Your BIRTH Partners

Community within Birth

January 27, 2020 Your BIRTH Partners Season 1 Episode 1
Your BIRTH Partners
Community within Birth
Chapters
Your BIRTH Partners
Community within Birth
Jan 27, 2020 Season 1 Episode 1
Your BIRTH Partners
Welcome to Your BIRTH Partners podcast!  Today you'll learn why we are committed to doing this work, and what we want this organization to mean for you.  You'll be introduced to our podcast team: Maggie Runyon [nurse], Pansay Tayo [doula], Ray Rachlin [certified professional midwife], Angela Mike [certified nurse midwife], and Abby Dennis [obstetrician].  We'll also have a chance to talk through what community means to us and how we want to see inter-professional relationships flourish in the birth world.

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

Show Notes Transcript
Welcome to Your BIRTH Partners podcast!  Today you'll learn why we are committed to doing this work, and what we want this organization to mean for you.  You'll be introduced to our podcast team: Maggie Runyon [nurse], Pansay Tayo [doula], Ray Rachlin [certified professional midwife], Angela Mike [certified nurse midwife], and Abby Dennis [obstetrician].  We'll also have a chance to talk through what community means to us and how we want to see inter-professional relationships flourish in the birth world.

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

Maggie Runyon, RNC-OB:   0:05
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:   0:39
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:   2:12
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:   3:05
That's beautiful. And what brought you to want to participate in this space?

Pansay Tayo, Doula:   3:09
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:   4:29
We're so glad you're here. Ray?

Ray Rachlin, CPM:   4:33
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:   5:01
What kind of brought you to this project?   

Ray Rachlin, CPM:   5:05
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:   6:32
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:   6:43
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:   8:27
Thank you so much. And, Abby, you can close us up!

Abby Dennis, MD:   8:29
My name is Abby Dennis. I am a physician practicing ob-g y n. 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:   10:36
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:   12:50
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:   14:42
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:   15:32
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:   18:16
Wonderful. And you, Pansay?

Pansay Tayo, Doula:   18:20
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:   20:16
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?

:   0:00


Abby Dennis, MD:   0:00
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:   0:00
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:   23:26
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:   29:14
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:   32:30
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:   33:17
That's right, that's right. That's why they won't see with the birth team, right? Absolutely. Yes, definitely.

Ray Rachlin, CPM:   33:24
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:   36:00
Yeah, I think you did.

Abby Dennis, MD:   36:01
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:   37:16
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:   37:29
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:   38:03
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:   0:00
No, it won't.

Ray Rachlin, CPM:   38:59
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:   39:27
I agree completely.

Angela Mike, CNM:   39:29
You guys are so smart, l love smart women; it makes me feel empowered.

Maggie Runyon, RNC-OB:   39:35
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:   40:50
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!