Holding Space for Ourselves as Birthworkers #054

We spend so much time as birth workers thinking about how we can take better care of folks...yet so many of us do a downright abysmal job of taking care of ourselves!

Throughout this season we focused on how we can hold space for the complicated pieces of pregnancy birth and postpartum and so much of that attention has turned to how we can show up better for our clients.  AND while we're doing that we also need to show up better for ourselves.  No matter what our role within the birth care system whether we support folks in hospitals or out in the community-there is so much tension.  There is no time like the present to consider a new way to be in relationship with our community, with our clients, and with ourselves as we hold space for the complicated parts of being a birth worker.

I am thrilled to have Desirée Israel (she/her) on as a guest for this episode to guide this conversation. Desirée brings insights together from a wealth of experience as a birth worker herself along with being a psychotherapist and all around community leader, founder of Motherland Co. & co-founder of the Perinatal Mental Health Alliance for People of Color and The Bloom Collective.  Join us as she walks us through the ways that we can better hold space for ourselves.

Tune in as we discuss:

~the pressure of advocacy due to awareness of mistreatment in obstetrics

~connection and correlation between chronic health conditions and birth workers with vicarious trauma and burnout

~scheduling a routine of self-care practices

~how US healthcare systems need to adapt practices to better support workers

~establishing boundaries and navigating guilt as a caregiver 

~respecting client autonomy and releasing our own birth expectations

Transcript

[00:00:00] Maggie, RNC-OB: Oh, well, Desirée. I am just really thrilled to have you on here and to help us to close out this season of talking about holding space. So if you want to just tell our audience a little bit about yourself and your work, and what's brought you here.

[00:00:12] Desirée, LCSW-C, LICSW, CBS: Sure. I am a reproductive psychotherapist and certified breastfeeding specialist and herbalist, also trained doula who works primarily with people, preconception pregnancy to postpartum and also birth workers who are experiencing may experience burnout or secondary trauma vicarious trauma in doing this work. 

[00:00:35] Maggie, RNC-OB: And I am just so overwhelmed by all you do.

And all you have like created through your work and the community you've driven. So thank you so much for all it. I, you know, we're starting off asking all of our guests is tell us a little bit about what does holding space mean to you? 

[00:00:49] Desirée, LCSW-C, LICSW, CBS: So holding space can mean a lot of things, but for me, it's active listening.

And then as a clinician, you value silence. [00:01:00] So a lot of times in session. You think you want to fill this space with conversation and dialogue, and sometimes it's just paying attention to, what's not being said and not just even body language just, you know, respecting the space, respecting the silence and holding that space for the person that you're talking to.

[00:01:25] Maggie, RNC-OB: Hmm, that's beautiful. So we want to dive right into the deep part of this throughout this whole season we've been talking a lot about complicated pieces that come up in pregnancy birth postpartum as we're navigating those with our clients. And so we've had a lot about how can we show up better for them, but in this episode, I really want to talk about how do we show up better for ourselves.

So if you want to maybe speak a little bit to the work you've done with birth workers around like vicarious trauma. 

[00:01:51] Desirée, LCSW-C, LICSW, CBS: A lot of What I'm noticing is like in the beginning with sessions, it's a lot of venting. It's a lot of this is what happened in that [00:02:00] hospital setting. This is what happened at this birth.

And I can't believe that this doctor said this, and I couldn't say anything because I'm trying to give my client autonomy and they want to hold space in the best way that they can, but knowing that they can only do so much when it comes to advocating and, and making sure their clients have informed decisions and can advocate for themselves, but they're holding onto a lot because they see as the birth worker, they see the wrongdoing happening while the birthing person may think, you know, they had this perfect birthing experience.

When all this maybe obstetric violence happen microaggressions the way that people speak to them. And it's like, okay, but I had this healthy baby. Like, they just think about the outcome and. The birth workers, just sitting there with all this stuff from this birth and needing to process that. So that's what I'm typically seeing in sessions.

[00:02:58] Maggie, RNC-OB: Yeah. [00:03:00] Like there, since we've, I've seen a lot of like rhetoric on social media about the whole, like what is, what is like typical, what is common versus like, what is normal? You know, and I think we have, like, we have normalized so much of poor birthcare, to be Frank, you know, we've normalized, abusive power.

We've normalized this healthcare hierarchy, that doesn't honor birthing people as the experts of their care. And then for those of us who are opening our eyes to this who are aware of it, it is so jarring to witness it over and over and over again. And in some ways you were of course thrilled when your client is happy, but when they are totally fine and you're feeling wrecked by the birth, I feel like that's almost like it's this extra layer of confusion and doubt that comes into it in terms of what you're experiencing. Are there techniques you've used particularly like help people work through that? Is that something else that you've seen that piece where maybe as birth workers, even we feel like we're [00:04:00] having a very different experience of the birth than the birthing person.

So we're trying not to, you know, center ourselves, but then we walk away from the birth dealing with some heaviness of our own. 

[00:04:12] Desirée, LCSW-C, LICSW, CBS: Absolutely. It's, it's happening more than people realize. And as the birth worker, you know, you, you check in you, you do the, you do all these things for your client, but then who's checking in on you.

Because it's, it's a, it's a completely different experience. Even for the partner. There's a partner present at the birth. You know, that person is seeing the birth from a different vantage point as well. And then I have some birth workers that gives their clients like a written birth story. Like at this time you were at the centimeters and this effaced and then putting some details and you have to kind of revamp it to make it pretty for the birthing person to, so they feel like they were a part of that experience.

[00:05:00] So they were living the experience but to see it written in words like even that process for some birth workers is difficult because they're like, well, at this point, this nurse said this and it made my client feel this way, but they may have forgotten that in that process, it's a lot of masking. And not not being able to say the full truth, but just like, like I said, a lot of holding.

Which leads me to why in my program and the dissertation that I would like to do, the research that I would like to do on connection and correlation to chronic health conditions and birth workers with vicarious trauma and burnout. So we're seeing a lot of things.

Trauma is in the body. So even if you, as the birthworker are seeing a traumatic birth, you're holding that somewhere in your body. And if you don't release that, that could cause gastro issues that could cause [00:06:00] forms of cancer. Like there's, there's linkages to this in studies where, I give this example and people are like, whoa, I don't know if anyone watched the keepers on Netflix about some abuse that happened here in Baltimore at one of the high schools and one of the husbands of one of the women that was abused. He ended up with throat cancer and that was because in correlation to her speaking her truth to him, but her not wanting him to say anything to anyone. So imagine,holding that secret affected his health and he developed throat cancer from that. There are other correlations we're seeing lot of birth workers, midwives passing last 10 years. And for them to have been seen as the highest quality of healthcare, but they themselves are in poor health. So we really have to take care of ourselves. We have to have to let that out, whatever you're holding those bursts that you've attended traumatic and non-traumatic as well, you know, [00:07:00] let that out.

You have to have. 

[00:07:03] Maggie, RNC-OB: Hmm, that's so powerful. I am really excited for you to be able to like dive into that research because I think while we live it and experience that having the data, being able to pull all those cases together would hopefully help to change some of the ways that we are operating for folks who are very data driven, to be able to see it really spelled out for them to understand what's happening.

Because I think there is something like you said, I think whether you, you know, whether you're a community birth worker, whether you're in hospitals, Wherever you are being in the space that we are at right now with just the vitriol in birth care, how tense it is. I think even as you know, when in so many hospital birth settings, we're really taught to not trust birth, to not trust birthing people. So if you feel like you're going in every day, ready for a battle and thinking the worst thing in the worst thing is going to happen, everything is going to be so hard. There's going to be all these issues like that weighs on you [00:08:00] so much. And then if you're coming in with all this knowledge about the issues present in the MIC, how this is all playing out, you're also really tense about that.

So I feel like folks, no matter what your role is, Within, you know, across disciplines in birth care, you're feeling really tense and really activated, just walking into work most days. And that's, that's not a good way to live. That's obviously, that's, that's not like a healthy way to carry yourself all the time.

You know, just being blunt. What is the way through for this? Like how do we get from where we're at now to a place where birth workers, refroze don't feel that way. 

[00:08:34] Desirée, LCSW-C, LICSW, CBS: It starts with us. I have a doula friend. Who's very clear on boundaries of self care, Vanessa and you know, scheduling those appointments for yourself, whether it's chiropractic care, whether it's a massage, these things aren't luxury.

These things are necessary to move things out of the body. It's been proven and, and, and data and just history. [00:09:00] The benefits of chiropractic care massage therapists. Those things are vital. So whether it's on a monthly schedule for you a weekly schedule, bi-weekly just scheduling those things having health insurance, or if you don't have insurance having a holistic provider that you can see on a regular basis that you can save up for, through your births, having a consistent provider is, is necessary.

Cause we're seeing too many people coming up with all types of. Illnesses. And this, this is beyond COVID that are preventable. Like we know that maternal mortality is 50% preventable. These things that are happening to our bodies as birthworkers is preventable as well. So we're not taking care of ourselves.

We cannot help anyone else through, through birth postpartum or anything. And then also. The healthcare system paying attention to the work that not just their staff do, but birthworkers as well. There needs to be a better [00:10:00] relationship between birth workers and, and hospital systems. I know birth centers have, have a better relationship with birth workers.

But just even from my research, When we look at vicarious trauma and burnout, a lot of studies, most of the studies are not done in the U S they're done in other countries who pay attention to their health care workers. We do not do that. It's evident in our FMLA system, it's evident in our maternal maternity leave system, paternity leave system, parent leave system.

It's evident. So I'm hoping that, you know, the research that I've put out just Creates a path where this is talked about more but also us paying more attention to what's happening around us and, and our bodies. It's not just, oh, I have a headache or, oh, I have tension here. It's, it's deeper than that.

And we have to, you have to pay attention to that. 

[00:10:55] Maggie, RNC-OB: Yeah. You know, with all your conversations, there's always kind of like the personal responsibility piece that we can do in [00:11:00] terms of setting boundaries and taking care of ourselves. The big system piece where things need to change so that we have different, we'll all share in this unified scene.

Krysta Dancy, who's another trauma therapist and shared about like a research program that had been put into place in a hospital where they kind of, they totally changed how they were scheduling. They changed staffing. They were all trained like trauma therapy, like processing groups for staff after it were like they did a complete overhaul and in a NOT shocking turn of events...Everyone was feeling better, right? Mental, physical health was improved. Like it wasn't rocket science per se, but like taking care of ourselves as birth workers for hospital system to take care of the folks, like you said, both the people are employed by them and the community relationships with folks We need to completely change the way that We are looking at that hospital administration. And obviously because of the, just the impacts of COVID, obviously there's a firm eye on healthcare systems and how that's all working. And I can only hope that. All of the hardships that have been faced by that are at least getting some folks to pay attention at [00:12:00] at levels that they can impact change on these bigger administration levels, bigger healthcare systems that are going to start setting a new standard, because they're going to have to, because we're been pushed past the brink and it can't continue this way.

[00:12:13] Desirée, LCSW-C, LICSW, CBS: It, it cannot where we're so behind the U S is so behind. When you look at other countries that are doing more like human centered design wellness design, basically paying attention to their workers and, and creating space for rest. That's a big thing. We tell our clients to rest sleep. When the baby sleeps, we need to rest as well.

That's a whole nother conversation on sleep, but 

[00:12:38] Maggie, RNC-OB: Yeah. I feel like in all these conversations, we hear it. And we're like, oh yeah, of course I should take better care of myself. Yeah, I should. I should feel okay. Doing that. Can you maybe speak a little bit to how you would approach the conversation with someone who's feeling really hesitant still about doing that?

Like who's feeling so overwhelmed by the disaster. That is our birth care system. And so it feels really hard to [00:13:00] find those pockets of rest and not feel like you should be doing. Just a little bit more for someone else. First 

[00:13:07] Desirée, LCSW-C, LICSW, CBS: I find, I've encountered people like that. I find that those who are like that typically do not have a support system, not, not saying their family, I'm saying an outside support system of other birth workers that they can convene with, whether that's virtual in person, whatever. And that for them is rest in a sense, just being able to convene with other people with light experiences, kind of like a support group.

But it's, it's that camaraderie of support where, okay, I know that after this birth, or if I'm feeling overwhelmed, I can talk to these group of people or there's a phone tree of other birthworkers that I can talk to, and. Making that small of a change or adding that to their routine after birth can help immensely.[00:14:00]

[00:14:00] Maggie, RNC-OB: Yeah. Yeah. That's beautiful. I, you know, I want to see such a different way that we connect in community because everyone should have that. 

[00:14:08] Desirée, LCSW-C, LICSW, CBS: Absolutely. I have it! [

[00:14:09] Maggie, RNC-OB: laughter]everyone should have 

those people who they can, they can call and just say like this. Ridiculous. And whether you're looking for advice, you just want to vent and you just tell it, like, this is what I need.

I just need to speak to you as I drive home from this birth and get it all out. Yeah. It's so challenging when people don't have that. And I think, you know, and again, we see that across levels, no matter what your role is in birth. I think sometimes we, you know, we kind of malign physicians that as head of the hierarchy, they should be able to kind of line things up the way they want.

But there is so much that it's out of their control. As well as they're operating in these systems, as they're trying to get over training, that wasn't great that didn't prepare them for the reality of birth as they're trying to do this. And I think one of the things I've seen too, especially in that group is that there is the weight of so much responsibility.

It makes it really hard for them to. To reach out to folks and talk about things in a way that maybe feels [00:15:00] more available or more comfortable for those of us who fulfill different roles. And so I always just want to, like, I think as we talk about issues in birth care, it's about the whole system and our role in it.

And I want physicians to, we know at the same time, like one of the. hightest rates for suicide

[00:15:15] Desirée, LCSW-C, LICSW, CBS: I did not know that. 

[00:15:16] Maggie, RNC-OB: Yes. and I think it's, unfortunately they, they know the body well on an anatomy and physiology level, they know pharmacology well which is really heartbreaking on several different levels.

Wow. And so I, you know, I think is where like thinking through this, in terms of how we connect with each other, how we connect in community, how we connect, like across the way for each other. I just feel so much heaviness as we're watching, like what is happening in birth care right 

now? 

Absolutely. It's extremely 

[00:15:47] Desirée, LCSW-C, LICSW, CBS: heavy.

It's hard work even as a therapist and I'm preaching to the choir. I'm preaching to myself when I say, you know, take care of yourself, boundaries, self care. Cause even I have a difficult time doing that sometimes, but I, I [00:16:00] have my community of people that reel me in that, you know, Hey, Des, you've been working a lot.

You should probably schedule that massage or keep it on Auto schedule or anything 

[00:16:13] Maggie, RNC-OB: don't leave before you book the next one. Right? 

[00:16:16] Desirée, LCSW-C, LICSW, CBS: So yeah, it's heavy. We do some heavy work as far as your 

trauma. 

[00:16:23] Maggie, RNC-OB: Yeah, absolutely. I think, you know, like you said, I think I've definitely found in each of the places I've worked, the people who I can relate with who we.

Talk to afterwards. And I feel like that makes a huge difference. I also feel though a big piece. So I've been a nurse for, 10, 11 years now in the birth arena. And it's been a huge journey. There are lots of Hills and valleys there in terms of trying to figure out like, wow, can I do this work?

I love being a nurse, but gosh, I am in the system that is challenging and that is not set up in many ways to be supportive of me, of [00:17:00] birthing , people of anyone else's in that. And so I feel like there's this whole piece that like each time you were involved in a traumatic birth, each time you witnessed something that, you know, does not have to go this way.

It, it adds up layer by layer, by layer. And it makes it really heavy to like, okay, so we're going to go back and do this again. And just like you said, at the beginning, you know, as soon as you have to just vent and say like, I, I didn't know what to do. I felt like my hands were tied so-and-so was saying this or, and it, whether that could be the providers making a decision you don't agree with me.

Maybe it's the birthing person. Who's doing something that you think like, oh, it's, that's your autonomy. Your, you get to choose. I'm worried about how this is going to play out. Like it goes across everyone who involved in it. Like, I think oftentimes as nurses, we feel like we're, we're kind of there holding that space for everyone.

we're part of the hospital system. We often are billed as like the helper for the provider. Who's like putting into place, whatever they want. But most of us, like, we feel a deep sense of responsibility to. Our patient to the birthing person to honor that. And so there is a huge rub that comes between like balancing all of that.

So I absolutely agree with you. I think that like [00:18:00] having community, having people you can vent to afterwards, having people who, and I've done it many times who you call crying after a shift, you just say like, this was, I didn't know what to do. And sometimes you're asking like, well, is there something different I could do?

And can you tell me that? And sometimes there is, and sometimes you're just like, Yeah, it just sucked. Cause sometimes, you know, life does. I feel like that is one of the reasons I wanted to like wrap up this season, having this conversation with you is because I think there is so much, there's so much heaviness.

We care for ourselves. And we typically, as a lot of the folks who get involved in birth, we have the personality types where we are we're givers, we're, you know, the supportive people where the people who like helping people and we tend to be much better at supporting other people than supporting ourselves.

And so as we've turned our attention to all of these, like really intense. Issues in this season. I want to make sure we're wrapping up with people, knowing like you are worthy of being cared for yourself too. And like, sometimes that means stepping into heart and sometimes it means stepping back. 

You said it, stepping 

[00:18:57] Desirée, LCSW-C, LICSW, CBS: back, I think, and that's difficult for [00:19:00] some people stepping back, letting someone.

Either take care of you or just letting someone else handle something. Even when it comes to home life where if we're too overwhelmed and if we have the funds outsourcing things, outsourcing laundry, outsourcing housekeeping, cause a lot of, a lot of birth workers I know are mothers themselves and it's hard to, to balance it all.

So that, that is taken care of yourself as well. That that should not come with any type of mom guilt, any type of guilt whatsoever, because you are, you are still taking care of yourself. Mm. 

[00:19:36] Maggie, RNC-OB: Yeah, I think there's so much, there's only just get, we carry their about like what our, what our roles, what our rules are and how we're allowed to like, show up for our family.

What counts, you know, in, in whoever's keeping track of, our parent points, you know, The whole thing's made up, but we, we, you know, it's ingrained. Like, we take that very seriously. So I appreciate you saying that too. Like all of those [00:20:00] things, like it's not selfish. It really isn't. It's okay. It is 

[00:20:05] Desirée, LCSW-C, LICSW, CBS: not, I love, I love Instacart because they'll, after you do an order, like you saved four hours by Doing your order, three, four hours.

What could I have done with those four hours if I was grocery shopping? 

[00:20:21] Maggie, RNC-OB: Yeah, I think valuing our time, you know, like everything else we can make up time is like the one thing we can't, we can't make more time. Theoretically, you can make more money. You can, you can make more like lots of other stuff, but you can't make more time.

And so like, thinking about how you're using that, how I don't know if there's, if you could touch on a little bit, maybe of as we work through this, as we're trying to like bring trauma-informed care into every care interaction as we're treating all of this, like sometimes despite our best efforts, even when everyone involved in the birth has done everything possible to try to set them up for success, we have a difficult outcome. We have an unplanned, a negative outcome. Do you have like some tips and tricks that you [00:21:00] used with birthworkers to help birth kind of move through that when they're dealing with just really intense situations from birth

[00:21:07] Desirée, LCSW-C, LICSW, CBS: One therapy, not just with myself, but cause I, I do see people just, I have a lot of birthworker friends, period. So those that I don't see in therapy as always suggest therapy to other birth workers

[00:21:22] Maggie, RNC-OB: there's so many things we do to set ourselves up. We take, we take the classes, we do the extra courses. We do our own work. You know, we do the therapy, we're involved in this and then dealing with the heaviness of a job like this, where sometimes.

I don't want to say your best. Isn't good enough because that's not it, but it feels like, it feels like you did everything possible 

[00:21:42] Desirée, LCSW-C, LICSW, CBS: and some you have to be okay with that. I think it's, it goes back to the guilt piece. Because autonomy is difficult.

You're trying your best to have your clients be empowered. But you will, [00:22:00] you are still a professional and you know, your stuff. So it's like, you can only push the limit so much. And without it feeling like that, person's being forced to do something or controlled and no one likes that. And. I say and I've said this to a client, when you see something, say something and it doesn't have to be in a way where you're taking control of the situation.

It's, reframing it for your client, like for them to understand. And it makes it seem like they're making the decision themselves. Especially if you can explain it in a way where they understand? It, autonomy is extremely difficult, but it, it comes with so much more than we expect. 

[00:22:43] Maggie, RNC-OB: Yeah.

Yeah. Oh, I feel like my like belief in autonomy has definitely been like challenged the past few years. It was trying to figure out like, how does this work? Like I do. That's like a core belief of mine is that people get to choose, make their own choices about their body and what they do, you know? But like you said, sometimes that, that doesn't mean I agree[00:23:00] but it's still, their choice.

I still have to respect it. Mm mm. I'm challenging. Well, is there anything else you want to leave our audience with as we wrap up this conversation? 

[00:23:12] Desirée, LCSW-C, LICSW, CBS: Well, we're talking about self-care boundaries taking care of ourselves as birthworkers starting next month. Vanessa, the doula I mentioned and myself, we'll be hosting aids support group.

For birth workers. Yes. These issues, whether it be just venting things that they see at births Even with a birth workers that have dealt with pregnancy loss with their clients and infant loss with their clients. That's not talked about enough at all. We talk about it with the client, but not with the birth worker that is experiencing that as well.

Even postpartum doulas, seeing things in the home that, you know, we talk about autonomy, seeing things in the home where you're, when you could only put so much. I know that me as a social worker, I'm a mandated reporter. So there are certain things that I see that, you know, [00:24:00] yes, I have to report, but as, as a birth worker, what does that look like?

And then just holding space for yourself and holding space for each other. So that support group will be starting next month in January. So yeah, we were excited were still in the, in the development stages. We don't have a start date yet. But it will be forthcoming. So I'm excited for that.

[00:24:18] Maggie, RNC-OB: Fantastic. 

We'll definitely include that information in our show notes and everything is very get announced. People can follow along with that. 

[00:24:22] Desirée, LCSW-C, LICSW, CBS: I keep saying Vanessa, Vanessa Hannibal, she's a doula and an BCLC in the Washington DC area. So I'm excited to be working with her. 

[00:24:31] Maggie, RNC-OB: Oh, that sounds fantastic. Well, that sounds like you all are bringing.

All of these sides of birth work together. So that's beautiful. Well, thank you so much for coming on and having this conversation and digging into a little bit about how we can show up better for ourselves. This work. I really appreciate.