B.I.R.T.H.-Respected, Trusted, Heard #020

Part two of breaking down our motto: "Be.Inspired.Respected.Trusted.Heard."
How do we ensure birthing people are respected, trusted, & heard?
What does it mean to respect & trust birth?  What actions can we take so those in our care are actually heard?
What steps do we take when we're working within a healthcare system that doesn't seem to trust birth and makes it hard for birth pros to give the time and attention they need to hear each person & respect their wishes?

Transcript

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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!