Your BIRTH Partners

Relating and Caring: Birth Pros & Clients

November 02, 2020 Your BIRTH Partners Season 2 Episode 8
Your BIRTH Partners
Relating and Caring: Birth Pros & Clients
Chapters
Your BIRTH Partners
Relating and Caring: Birth Pros & Clients
Nov 02, 2020 Season 2 Episode 8
Your BIRTH Partners

We are continuing our conversation this week with Irnise Williams JD, RN who joins Dr Abby Dennis, MD & Maggie Runyon, RNC-OB.  We're talking about the different dynamics of provider to patient/client relationships.
We're talking about why we struggle to have nuanced conversations around care decisions.
We're calling out the use of threats to coerce care choices.
We're identifying some of the complicated biases & the role racism plays in engaging with those in our care.
We're calling for change on individual & system levels to move towards a better way of being in #birthcare.

Support the show (https://www.paypal.me/yourbirthpartners)

Show Notes Transcript

We are continuing our conversation this week with Irnise Williams JD, RN who joins Dr Abby Dennis, MD & Maggie Runyon, RNC-OB.  We're talking about the different dynamics of provider to patient/client relationships.
We're talking about why we struggle to have nuanced conversations around care decisions.
We're calling out the use of threats to coerce care choices.
We're identifying some of the complicated biases & the role racism plays in engaging with those in our care.
We're calling for change on individual & system levels to move towards a better way of being in #birthcare.

Support the show (https://www.paypal.me/yourbirthpartners)

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!