, I love your vision for it, because I think that is what so many of us would love to see. Yeah, as like, the future of it in ways that feel like sustainable for everyone that no one feels people aren’t burned out, that birth workers aren’t just pouring their heart and soul into it and, and then not able to feed their own family, to care for their own selves, because they poured so much into like, that’s not sustainable. And that’s not, that’s not what we need to do. And then in terms of, you know, centering the experience for trans, non binary, gender non conforming queer families, what, as a birth worker, what do you feel like you want from I know, you said, you know, you kind of want to, like unite other birth workers around that who share these identities who are looking for that. And it’s hard sometimes to find that clients like what do you think is happening there? Do you think clients prospective clients aren’t just aren’t able to find birth workers that maybe align with these? Like, it’s just is it like a, for lack of a better term of marketing? Like getting out there issue? Or do you think like, the numbers aren’t matching up? Or where do you think that, that issue falls,
Jen, Full Spectrum Birthworker 21:50
probably a combination, probably a combination of like, of marketing, because like the, the ones I’ve I that I know, of, like the queer birthworkers that I know, who are really like, in this work, they’re like, you know, like booked, like, they can’t even handle the amount of people that they have, right? And then it’s also accessibility of like birth work in general, because doula work is often seen as very white, right? Like, that’s kind of like, like the thing but still, like, seen as a very, like white profession, and just like, generally, like a very white thing to do. You know, they’ll say, like, “Oh, that’s so Woo, or like, you know, like granola,” or whatever, all those like descriptions of things. So I think that that’s also at play for folks who aren’t white as well, just generally, like not having an understanding of what a doula is, or like, what a birth worker is, and like, what the value of having one would be, and just like not really seeing it as something that’s like, for them. And it’s also just like, as a queer person, it’s also kind of hard to, to trust other people, you know, for a lot of folks, like, you know, they’re, they’re just like, basic things like, like, avoiding going to the doctor, and like, all these things, because of like, the harm that that has been caused, right? So I’m sure there’s a level of mistrust of like, oh, how do I know that this person is, like, not caused me harm? You know, it’s hard to know, I’m sure, like, everyone has different, has different reasons. I assume that definitely, like part of it.
Maggie, RNC-OB 23:39
Yeah, that’s it. I mean, I, I always feel like when we talk a lot about, you know, collaborative care, and that that’s our vision is communities that are like reaching out that are giving referrals that are, you know, where we all are living, and breathing are our strengths. You know, whatever it is that we bring to this sphere, without feeling like we have to cover for everything, because no one can do that. And not putting that like extra pressure on ourselves, that then also ends up not serving our clients. Well, you know…
Jen, Full Spectrum Birthworker 24:06
Right.
Maggie, RNC-OB 24:06
Like, we’re all trying to wear too many hats. Yeah, they all don’t fit well. So then we’re not bringing your best self and then people get substandard care that they, you know, don’t need to and I, I feel like that’s one of the things that I know, we’ve talked in spaces I’ve been at before, like, certainly birthing the binary, where we met, you know, we talked in in those spaces sometimes about like, how and when you show up for your trans gender non conforming non binary clients as someone who is not. So like, for me as white cis, heterosexual woman, how can I show up for that community? And what does that look like? And so sometimes sure if I’m like the only person who’s around and available, yes, absolutely. Like, I’ve tried to educate myself and so that I can be as supportive as you can those places, but chances are, that’s certainly not going to be the case. There are people out there who share some of those identities with them. And so how do we like how do we refer? How do we grow community so that people are best like matched and that they’re going to have better experiences. You know, also, is that an opportunity for you to say, “Hey, I would love to support you. However, there’s also this other doula group, you know, would they be a better fit for your needs? What are you looking for?” Like, I think there’s part of it that we need to maybe just do a little bit of that work to like, interrogate ourselves and work to our community to make sure that we’re like circling around with that. And then, I don’t know, I feel like it gets complicated. I think that’s where, like, again, that spirit of like, scarcity versus abundance and financial stuff gets in people’s way, because they have someone reaching out for their services, and they want to book those services. So sometimes I think folks say, yes, yeah, it’s maybe not gonna end up being a great fit, because we’re, we’re worried on that too…
Jen, Full Spectrum Birthworker 25:43
Yeah, yeah, I think I think that that’s super tricky. Because like, and like goes back to like, not assuming that you know, what people’s needs are better than themselves. Right? Like, if someone reaches out to me, and you know, they’re Black. I am not Black. I’m, you know, my background is like Dominican, Latinx. But I am like lighter skin and I benefit from white privilege. So if someone wants a birth worker or a doula that can relate to the Black experience, like I just can’t, right? So are at least not in the same way, obviously. But if they reach out to me, like, based off of what’s on my website, or like, also what’s on my Instagram and things like that, people kind of know what I’m about. Right. So like, I think it would be rude if like, I told this person like, “Oh, were you actually like, looking for a Black doula or whatever,” you know, like, something like that. Like, it’s like, I guess, like, people just kind of tell you, you know, like, if someone is looking for specifically, like a black doula or a Latinx, doula, or like a queer doula, or whatever, like, people are very vocal about that stuff. And they know from the beginning, right? So like, if someone like reaches out to you, and they don’t like explicitly say that, then I don’t know. I’m like, I’m like, trying to work through it in my brain right now. I guess maybe that would be something like, like in the intake like you, I asked you. Yeah, like, what specifically are you looking for? Like, what type of support are you looking for? Because because from my perspective, right, I feel like if it could come across as like, you know, like, let’s say, I reached out to you, Maggie, and I’m like, “Hey, Maggie, I want you to be my doula.” And then you’re like, “Oh, hey, like, that’s great. But actually, were you looking for like, another doula who was Latinx? Or whatever? Like, I don’t think I would be the best person to support you.” Like, I would be kind of offended.
Maggie, RNC-OB 27:42
Yeah…
Jen, Full Spectrum Birthworker 27:44
Like, I feel like, Oh, what, like, you don’t serve me, you know? Yeah. And that’s not to say that everyone would feel this way. But I think it is, like a tricky balance of like, of how you navigate that conversation, right? And it’s the same thing with like, if, if someone reaches out to me, and they’re trans, and they want to talk to me, and they want me to be their doula, like, who am I to tell them that? Like, I won’t be their doula, you know? Yeah. Like, it’s, it’s not necessarily like, like, exclusive. And so maybe like, you bring in a question of like, like, towards the end of like, “hey, like, I would love to work with you. Have you talked to any other doulas yet?” And most likely, you will know them. And if like, yeah, if they are someone who’s Black, and then like, everyone else that they’ve talked to, is why maybe it would be like, Oh, actually, like, have you talked to so and so, you know, that, like, matches their identity? If they want that, or something? You know, I don’t know. Like, I feel like there could be kind of like a, like a workaround versus like, you know, making it weird.
Maggie, RNC-OB 28:50
Yeah, yeah. And I think I’m glad that you like dove into that, because I think there when I’ve had these conversations with, so that’s like, right, like, it’s complicated. And it’s hard, because we want to make sure people feel well supported. Well, it’s like you said, we’re also not trying to, like, guess, and look at them based on whatever, you know, how they’re presenting, or what they’ve told us about themselves. And guess what that means that they want a certain thing, whilst also trying to like make sure people feel well supported, they feel like we’re going to meet them early. So I think there are probably ways in in intake and as you’re, you know, getting to know someone that you make sure, maybe it’s about making sure that they understand where you’re at, what your identities are, how you’re gonna relate, you know, and I also, I also know, you know, folks who intentionally want someone who is different than them in any number of ways because you want like a different experience, like, “Okay, I want to have a birth worker who knows something else about lived experience, than I do.”
Jen, Full Spectrum Birthworker 29:44
Mmm yeah.
Maggie, RNC-OB 29:45
They’re gonna help bring this in perspective, you know, so, you know, there’s certainly like that piece of it, too. I think like you said, I mean, I guess ultimately it comes down to obviously we’re just we’re trusting birthing people to know what they want really comes down to making sure that we are being open about our positionality that we are
Jen, Full Spectrum Birthworker 30:02
Yeah.
Maggie, RNC-OB 30:03
We’re not mostly that we’re not talking out of both sides of our mouth. You know, we’re not saying like, “Oh, I’m going to go do great job, right? Yeah, I’ve served plenty of trans clients…” Yeah, when you haven’t, and you don’t actually know how to how to do that, like, obviously, that’s when it would be like, super disingenuous and not, not going to end up being a good fit. But our awareness around that.
Jen, Full Spectrum Birthworker 30:23
Yeah, and, and that’s such a good point. Because like, you know, a lot of times when when we start talking about, like, supporting queer people, gender diverse people, the first thing that people talk about his language, right, but honestly, like, that should be the last thing that you’re talking about. Because, like, it’s one thing to be able to, or to, like, you know, use proper pronouns, and respect people’s pronouns and things. But it’s another thing to actually like, have reflected on like your ideas of gender, and like your ideas of sexuality, and how that shows up for you. Because like, you don’t want to change your website, right. And like, you know, all you have, like birthing partner, and like, all these things, and like, you have a bunch of like, queer looking people on your website, and it’s all great. And then like, people come to you, they’re excited to work with you. And then you say, some shit during the intake or the interview, or whatever, or like, while you’re working with them, and you end up causing them harm, you know, so like, we have to be very reflective of like, if we are presenting the safety to people, that we’re actually like, embodying it, and that we actually like, are at that space, you know, that, like, we can do that. And like, really, like, support people in the way that they deserve to be supported, you know, and it’s the same thing with on your Instagram, or like, your website, or whatever, you have a bunch of photos of people who are Black, or who are brown, or just like other people of color, right? And you’ve never worked with someone who was Black or Indigenous or another person of color in your life, like, what are you doing? You know, it’s like, you’re presenting this thing that like, okay, yes, you have like, thought about, like, anti-racism, and like, you come from this place with supporting anti-racist practices, and like, you’re inclusive, and like, all these things, you’re talking about something. And then it’s like, like, they’re not really considering that, like, you have different rights as someone who’s not white. So I think that that is like a challenge, because a lot of us, like, I want to present this persona that like, we’re inclusive, and I want to say person, we can support everybody and all this stuff. But like, that’s not true. You know, we all have our limits, and like, we’re all in different spaces in this journey. And it’s like being honest with yourself about that. And there’s no, there’s no shame in that, you know, and that might be an example where like, if someone reaches out to you, and they are like a queer person, or they are a trans person or something, or they are like a non binary person, and they’re telling you that this is like, what their needs are and stuff and like, you genuinely don’t feel like you’re the best person to support them. Because you just don’t know how is like being upfront about that. And then also having people on your referral list that, like if you can meet their needs, that you know, where to send them to, and it’s not just like, “Okay, well, I can’t do this bye sorry,” you know?
Maggie, RNC-OB 33:37
Yeah, there is that piece, you know, we’re talking about there’s kind of in this, like, growing awareness that things need to change. And, you know, especially in the birth world, as it comes to supporting gender diverse, folks. Yeah, but they’re definitely not like performative allyship kind of piece that creeps in. Right? You know, I guess that’s where I’m so grateful for folks, like you who are invested in this work and in creating spaces that actually center trans non binary gender nonconforming people. like you said, I think that creates a very different dynamic. But I also think that there’s this not, not everyone is going to do that. Not everyone is the right person to center. You know what I mean? And obviously, there are plenty of cis heterosexual folks still out there giving birth who also need support. So it’s not that everyone needs to do that.
Jen, Full Spectrum Birthworker 34:30
Yeah.
Maggie, RNC-OB 34:31
You know, where do you think when you’re looking in, like when you’re talking with folks and supporting clients, where do you feel like the biggest gaps are when you have trans non binary clients who are kind of operating within spaces that have typically been kind of very cis-heteronormative? What do you see like where do you see the biggest gaps that folks who are in those spaces can maybe like tune into and be more aware of like how they’re showing up?
Jen, Full Spectrum Birthworker 34:58
Yeah, so much things, one of the gaps that is kind of the one of the more obvious ones is just a lot of the language surrounding birth in terms of like, if you are someone who gives birth in hospital of like, you know, all the nurses calling you, Mama, and like calling your partner, daddy or whatever, or. Yeah, or like the opposite, you know, so my partner’s non binary, but they were, you know, they were assigned female at birth. And so I’m sure like, they would be like, Oh, Mama and Mama, you know, which, like, I would hate that, first of all, yeah, just like and I’m a cis person. And like, I know that they would hate that too. But just like, generally, that the this like, the way the medical system works now is not person centered at all. It’s just like, nobody learns anybody’s names. It’s just like, these assumptions of like, yeah, like mama, and like, whatever, all these things. And then there’s like, a lot of misinformation on general, like body awareness and like health awareness of pregnancy in people who are not women. So a lot of people who are on testosterone, like believe that they can’t get pregnant, or they’re told that they’re infertile, or whatever, like that, it’ll make them sterile or something, which is just like not true. just like generally, like, we don’t know how any of this stuff works, you know, because it hasn’t been like formally studied, quote, unquote, like, a lot of stuff, a lot of the information out there has been, like, trans folks figuring it out themselves, you know, so like, in terms of you, and I’m like, how long to be off of testosterone, like when to get pregnant. Or just like, if you can breastfeed and like, be on testosterone at the same time, or like chest feed or body feed, you know. And so that’s another gap of like, just general like, like, yeah, knowledge on body, and like, how all of this, how everything functions, and then how intersectionality affects all of this. So like, there are other factors to consider, like racism, like overall racism, and the medical system, and like discrimination against family structures and things like that. Like if people want to have more than one partner in the room, or they’re like, co parenting, and it’s not a romantic relationship, and like, whose name gets to be put on the birth certificate? And how, like, the birth certificate doesn’t guarantee parental rights, and like, you can’t really have more than more than two legal guardians, you know. And there’s just like, so many things that and so many folks that are left out of legal protections and like all of these things, and also how expensive all of this stuff is, and invasive, right? Because if you’re someone who is, who even has the mental space to go through the process of second parent adoption, and I’m in New York, so I’m sure it’s like different other places, but you most often have to do people come to your house and like, see if you’re like a fit parent or whatever, it’s like a safe household. And someone in one of the birthing beyond the binary classes brought up that like that they wouldn’t feel safe with that process. Their family is polyamorous. So it’s like, then having this like, outside organization come in, and like, deem them fit or unfit, like, that is very invasive, and like, feels harmful because like people do get their kids taken away, you know? Especially if, if you’re Black. So there’s just like, there’s just like, in so many different areas of family support that goes outside of the medical system, because like the medical system reflects like the grander scale society, right? So it’s just like, if you’re talking about what are the gaps, it’s like, you’re talking about the gaps everywhere, you know, it’s like, what are the gaps in our society? You know, and it’s just, like, so hard to like, narrow it down to like a smallest.
Maggie, RNC-OB 39:25
Yeah, no, obviously, we could talk about that all day. You know, diving into I think there are, yeah, again, like, there’s so many good stuff you just brought up. Like, I think there’s that whole piece of like, how are we like supporting versus like, like surveillance, you know, what I mean? Like as especially like, within hospital structures, you know, like, how are, you know, the health care workers? Are you acting as like an agent of like, some sort of carceral system where you’re trying to like, report folks and you know, are you actually just like supporting whatever their dynamic is, and then there’s the piece where we as a society, you know, it, like decided to care so personally about what other people are doing in their personal lives and make huge sweeping judgments about them that impact both personal moments, but then also impact them on a legal basis. And it like there. I mean, there’s that piece of it that I think I was just having conversation with a co worker the other day about this exact issue and how we, as we make changes, where I work in terms of some of our paperwork, being more inclusive, having a birthing parents worksheet, instead of a mother’s worksheet, and kind of working small, very baby steps towards that, how there’s been some pushback, and there’s just people are just somehow take it very personally, that these inclusive steps are being made, and seem to feel that it is somehow negatively impacting them, you know, all of us as we keep working through this, like, if you’re finding yourself as you’re, you know, as you’re supporting this in whatever your capacity, whatever your role is, within birth care, but like, you’re finding yourself so invested in the person your cares, like, your personal life, that’s like a clear moment for you to like, just take a step back, like, it’s, it’s obviously not about you, because it’s not your birth, it’s not your baby. And I think we have to have, like awareness just around that.
Jen, Full Spectrum Birthworker 41:19
Well, you know, it’s like, it’s like a byproduct of capitalism, right? Like, capitalism makes us feel like, we have to compete for everything, even like, our own struggles. So yeah, it’s like, it’s like, oh, my struggle is bigger than yours. You know, and it’s like, I think part of is like, women have fought for so long to, like, be seen that like, any, like, putting the attention on like, anyone else feels like a threat. And even just like, our whole lives, like, We’re fed this narrative that like, you know, only women can give birth. And like, that’s why women are amazing, and like mothers and like, all this stuff. And so for people who that’s their whole identity, you know, like, of course, you would be upset that we’re saying that not only women can give birth, you know, and that other people give birth to, and that we have to, like, take care of other populations, too. So it’s like, I mean, I understand, like, the thought, and like, why people feel that way. But it’s also but yeah, it’s like, it’s not like, that’s a very, like scarcity mindset, right? That like, if we take attention away from like, from this that like, then there won’t be enough for us. But the whole idea of like, queer reproductive justice is that, which is not something I came up with, it’s something that king came up with, but the whole idea of reproductive justice is that it improves things for everyone, you know, because when we are serving the folks who have been most marginalized and most most prosecuted, then it makes things better for everyone. You know, it’s like, what we’re talking about is, is Human Centered Care, right? Of like, you go to the like, what would that be like? For that would be my question for all these people who feel like, you know, they’re being discriminated against, because they’re sis women, you know, of like, what would that feel like, if you went to a doctor and the doctor actually listened to you and asked you questions about yourself? And it wasn’t like, just like, oh, okay, whatever, you know, whatever. Yeah, Mama here, you go off off to whatever, you know. And so I, you know, I think it’s just like such a silly argument. Like, we like we don’t have to do that. All all that does is like distract people from the real issue, which is the medical industrial complex, and racism and white supremacy and like, all the other things that are wrong in our society, you know?
Maggie, RNC-OB 44:04
Yeah, that’s the word. It is. I mean, I think that’s what we’ve talked, you know, a lot this season too about like trauma informed care, you know, obviously, like holding an element of that and like truly offering like trauma informed care, person centered care, individualized care for each person, that honors all the ways that they show up in the world that honors their individual history like that is something that is good for everyone. Even if you carry identities that typically move easily through the world, like you’re still going to get better personalized care. If we as birth workers, as healthcare workers, provide trauma informed care to everyone. Like it’s, it’s in the word inclusive, but for some reason, so many people have taken that to me like, well, if you’re including them, then you must be excluding me. And that’s, that’s not the reality. And I think that is something that’s like, huge work there. Like you said, I think the whole like calling people like mom and dad and stuff, like, let it go, folks, let it go now, just let it go. And I say this I’m like, I’ve absolutely done that, like as a as a newer nurse, like that’s what people did. You’re like, Okay, I guess this is like some it’s like a sweet term of endearment. Like, I’m kind of like new role like I get it that he didn’t come from the bad place you come from like this, like, this is your new role as parents, I want to, like, honor that and see that, like, I’m sure it came from the place. But nowadays, like most people, like I don’t want to be called mama. Most people. I’m sure there are people out there who love being called mom and dad in birth and appointment. So like, I’m not disrespecting their personal experience. But I think the vast majority of us prefer being called like the name you know. So like, I also think that’s something that we like, it’s not just, it’s not just about improving the experience for trans and you know, gender nonconforming people. It’s about making it so that everyone feels more respected. Everyone feels heard, everyone feels like they’re an actual like person giving birth. Instead of like, that was our fifth mom for today. Like, that doesn’t feel good to us as like as like birth care workers either. Like that’s not a good feeling to feel like you’re just in a factory and like, Yep, yeah, yep. Yep. Like, that’s not I don’t know. So. Yeah. Yeah, I feel there’s so much there. Well, listen, I could literally talk to you about this forever. But is there anything else you want? As we kind like wrap up this episode? Is there anything else you want to share with like our audience about how they show up, provide more firming care, do better at birth workers?
Jen, Full Spectrum Birthworker 46:24
So I actually because of me, I want to read something for everybody.
Maggie, RNC-OB 46:33
Yes! I love that you prepared something to read.
Jen, Full Spectrum Birthworker 46:36
Yeah, well, it’s like a, one of my friends sent me this poem recently. And I was like, Yeah, this is like exactly like the, what I’m trying to like, embody with United in Birth. So the, it’s a poem by Yung Pueblo from their book, Clarity and Connection. And it’s like the first poem in the book. And it says, “All human beings are united by birth, life, death, and every emotion in between.” And so I really liked that. Because that is like, ultimately, what I want United in Birth to be about that. You know, birth is an experience that unites us. All right. And it’s something that we have to remember that as birth workers, as doulas. We are guides throughout this process. And we have to hold space for however it is that people show up and what they need. And it’s about them. It’s not about us.
Maggie, RNC-OB 47:59
Yep, that’s it that Yeah. That’s a show folks. Okay. But yeah, I mean, like that is that that is what it is. And I think it’s continuing like reminding and recentering the birthing person like in our care that that’s what eventually is going to get us like in a different place. As as a birth care whole where people really feel like they can feel confident going into it that someone is like is seeing them is centering them and their lived experience and that it’s not about us like we’ve chosen this path for our work, which is beautiful and wonderful and challenging. But it’s still not about us.
Yeah.
Before we totally closed let’s let our listeners know, where can they find you in all your work best? Where? Where do you like to hang out on the internet?
Jen, Full Spectrum Birthworker 48:45
Oh, let’s see. Yeah, I guess Instagram would be the best place I yeah, I take breaks. But you could be there. You can either follow me on united and birth, which is like my collective Instagram or my personal account, which is @JemOfADoula.
Maggie, RNC-OB 49:06
Awesome. Thank you so much.
Jen, Full Spectrum Birthworker 49:08
Yeah, thanks so much, Maggie.
Maggie, RNC-OB 49:09
I just so appreciate everything that Jen shared in this episode, you know, I’m always so grateful to our guests for coming on and being willing to just dive into anything and everything that kind of comes up during our conversations. And, you know, I appreciate how much we were able to touch on this in terms of, you know, thinking about the care we provide for folks and also continuing you know, our conversation from our last episode with Cheyenne Scarlett, about thinking about reflection, thinking about what we are bringing to birth work and and where it is that we need to kind of step back and take some of that and, you know, be aware of, you know, how we’re showing up as you know, as guides as support folks without putting, you know, our needs or our visions or, you know, our own biases and limiting beliefs, you know, above that our client and so I hope that this has inspired you, as you you know continue to build out your practice and create more inclusive care for trans and non binary and gender non-conforming families who come into your care. So, we would love to hear your feedback and continue this conversation. Look for us on social media. We are Your BIRTH Partners across all platforms. And we’d love to hear for you on there, give us a shout out. And we’ll be sharing in our show notes some resources as you know, you continue to explore how you can best provide support for gender diverse people in your care. And we’re grateful to have you alongside us on this journey as we all work towards creating more inclusive collaborative birth care communities rooted in autonomy, respect and equity. Till next time.
051: Intimate Partner Violence in Pregnancy & Postpartum
Maggie, RNC-OB 0:08
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birthcare communities rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Hey there, and welcome back to the podcast. In this episode, we are continuing our season on holding space through complications that arise during pregnancy, birth and postpartum. And we’re gonna talk about the intersection of perinatal health care and intimate partner violence. So this is obviously a really fraught topic, it brings up a lot of emotions for people as we look to support folks who are experiencing trauma, who are experiencing violence. And there’s a lot for us to sit with as we uncover what our role is in supporting folks who are experiencing violence as they look for safety. And this is a topic that touches many of us personally, those of us who experienced it in our own lives, as we’ve supported loved ones, and of course as birth workers have some sort of familiarity already with the you know, there’s been a lot of discourse around universal screening, and how we’re providing assistance and support to those needing resources. And, you know, I think there is so much to dive into in terms of what it looks like to put that into practice, holding space for the complexity of family dynamics and to help guide this conversation and share some of their wisdom, we have Dr. Phyllis sharps coming on to the podcast. She is a researcher and nurse who has cared for vulnerable populations in perinatal health care for over five decades. And she brings a wealth of experience and knowledge and insight into this topic and how we can all show up better for those in our care. So on to the show!
Oh, welcome, Dr. Sharps, I am really excited to have you on the podcast to share more with us about your work and your research and how we can be more supportive for folks experiencing intimate partner violence. So thank you so much for coming on to chat with us. If you could just tell our audience a little bit about yourself, your work kind of your history.
Dr Phyllis Sharps, PhD, RN 2:25
Okay, hello, and I’m glad to be a part of the podcast. As we said before, my name is Phyllis Sharps. I am a nurse with specialty education and expertise in maternal and child health. I have a PhD in nursing research and measurement, and really have devoted my more than 50 year plus career focusing on the health of pregnant women and particularly vulnerable women or women who are likely to have poor birth outcomes. We know the research tells us that brown and black women have worse birth outcomes compared to others and and I’ve tried to understand and design research based interventions that would address some of those risk factors. And particularly, I focus on violence against pregnant women and women in early parenting-the first year or 18 months or so after birth. I have recently retired from John Hopkins School of Nursing where I was a professor of nursing for more than 20 years.
Maggie, RNC-OB 3:35
Well, congratulations on your retirement and decades of working so hard to improve perinatal health care, grateful for your work. We are organizing this entire season of the podcast around the concept of holding space through complicated pieces. Can you share a little bit with us about what it means to you to hold space how that’s shown up throughout your your research and your work?
Dr Phyllis Sharps, PhD, RN 3:58
So you know, I think pregnancy is is a very interesting time period in a woman’s life. And and why I was drawn to that in nursing is because I you know I love the health of women, women and young infants. And I feel that when you empower and improve the health of women, you’re improving the health of the family in the community. We have a lot of I think myths around pregnancy that it’s it’s a happy time and people are very delighted and yet, for some women that’s not the case. And for me holding space is about thinking that not all women come to the pregnancy space or the the labor and delivery space or those early months after postpartum after the baby is delivered. May not be a happy time. May not be a happy time both for the mother and the fetus in the family that the baby is coming into. So as nurses, I think we need to make space for all of those, those types of families and babies and circumstances and and provide. You know, right now equity is very important but providing care that encompass all women, no matter what their circumstances is, without being judgmental, and bringing biases and prejudice that may care we provide women and just kind of getting in touch with where you are as a provider, as a nurse as a doula as a companion, you know, what’s in your head or your feeling or your background? About women? And how are you able to either put those things aside or to use them in a way that really supports women going through now, even if it’s the happiest of women and the happiest of all times? You know, many women enter with fear. They’ve heard stories. They’ve had a previous birth that didn’t go as well. There’s a lot of, you know, just personally, anxiety and ambiguity about, you know, how am I going to be a mother, if it’s my first time if I’m bringing another child in? You know, I remember myself thinking about well, how do you love two kids? How do you have to do have to love each one of them equally? And you do, but you get comfortable with knowing that it might look different? And I think that that’s what we have to think about when we’re making space and including everybody in the maternity tent, if we want to call it that.
Maggie, RNC-OB 6:49
Absolutely, oh, it’s so good. Yeah, I think there’s, there is just, it’s so much looking into like the journey of parenthood and starting with pregnancy, knowing that everyone comes from really different circumstances, really different feelings, you know about that. And so I love that reminder about how holding spacious lets us to hold all of those, all those pieces, all the different family dynamics, all of the feelings as we as we care for folks, thank you. So I’m hoping maybe to just kind of ground this episode, if you could share with us some of the statistics facts that we know about intimate partner violence and the intersectionality, with pregnancy and birthing people.
Dr Phyllis Sharps, PhD, RN 7:26
So intimate partner violence shows up in different ways around pregnancy. And I like to think about it as that childbearing year. So it’s kind of the months be for in the middle of a pregnancy maybe until two to three months after the baby’s born. So about it’s about a year space. And we know that some women who’ve been abused are survivors of intimate partner violence that will continue in the same way does it change, it just continues? For some women, women, it gets less. And you know, because there’s, maybe the partner is thinking about not harming the unborn baby or, for some women, it starts for the first time in pregnancy. Our most recent recent statistics suggest that somewhere between four to 10% of women are abused during pregnancy. But what startling to me and continues to be very startling is that the leading cause of death for women, pregnant women is homicide of women being in and often it is by and most often, it’s by an intimate partner and can be a current partner and it can be an ex partner. So you know, I think the good news is our science around care of mothers has improved such that we are able to manage the infections and the hemorrhages and other things that used to cause death of mothers but these are other issues around violence against women around hurting women while their pregnancy and not only is it the physical injury, is it’s the death could be of women. We know that unwanted often unwanted and miss time pregnancies come because of a result of being in a violent relationship where and it can it you know, it may not necessarily be physical violence but its core. So techniques such as withholding birth control pills or or throwing them away or not using condoms or not allowing her to use self protective devices such as IUDs and other things to diaphragms if people still use those things that would help her delay pregnancy and maybe time the pregnancy you know way that works with a couple, there often is not the ability to have conversations. We know that 50% to 75% of women who were abused during pregnancy were also abused before. So, oh predictively if you’re being abused or before pregnancy, the chances are pretty good, that that may continue. Teenagers are at higher risk, not only from, you know, a boyfriend or partner, but sometimes family members. Both disappointment, anger, that kind of thing about the situation of a young woman, again, you know, that that deaths there several publications, in one, I have out with a group of other researchers looking at some of the pregnancy associated violence and death. And we certainly see it in large urban cities, New York, Chicago, Washington, DC. And I think if we had better reporting systems, we would probably find even more in rural areas, too. So we also know, our data suggests that women of color, Native American women, African American women, Latina, have higher rates, but I hope I would like people not to go away thinking that it’s necessarily a racial, because you know, “I’m a particular race, I’m going to have more violence,” but we have to also look at the circumstances. So there’s certainly higher rates of poverty, unemployment, living in neighborhoods where there is already disorganization and other kinds of crimes. And so it’s a combination of all of those things, young women we know are at higher risk than more mature women, educational status, also seems to make the difference. So and then the issue of certainly gets influenced by substance use. And so we also need to understand too, that the data suggests that women who are using substances often are using it in a way to cope or were introduced to a substance by a partner of violence was also using. So again, going back to your thinking and thinking and making space, I think those are things that we have to keep in mind caring for women that don’t form ideas and opinions that may interfere with with our care of women. We also, and I’m not going to get on my band this morning, but we know that there are abusers or, you know, the person that’s committing the violence against a woman has access to a gun is more likely to be a fatal incident and will end up in a fatality. For the though, there are lots of things that we certainly can think about in terms of maybe how to keep women safe. And that that has been the focus of my research also. Wow.
Unknown Speaker 13:13
Oh, there’s so much there. I want to pull out a couple things to highlight. I think one, you know, we’ve talked a lot about perinatal morbidity and mortality. And, you know, watching how those rates have changed over the last few decades. But just that reminder, that still the largest cause of that is homicide is chilling, you know, that, that this is such a present, you know, reality. And I think the statistics you shared, you know, maybe one in 10, one in 25 of the people that we’re seeing during pregnancy, are experiencing intimate partner violence, like I think that’s hopefully served as like kind of a reminder and a wake up call about just how present this is. And that’s across, you know, like you said, that’s across communities across the country, we see, you know, so thinking through our practices and what comes up and how we’re, how we’re screening, how we’re looking out for that all those biases, you talk to the systemic factors that play into it. Like there is there’s a lot to unpack there. So I was wondering, maybe first question, that what have we seen change in the pandemic in the last you know, each year?
Unknown Speaker 14:13
That was the next thing. One of the things that we’ve seen is more of a volume on hotlines and emerging phones that are set up to for women that are experiencing violence women you know what when we do the quarantine but having people stay in their homes, shelter in place that the lot quote, lockdowns or force women are forced to be often in the home where the person is. And so they don’t have you know, perhaps if they were going up to work or going outside, they might be able to access resources without increasing suspicion. But when when you’re home and you know Maybe there’s no place to be private or have a phone conversation with that kind of thing. And so even though resources have been available for websites and other things, finding a way to do that, so that that you don’t create more suspicion about the abuser, you know, what, what are you doing? Who are you calling kind of thing has been a challenge. I’ve reviewed a lot of research proposals where groups are trying to do take advantage of telehealth and do those kinds of interventions. But of course, there are also safety issues around, you know, people using their iPhones or iPads, computers. And you know, and if somebody comes in, now, what are you looking at? Who are you talking to, and then and the nature of the calls have have changed in terms of they’re often very short and very frantic, because you realize, you know, that a woman only has this short window of time. And children, again, we took away the safety net of schools for almost, for many children. And so now you have both mothers and children in an environment that’s not necessarily safe. And and then we have to do take some thought to that mothers are often in peril, because you know, there are some folks law and our legal system that interpret laws related to child abuse, says mom not making a safe environment. But if you’re not in control of the abuser, how you can make an environment safe, absolutely. is a challenge.
Maggie, RNC-OB 16:44
Yeah, I mean, that Yeah, that’s so complicated. I feel like one of the things I’ve seen so bedside as a, you know, labor and birth nurse, I typically, you know, we’ve tried to screen universally, you know, everyone who comes in at admission, we’re trying to ask them as part of their intake. If they’re, you know, if they feel safe home for everyone, you know, how they’re being taken care of. However, since we’ve had to change the visitation policies, and people are like, we used to have people go out to the waiting room or go check some registration form of Go grab XYZ from the car. That’s not, that wasn’t happening for a long time, and that’s still not happening, and, you know, plenty of facilities around the country. And that creates this challenge in how we’re assessing, when the someone’s the other, you know, their partner is there in the room or another family members are in the room, and we’re not able to create the ability to get like private space.
Dr Phyllis Sharps, PhD, RN 17:29
So one of the ways I have found that is helpful, because we part of my career, I was a nurse in the shelter, domestic violence shelter. And we the nursing staff, which was myself and nursing students would screen women, as a part of our health take intake, and sometimes women would bring their children because, you know, they weren’t babysitters, or that kind of thing. And so I would often give them that part of the screening and ask them today, read this and answer those questions. And, yeah, I work in, you know, that there’s just a part of the interview and make it seem very natural. And, and hopefully, you know, she would read it and then not asked any question. Yeah. I think when I’m when I was in the military, I did many of the things that you said that we would, because in the military, certainly, men are encouraged to take their wives for care, and they get time off to do it. And so that’s, that’s a good thing for most families. But if you want to screen we often would send women to the bathroom to collect their specimens and, and ask them a few questions. Most most men are really nervous about stuff like that. So yeah. Oh, in that they’re kind of thing. But yeah, I can imagine it is a challenge with circumstances of the pandemic unlimited visitors, and that perhaps a woman is in an abusive relationship or increase suspicion for the partner, you know, what are you doing, and why can’t I come in?
Maggie, RNC-OB 19:06
Right, right. And then maybe if you could talk a little bit, I know you had mentioned you touched on it, that kind of the biases and assumptions that can come up, can you speak a bit more to what are some of the things that we as providers, as healthcare workers might be holding on to that make us less able to recognize signs of intimate partner violence?
Unknown Speaker 19:25
So, you know, I think some of the things to be aware of, you know, I think you certainly, there’s been a lot of focus on traumatic births and that kind of thing, but also think about that women who are abused or also have have traumatic experiences, both physical and sexual, and particularly if there’s been sexual abuse and think about what we do in labor and delivery, for instance, we put you in a small room. They ask you to take your clothes off. We’re explaining what you’re doing, but you don’t have any control of the speculum exam or the digital exam, and you know, and people are talking, often not to you, but about you. And so that if we understand also post traumatic stress syndrome, that that situation of the vaginal exam and in understanding what’s going on, in labor, so forth, can, can reinforce or have me relive a traumatic experience. So, as much as we, you know, we depend on all of these types of exams, a very seasoned nurse and doctor should be able to care for a woman with with not as many maybe typical exams as we have, but also be have a suspicion or alert that for a woman, is that traumatized? Or sometimes the behavior looks irrational to us? You know, and I’ve heard people say things like, well, you know, you’ve had intercourse. So why is this so? Well, you know, it’s not the same thing. For you know, if you’re entering in a relationship, where the, in the, you know, the act of intercourse is mutual, and that kind of thing, that’s a different situation than a forced sexual encounter. And oh, you know, I think that I have, when you notice that maybe a woman is, is just or young teenagers being just you having a hard time managing, start thinking about what is maybe there’s some traumatic sexual experience or violence experience, and, you know, try to certainly de escalate it, figure out, you know, if there’s a way that you can do provide good care, without me so many exams, but also a trusted nurse, or someone that seems to have a little more rapport with the patient might talk to, and see if we could understand what the fears are, if you’ve if you’ve been in labor and delivery long enough, you know, when people are getting into transition, you know, there are there physical signs that women make that you know that okay, she’s probably around eight or nine, and you might, you know, be able to say to her, we think it’s getting close to the time when you need to push, maybe we could do an exam now and forego some of the other internal exams that you may usually do. I also think, as you have mentioned, doing universal screening is just making it part of a conversation that we asked all women so that women don’t feel that I’m asking you, because you’re Black, or you’re brown, or because I see you had a history of substance abuse or not married, you know, that kind of thing, just, you know, ask all will make it seem very normal. And I think the things that you’ve pointed out that if you can do it in private places, or when no other family members or spouses around, that’s good. I think that we can help nurses, and physicians in terms of screening is that you don’t have to be the expert on on domestic or intimate partner violence. But it’s very important to ask the question, because, you know, she’s delivering in a hospital or a birth center there, there, there are resources there, there are people that can do and so, you know, once you identify, certainly say, I’d like to have, you know, the social worker or whatever. Would that be okay for them to come and speak, speak to? You know, are you safe, you know, those kinds of things. So she’s very much involved, and it is a routine part of care. And, you know, the resources available in your agency that she can help women with?
Maggie, RNC-OB 23:43
Yeah. Oh, yeah, absolutely. I think it’s so important to have those resources both like in the hospital and you know, outside of a community resources to, you know, refer to thinking about one, I love your point about having more trauma informed care for all of our all of our interactions, right? Like that needs to be the standard is that awareness that everyone has stuff in their history, we’re not always going to know, right? Not everyone is going to disclose to us even even if we screen even Yes. So that reminder to just treat every interaction person who’s giving birth, making sure that they are they have as much power as they possibly can, making sure that they’re able to direct their care that they know that they can say no to, you know, a pelvic exam or that they don’t have to get into a position that we are suggesting, you know, I think that those are like huge changes we need to make for everyone to increase that comfort. So I absolutely will share in the show notes and resources, some like courses and lectures, some scripts people have done for how to how to offer like a pelvic exam in early trauma informed way that helps people to feel more safe and supported. So I will share those later for folks. And then the one piece to what maybe to speak to is, you know, if we’re doing that screening, and we get a disclosure. What steps do we take if you could maybe talk through that a little bit. I know Sometimes that’s come up and you get a disclosure and you’re like, Oh, you’re surprised, but you weren’t expecting and then you’re not sure what to do. And maybe they’re disclosing things like the partner is here is going to be present for the birth or is going to be, you know, is continuing as part of their life like that can bring up I think, a lot of really complicated dynamics for us to hold that space.
Dr Phyllis Sharps, PhD, RN 25:19
You know, I think certainly, your unit or the place that you’re working with the agency should have a protocol work done so that when that happens, it’s like, what do I do now? So and part of that protocol should be knowing what resources are available there in the hospital? Is it a social work team, said a domestic violence advocate at a shelter nearby? You know, that kind of thing? I think the reality is that you’re right, the partner is there. And he probably looks like a, you know, pretty normal, he doesn’t have like, you know, a tail or a pitchfork, or like the devil, right? So I see, again, being careful not to let your biases and that kind of thing in to as much as possible, provide care, the same that you would do for any other family. And, and I think you could talk about that we have a number of resources, and folks that are working with families, and you could talk about infant care or bringing the baby home in a way that doesn’t alert them, but also would provide help for her, let her know, you know, that these resources are available, we offer them to all parents, we, you know, we can call and have the person come now or want, you know, she might want to during labor, but during the postpartum stay, or have some type of brochure that, or a handout that talks about resources, but not in a way that it did like this is a place you call for the domestic, right. And then alerting the the Social Work team, that we have a family, the mom disclosed that she was, you know, in a violent situation, the partner is here so social workers should know how to come up or the advocate should know how to come up and talk to the family. And you know, the partners here he visits frequently, and that kind of thing. But I think if you have those things all worked out, and you’ve checked with your support personnel, whether it’s social work, whether it’s a shelter, and you may as you put those protocols together, you may want to have the Social Work team, the domestic violence advocate, be a part of the planning team. So it comes together in a way that everybody feels comfortable, and nobody feels that I’m stepping into your domain kind of thing. And sometimes there is tension between I find domestic violence advocates and nurses, you know, social workers, so you want to have everybody on the team, and knowing where the resources are and how to handle and then, you know, once that protocol is developed, it would also be important, certainly the nursing team, but if you have some physician champions that will be a part of the team and understand what’s going on that that’s always a plus.
Maggie, RNC-OB 28:21
Yeah, there’s really helpful recommendations for everyone listening, just thinking about what what, what do you have set up on your unit through your facility? What is the process there? And then maybe, you know, a lot of our audience are also community based birth workers. So doulas, lactation counselor, you know, out in who are out outpatient aren’t necessarily affiliated with a hospital. I don’t know if you could speak to some of the things that steps that they can take. I know you’ve done so much work with like the DOVE trial and done a lot of like community based pieces. Are there elements of that that we could take as community based birthworkers and bring into our practice?
Dr Phyllis Sharps, PhD, RN 28:53
So you know, I think it’s, it’s the nature of what you do with the clients in your role. So if you have a screening or health intake or intake process, you may want to ask that question. And we do know that sometimes women either choose not to breastfeed, for example, or have difficulties maintaining breastfeeding because a partner doesn’t want to do it or things. So have some thought about how that might be handled. You know, I think in the case of doulas who are supporting births, just to be aware, that if you know if a woman has declared that she’s in a tough situation, her partner may also be there, and that you would need to think about providing care in the same way. But also, what would be the protocol is there some difficulty around the partner is theirs concerns about safety. I, the other thing I talked about as much is also being alert to depression. Because they often told, you know, depression and partner violence often exist in the same space. And so that’s another avenue to go in terms of resources for women, we certainly we can talk about that, you know, when mothers are sad, we not we are concerned because maybe they’re not eating as well sleeping as well, we have resources that could help the same thing with you know, if you’re, if you’re breastfeeding, if you’re a lactation consultant, supporting a mom, and you have a suspicion that there may be depression, often, you know, it’s hard in postpartum or after the baby’s born, because depression can be caused by sleep deprivation, which mothers adjusting and that kind of thing, so, but if, if the sadness persist after three to four weeks or so then we may have an underlying depression. And, or the anxiety or mothers who are in the early postpartum, who are not hungry, is always like my antenna goes up, because there are not so many mothers who’ve given birth that are not hungry.
Maggie, RNC-OB 31:20
Right, right.
Dr Phyllis Sharps, PhD, RN 31:21
And, and so paying attention to those kinds of things, a lot of anxiety about the baby, you know, just kind of more than what you have experienced as kind of I don’t want to say normal, but, but things that make you alert, because often there are issues around partner relationships, and so having resources available in the community. And again, I would say, getting to know if there’s a shelter, or another type of support group for women that are in abusive relationships, getting to know those people and have them on your team, even in community settings. And, and having them come out either in conducting sessions, you know, for your your group in terms of what to look for, or what resources are available, how to talk to moms and get them in a safe space.
Maggie, RNC-OB 32:18
Yeah, yeah, I feel like it’s been observed there, too. And I’m sure you’ve seen this a lot in your work. I think sometimes when we have a disclosure, when we know someone is experiencing violence, we are that that piece, again, of like holding space versus trying to fix stuff that we’ve talked about a lot throughout the season, that piece of us comes up where we just want to like get them out of that situation, we want to move on. We also know though, that the vast majority of people who are experiencing violence Do not leave after the first time that they’re, you know, even once they disclose it, they’re not always ready for that. Is there anything else you can kind of share with us to help navigate that and support folks through that as they’re dealing with complicated relationships?
Dr Phyllis Sharps, PhD, RN 32:55
So So yeah, I think you said, important for those of us in health care, nurses, doctors, social workers, probably lose, we want to fix things. And I think you have to be caught in for domestic violence, people think that the fix is leading. And research says maybe not for someone. And that’s a circumstance that women often women get murdered in by partner in the act. So the way I have framed my work, is that I, let’s talk about ways to keep you safe, and keep the baby safe. And so I think instead of focusing on how I’m going to get you out of that situation, and fix that situation, because many, there are many reasons why women stay. And so that that’s the question also to think about, it may have to do with some really basic things like, you know, I need a place to live, I need food to eat. I mean, clearly, you know, those kinds of things. But, but what, but as you’ve said, many women will attempt to leave many times, and it may be on the sixth or seventh time that they’re successful. Often women make the decision about leaving when they come to the realization that this person could hurt my child will hold a different way. So, so talking about we talked about safety plans, and again, I don’t think that you know, necessarily as a nurse or doula like you don’t have to develop the safety plan, but you can think help women think about safety. And you can work with your community, folks, because they’re, you know, they they know they’re more adept at doing that but you know, things about are their weapons in the home. If you sometimes women can predict when when what’s might set the person off. So steer if you can steer away from having to physical fights and things in the kitchen in the bathrooms, or, because those are dangerous places, you know, if you fall in the bathroom and hit your head on the tub, that’s not so good. There’s knives in the kitchen. So just helping, you know, is there a place you could could go? How to manage your children? And, you know, even the youngest child is hearing and feeling and seeing what’s going on? So how do you manage that? Is there a place that they might go, you know, that kind of thing, how to keep them safe? If that’s, that’s important. And again, I think working with advocates and or social workers, even in community settings, will be helpful as people begin to think about that. So I think thinking about how to keep folks Safe is a way I have tried to manage what I do with that disclosing community settings.
Maggie, RNC-OB 35:58
Thank you. That’s so that’s a really helpful framework for moving forward that Well, I just so appreciate all the information you share with us. Is there anything else you want to share with our listeners, as we kind of close up this topic?
Unknown Speaker 36:11
You know, I think, from my own research with, which was a nurse home visitation program, called DOVE, which was an acronym for domestic violence, enhanced home visitation, I think the most important thing that we’ve learned, other than that the intervention
Maggie, RNC-OB 36:28
was, which is very important
Unknown Speaker 36:29
is talking to women and allowing them to tell their story. And and conveying that you believe them that you’re genuine. So the question is important, and over and over as well, you’ve worked with home visitors who often we’re very reluctant about asking, and it’s personal business, and that kind of thing, they really realize that in some ways, we may be further victimizing women when we don’t ask because we’re not giving them the option of being connected to resources, having them tell their story, affirming that, that you know you believe them, and that that should not happen to any woman and getting them connected to resources, whatever that is. And however, that can be done in a way that’s mutually honoring her and giving her power to make decisions, I think, is important. And it should be in our space when we are working with pregnant women.
Unknown Speaker 37:32
Oh, wow. Yeah. that’s so it’s just really powerful to remember the opportunity, we have to create space, like you said, one of it’s like, we have to create that space first before we can hold it. And so for those of us who feel hesitant to have those discussions with folks remembering that that actually creates an opportunity for them to connect more with us and to share their story.
Dr Phyllis Sharps, PhD, RN 37:55
This, I mean, I’ve talked to many, many witnesses in my career about that, and no one has ever gotten mad or angry at me for asking the question. So it has to do with us getting comfortable. And, and having a conversation. You know, I think certainly you don’t want to do it. Like I call it the screening checklist where you’re just running down questions and checking, but it’s you can have a conversation. And so that it feels feels like that it’s a normal part of what you do, and that you’re communicating interest in the ability to share if she chooses to do that.
Maggie, RNC-OB 38:32
Yeah. Yeah, that’s a that is. So we have a huge opportunity to, to assist folks with this and to support them on their journey and to help them create more safety and have healthier relationships. So I so appreciate you coming on and sharing all of that with us. Dr. Sharps, thank you so much.
Dr Phyllis Sharps, PhD, RN 38:53
Okay. It was fun.
Maggie, RNC-OB 38:57
For me too! Thank you.
Well, I am just so grateful for Dr. Sharps coming on and tackling this conversation with us. I know this is such a heavy topic. And it can be hard to think through these issues. I know that listening to them like this brings up personal experiences that we’ve had with intimate partner violence, it makes us think of loved ones, of our clients. And I hope this is an opportunity for you to double check the resources that you have available that you’re able to share with someone who comes into your care, be that community resources, the you know, organizations and individuals who are able to step up and support people who are experiencing violence. If you work for a health care organization, institution hospital, that you can take this as a reminder to make sure you all have a plan in place for someone discloses a history of violence or current violence and how you can support them and collaborate I still appreciate the nuance that Dr Sharps raised in this conversation as we think through what the resolution of intimate partner violence is, the options that are faced by those in our care, and all of the complexities that come along with the intersections of pregnancy, birth, postpartum and intimate partner violence. As always, we love to hear from you and understand more about your experiences, your concerns, your questions, the things that you have found helpful as you navigate similar situations. We would love to hear from you on social media, we are Your BIRTH Partners across all platforms. We’ll also be sharing information in our show notes about some you know, greater national organizations that will be available for anyone some basic fact sheets and information you can easily share with clients to to system as they build their safety plan. We’ll have all those linked up through our website and we are just so appreciative of you being here with us having these conversations and thinking more concretely about how you’re building inclusive, collaborative work communities rooted in autonomy, respect and equity. Till next time
052: Supporting Lactation Triumphs & Challenges
Maggie, RNC-OB 0:07
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth care communities, rooted in autonomy, respect, and equity. I’m your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back to the podcast. As we continue our series on holding space for the complicated, we are diving into all things infant feeding journey. And this is one of those ones that is way more complicated, or can be more complicated than a lot of people think or expect or hope for. And I think there has been so much discourse in the, you know, decade plus that I have been in the birth care arena, around how we talk about lactation, and you know, breast is best, fed is best, and there is so much more nuance to it than either of those adequately convey. And so I think it’s really important to dive into how we talk about this with clients, how you know, people who are pregnant and postpartum are thinking about their feeding journeys. And so to explore all of this with us, we have Naya Weber coming on who is an IBCLC. And we’ll be talking about how we hold space for lactation, the triumphs, the challenges and everything else that comes with it. So onto the show.
Oh, well, I am just really excited to dive into this topic around body feeding and how we support people on their feeding journey. So tonight, if you just want to tell us a little bit about yourself your work What brings you here?
Naya, IBCLC 1:50
Sure. My name is Naya Weber. I’m a board certified lactation consultant, and I live with my family in Austin, Texas. I’ve been an IBCLC for about four years now. But I’ve been supporting parents with their infant feeding for nine years, which sounds crazy when you say it out loud. But I’ve been doing this a while. It’s definitely something that I fell into just because of my own experiences. And I found learning about lactation to be just really, really incredible. Our bodies can do some incredible things, when we have the proper support and the proper tools in place to make it happen.
Maggie, RNC-OB 2:25
Yes, yeah, I think it’s so it is such a wonder just every time we learn more about I remember learning as a labor delivery nurse first about like the birth process and just learning about like conception and thinking like all of the things that have to go right. I’m always just wowed by like everything our body is actually capable of. And I think lactation gets, you know, there’s like complications to it’s this like very, you know, natural human experience. But that doesn’t mean that it’s easy. And I agree there’s so much to dive into there. So I’m really excited to have you on to talk about this.
Naya, IBCLC 2:56
Yeah, I’m happy to be here.
Maggie, RNC-OB 2:57
So we are doing this whole season is around holding space for challenges, complications that come up. And I’m wondering, we’re asking all of our guests to just tell us a bit what does it mean to you to hold space?
Naya, IBCLC 3:06
That’s a great question. For me, holding space usually means just listening to the family and validating their concerns and their experiences as a lactation consultant. Oh, one thing I forgot to add in my intro is I work outpatient. So I see families after they’ve been discharged from the hospital or birthing center, you know, not just that immediate postpartum period, but throughout the first year or even years of lactation. But as a lactation consultant, I’m often one of the first providers that has had a chance to sit down with the family after birth for an extended period of time. There’s a lot to squeeze in our visit. But I always try to leave some room to ask the family about what the pregnancy was like what the birth story was, like. Obviously, from a physiological perspective, the birth story can play a role in how lactation goes how it’s established. But parents often needs someone to just sit and listen to their perspective, whether they felt heard or listened to in the labor and delivery room. Whether the pregnancy was difficult or again, conception was really challenging. I’ve noticed that if pregnancy or birth or conception seem to be particularly challenging, some parents feel almost like an added pressure to me body feeding work. It’s almost like okay, this is the this is the one thing I can control after stuff that was really beyond my control. And I feel like that’s true to a point. But to get back to your original question, I think it’s just listening, validating and not trying to fix the problem, but letting the family feel their feelings and that includes partners and non birthing parents as well. Having to see, you know, your loved one go through something traumatic or seeing them in pain or complications, postpartum or post birth can be really traumatizing for partners as well. And obviously, if it gets to the point where there’s a lot of tears shed, it’s obvious that they’re not ready to talk about this yet, because that happens too. Sometimes, to stay within my scope of practice. I do typically do refer on to some great mental health providers, some great counselors that we have locally that that focus on this this really crucial period in a person’s life.
Maggie, RNC-OB 5:10
Oh, yeah, there’s so much there i, that piece of or parents feel that extra pressure than that, like, “Okay, if other things didn’t go smoothly, or the way that we had planned lactation is going to be the way” that like, they it’s almost like they’re this feeling of like redeeming your journey, right? Which is so human, obviously, like, that is such a real thing to try to, like we want to push through and have something that feels like better, but also, so just heavy on the other side of it, watching someone who’s already had perhaps a very traumatic birth experience, then put so much pressure on themselves, you know, it’s hard to try to hold that space and, you know, recognize and validate those feelings while also letting them know like, it’s really okay to if this also doesn’t go the way you plan, but we can work through that piece of it. What do you what do you find is helpful when you’re talking to clients who are having that because I think that is something that the vast majority of us, no matter what we where we practice and what our role is within birth, like, we see clients who are going through that.
Naya, IBCLC 6:10
yeah, I think it’s really helpful to remind them that goals can change. And to even if they have this goal of I’m going to exclusively body feed for six months, and then continue to 12 months with complimentary solid foods as as recommended by all of the different health care agencies, even if that doesn’t work out for whatever reason, just remind them that your goals can that their goals can change rather, and that my job is not to shame them into breastfeeding, and not to push them into doing something that they don’t want to do. But rather to support them in whatever their infant feeding journey looks like. I feel like that’s, that’s helpful for me to tell them. But it’s also helpful for me to tell me because obviously, I want that magic lactation wand to like “Bibbidi, bobbidi, boo” and fix, fix the latches and make milk magically appear. And so there’s definitely some hard days from work where I’m like, this mom is just trying so hard. And I am not sure what’s going on, or I’m not sure why we’re not seeing the kind of milk or things like that. And so it’s it’s definitely one of those things, where some days I come home and I tell my husband, I’m like, “Look, I need like an hour in the bedroom just alone, I need to decompress.” So I’ll scroll on my Instagram or social media or something like that decompress, and I’m like, “Okay, now I’m ready to mother and be a human and do all of the other stuff.”
Maggie, RNC-OB 7:34
Yeah, it is. I think it’s we’ve talked a lot through the season about this whole idea of holding space, and how hard it is to do that, when we’re also holding our own stuff. You know, like, we’re all we’re all real people on this side of it, you know, whatever kind of professional cap we’re wearing whatever role our role is, and being able to navigate that is like is tricky. And I think that leads into one of the big questions I’d had for you coming to this episode is if we could break down some of the nuance about the ways that we talk about infant feeding. So you know, there’s kind of this whole push towards breast is best, you know, that became like the big slogan. Yeah. And then there was a big push back to fed as best and I think there is way, way, way more nuance in both of those than then a catchy slogan can push. So I would love to hear… I have thoughts on this. But I would love to hear from you about how you kind of work that out. What what do you see is happening in that dynamic?
Naya, IBCLC 8:21
Yeah, I’ll be I’ll be honest, both of those phrases get under my skin for a multitude of reasons. I it’s exactly why you said feeding is so much more nuanced than something that’s catchy and rhymes. And I think, you know, the breast is best movement means well, and it meant well, but it definitely puts a lot of pressure on parents to exclusively breastfeed, chest feed, or pump. One of the things that I think it’s, I feel like it’s one of those well meaning things that expectant parents get put into their heads at some point during pregnancy, they’ll read it in a book or they’ll have a care provider mention it. But then if they’re not able to meet those goals, then they feel like failure if they’re not able to provide human milk for their baby for whatever reason. I think it’s also important to remind parents and talk through the fact that lactation doesn’t have to be all or nothing. It’s typically something that I talk through, especially after traumatic birth, if there’s a history of surgeries or for whatever reason, if goals are not met again and it goes back to just kind of re establishing those goals changing them up as you get further into the process. But to get back to your your question, I think you know, I feel very similarly about the fed is best movement obviously a fed baby is best; no one’s gonna argue against that. But the phrase really seems to dismiss the emotions around what happens when lactation doesn’t go as planned. It’s really easy for an outsider to say “Oh, well fed is best your your your baby is growing,” but it’s difficult for the milk making parent to truly believe that and I know that they believe it. They understand it on a very logical level, but I feel like on an emotional level, it’s challenging. It takes some time for them to wrap their head around that and there might be some anger, there might be some resentment, definitely disappointment and frustration around the way that their own journey went. As I said earlier, I also feel like my job as an ibclc is is not to force lactation on someone or to shame someone into breastfeeding, chest feeding your body feeding, I don’t think any decision is best unless it’s done so in an informed way. And that’s really my goal as a lactation consultants is to lay out all of the options for parents, let them choose what they feel like works best for their family and for their particular situation. And then support that I think any decisions made after that point deserve nothing but support. And I found, you know, in different lactation consultant forums and things, people saying that informed and supported is best. And I think that’s, that’s definitely the if I were to, if I were to whittle down what I do to one catchy slogan, it would be informed and supported as best whatever that looks like for the family,
Maggie, RNC-OB 11:01
Yeah, oh, I love informed and support as best it would be handy, if that was like, really cute and three letters and right. But the reality is that, like, that’s not, that’s not life, right, like, so what your birth care can’t be, like, some catchy slogan. And, you know, I think informed and suport were to covers that whole piece of it, you know, because no matter what way you choose to feed your baby, when you had to know like, what your options are, and we all need support, we need support in figuring out what bottles to give our baby, we need support and figuring out how to latch like that is, and that’s been for, you know, millennia, people have had support, obviously, now it looks different, because the way our families are structured, and you know, communities are set up that we have, you know, people who are particularly filling these roles for infant feeding, but we have always had support in doing that, that is not something that is some modern day concept, or some modern day failure that we need that like no, we all need that. One of the things too, that way, you said that I I’m thinking about how in I’ve worked, you know, around lactation for the last decade as a as a nurse, and an additional trainings and all that jazz. And I think one of the things that often comes up for staff who work in a hospital, when there is a push towards, okay, we need to get our, you know, initiation of lactation numbers up because there’s all this, you know, pushed from all of the healthcare organizations that just recognize that there are benefits to breast milk. But one of the things that comes up with that, like the staff, especially for the nurses who often do a lot of the heavy lifting around, you know, supporting lactation is that they feel like there is this intense pressure to get these numbers and that then they feel uncomfortable in the way that they’re talking to parents. And, you know, I know I’ve developed my ways, much like you were talking about in terms of just like, sure, we go in and say, “Hey, what was your goal in how we were feeding baby? Let’s just make sure we’re on the same page to start with. Okay, great.” And then as you know, issues come up or as challenges present, you know, right. We’re trying to work through that. But can you maybe speak to I know with when I was in a hospital to do like, Baby Friendly. And then now in Pennsylvania this thing very similar called Keystone 10. As you’re working those steps, staff has to meet all these metrics, which can feel very antithetical to like person centered care where we’re actually like addressing the person who’s in front of us. Can you speak to maybe how you kind of address or see some of those challenges play out?
Naya, IBCLC 13:20
Yeah, definitely. There are some families that I work with where again, they want to partially breastfeed or produce milk for their baby, parents may value sleep over overnight feeds and for that family, they want to use formula for those overnight feeds. Okay, let’s talk about how to make that happens. So oftentimes, I will hear them say, Well, I felt really pushed to do this. In the hospital, I felt really like I had to do this. And even though I didn’t really want to, or, you know, the lactation consultant of a nurse that supported me in the hospital, just kind of like shoved my baby onto my breast or chest. I didn’t really get a good sense of how to properly latch so sometimes it’s going back and almost having to have them unlearn what was told to them in the hospital and I never want to throw my my hospital colleagues under the bus. I know that they have numbers. And there’s like you said numbers and metrics that they need to hit and so many patients that they need to go through and see. And so I think part of what should happen in the hospital is helping families set up care once they’re discharged. So this way, if, if nipples are already clock cracking and bleeding, while they’re still inpatient, they can get support for that outpatient or if you know, there’s a concern about diaper output and things like that having support in place or even giving if it’s as simple as giving parents a list of local lactation consultants that they can reach out to. That’s doing most of the legwork for these parents that are exhausted, sleep deprived and healing from from birth. So I think setting setting them up for support, not even success, but setting them up for support once they’re discharged can really be helpful. I can’t speak a whole lot to to the number and metrics just because that’s that’s not my world. I don’t have a huge understanding of that. But I can absolutely say as someone who sees patients, when parents once they’ve been released, I see the frustration, I see that occasionally it’s making someone feel like crap instead of, you know, supporting them through through a really difficult first couple of days of life of their baby, and what should be, you know, kind of a special time of bonding and skin to skin and things like that can get overshadowed by all of these these feelings of inadequacy or feeling pressured to do something that they may not want to do.
Maggie, RNC-OB 15:35
Hmm, yeah, what are some of the I know, it’s always like, helpful for us to think through kind of like some scripts, some words in language, particularly that we can use to address those? Are there any you can share maybe how you would discuss that with a client, if they’re coming to you they have anxiety, perhaps about how their you know, feeding journey is going, how you kind of helped to parse out what what the right way to do it? And what kind of support they want?
Naya, IBCLC 15:58
Yeah, absolutely. So a couple of questions I always ask them is, and we talked about this at every visit, lactation issues, don’t always get solved with just one visit. So for follow up visits, we always talk through what their goals are. And so for that, first, that initial visit, it might be oh, I want to breastfeed my baby, for six months, at the follow up visit, it may be I want to go till three months. And then if there’s a third visit, it might be okay, I want to wean, and that’s fine. Let’s talk about how to do that safely. And so I definitely checking in with them, I always ask what their goals are. And then whenever we’ve come up with the feeding plan, I want to make sure that they’re comfortable with it. If it’s if it’s a lot, if it’s a triple feeding plan, for instance, where they’re putting baby to breast or chest, then pumping and then offering a supplement of pumped milk or formula. We’ve talked about how, you know, we’re gonna we’re doing this for the short term, we’re going to try and get away from it as soon as possible. And if for some reason, we’re not seeing the desired result of you know, baby being able to feed directly off the body. How can we how can we change that? How can we make it so that this is sustainable for you. And so making sure that the family is really comfortable with the care plan that they understand it, those are also things that I do. And the practice I’m with actually has a 24/7 number that that patients can call and clients can call, if they need support in between visits, if everything goes off the rails, when they get home, I always encourage them to call, we can move that follow up appointment up. But I think for me personally, it’s been just letting them know that there is support once they leave our office, it’s not like okay, I’ll see you in a week or I’ll see you in a couple of days, they they have someone that they can reach out to they have a place to call, they’ll have a lactation consultant, call them back and talk through whatever’s going on. And again, it sometimes it means bringing them in sooner, sometimes it means ending the journey. Sometimes it means modifying their plan. So maybe baby’s not getting quite as much human milk as they are formula. But the birthing parent gets to rest the partner gets to rest they get to enjoy their baby when they’re this tiny, and things like that.
Maggie, RNC-OB 18:00
Yeah, and that’s, you know, so that we put so much pressure on ourselves. And like, I think so many of us probably look back on those, just the early, very early first weeks of postpartum, when it should be all about just enjoying your baby getting to know this person who you you know, brought into the world. And how much of that time we end up instead, obsessively tracking our baby’s feeding and an app on our phone at 3am. As we’re waiting details to ourselves about their sleep or their feeding, like there’s, I don’t know how much of that is part of its, you know, personality, not everyone goes through that. But how much of that is like avoidable with like knowledge and understanding that like, okay, it is going to work out like there is going to be a plan and that, I guess filling that need for perfection as a parent, and I’m still very much on that journey. So several years and still working, you know, reformed perfectionist, I feel like that piece of it is like really present in feeding journeys.
Naya, IBCLC 18:54
Absolutely. I think a lot of times, especially for the clients that I have, you know, a half dozen visits with or see several times over the span of the first few months of baby’s life, I always tell them that we’ve made progress, and we do we we typically see progress at every visit. And that I think is a good way to remind parents about just parenting in general exactly what you said, parenting is all about progress over perfection. And sometimes that looks like baby having a more active feed at the body, or the parent being able to express more milk out, even if it’s not fixed in a couple of visits. If things are going in the right direction, then that’s progress. And these are steps towards their end goal, which again, they can change. They can move the goalposts if they want to that’s absolutely their right as parents.
Maggie, RNC-OB 19:37
Yeah, yeah. So when you’re supporting, you know, clients, they’ve come from the hospital. Are there certain gaps that you’re seeing that they that they wish had been addressed during, you know, their time whether that was you know, prenatally or you know, during birth postpartum? Yes,
Naya, IBCLC 19:53
Yes, for sure. There’s some things I wish that that body feeding parents would just kind of understand and know that it’s It’s normal. One is how frequently newborns feed. I feel like you can learn it in a class, you can read it in a book, but then when you’re in the throes of it, you’re like, how is this baby hungry again, and that, you know, just the first several weeks of life are really like one long growth spurt, and your baby is growing so quickly, I wish that that parents would know. I also feel like it’s helpful to kind of see the hard stuff that families go through on social media. Sometimes it feels like if I’m scrolling through my Instagram, sometimes it feels like we’re just bombarded by these images of parent and baby, peacefully nursing in a field like baby’s naked mom’s wearing a gorgeous flowy dress, where there’s freezers that are chock full of milk. But what people don’t often see that comes along with that is all of the work that that dyad has put into getting to that point. I will say for most people, body feeding does become effortless at some point. You don’t have to work as hard to it baby is able to latch independently. But I think it’s important that we focus on the journeys to get to that point, not only the part where everything seems to come easily and magically, I think that’s that’s one thing. I wish that that people would know. Also, I think explaining to people that body feeding just comes with a learning curve. It’s not something it’s, it’s natural. Absolutely. But it doesn’t come naturally to a lot of people. Somebody said at some point, body feeding is natural, like walking, not natural, like breathing. So it’s a it’s yeah, it’s definitely It takes skill, you have to practice and you’re learning your baby is learning. And even if the parent has done this before, it’s your learning together. It’s a different journey. It’s a different baby birth may have looked different, the pregnancy may have looked different, all of those things. So I think understanding that there’s a learning curve. And yes, there are definitely those unicorns out there who are able to just put baby to breast or chest that baby is able to latch magically milk supply comes in as as needed. And everything goes well, they never see a lactation consultant. I still remember after my oldest was born, he was a couple months old, and we went to go visit his my husband’s family in, in California. We brought we brought the baby with us, of course, everybody wanted to meet the baby. Sure. And so I remember, he was five months old. So he was still exclusively breastfed only on my milk. And I remember talking to my husband’s aunt and cousin about like, oh, we had all these issues. We were triple feeding. He was born a little early. And both of them were like, Well, I never had any of those issues. My babies were just born and I put them to the breast and they did great. And I’m like, good for you. And that’s that’s a really helpful feedback. I know right now it’s like, oh, okay, well, you know, not like that for everybody. So sometimes you do have those people that are like, Well, why is this in? And again, it’s just those Well, meaning family members loved ones that are just like, why is this so hard for you? And that’s that, I mean, just saying that out loud? I feel like my stomach just kind of gets all turn-y and not so great. Yeah, I know that they typically mean well, but I think just remembering that there’s a learning curve with it. And that that person that said that to you probably went through it too. It just time has erased all of those hard things. And a lot of those memories. So that’s, that’s something else that I wish that people would just kind of understand a little bit more or know about body feeding before they started it.
Maggie, RNC-OB 21:29
Yeah. Oh, those are all really good. I feel on that note, too, with families because I feel like there’s always a lot of there’s a lot of different family dynamics to work through between both, you know, maybe it’s probably a two part question. Because I think this is something that we see as you know, as birth workers on the side where, you know, primarily, our client is the birthing person, you know, but it’s not just them, inevitably, we are taking care of, you know, a whole family. So there there can be conflicting feelings on the partner. There can be different feelings from the grandparents, whoever else is kind of involved in taking care of baby. I feel like I see the one hand where there can be kind of like dismissive of experiences, dismissive, why they’re working so hard to something that should come naturally. I feel like that comes up. And then there’s the other piece of it, where, if anything, seems hard at all, then why are we bothering? Yes, thing? And I mean, I see it on a almost weekly basis at work where there is someone else in the room, not the person who is actually lactating, who feels like should we just call this what it is and switch over? And that’s not what the parent, not what, yeah, that’s not what the feeding parent wants. And so, what are some of the ways maybe if you have like tips for kind of working through that, and maybe like sussing out some of those issues?
Naya, IBCLC 24:43
Yeah, I definitely run into that. And again, it’s typically people are coming from a good place. I think that’s important for the person to remember that. They don’t want to see their loved one sad or upset or frustrated or spending all their time hooked up to a pump, things like that. But I think it’s also important for that the family member, not the not the milk making parent, but the family member to remember that this is not their journey. And their job is to support and sometimes that support means it kind of comes back to to what the podcast is about this season, it comes back to holding space and just letting be milk making parent, explain that this, this is so rewarding for me. But it’s so hard. And just listening and not trying to fix the problem necessarily. I feel like a lot of times loved ones, especially partners, typically, at least in my case, it was it was more my husband and anybody else was like, well, then we can just we can stop. You don’t have to do this. And I think it’s because he saw me in such a hard place. And it was coming from a good place. But I didn’t want my problem to be fixed. I just wanted someone to listen to me talk about how hard it is. So I think for the the family members, if anybody’s listening to this, and they’re going to be supporting a new parent with with infant feeding with body feeding, just remember that sometimes they want to be listened to and they want to be heard and they don’t necessarily want their issues to be fixed at that moment. And then something else that I think is not discussed a lot is that lactation doesn’t have to be all or nothing. I think typical postpartum care, maybe it’s our society has a way of making lactation sound like you have to give your baby only human milk or don’t do it at all. Like it’s not an all or nothing concept, I firmly believe that any amount of milk parent produces is beneficial in their baby’s development. And again, it’s exactly what you said, “Oh, well, it’s okay if you can’t body feed or breastfeed or breastfeed, just offer a bottle.”And I feel like there’s just so much more to it than that. It’s again, they just they want to feel heard they want they don’t want to be told to stop and offer a bottle. Instead, they just want someone to say you know what, “it sucks right now. It really does. But I see how hard you’re working. And I know that you really want to make this happen.” And so just providing some words of encouragement, and even reflecting back what that person has said to you and confided in you can be really, really validating in their experience. And it might be kind of the encouragement that they need. Even if it doesn’t seem like your typical like Go Team, you can do this kind of peppy stuff, it can really help a person that’s that’s in the throes of of lactation trying to make body feeding work, and is running into issues for whatever reason.
Maggie, RNC-OB 27:21
Oh, yeah, that’s also good. It comes back each time to that, right. You know, like the, the way that we typically learn to, to support someone is to fix it as a healthcare professional. And so being able to, like, tease out those moments where you’re allowed to just say, “This is really hard right now,” like, that doesn’t make you less doesn’t mean you’re not doing your job. That doesn’t mean that you’re like, admitting defeat or anything, it just means that you’re acknowledging like, wow, this is hard. I think we are quick, in our side, we’ve talked about this before, just about postpartum in general, we’re so quick to just try to make everything like smooth everything over, you know, like, oh, but the baby’s here, it’s it kind of goes along with the whole, like, healthy mom healthy baby narrative. You know, it’s just an extension of that where, postpartum each thing, we’re just like, “Oh, you’re looking terrible. Oh, you haven’t slept in yet. But look at the baby. So the baby is cute, like that’s, which is true. And you know, it’s both it’s both things are joyful, and wonderful and beautiful, and really friggin hard right now. Yeah, I think that’s something that we all can grow our capacity to hold that duality for those in our care to, like, be there with that space and not just trying to make it all, you know, toxic positivity stuff that I think just happens very easily. Yeah, this is, oh, this is like, also good. I could ask a million questions. Is there anything else I like that you want to share with us that, you know, you feel like everyone else like needs to know and understand about, you know, body feeding and lactation journeys?
Naya, IBCLC 28:51
Yeah, just a couple of things. And I talked about them a little bit already. I think just acknowledging that lactation goals may change and bodybuilding goals may change, it may look like initially, the parent wanted to put baby to body for as many feeds as possible. But for whatever reason, baby pumping feels better for them, having their partner help out or support people help out can definitely give parents a little bit more rest, it can help take some of the pressure off of that person, the milk making parent for sure. So I think understanding that lactation goals may change is a big one. And then I think the other one is to make sure that families understand that lactation isn’t all or nothing. There’s lots of room for discussion. There’s lots of room there’s lots of options for how you can feed your baby especially now. My oldest is 11 And I remember when he was born I didn’t obviously didn’t know nearly as much as I do now. What what got me to this point, but even just some of the the pumps that they have in the milk collect Oh, yeah. Now compared to what they had even a decade ago, I’m just like, “Man, this would have made my life so much easier.” If I could have had this and it just it didn’t exist at that time. So I think making sure that that parents understand that lactation isn’t all or nothing. Any milk that you provide your baby is a good thing is important. And then also just learn as much as you can while you’re pregnant. For parent, learn as much as you can, while you’re expecting baby, understand that things may change based on how birth goes and what what you decide after baby is born. Take that take the breastfeeding class, take the prenatal lactation class, it’s worth the investment. You’ll learn a lot about what you can expect in the first few days and weeks of life. And then I think for providers, it’s to make sure that they have the list of people of support, really, and it doesn’t just look like lactation consultants, it can be postpartum doulas, it can be mental health therapists, it can be pelvic floor therapist to depending on on what everything was like. So for providers, I think having a wide range of professionals that they can call in for support, if needed, is really important, too.
Maggie, RNC-OB 30:58
Yeah. Obviously, we’re all about, you know, collaborative care, and like, yeah, you know, owning our, our expertise, and then like being able to connect and refer around that. And I think that is like a huge, huge piece of of that to prepare clients ahead of like you said, I think you know, they’re certainly like, so great to be able to go to a class and get that information isn’t let’s just start with a baseline, everything isn’t going to make sense. Until you actually have the baby, like you said, you hear eight to 12 times a day for feeding or more. And you’re like, Okay, that sounds good. And you’re doing it you’re like, so it’s all the time somehow. Okay, right. You know, like, it’s just, you know, lived experience versus like the textbook, but I think like preparing them for that. And then starting like, like you said, certainly, like think through some of those things ahead of time. So you’re not trying to create an issue where there isn’t, but just recognizing like, Okay, this is our plan. We also know, like some challenges might come up, how how might that look, you know, like if you know, you’re someone who sleep is really important to you, and that you need a higher capacity for it. And you know that having a baby, there are obviously going to be some disruptions in your sleep, thinking through like, Okay, what’s the best way for us to handle that? Does that mean, I am going to just get up and you know, put the baby to my body? Am I gonna pump ahead of time? are we going to use some formula?” that like walking through some of those things ahead of time, so it doesn’t hit you when everything is already just like high emotions during the postpartum period. And like, everything feels just so intense, then, yeah, I think maybe having us as you know, as birth workers, whether that’s, you know, a physician or midwife prenatally, with a doula whoever is talking to them ahead of time, maybe bring some of those up about like, how are you planning on addressing some of the situations just so everything doesn’t feel so new? And like there’s so many things going on right now, if you already have like a little bit of a chance to think through some of that?
Naya, IBCLC 32:36
Yes, absolutely. I think planning for postpartum and that looks more than infant feeding again, just who’s gonna take care of the dog who’s going to walk the dog? Do you have meal trains in place for when baby is born and planning for postpartum? I think the way a lot of families will plan for birth is also important. I’m starting to see a shift, at least in maybe my very curated social media feed about people talking about this and how to plan for postpartum, even before birth happens. So everything from meals to household responsibilities, something I tell I tell my clients if I’m doing if I teach prenatal classes as well. So something I’ll tell them honestly, is plan for all of this stuff. If you can outsource anything, if it’s in the budget, outsource it, get a housekeeper do hello fresh, order takeout, you know, whatever you’re comfortable with doing. But planning for all of that will make life after you come home from the hospital or birthing center. So much easier. A lot of those things are taken care of.
Maggie, RNC-OB 33:34
Yes, yeah. I think there is so much that that preparation just helps us to for those of us who are kind of called to feel like everything has to be in a row and are maybe going to be more easily thrown off when things do not go smoothly. Having a little bit of a plan and something to fall back on. And having more of those support resources already kind of in mind can be really helpful. Yes, absolutely. Well, I thank you so much for coming on and having this conversation with us. Can you share with our listeners? What’s the best way for them to like, follow and find more of you on on the internet?
Naya, IBCLC 34:02
Yeah, you can find me on Instagram, my instagram handle is @ it’s more than milk. And then I have links to if you happen to be in the Austin area or beyond because I do telehealth too. And if you’re looking for lactation support, you can find all the links, how to work with me over in my bio. So yeah, you can follow me over at it’s more than milk. And it’s the same handle on Facebook as well.
Maggie, RNC-OB 34:25
Well, we will share those on the show notes too. And any other like resources that you have for folks to look into.
Naya, IBCLC 34:29
Yeah, absolutely. Thank you so much for having me on. Maggie. This was great.
Maggie, RNC-OB 34:33
Thank you so much.
Oh, that was just such a powerful conversation with Naya and I appreciate the different clips she shared with us. I know I will certainly be using the one about you know, feeding your baby being natural, like walking, not natural, like breathing. I think that is just such a helpful distinction. As you know, we’re just become more comfortable with our emotions. as parents and as we all work to hold space better, and to be able to acknowledge the parts of postpartum and parenting that are challenging where there are struggles where we need to adjust our plan. And so I hope you found this episode helpful as well as you love to go out there and support other folks on their lactation journey. We would love to hear from you give us a shout out on social media. We are Your BIRTH Partners across all platforms. And we will be sharing more resources and information from Naya in the show notes so you can look right there on our website. We hope you find this helpful. As you know, we all work to create more inclusive collaborative with your communities rooted in autonomy, respect and equity for next time.
053: Doulas: Collaborative Care & Advocacy
Doula-Collab, Advocacy #053
[00:00:00] Maggie, RNC-OB: Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive, collaborative birth care communities, rooted in autonomy, respect and equity. I’m your host, Maggie Runyon, labor and birth nurse educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care.
Welcome back to the podcast. As we continue our series around holding space, we are digging into what it looks like to hold space from the perspective of a doula. So, you know, I think this is one of the things that there has been so much talk about. What it means to hold space and scope of practice, quote unquote, and you know, all these things, all of these kind of rules that we try to put in place around what it means to show up as a birth worker and to [00:01:00] support your client.
And, you know, I think with, in that sometimes we lose sight about what does it mean to, to advocate as you hold space, how is holding space really an active, not a passive thing. And where are the, where are the rubs? Where are the, where are the parts where theis doesn’t fit into the birth care system narrative that you know, has been created.
So to really explore and dive into all of this, I have Traci Weafer coming on, who is a doula childbirth educator with more than two decades of experience supporting birthing people. And we’ll be diving into all the nuance around these relationships. What collaborative care looks like, or at least what we dream it could look like in the future, understanding that at times complex relationships between nurses and other hospital staff and doulas and working on our own stuff so that we can have collaborative care relationships that best support the birthing person and their needs. So I am excited to [00:02:00] bring you onto the show.
Well, welcome to the podcast, Traci. I am just so glad you are here and we’re going to get to dive a little bit more deeply into doulas and their roles as part of the overall birth team. And dive into some of the nuance beyond that relationship and how it comes across. So if you’ll just tell our audience a little bit about yourself and what brought you to this work.
[00:02:20] Traci, Doula: Oh, wow. So that makes my brain exploded every time somebody asked me about that. So I’ll keep it. I’ll try to keep it nice.
And thank you for this opportunity. I appreciate you. And I appreciate what you’re doing here. So I am a doula. I’m a childbirth educator. Um, I’m really just an all around consumer advocate in birth and. You know, just really diving into what it means for me and what my responsibility is in the birth room.
And even in prenatal, sometimes as far as being an advocate, I’m a evidence-based birth instructor and a spinning baby parent educators. So I just all around, you know, [00:03:00] birthy type person.
[00:03:02] Maggie, RNC-OB: Yeah. Oh, that’s a lot of hats and I think you were them all very well.. Yeah.
[00:03:06] Traci, Doula: Well, yeah.
[00:03:07] Maggie, RNC-OB: So thanks for coming on here. I will start off this whole season. We’re talking about holding space and what that means. So we were just asking all of our guests, first question, what does it mean to you to hold space?
[00:03:15] Traci, Doula: So for me to hold space means to listen and dive deeply and intimately into my client’s lives. I warned them pretty quickly that I can’t do my job well, unless I know them well, but that means.
And that means to separate myself from what they need. That means, you know, bias checks and making sure that. You know, emotionally and physically, I’m a hundred percent in order to do that. So holding space for me just means that I am a hundred percent, so I can be a hundred percent for them and their need and whatever that need is, which is going to be super individual, you know, different client.
[00:03:57] Maggie, RNC-OB: I want to pick up a thread from that you just touched on, [00:04:00] you know how that means you need to like, be aware of where you’re at. Can you speak a little bit to like how that has perhaps evolved in your practice or if that was always really present?
[00:04:08] Traci, Doula: Yeah. I mean, I think it’s always been present for sure, physically, for sure, because I have never, I have never, no, I’m not going to say never.
I, that was not a priority. Like the physical wellbeing was not necessarily a priority in my life, so. So stamina and all of that was, kind of, I was hit in the face pretty quickly with that. And then just the mental part and emotional part of not taking into account what I was, um, what I was getting ready to do, because, you know, I started out postpartum and then postpartum care.
And then I was a midwife assistant for six years. You know, I was in my comfort zone until I started doing hospital births and wow. That [00:05:00] was such a switch physically and emotionally. So, you know, mentally it it’s, uh, hit me pretty hard. Uh, so, you know, just taking responsibility and stepping back and saying, okay, what does this mean?
Getting really real with preparedness you know, on, on that side and then mentoring. So coming kind of full circle with that and trying to pass down as much as I can cause I’m, you know, we’re not going to be around forever, so we should pass this stuff down. We know it’s, it was evident that other people were kind of doing the same thing, but it was, you know, surprising to me that it was not being taught a lot in like trainings and, um, you know, a lot of organizations we’re not touching on the hard parts of, of this, they were just saying, Hey, let’s just go and do position changes. And, you know, not tell somebody that they might be up for 36 hours or so.
So yeah, that, that was. [00:06:00] Yeah, that was a rude awakening that I’m trying to help other, you know, newer doulas be aware of even before they commit to work, um, is just identifying what you really need to do for yourself before you can be present for your clients.
[00:06:17] Maggie, RNC-OB: Yeah, that’s beautiful. Absolutely. You know, one of the things, and I think you probably started touching it there. Where do you see gaps in the way the typical birth care system kind of acknowledges the role and power of doulas as members of the birth team?
[00:06:33] Traci, Doula: A gap that I, well, I see many, but, you know, I see a gap that I really see as far as all of us on the birth team. So you have, you know, you have your doula that was, you know, that was hired or chosen or picked or appointed.
And then you have, you know, your nurses are those who manage, um, most of the labors. And then you have your provider. That you know, that you’re collaborating with on the medical [00:07:00] side. And then there’s other kinds of obscure people around too. But I think the gap is not understanding each other’s profession so that we can work well together.
And, you know, back when I first like really started paying attention to, you know, advocacy and what my role responsibly was to my client to figure out communication and, and getting the team to jive a little bit better. I started like doula-ing, everyone. And I’ve thought to myself, I don’t, I don’t know a nurse’s job.
I don’t know the ins and outs of the pressures and the, the logistics and, you know, in, in all of these and all of these things. You know, going back to re you know, taking my personal responsibility, um, getting to know those professions helped me be a better doula, but what I’m not seeing is well, and I think it’s on both sides, you know, [00:08:00] nurses and providers.
I don’t necessarily, and I’m not saying all, but I would say for the majority are not, you know, they’re just coming in with a perspective of, oh, they’re a doula. And then they come with their own assumptions and biases or whatever, just because of rumors or maybe they didn’t work, work well with some. So there’s a wall that’s that’s built.
So the gap is assumptions, biases on both sides on both sides that, you know, because you have doulas over here that really believe that providers and hospitals and, and, and nurses should automatically do these things, but they’re not taking in consideration the mental, the physical, and the training part of who they are in, in a broken system.
And then, you know, and then the other side, you know, providers and nurses and, and all of those staff, people are not taking in consideration that the. [00:09:00] Birthing person has this extra support person or advocacy person that they should be paying attention to or learning their role so that they can collaborate with or work well with, for, you know, just focusing on the birthing person.
So that’s the, just the relationship gaps or the conversation gaps that I say, just because of everybody being frustrated and everybody thinking that the other person just needs to do. You know, do right. Whatever that means.
[00:09:34] Maggie, RNC-OB: Yeah. I really, without so much, I think, I mean that in a nutshell is why Your BIRTH Partners started, why this podcast exists is from, as a nurse, having those conversations with people and realizing that absolutely there are outliers, but most of us, we want, we want the birthing person to be happy.
We want the birth to go well, we want all of these things are ways of going about that can be very, very different in our approach. That can be very different. But [00:10:00] yeah. We often, I think, you know, we end up just so siloed that just like you’re saying people on any role within it get kind of stuck in their little rut and their assumptions and their biases.
And it’s hard to bust out of that. And a lot of that depends on like the culture that you run it, whether it’s, you know, the hospital unit you work on, or it’s the, kind of the, the group of community birth workers that you found, some of those make it very difficult to kind of like reach across the proverbial aisle.
And make relationships and create that it can become very antagonistic, which helps literally no one. And so I, that is a huge passion of mine is seeing like ways that we can improve that and have better dialogues across the disciplines. So we understand each other better and are able to like see the reality piece of it and get rid of some of those, like the preconceived notions, the kind of like comical almost charicatures that we create in our heads about what each of these roles do. So, Ooh, it’s a big one. I, you know, off of that, what do you think is. You know, maybe I feel like there’s a lot of nuance around [00:11:00] what scope of practice means for doulas. So could you maybe speak a little bit, and I know, you know, our audience spans perfectly across all these disciplines.
Can you speak maybe a little bit into like, kind of, what are some things that you’ve seen happen when people talk about scope and where it should be and what doulas should be doing?
[00:11:15] Traci, Doula: Oh man, you, you just opened the flood gates to scope. Wow. So, you know, foundationally. I think we need to go to the term and how it’s being used and how it’s being abused.
You know, the, the term scope is for licensed people, people who have licenses, you know, nurses have licensed, this is your scope. Don’t go out of it. And doctors too, w you know, lawyers too. So everybody that has a license has a scope. So the confusion is, is this dual is, do not have scope. And, you know, because we are not licensed, we are not regulated.
So in, in this conversation and it’s, you know, it’s because the only scope, if you will, that we have [00:12:00] is, you know, we don’t do anything clinical, you know, we don’t, we know all of these things, but we don’t do anything clinical. We don’t medically diagnose those kinds of things. So the abusive part that I see of the terminology of scope is when.
You know, when somebody wants to say that a doula is doing something wrong, they say, you know, stay in your scope, which, you know, what does that even mean in the grand scheme of things? So when, you know, when, when somebody doesn’t understand a doula’s job and they get frustrated with the doula, then they’re going to throw out.
The scope terminology. It’s just the suppressive narcissistic way of keeping the doulas in line, um, and gaslighting them into thinking that they’re doing something wrong. So there is a ton of confusion around, wow, what can I do? What can’t I do as a doula, but then you’ve got this power [00:13:00] structure of providers that don’t necessarily like doulas for all kinds of reasons.
And then nurses that are like, I don’t know, And their job. So we’re just going to kind of bully them, not even kind of sometimes bully them into thinking that they’re doing something wrong. So, you know, that’s where I see the whole line of, of scope, this abusive terminology that. That even doula organizations and doulas have used even in horizontal violence at times also, you know, we’re not supposed to be doing these things.
We’re supposed to be doing these things, but all of it’s a distraction, Maggie. I mean, all of this is just a distraction in, in not taking personal responsibility for ourselves. Period, you know, cause if we’re trying to attack somebody else and what they’re doing, then we’re not taking responsibility for our own stuff.
I could go for days on this.
[00:13:58] Maggie, RNC-OB: Yeah. That’s, it’s so interesting too. [00:14:00] Like, I think we’ve talked as, as a nurse to like scope of practice, like you said, it’s a legal term, you know, it’s not even something that like, we create us as nurses or physicians or midwives or anyone who has a license, you know, and it’s this whole, like, you know, what would a reasonable and prudent nurse, you know, you name it, do in this situation, which I think obviously, like there’s a huge range within that, but we try to make it very limited.
We want to put like walls around this. Yeah. Is much bigger than that. Uh, and like you said, I think that’s all, you know, we all have different personalities and different ways of existing in the world. But I think for people who thrive in well controlled environments where they feel like they understand the black and white way to do it, that makes them feel like, okay, I understand your role is the things you’re allowed to do.
Birth is not black and white. So. That inevitably we end up rubbing there because providers, nurses, and birth workers, anyone, you know, who has that, who wants things to just, okay, we just, you do this, you do that. And then it doesn’t work. [00:15:00] And so inevitably then they end up feeling like, well, someone here did something wrong, someone here did something outside of what they were supposed to do to make this all go.
Right. When it’s so much beyond any one person, you know? And I, I feel like that we’ve talked so much on the podcast about like that letting go of control is such a big part of holding space to, you know, like we have to be able to keep that, that piece of like, oh, that’s right. I have to like be here existing in this like responding and, you know, reacting and moving within the space.
But. I don’t get to just say, like, if you just do this, Tracy, then you’ll be a good doula. So then we’ll have a good birth and I’ll be going there. Like, that’s just not reality, and that’s like hard for us to still like people listening to me. Probably like, of course, that sounds silly. But so many of us operate.
We like, we fall into that kind of way of feeling like, okay, if I could just do this, right,
[00:15:48] Traci, Doula: the only, you know, scope. You know, again, you know, is the only scope of doula has with their client is, is what the, what the client and doula relationship is. And you [00:16:00] know, that, that’s what the breakdown that we, we said at the beginning was, you know, you know, nurses not understanding what a doulas job is as far as the relationship and is, you know, is there a threatening part of that, you know, Let’s let’s cancel out the animosity and let’s just all work together for the, for the good of the, you know, of the client.
And it might be, you know, just building that trust or it might be trying to break down some of this, you know, and, and you touched on it. What is a good Dilla? What’s a bad doula, you know, I hear. So much, you know, and well, I worked with some really good doulas. Well, what does that mean to you? Does that mean, you know, does that mean that you did all really work together for it through conversations, you know, with empathy and compassion and you got the job done?
As far as what was needed for the birthing person, or did that doula help you get that client to comply or was that doula really good at getting that [00:17:00] client to, you know, to breathe and to not freak out? You know, what does good even mean in the grand scheme of things? So we, so we have to go back to foundationally checking our bias.
When we talk about, you know, all of this stuff and. You know, it’s hard to, to do that when you’re going in fresh. And I think that that’s why doulas kind of gravitate to what their comfort zone is. Like. I’m only going to do home birth. I’m only going to do birthing center birth. So they shy away from a lot of these hospital births because they don’t know how to break down.
That animosity. If, if, you know, if that’s what’s happening or tension in the room, because you have to know how to do that, you, you have to know how to come in because we’re the ones that. Can do that. We’re the ones that can’t hold the majority of the space and the room hold space for the [00:18:00] client hold space for the nurse hold space for the provider, or whoever’s coming in into the room.
We have a pretty significant role in that we should be able to hold space for everybody, honestly.
[00:18:14] Maggie, RNC-OB: Um, Hmm. Yeah. It’s frustrating. How far away. We get from just approaching it like that. Absolutely doulas have like, you know, unique skill set and certainly most get like more kind of training and practice in like just the art of holding space of like that.
Yep. Here I am. I’m like supporting you in doing this, whereas so much of like training for nurses and other providers ends up being about the, the medical clinical kind of side of it. So we don’t get to emphasize as much on that, but it’s also like, The approach of all of us were thinking about that. Like if all of us just walked in feeling like, okay, right.
Because obviously as a nurse, I feel like part of my job is to hold space. So what if you were viewing that for like holistically, you know, it’s the whole space you’re holding that hold space. And if we were all doing that, like how different it would feel, because I [00:19:00] also feel like absolutely it’s wonderful when.
Doulas can come in and feel like they know, they know how to do that. They’ve honed some of those skills. They feel ready to like, okay, Hey, we’re going to ease in here. And like, you know, read the room, understand this whole, that still advocating for our client, working as a team with everyone. But it’s also not the job of the doula or the job of the birthing person to present themselves in a certain way that is acceptable to the hospital staff.
And so I also feel like obviously as us, as those of us who work in hospitals, where we understand the power dynamic. It’s way, way, way over to the hospital. And everyone included within the hospital. We have to do more of the work of being opening and accepting and, and having those conversations and whether that’s something you have in front of the birthing person, you asked to do it like step up for a second and just like, Hey, let’s talk through a couple of things.
I wanna understand that. And making it all feel, then I’ll have to be so clinical. Like we can just be humans as well and have those conversations again, like with the birthing person or without, depending on what you know is going on. Like, just to understand who else is in the role and like who the team is that we also need to [00:20:00] like extend the olive branch a little bit more to, to open up that space and create one that feeds.
That doesn’t feel antagonistic and it feels like we’re open to having discussions. So I think there’s plenty ….
[00:20:09] Traci, Doula: And I think that, you know, hospitals and, and nurse managers and, you know, clinical educators and all those people, you know, I think that they need to start reaching out to their Dillard communities and, you know, Hey, how can we work together?
How can we do workshops of just getting to know each other? And you know, it’s not about. And it’s not about certifications and it’s not about, it’s just about those that are out there serving their communities and coming in with these families and, you know, learning how to have organic conversations of, you know, Hey, tell me, tell me what’s going on.
You know, tell me your, your deal breakers. Tell me what I need to know about you. I mean, if we’re going to be trauma informed, we just need to be human informed. I feel like.
[00:20:59] Maggie, RNC-OB: [00:21:00] Yeah, there’s so much, we’ve talked obviously a lot about trauma informed care as, you know, holding space as a big piece of it, and it really, every time it comes down to like, just, just be human, like just try not to be, we don’t need to be robotic and clinical about the way we’re doing stuff and like going down the checklist.
Pause and put on your regular face and then like try that instead. I, I think too, there’s that piece in, because you know, I get it. Obviously I have been the nurse at, you’re just, you’re incredibly busy. You’re rushing from one thing to the next and things are not going smoothly for any number of reasons that are within an outside of your control.
And you’re finding yourself in like a situation where you’re trying to work with whoever it might be a provider, who’s got a different plan. It’s, you know, a birthing person who just, wow, like they’re wanting some things that are not standards the way you do things. And so you’re trying to figure out, like, how does this work with an, all the things that I feel like I’m supposed to be doing?
We take it personally. Maybe when these difficulties come up then in, in our flow. And so I’ve seen that a lot as [00:22:00] you know, with other nurses who are reflecting on the relationship with doulas, that they feel like what ends up coming? Like, well, it’s the doulas fault. Right? Right. You know, like the doulas being difficult, the doula is making this hard.
And so I think that’s one of the things too, that we have to be aware of. And absolutely maybe, I mean, maybe the doula is having a terrible day and they really are making things harder than it needs to be. Okay. Sure. That’s totally possible. But I think it’s about like also like taking a moment to like, reflect on like what’s going on with us.
Like, okay. Is it really about that? Or is about the fact that I have like two patients right now and really, I should have one because I can’t do my job taking care of both of them. Like, is it, you know, is it about like everything else that’s going on behind the scenes? I feel like so much stuff we talk about has to do with it’s changing the whole way that we, that we staff and attend birth and how we like look at that piece of it that helps us to work as a collaborative team.
Okay. And get past some of these issues, the rub.
[00:22:51] Traci, Doula: Yeah. And I think the deal is it’s just easy. It’s just easy to make the doula the scapegoat of, of, of all, you know, of all [00:23:00] tension are all things that are, that are happening because you know, that’s not a staff member, you know, that’s not somebody we can write up.
That’s not somebody that, um, you know, I can actually book, you know, it can’t, it can’t go to it. Somewhere, and it can’t stop with me. So I have, I can’t put it off on the birthing person, cause that would make me inhuman. Right. So I have, I have to get that, that oppressive waterfall to go somewhere and it’s, and it’s going to go to the doula, you know, which.
Which is that is so common. And it’s been through my 23 years, 23, 24 years of, of doing this work. And it’s always been that way. So if it’s always been that way and how can we break that? You know, we have to go back to definitely our biases and our own work and our own. Why am I thinking the way that we’re thinking in and you know, one of the workshops that I do, we absolutely go through.
Why do I feel the way that I feel? Why do I think [00:24:00] the way that I think, and you know, bias in itself is not bad? You know, I just want to throw that out there. We use that word is, you know, bias. You know, we want to run from it, but no, I mean, it’s an accountability word to me too. Understand where, why are we acting the way that we’re acting and why are we trying to blame anybody for anything let’s personally take responsibility.
And that’s just tough. You know, that that’s tough for all of us. I mean, we, we do have to recognize that we’re all trying to work. Within this system that was, you know, built for business and built on, on, on some, you know, really tough things that we’re trying to navigate. And we really just need to resign the fact that we’re doing that together.
Magnate. I mean, whether or not we like each other as irrelevant, right? I mean, I’m not here to make friends. I’ve met a lot of really great people. In the grand scheme of things, we are here for the birthing person for on my [00:25:00] side, on your side, you know, and we just need to come, you know, to, to this birth on that.
Hey, yes, we’re going to have a great jump today. So, and I say jump because, you know, Nemo comes to mind and, and Crush and you know, little guy and he’s like, Hey, we’re going to have a great jump today. And that’s how I approach every birth, whether or not. You know whether or not, I feel like there’s there’s tension or animosity in the room, or, I mean, I’m not like, I, I don’t feel like I’m, well-liked.
When I walk into a room every time I walked in a room, of course, you know, is still as well. A lot of times, you know, work with the same people over and over again. Um, but not every time, you know, especially with new nurses. So, you know, if, if we can just go in. Focused on that birthing person and the other side too, and [00:26:00] then saying, Hey, I don’t know you, but just have a clean slate every time I think is going to tear down some walls.
I mean, we can really do some amazing work if we just take responsibility for our stuff.
[00:26:14] Maggie, RNC-OB: And it’s that simple and that hard, right? Like, that’s right. That’s it. Let’s just go do it, like break in this. Yeah.
Yeah. Mm. I want to pick up a thread too. We’ve talked a lot about like an advocacy holding space. I think oftentimes the way we have learned to think about those words in like the birth space, we feel like they are at odds with each other.
Like you’re either. Holding this kind of mystical space as if you’re like almost an ethereal kind of creature holding the space, or you’re like being in there taking action advocating. Can you explain a little bit about how you see that working as your role as a doula?
[00:26:54] Traci, Doula: My philosophy, which is different from other doula philosophies. Um, because [00:27:00] there, you know, there are, you know, in the doula world, there are doulas who only do labor support and are only there for, you know, the kind of what we thought, you know, holding space was going to be at the beginning of, of doula dumb or, you know, when that construction that complex happened.
But then as we’ve grown through time, you know, the advocacy part. To me has been like fundamental because, you know, I was seeing that communication was breaking down and, you know, birthing people were not able to, to answer or speak or, or come out of there, you know, labor land, so to speak, to have conversation and even not.
Affected in their space. And so I, you know, I’m thinking, of course I need to be having conversation. Like this person has hired me to be with them to hold space for them, which means that they need me [00:28:00] to have conversations or relay information or other people say amplify their voice, you know, in that space.
So that they can labor, you know, or, or maybe they physically can not speak, um, because there’s a difference between personality and being non-confrontational and then trauma responses. And we have to be aware of those. Um, you know, so I think the breakdown of that. The system wasn’t or, you know, staff is, is, was not prepared for that.
And so when, when doulas were starting to come in and holding conversation and even being more vocal with their clients, you know, even having conversations in front of staff members, they were like, wow, wait, what? Like, you know, and that’s where the whole stay in your scope thing. I’ve heard the most.
We’re educators we’re this is the things we were supposed to do. So if the system is not [00:29:00] good at some things, which, you know, we can talk about informed consent or getting consent obtaining consent. First of all, forget if it’s informed or not just get it right. Just present the question. Um, You know, that was not happening.
And so when doulas were coming in and starting to do some of those things and advocacy, um, the advocacy word started or started being this cuss word of, oh, these are things that doulas are, you know, really should not be doing. But, but I feel like. That’s a foundational part of just good care. If, if a deal is there and holding space, that’s part of me holding that space is to make sure that all of those things are happening.
It was through really great conversations and, you know, I have a system and I know how to communicate well. And I think that that’s, some of it is, is knowing how to have organic conversations and it not being [00:30:00] necessarily a script, but understanding where the other person is coming from. With perspective and being able to hold those, those conversations.
But yeah, the advocacy word has definitely kind of titled waived the
[00:30:14] Maggie, RNC-OB: yeah. Yeah, it’s hard to like how advocate became like a, you know, a dirty word, like as if that’s not what all of us should be doing in any of our role in, within healthcare, within life. Right. You’re supporting someone else and not like part of that should be making sure that you’re advocating for their wishes.
And I think maybe that’s that like you’re advocating for them. You’re not advocating for yourself. And absolutely. We get tripped up on that. I know. I mean, many years ago as a new nurse, I started to like understand some of the ways that I felt like, oh, this is the way. Birth seems to like, go well when we do these things.
And so like, yes, if I could, if I could just get each person to tried this position or, you know, wait this long to do X, whatever, you know, like all of these ideas, it can be easy to like [00:31:00] push for that, whatever that means for you. Like, you know, someone who had a really traumatic birth and then felt so much better after they just got their epidural right away, they might see someone coming in, who’s showing discomfort and they’re like, let’s just get the epidural right now.
Cause then you won’t have that. You’re not going to have that feeling. These come up in all different ways for people who have all different kinds of like their own personal birth ideology. Right. But I feel like that can, I think that’s what people maybe shy away from part of that advocacy feeling. Is that feeling like, is this you talking as you, or is this you like helping to amplify that?
I see it happen with any role, you know, I firmly believe like the birthing person is the expert. In their life, in their care, in their birth, in their child’s care, like the whole way through, you know, but with so many others of us who are also experts in, in our work, in our field, there ends up being like rub there, maybe between those.
I don’t know if you could definitely see if you could speak to that piece of it a little bit and how you see navigating [00:32:00] those waters.
[00:32:01] Traci, Doula: So w I mean, for me, I have kind of developed this way of making sure that the nurse knows and is welcome on this team and, you know, Like really fundamentally just building it from the ground up.
As soon as I walk in the room and I never take advantage of nurses that I even have done births with over and over and over again, I do it every time, you know, I go in and I just build that, you know, crash the, the animosity, if it’s there, even if she doesn’t like me or doesn’t like doulas or whatever, it’s not gonna matter.
You know, we’re, we’re here for, for that birthing person, you know, and just making sure. That that’s there, you know, first and, you know, because speaking, you know, there’s so many doulas too, that are being trained, not to talk to staff or you don’t advocate. And I think that that’s just [00:33:00] a breakdown of, you know, of that’s what builds animosity.
That’s what, that’s, what happens. You know, if you don’t have the conversation, you know, nurses are feeling like there’s something secretive going on, you know, there’s something, you know, she’s not in the team. Decision-making process to, you know, she feels left out. She’s going to feel like her job’s not being valued.
Like she’s, I mean, she’s managing this birth. She’s the one that should be, you know, in this, in this process also. Um, so communication is like my key factor in an advocacy period. And. You know, definitely not me making these decisions. And I wish that that was kind of understood. Um, that’s kind of one of those oppressive abusive lines that I hear a lot is doula should not speak for, you know, I don’t have power of attorney.
I speak for them. So I, I, I wish [00:34:00] kind of those things would go away in a perfect world because that’s not what’s happening. So I feel like doulas have the pressure of having to build that trust foundationally also when they go into the birth room, which I think is, uh, actually unfair is the system or staff wants.
You know, the, the trust from us. So I feel like we should be risking reciprocated on that respect of the trust from, from them and, and understand that we are not making decisions. We, we are, we are conversation facilitators. We are, you know, we do know now, not all of us, of course, experience level. You know, very experienced, still is, do know what’s going on medically, you know, they do have like the evidence background.
They do understand, you know, the biomechanics of baby rotation and all of that kind of [00:35:00] stuff. So. To understand that. And to, you know, for, for me to facilitate, facilitate a conversation of saying, Hey, you know, this is kind of where we are. I’m hearing that this is medically what’s going on, you know, Hey, how do you feel about that is better than pulling out.
Something and saying, Hey, here’s the evidence. Can we look at, you know, can we look at this because I never want to question the knowledge or where a nurses in her experience or where she is too. So having those conversations, and honestly, I’m not a fan of saying, can you give us a minute? Can we talk. I’m not a fan of that.
I am a fan of everybody having conversation around the birthing person who was on the team and me facilitating that in a safe space still. So I will position myself in the room so that I’m holding space for my clients. So they feel safe, but that the staff person is also able [00:36:00] to say what they need to say.
Um, because. They’re the medical people that are managing their, their, this birth. There’s there’s no real reason why we can’t all have a organic conversation and get the needs met of, of the client. Now, is that always. As easy as I make it sound. Absolutely not, dude. Absolutely not. It takes practice. It takes time.
It takes experience and it takes all the, all the work that I was saying at the beginning to be able to do that. Um, you know, is the nurse always loving that? No, but I don’t care. I’m there for my clients. Um, and sometimes nurses will excuse themselves, you know, Hey, I’ll give you all this. Because they need a second, they need to step out.
Right. But, um, but I don’t separate that. You know, if, you know, if my client wants a second, that’s different, but I’m not somebody that’s going to [00:37:00] differ. I’m not a doula. That’s going to default to that to just stop the conversation. Um, I’m not going to do that. I feel like everybody. Everybody has a word.
That’s my foundational like philosophy on dealing with people. Everybody has a voice, everybody has worth. And that means the nurse. That means the provider. It might not always, we’re not going to not necessarily agree. And just because you’re in on this conversation, doesn’t mean my client’s gonna do what you ask do, but we’re going to have, we’re definitely going to have a conversation about.
[00:37:31] Maggie, RNC-OB: Yeah, I feel like that’s just, I mean, that’s so much of, like you said that whatever word we’re, you know, informed consent shared decision making any of these words we use, which I know anyone can have different feelings about them and what they mean, but mostly it means. The birthing person gets to make their decision because it is their body and they get type consent about, and that they understood the options that were available out there from all of the people who they have chosen to be part of their team, whether that is their doula, it’s their provider.
It’s anyone else who is involved in that? You know, I feel like there’s [00:38:00] so much of that, that we need to just keep remembering that like the plan of care, consent, like these are conversations. They are not always moments in time. You know, we want it to be this. Right. Boom, right there. Right. And I think it was, as we realized that that’s just not how it, that’s not how most of us make decisions in life.
[00:38:18] Traci, Doula: One of the, one of the, you know, one of the situations that I always bring up is, you know, yes, we can. We can stop the chaos or we can slow down what’s happening. Cause just like you said, these are moments and these are not just been been boom. You know, we, we want to say that they are, maybe they are when we don’t really know how to advocate, but if I see a nurse coming in the room and she’s heading towards some gloves that are sterile, then I’m going to automatically think that she’s getting ready to go into. my client’s body So I’m going to start that conversation before those gloves were even unfolded, you know, and I’m going to use names and I’m going to make eye contact with that in our song to say, Hey, it looks like you’re going to be doing whatever. Can you please explain, you know, stuff? [00:39:00] Because you know, you, you have this mode of I got to do a checklist. I’m being asked to go get the, you know, cervical stats, um, from, you know, managers or doctors or whatever. So there’s tunnel vision. So, you know, it’s not just about saying, Hey, Hey client, I see her going for the sterile gloves, which is what a lot of doulas, you know, are comfortable doing.
But what if that client is laboring to where she. Speak, she can’t have this conversation. We have got to know how to do it, and it’s okay to do that. And foundationally, I think, um, advocacy should include that and that’s not disempowering a client and that’s, you know, that that’s just what has to happen.
And I see it be very productive and very beneficial. Um, even with. I’m experiencing a provider that has never had conversation or never [00:40:00] felt like they owed a conversation to a doula. And of course, I’m just going to be that, um, very, uh, verbal doula that is, you know, Hey, what do you do in there? Hey, what’s going on?
You know, Hey, did you know, did they say that they wanted that because I haven’t really heard a consensual conversation and I’m not questioning their, their medical approach. At all. Um, you know, I’m just saying, Hey, can you kind of explain to me what’s, what’s going on. I’m curious. I would love to know why you, you are doing what you’re doing, you know, or whatever.
It’s just stopping the chaos. It’s just, you know, it’s just making sure that everybody is on the same page. And of course, you know, when things can get, have a lot of tension, then a doula in advocacy needs to know when, um, It’s escalated to where, you know, Medical things need to happen. [00:41:00] Medical things just need to happen.
Right. But you’ve already laid that foundation of expectation of care. And if you lay that expectation of foundation to care, to center your birthing person, then when it escalates, then you’re not going to have all of the. Wait, what are you doing? Are you consenting? Have you done this or have you done that?
Um, it’s just, it’s smooth. And of course your birth in person’s like, yeah, if anything’s wrong, let’s let’s go because the trust is there.
[00:41:28] Maggie, RNC-OB: Yeah. Yeah. I feel like it’s something that like, we talk so much, we think so much that we have like trust. Like if someone, I guess I think I’ve heard it in conversations on a unit where someone, a birthing person is not just automatically going along with whatever plan was suggested to them, you know?
And there’s this feeling of like, oh, well, why don’t they trust us? Right? Like they came here to the hospital, they, they were going to this doctor, what, what do they expect? What do they want? You know, I feel like so much of that is like, we have to. We just have to recognize it like, [00:42:00] oh, right. Like trust is earned.
Trust is built like, yes, absolutely. They picked you out of a, however many physicians and midwives, whatever providers that were available to have a baby in this area. But that also doesn’t mean that like you have them for every single thing that you think they should do. And I think it’s like that, you know, the, the patriarchal roots of medicine are strong in our training and how we, we learned to think about those in our care.
And I think those are things we have to like actively work to, to get rid of. And it doesn’t make us, you know, I think we’ve only had this conversations. People get very defensive. And I have to! Cause it’s hard to like confront the parts of yourself that you realize like, oh, that’s actually not a good thing.
So that like doesn’t feel good. But I think it’s realizing that like, oh right. Like they don’t automatically trust me just cause I’m a nurse here at the hospital. Like sure. They don’t necessarily, think I’m a bad person. And like, yeah, I guess they’ve been doing this for a while, whatever, but like, that doesn’t mean that they automatically need to just go along with whatever I’ve said. Cause, cause I met you five minutes ago and I’m your nurse this shift. So [00:43:00] here we go. Like that’s not, that’s not fair. That’s not a fair way to try to like establish relationships. So it has to be earned through these conversations through taking the time to pause and listen and, and that is hard work.
Like no one said that the job of being a birth worker in any of these roles providing birth care was easy. Right? No, it takes it’s, it’s hard work. It’s hard work physically and emotionally and mentally to establish rapport with folks to get through these conversations, to have these relationships, but it’s worth it to do it, but it is hard.
And so I think those of us who maybe think that it’s supposed to just be easy, if we could just get people to do it our way, and people would just listen or just trust us like that, isn’t that isn’t the work, you know, like that’s not, that’s not the way it is that it is best done. And that, you know, when we, when we act like that, We have these confrontations with staff, we have this animosity, we feel like people are just so difficult. Now everyone wants to do things a different way, you know, and we ended up taking all that and like creating this negative culture around it. Instead of just realizing like that it’s, it’s hard and worthwhile [00:44:00] work to establish these relationships, to talk through consent and that most of us like you’re an oven age, by the time you’re a birth worker you’ve learned to talk and do things at the same time.
So even in an emergency, you are able to, for the most part, if it’d be like the full lengthy explanation, but your. This is what’s happening. “Hey, I saw XYZ on the fetal monitor. This is what I’m concerned about. I would like to try to do this,” like, Ooh, that didn’t take that long. Was that five seconds, Tracy?
Not even like, it’s just that you don’t have to just plow through people, you know? And I think that’s where we just have to keep reminding ourselves that like, even when we are concerned about something, if we’re feeling activated by something that’s happening in that birthing process, like we need to be aware of that and then still keep connected by the breath.
Mm. Well, I could literally sit here and we could just have, keep having this conversation all day, but is there anything else you’d like to leave our audience with as we kind of wrap up?
[00:44:48] Traci, Doula: Oh, that’s a, that’s hard. Like, I don’t even know. Like I don’t, I don’t know. I, I think, you know, as far as advocacy and personal responsibility, you know, and just trying to focus [00:45:00] on, on the birthing person, do this again, honestly, but foundationally let’s think about.
Where we’re working and that system, you know, of all the isms let’s foundationally, think about that, you know, and then personal, personal work, you know, bias, work, mental work, physical work, being a hundred percent, making sure that all of that. Being taken care of because healing is a continuous process, all of, and even bias work, continuous process.
All of that is in check. Every time we go into a birth space with a birthing person surrounding our focus around them, you know, that’s actually my keeping your power workshop for, and that’s for everyone, making sure that we’re, we’re just having organic conversations coming out of the scripts and just talking and being honest.
About things so that [00:46:00] birthing people have a voice, first of all, a voice, and then to hear their voice and to, to, uh, know their worth. And so that trauma can just hit the floor and not even be a thing. And so that they’re psychologically whole coming out of the other side. We can, we can work very well as teams and change some lives.
And I’m saying it. It’s been fantastic. And, you know, that’s what I want. I want this to ripple and I want, you know, I want to, to, you know, rule the birthing room world with, you know, great teams. And I think that we can do that. Definitely.
[00:46:41] Maggie, RNC-OB: Yeah, we can. And it’s happening. It is, like you said, there are models of it.
It does work. It just takes time for everyone to. Examine what they need to do to change, to, to make that happen. Yeah. Well, thank you so much for taking the time to dig into this all with us. I really appreciate it.
[00:46:58] Traci, Doula: Absolutely appreciate it. [00:47:00]
[00:47:00] Maggie, RNC-OB: Oh, well, you know, this is one of those conversations that like almost every episode on the podcast, there is just so much more to dive in.
To really get into the meat of all this and to understand how this translates into practice. You know, I think some of the things that Traci had talked about today feel like, oh yeah, like good ideas. You know, that saying that like, wouldn’t that be nice? And I think the reality is understand that like, yes, it would be nice and it eats happening at places.
So if you finding yourself in a community, in a practice setting, That, this seems impossible that having these kinds of conversations with clients that having this sort of collaborative care relationships with other staff feels like it’s unachievable. That that is a reflection of the culture of your community, your unit, and does not reflect the possibility that exists within collaborative care.
And you know, so much this conversation together with Tracy. The goals and the mission of what want your workforce to be about. We [00:48:00] want to bring up conversations that hopefully you can then have in your community, as you can even explore this and see, how can we steams show up in your practice? What do you need to change to have this be a reality?
How do we better support folks and act as advocates? All of us, no matter what our role is within birth care, how do we constantly center the working person as the expert in their experience? Use our professional roles and our education and everything that we work for to support that and to help to inform their choices without making them for them or demanding that they do something in a certain way that best matched up with our birth aesthetic and.
That you enjoy, as we would love to hear from you about what struck you about this episode, what jumped out at you, you can reach us best on social media, where your birth partners across all platforms. And we would love to hear more about what you thought and you can reference the show notes. We’ll include some [00:49:00] extra leads for digging into more of this and the trainings I had Tracy mentioned.
She offers we are so excited to continue to create more inclusive, collaborative birthcare with you all rooted in autonomy, respect.