Birth Nurses: Unique Position & Power #044

In this episode we are exploring more of the dynamics that govern labor and birth nurses.  Special guests Paula Richards of NurseBrownGirl & Mandy Irby of The Birth Nurse join Maggie to breakdown some of the challenges we face in the day to day reality of delivering perinatal care that does not always match up with the impact we want to have as nurses.

We discuss:
~What it means for us to hold space...and how we found our way there
~Discrepancy between vision, training, and practice
~How productivity and outcomes are valued over patient experience
~Role of mentors in questioning the status quo
~The repercussions of centering pathology instead of physiology in OB nursing
~How nursing power is subverted
~Our vision for learning to harness nursing power to amplify the power of birthing people

We also introduce the new Trauma-Informed Birth Nurse Program, which is a deep-dive into how perinatal nurses can show up better for all of their patients by grounding their everyday practice in trauma-informed care.  Find out more about the program and its first offering starting October 20th.

Transcript

Maggie, RNC-OB  0:06  
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth care communities, rooted in autonomy, respect and equity. I'm your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care. 

Hey, y'all, welcome back to the podcast. So we are continuing our series on holding space through the complicated. And when I was considering different topics for this, one of the ones I knew I wanted to dive into was how we as professionals hold space through the everyday and I thought about how, as a nurse, this was something I really had to actively cultivate. And I didn't necessarily find that it came up explicitly in my kind of official professional training as a nurse or orienting on units. There is a piece of nursing culture that is often focused on still that kind of antiquated, handmaiden role, where we're there to be helpers and to get stuff done more quickly, and to make sure that the providers have everything going smoothly for them, which is fine. But I really feel that nurses have a unique power and position in hospital birth. And I think it's really important for us to dive into some of the ways that we can use that power and that opportunity to hold space, to create moments where we are more tuned into the person who is in our care. And if we don't do that, otherwise, we're just contributing to the harm that is often within our modern birth care system. And this is something that I've been thinking and talking a lot about recently with two friends and colleagues, Mandy Irby and Paul Richards, and I am just thrilled to have them come on the show and share their perspectives and their experience as we explore the roles of nurses in holding space and creating a future of better birth care. On to the show!

Oh, I am just so excited to have two of my favorite labor and birth nurses on today to dive into everything around power and positions and holding space as nurses. So Mandy and Paula, if you would like to just tell us a little bit about yourselves and kind of where you're at in this work. That'd be great.

Mandy, RNC-OB  2:27  
Hey, Maggie, thanks so much. I'm Mandy Irby and online I'm The Birth Nurse. I'm a labor and delivery nurse as well and and nurse and parent educator and also a trauma informed birth strategist. And hey, hey, friend. Hey, Maggie. Hey, great to be back. Thanks. Thanks for the invite.

Paula, RNC-OB  2:49  
Hi, guys. I'm Paula Richards. I guess again on the internet, you can find me at Nurse Brown Girl on Instagram. I'm a labor and delivery nurse as well and nurse educator. That's about it. 

Maggie, RNC-OB  3:02  
Well, there's a lot more than that, but I'll let you get away with that for now. So I have these two fabulous nursing educators on here. And I want to start out this whole season we're talking about holding space through the complicated and so we're actually asking each of our guests if you could just tell us what does it mean for you to hold space as a nurse? Get in there Paula!

Paula, RNC-OB  3:20  
Okay, I was gonna say leave it to me to not know how to answer the very first question that's like super important right? It's the kind of thing where that even that phrase holding space is something that I've been familiar for quite some time and not not to sound like a doofus, but it feels kind of like a vibe, right? And so being a vibe it's you know, how does how is that defined? I was gonna use that term in a class of primarily nurses and the person that I was collaborating with actually put me on the spot analysts like "Dude, not everybody knows what that means. So I'm gonna need you to break that down." So I guess to me, like without, you know, cheating and looking at notes and being beyond like, I think I've defined it before, off the cuff, I would describe holding space as presence or presencing another human. And as a labor nurse, holding space means being present for an individual patient or you know, maybe it's the whole family unit through that birth process and transition from you know, maybe a family with no children or family with, you know, a few kids to like, what a family with more kids looks like, right? Because those dynamics are always changing. So yeah, it's kind of being present for them and meeting people where they are in that capacity. 

Mandy, RNC-OB  4:50  
Oh, I like that, Paula. I also like it's a vibe, because I think it is a vibe, but I think when you say it's a vibe, I feel like Maybe I'm not in. I'm not in the know, am I doing it right? I'm not. I'm too old for a vibe. But a vibe is like, Oh, wait. I think it a vibe give space for everyone's unique, one way of holding space and two person you're holding space for.  And with a little bit of background, Paula and I are friends. Well, we're all three friends outside of this recording. I think Paula, you and I have been practicing holding space for each other incredibly intentionally recently. And it's opened up my understanding of what holding space for me means. And I think that's helped me have a better understanding of holding space, how I can do that for others and show up for others. But it is kind of something that I've been learning outside of the hospital and outside of my labor and delivery nurse role. And then bringing it back to the bedside when I was at the bedside, was challenging. And not everyone knew what that meant. They thought it was like a vibe, 

Paula, RNC-OB  6:14  
some "witchy woo,"

Mandy, RNC-OB  6:16  
yeah, some woo, right? Exactly. Woo. But it really was just being curious, and confident not confident, but comfortable with whatever came up. So whatever came up in that person's journey, whatever information they disclose, to me, this is holding space for my patient, assuming there's one, even though the room is kind of the whole, another vibe, right? Yeah, family, the family, right? whomever they've brought, whomever they're wishing was there, you're kind of getting curious and comfortable with whatever comes up, which is, I think, I think kind of like lame compared to all of the going and running and pseudo emergencies slash real emergencies that go on in our work. But the holding space part felt really challenging for me, because I had to be I had to be still and quiet, to allow for all of that uniqueness to unfold instead of interjecting any sort of plan or feeling into it.

Paula, RNC-OB  7:17  
I call those like the factory settings, right?

Maggie, RNC-OB  7:22  
Yeah, sure. I find it interesting to like both of you as you're talking through it. I feel like for listeners, we think like, of course, like that feels very a part of nursing, right like that. You're just you're sure you're being present with someone, you're there at the bedside, you're like taking it all in. But I think there's a huge discrepancy between that as like a vision and maybe even how we thought we would be as nurses going into nursing school. And then like, how we learn to be nurses? I feel like maybe we have some theory classes early on, in, like nursing education that we learn about, like, Oh, yes, this idea of like nurses role, you know, within the patient's lives. And then, so much of our, like, nursing training, and so much of nurse residencies and, you know, getting on the unit and orientation is really focused on those like, kind of hard skills and giving medications correctly. And that's important. And understanding the policies, and you know, all of those things, they matter, too. But I feel like we get pretty far removed from kind of that baseline of just being there with someone and then responding how they like with what they need in that moment. And I don't know if you could speak a little bit about like, Where do you think you have learned best how to cultivate this idea of holding space for people, and maybe it came up for you in your, you know, in your more formal education than it did for me?

Mandy, RNC-OB  8:44  
Well, where did it come up for you?

Maggie, RNC-OB  8:47  
So...Mandy, you trickster! [laughter]

I mean, I can answer first is that no, that's good. Yeah. So I know, I came into holding space more as I was, I mean, it wasn't that it was it wasn't non existent in my life up till the end. And you know, it came up in nursing school, I think in probably, maybe not using those exact words. But certainly that idea of it is very much a part of who I want to be as a nurse, how I want to show up, but I don't think it was until I was out of college and had been a nurse for a couple years and was trying to get involved more in like community spaces and sitting in circle with people and holding that and then as I went into my Master's in nursing education, I was involved in like circle leadership and how that works from faculty show so I think it got me started on that road more about like, Oh, yes, holding space has its own full thing. You know, like that is, that is enough. But I don't think I recognized it was enough. And I think it's doesn't it's hard for me, we were talking earlier before recording about like enneagram types and all that and I'm very much a helper a type two. And it is hard for me to hold space for people. When there's a like piece of me that desperately wants to help and there's part of me that has to understand the difference between like helping someone the way that I want to help them and helping someone the way that they actually want to be helped. So that's also been like a huge personal distinction for me and something I'm still, like actively working on as I support friends and loved ones and, you know, clients through difficult situations.

Mandy, RNC-OB  10:12  
Yeah, for sure. I was just thinking, Paula, imagine if there is a competency, a holding space

Paula, RNC-OB  10:19  
holding space competency? I know, right?

Mandy, RNC-OB  10:22  
What would we? What would we do to check that off the box? Would we just sit with each other?

Paula, RNC-OB  10:28  
Right? Describe your vibe. or know a competency? Would it be written more like, is able to demonstrate vibing? 

Mandy, RNC-OB  10:41  
Exactly adjusting to appropriate vibe missed?

Paula, RNC-OB  10:45  
Yeah, yeah,

Mandy, RNC-OB  10:46  
with each changing patient. And I think in nursing school, they would say like, Listen to the patient, and we're assuming the patient, the birthing person, the pregnant person, like can identify what they need and ask for it. And in my mid 30s, I am just learning this and trying to get comfortable with asking for what I need and not apologizing for it and identifying it. And I can't imagine being an expert at that, in labor and birth. I mean, I definitely, I know that some folks get there and they're like, I need this, I need that. I just need this off. But they're not really always able to identify what they need. And they may not know the option. And I think that's where the labor nurse, I've always thought and I've always said the labor and delivery nurse has one of the most important roles in the world. And we have so much information on how to be creative, how birth, how creative birth is, how unique it is, how many things we've seen and done and tried. And all of like all of the options, not all of the options, but many of the options that may be supportive for someone that I think we can listen and identify and kind of get curious about maybe what someone isn't saying, maybe offer some ideas that might resonate, or they might throw that back. And then we have more information. And that comes from only started for me after many years at the bedside, where I was like, I just do not the what you call the factory settings are just not working. They're not working for me, and they're not working for everyone else I need to get I need to get more clear and asking the patient and listen to them is not it? Usually, I think it's more right vibing like, really sitting with someone and being still and asking and sitting with tough questions and with tough answers and tough emotions and and then the challenge is not taking it home. So then you have that whole like, shut it down. Yeah. So you, you have to walk into something it with that vulnerability, but then also try to practice the skill of not letting it in too deep and not letting it in forever and not letting it take over your personal life and your day and take it home with you. I think it's been in my trauma informed training, especially with sexual assault survivors, or folks with a history of trauma and loss. And then outside of the hospital on like community education settings, childbirth Ed settings, where we could kind of practice this, and then take that back to the bedside. And that's what I found that information. And I found it to be really helpful. But it also takes a lot of time. So it's also difficult, at the bedside.

Paula, RNC-OB  13:43  
It is difficult at the bedside, because I feel like so much of that involves humility on our part. Not only is our training focused around heart skills, but I would say I would take it one step further. And they're hard skills in service of productivity. Right? And so then what gets praised as a labor nurse is you know, the fact that like, you can bang out deliveries and you can you know, like, yeah, go to without IVs those IV sticks you

Mandy, RNC-OB  14:16  
30 minute admission. Done. Yeah.

Paula, RNC-OB  14:19  
Or, you know, an admission when you should probably not leave your active patients. That's right, yeah. But you know, like, we somebody's got an appointment for their induction. So you know, we need to get in there and get started. And then how do you make decisions about prioritization of care, right? So I think that for me, I learned to be a labor, a labor nurse, surrounded by mentors who were very intentional about continuing to ask questions. So one of them I mean, 30 years a labor nurse, and was still Bringing in articles or talking about a panel at a conference and made her think, you know, rethink an approach to care. So seeing that role model, I felt like was really important. And it's still kind of important. Maggie and I were talking about role modeling before recording, but just, you know, like how key that is, to our professional development to like to see those kinds of behaviors in action, especially when they're pretty scarce, right? And if your unit culture centers around productivity with no with nothing else, right, then a lot of us, I feel confident in saying, then only learn about birth happening in one particular way, which is kind of cool about the spaces that we have found ourselves speaking in, because well, there's a lot of shorthand and a lot of thoughts universal about our experiences, as labor nurses so much about the particulars or you know, how well you function within a unit gets down into how, how well can you acclimate to that particular units culture, right, and their own way of functioning? For me, I started so holding space for me, and how I see that practice of kind of observing what people need, I think comes from way before from my life, because as an immigrant, you have to like a lot of your safety depends on keen observation, and then, you know, astute understanding of what is acceptable behavior in order to assimilate, right. So that's kind of something that I feel like I've just practiced throughout my life, my initial approach to any new any new situation is kind of to take a step back, and kind of observe for key players, right? Like, who are your leaders formally and informally? Like, who would you go to to whatever, but that also, I guess, allowed me to see what behaviors by other clinicians and I started as a nurse directly into ob, so I learned to be a nurse, and I learned to be an OB nurse. Because this is what I wanted to do. I started noticing the difference between you know, like, a good outcome, and then a satisfying birth experience. Right? Because those two things, I mean, they don't have to be, you know, they certainly don't have to be mutually exclusive. But we, as a whole, like clinicians, as a whole, certainly aren't taught to prioritize the birth experience. Right, as opposed to, you know, like, they can like the heart outcome of, you know, like, where you're at cars, good and gases. 

Mandy, RNC-OB  17:58  
Man, so I feel attacked. Oh, I mean, gosh, good outcome. I wrote it down verse satisfying birth experience, of course, we sometimes think that they're the same, right?

Paula, RNC-OB  18:12  
Right, right. And then you know, so you kind of start noticing that beyond the confidence that comes with competence in the heart skills. I was definitely left asking like, this can't be all that there, there is. And my first hospital, I was really lucky to have a wide range of private providers and physicians and midwives. So you know, it's kind of it's just nice to see a variety of practice styles and approaches and then you know, you get to you get to see that number one, you know, it's not just one thing that works. And two, with the different types of patients, some of them brought their doulas with was just fascinated by again, just how satisfied with the birth experience are patients appear to be in the way that maybe others did not. And so I don't know maybe it's my brain that listens, like starting to dissect and tease out like, Okay, what is it that you're doing right? And initially, it's easy to pinpoint, like the you know, like, what is the hip squeeze thing that you're doing? Teach me and then it's like that hands on hard skill, comfort measure, right? But as you adopt comfort measures...here's where holding space comes into play. What's more important is knowing when to deploy those things. Right? Because you don't have to, I see I am definitely I definitely do this. Like I'll attend a workshop and I'm like, I'm gonna use it tomorrow and...

Mandy, RNC-OB  19:52  
I actually don't want to be touched ever.

Paula, RNC-OB  19:58  
Go away. Exactly. Right. Yeah, yeah, yeah, we're good here, or like, just sit there. Right. So it took me many years. And still, just as you were saying that the natural inclination to be like, actively physically doing something to help, right kind of gets in the way of getting to the heart of what our what our patients want.

Maggie, RNC-OB  20:22  
Yeah, we have a unique position, right, you know, kind of within the staff who's available to support her, you know, particularly in the hospital, I, you know, obviously labor and birth nurse, you know, we, we have the greatest numbers, there's a biggest quantity of us compared to midwives, physicians. And so I feel inherent in that, then, like, we, we have this ability to really set culture, like you said, and that it is obviously, it's also it happens in teamwork, it's dictated by things that are outside of their control. But by and large, the way that we as labor nurses show up at the bedside, the way that we support people, the way we listen, the way we tune in we, we vibe with them, the way that we hold that space has a huge way of impacting that piece of how is your worth experienced by you compared to like, yeah, and what were the numbers we're putting up on a bulletin board this month for outcomes? Like, yeah, we have a lot of potential there to create the space we want to exist in, like, we have the ability to make a culture where our patients come in and feel safe and supported, and that they are able to tell what they want to need, even when that's something that works for us like, and that I think it's not, it's not common, and I feel like especially in labor and birth, when there is something that like, absolutely, it's natural and beautiful, and people have been doing it for millennia. And there's also complicated parts of it. And I think we learn as nurses to focus on that complicated part. 

Paula, RNC-OB  21:50  
I could go on a whole tangent about like, fearmongering nursing education, that kind of, like feeds into that, right?

Maggie, RNC-OB  21:59  
Absolutely. Yeah, I feel like that's like there's like that huge piece of it, that we tend to cling on that and that that's what we I guess maybe that's what we worry about when we come on as nurses to OB.  People, when you talk to non labor nurses, they're like, terrified by the idea of "oh my gosh, like so you have to take take care, you have to take care of, you can't see or touch or..."

Paula, RNC-OB  22:18  
Yes and in clinical it's all about like emergency potential emergency. So you have to be prepared for right. Yeah, remember the blood as opposed to Yeah, the pressure to approaching pregnancy and childbirth as a physiologic process. Right, like what's inherently normal, like how its approached? Yeah, from a nursing perspective, in the, in the United States in particular, because I like to do my homework. So when I became a labor nurse, I mean, I was looking to work as a midwife. And so that resonates with me, Maggie, what you were saying about kind of like the power that we find in birthing rooms what I noticed in my area is that you know, the job markets not great but also still 15 years later get super excited about you know, being in labor rooms, right? Like even if it's like sitting and charting, sitting and charting, right, like that doesn't sound like it's not doing anything for the patient. And yet you're with them in a way that you're not if you're you know, watching a monitor from from the nurse's station, right? Yeah. But when I did my so so then I decided, you know, I wasn't in any position to like move regionally to a place where you know, midwives might be doing more labor sitting in that fashion. And also, I thought about the patient population where you know, 98% of the people in this area are going to birth in the hospital than when I'm what what am I doing, like not attending that right? in a hospital space I still have to remind myself of that you know, every time I'm like maybe it's time to let this go. But also right until we can fully divest right where are people going to go to birth while they're still going to come here and whatever the quote is about like highly developed skills in that you know,

Mandy, RNC-OB  24:26  
Right?  It's that fix it culture like right you're so concerned about what could go wrong because then we can fix it and then we can save everyone from all of the hard stuff and that's how people have been dying from childbirth and we can save them.

Paula, RNC-OB  24:42  
But that's all you know, like that. To me that's all born out of how obstetrics was developed in this country right? Ever in most other, what are we calling them like "high resource" countries I don't know everything seems problematic when that like words leave my mouth, but in places where Yeah, them. It was model of care predominates which is like literally everywhere else, right? You know, what we do as labor nurses is the worker of midwives, who don't necessarily train as nurse because the approach is totally different. Right? We are trained as generalists. But we're also trained, even though like what you know, like the prevailing theories of nursing, that makes it different from medicine, is what that our job is to help like patients attain their, like, the best version of themselves. So they want to attain right, like, so it's still very, like patient centered. And so in helping people achieve that we end up learning about, you know, like, medicinal approaches or surgical approaches, or, you know, therapeutic approaches, but it's still subservient to the centering of pathology, right. And so, and so when our, the very foundation of our education is grounded in pathology first, right, as opposed to like, whole human burst. What a contradiction, right? Like, yeah, I feel so hard. And I could teach nursing theory, like, I love that I love that nerdy shit, you read the words. And then again, in theory, or like, academically, a lot of has been up and written. And, you know, there's a lot of discourse around nursing versus medicine, but the two are so entrenched here, as nurses trained in this fashion, in which we're preparing for every, you know, emergency, and it's gonna, it's hard to unlearn, right? It's hard to divorce that, and then, you know, put a significant amount of time in learning about like, basic birth physiology, right, our training, just not encompass that, right, like, you have to go to grad school. And if you get lucky, like, you might understand some of that. And that, like, we really just sound like clowns, right? Like, how's your labor nurse not gonna know, physiology at the end orientation,

Mandy, RNC-OB  27:14  
I know. Right? Yeah, yeah. It feels like a huge chunk is missing when we're like, our patients have really great questions. And why am I not able to really readily explain that in like a full way?

Paula, RNC-OB  27:27  
Well, and I think the problem is that, in my experience, I felt comfortable in answering questions by not with a full understanding that that was based off of one particular like, set a routine. Yes. And so it was more about again, like those factory settings as opposed to like a true underlying understanding of pregnancy and birth physiology. Right. And so for me, the lightbulb started going off when having, you know, too many children to know what to do. I needed like, a little bit more job flexibility. And I started teaching childbirth classes for parents who have these questions, right? How does the body work? Like, how is how are you supposed to function? You know, and I had to, like, hit the books. And I was five years in, right to like being a labor nurse and feeling pretty, pretty good about the job that I did, and still finding huge chunk of missing information, right? Or misinformation. And you're just plain information that yes, makes you want to scream because, yeah. And that gets like it's continuing to be perpetuated. Right?

Maggie, RNC-OB  28:47  
Yeah, I feel like that. That piece of it, where we're just, we're falling in line with whatever we've learned, right? Whatever. We've been taught whatever they're saying, whatever. You know, when you're sitting there, and you're talking to someone, if the provider just has explained in one way, yeah, you're like, oh, okay, I guess that's like the framework we're taking for this. So I'd also really love to dive into like the idea of like nurse power, and like, how do we show up as like powerful advocates. And I think some people think of power is like a is an aggressive term that feels at odds with this idea of like, holding space for someone and being there. But I'd love for you to share a little bit more about like, how do we see nurses acknowledging their power, acknowledging this unique position we have at the bedside, and taking all of those to really be that that advocate to hold space for their patients through all of these different things that we're helping them navigate from physiology and childbirth choices and all of these things that that come up. How do you see that as like a part of it?

Paula, RNC-OB  29:51  
Can I say something? 

Maggie, RNC-OB  29:52  
Yes. 

Paula, RNC-OB  29:53  
Potentially controversial? 

Maggie, RNC-OB  29:55  
Yeah!

I mean, I don't know. I think most of us don't have the language. To describe what power looks like, because in my again, my lived experience, power looks like making sure like the wheels of the machine are like greased and functioning well, right again, because that's what gets praised. And if you're if you're working, it's so it's so it sucks.

Mandy, RNC-OB  30:21  
You're right, though. Yeah.

Paula, RNC-OB  30:25  
And it's not, it's not like power in and of itself, but you have to look at the power dynamics of the whole, right? So if you walk into a unit, where it's not the done thing to call physicians or providers after a certain time of night, right, like, you better figure it out, we have to do a pretty significant, like root cause analysis who like where does the Okay, what, what is happening here, right? Because we know them to have something bigger, right? And that's what's going on and like, who holds, you know, or seem to hold the ultimate power? And so I see nurses in those kinds of spaces, reclaim power, and kind of what feels like manipulative ways if you frame it in the negative, because it's subversive, for safety reasons. And so like power comes from power comes from calling somebody eight centimeters until they're a plus three station. Right? 

Maggie, RNC-OB  31:32  
Right. 

Paula, RNC-OB  31:33  
You know, like power comes from,

Mandy, RNC-OB  31:35  
wait, you can do that. That's a sneaky shit, that's sneaky

Paula, RNC-OB  31:41  
Power comes exactly like learning who you need to, like call somebody "four" when they're "six," because when they recheck, you know, like, when they come in to recheck them, you better be showing that like cervical change has happened, right? And so you better be stingy with that exam to buy you time, right? I didn't know a lot of things that I had learned to do were powerful, like, it had never been framed in that fashion, until I started talking to other birth workers who were like, I still don't believe it. And when I, you know, I couldn't like off the top tell you specifically, like, what I said, that, you know, had that kind of a response. It was like, okay, so like, my whole existence, I guess, is powerful here. What the hell is that? When did that happen? Right? I learned that as a charge nurse. I could say "no, we're not starting that induction because everybody already has a labor patient. And this is not emergent." And that's powerful. Right? Like, patient flow is powerful as a preceptor saying, you know, "my Oriente and I need this particular learning experience," and like prioritizing that is powerful, and scary, but we're not taught to call it powerful, right? Or like, or, like, feel like there's power in in those kinds of approaches or statements.

Mandy, RNC-OB  33:17  
You're using your power for good when you talk like that.

Paula, RNC-OB  33:21  
So that's why like, my, my initial inclination is to say, you know, like, I feel like most nurses that I work with be like what power you know, right? I'm just, I'm just here and kind of like told what to do. And a lot of the job can sometimes feel that way. Right? And so then you have to, I mean, I have to think about Like, who do I who am I here for, I do still have to pay bills, right? And I work several per diems just so that I can have like the privilege of say, you know, like, if I piss somebody off too much and I won't be back for four weeks and they can get over it before like pick up another shift right? Like I'll go find hours elsewhere. So for me personally, like power comes from that flexibility. It also comes like my own homework. So it's kind of like if I know guidelines really well and can read them right to back at you. Come at Come at me, right? Like when I give patients a particular piece of information, because we do so much patient education, right? Like from the moment we meet them. I feel like almost anytime I open my mouth in front of a patient in the back of my mind, I'm like, Who's gonna come at me?

Mandy, RNC-OB  34:35  
I'm so glad you say that.

Paula, RNC-OB  34:36  
And am I am I ready? Right? 

Mandy, RNC-OB  34:40  
Because when they repeat this Yes, it's gonna come back to me. Yes, because it sounds like me.

Paula, RNC-OB  34:46  
But Mnady said that I could, right? Exactly, Paula said, and my evolution was, you know, like, let's take like eating and drinking.

Maggie, RNC-OB  34:54  
Right? Yeah.

Paula, RNC-OB  34:56  
Nurses have the power to enforce bad policy or orders. When you know like when they set the tone until the patient Now don't be eating anything, right? And even that tone is like so patronizing and condescending and infantilizing. Right? Like, just line up all of those, like bad words.

Mandy, RNC-OB  35:19  
Yeah, the fact that people listen to that bullshit means that you have some power, right? Otherwise, they should be like, um, no one talks to me like that.

Paula, RNC-OB  35:28  
Yeah,

Mandy, RNC-OB  35:29  
Right, we should all feel like that cringy.

Paula, RNC-OB  35:31  
I'm gonna need you to strip down to this gown. Okay, right, like no questions asked, right? Like super powerful as like an agent of, again, the MIC (medical industrial complex).

Mandy, RNC-OB  35:43  
Right? for evil or for good.

Paula, RNC-OB  35:45  
Right, right. Yeah. And so it's just like, when I, for example, I decided at one point that I was going to take all of the gowns out of triage when I do triage, you know, like, everybody has their own set up. And I don't even remember, it's been a few years. So I don't know, what was the impetus for this, specifically, but I was like, Nope, not everybody needs a pelvic exam, or to be like, Fully undressed? Like, there are many different chief complaints. And I can hand them a gown if they ask one or if they really need one. But you know, like, that's not going to be the default. Right? I wasn't waiting for a policy to tell me that. But then also, like, at that point, you couldn't have told me that that was like, me exercising any kind of power. Right? 

Mandy, RNC-OB  36:35  
Right. 

Maggie, RNC-OB  36:35  
Right. 

Paula, RNC-OB  36:36  
Because I personally didn't feel like I had any agency.

Mandy, RNC-OB  36:41  
Yeah, we definitely talk to each other like that. Like, who said we could do that? Or did you ask so and so? 

Paula, RNC-OB  36:49  
Where's the study? Right? Like, the amount of conversations online with other labor nurses are like, um, do you? Can you cite your source for that, because I know that somebody's going to ask me. And like the last time I remember things we were talking about, like the source material is from the abs, and the data has not changed. But we just refuse to believe that, you know, you can turn pitocin off when labor is achieved, or like, whatever rail workout, and you don't have to wear a gown or, like you can keep your underwear on or whatever. 

Mandy, RNC-OB  37:25  
I think I realized my power as a nurse, when other birth professionals, other birth workers told me.  I usually have to get knocked over the head with stuff. And they were like, Oh, my gosh, you're a labor nurse? Oh, my gosh, you can affect so much change. And I was like, I don't think you know what I mean, when I say I'm a labor nurse, I am a worker bee. Like I literally told them, I'm a worker bee. And then they were like, Oh my god, so there's no hope for change. And I was like, Oh, no, I don't. I'm just learning. I don't know. But they, but they were like, Oh, my gosh, you're a labor nurse. And then I started to see my power, or our power collectively as labor nurses. One in the negative, like, someone could easily just say, No, you can't eat any food. And people just do it. Yeah, oh my gosh, and learning trauma informed care. I was learning like how you know, the ins and outs of our memories, and our trauma and trauma memories and our body memories, and really wanting it to be really important and meaningful positive, I wanted to be a part of a positive forever impact. And I felt an urgency around that. And then I felt very strongly inside in my body. When my power was used against me, specifically, this is the hardest, and I'll just like, touch on it for just a moment and then mute my mic. But when someone would say when a provider would say or a resident would say, "well, we need to break our water, we need to break their water. That's what's next. And they just won't do it. And they just don't want to. And they're just prolonging this" and all these awful things. You can insert your own experience with this probably. And they would look at me and say, "You need to talk to her about breaking water." And I would get confused. And they would say, this is what needs to happen next. "Do you think that she'll agree? If you talked to her about it?" That I was like, "This feels like the ugliest thing I've ever felt." And you know, inside I'm like you want me you right now are acknowledging this hard work. In this relationship that we have done, my patient and me have done together to trust each other and form this relationship between two strangers during the most intense, memorable time in someone's life. And you're telling me to manipulate that person with that. I was like, oh, okay, so I'm going to Stand a little taller for a second and say a bunch of stuff in my head back And then decide for myself if I'm going to do that. And I felt really powerful. Once I realized what that was, and saw it and looked around, and no one thought that that was disgusting, or no one, you know, said, "Hey, back up. That's manipulation. We don't do that." No one said that. So there was a very obvious and collective like, this is the culture. This is accepted. And this is powerful.

Unknown Speaker  40:32  
Oh, my gosh, yeah, like, and I mean, you both just touch on something. So like, if we have the power to enforce bad policies, we have the power to enforce good policies, to make change happen, to be the leaders of what we need to see happen in birthcare.

Paula, RNC-OB  40:49  
And call bullshit on policy. Oh, yeah, that's kind of been part of my journey is that I had one point was the nurse who would be like, "I'm gonna leave the room. And then you know, like, you do whatever you want in terms of for like, eating and drinking," right? Yeah. And I'm now at the point where I'm like, so data on eating and drinking and fast like that data and fasting and labor stupid, we shouldn't be doing it. But the policy is this, I just have to inform you, and this is what we're concerned about. And you can just tell people that you know, Paula said that nobody can tell you what to put in your mouth. So you're just gonna go ahead and eat right? Like, more recently it is. It's not just like, I hope that this doesn't get back to me. Or if it does, like, Do I have the evidence to back it up? I'm full blown just like, "FYI" exactly. And like the next the nurse behind me might come in or an SDM might come in and say like, "Oh, no, no, no." And so like full disclosure, this is actually what the ASA says. And this is what you know, like, what they might be concerned with, by you do whatever you want, because you're the boss, and you know, just kind of like feeling powerful enough to give that power back to the patient. Right? Because people who lack who are disenfranchised and lack agency can really then promote that in somebody else. Yeah. Like, it's part of those, like, the, like, systems of oppression, right? Where if you're feeling, you know, like, super down, or like, you don't have any power to make a difference, what, what's the point, it's an echo of that. You do need to own some of your power in order to start, you know, like moving that needle and making those changes. And then saying, like, you know, like, guess what, I got you in case of emergency. So here you go, what do you want to do?

Mandy, RNC-OB  42:56  
That's right, yeah, I could take that power straight from the resident and say, Oh, thank you very much, you have now lifted me up, I can go into the room and say, "we really need you to do this." Or I can go into the room and say, "Here's six options, you have three no one else is going to tell you. I'm never leaving your side. I'll back up whatever you want to do. This is what it may look like, or I can give you a minute. But when so and so comes in. It might look and sound like this. Look at me. And I will confirm your choice." Yeah. And then you're sweating and shaking and everyone comes in. And they're like, Oh, shit, they just like repeated it.

Maggie, RNC-OB  43:36  
When we're standing firm in our power and our knowledge of our role and what we have that that lets us feel confident in the patient's power. They are the one who gets to choose what happens. Yeah, like we just give space for their power to be evident instead of hiding behind. All these are things that we think we have to couple behind the provider preference and the policies and the way we've always done things and yada yada yada, like if we all stand firm, and what we know, our role is as an advocate for the person in our care, that lets them shine out you know, I always hate that like voice for the voiceless, because that's not it. We're just stepping back and letting their voice be be strong, be heard, and making sure that we're amplifying it, instead of trying to crush it with the policies voice. That's not a real thing. Policies aren't people and they're definitely not more important than people. But oh, well, yeah, I we could just sit and talk about this forever, which is what we do mostly, we sit here and we refund all this stuff all the time. And that leads me to the last thing I wanted to cover and share with you all is about the program that Paula and Mandy and I have all been putting together as we've been talking through all these issues and recognizing the way we want to see this change from this standard of helping whatever that means, which is usually inadequate to standing in this trauma informed standard. of advocacy that we want to see all of us feeling comfortable and confident doing as labor and birth nurses. And so we have created the Trauma Informed Birth Nurse program. Yeah, so and movement would maybe be a better term for it, because we really want to see this be a community of changemakers who are coming together and recognizing trauma informed care. as something that happens with every client. In every care interaction. It's not something that's reserved for special populations. And that trauma informed care lets us really see people with a heart, it helps us to gain those skills to hold space, it creates a way a lens for us to view everyone in our care more holistically, and really tune in with them. And so I would love if you all just want a shout out kind of whatever you're most excited about. for that program, we'll be sharing everything in the show notes, we'll link to everything. And we'll be pumping it up on social media. So you can look for stuff there too. But I'd love to just hear as we kind of close out what you're kind of most excited to see, kind of as like the future of us taking this this power and disposition we have and bring it forward.

Mandy, RNC-OB  46:07  
Well, I'm, like sizzling with excitement. What a weird word. I am so excited about all of the parts, mostly excited that it's being created by these minds that are here on this podcast, Maggie and Paula just the way Maggie explained it, I think it's perfect. I'm most excited about everyone that's involved. We have what do we have, like 15? People? Yeah, we have so many people involved, it's really nurse education, like I've never seen it before. And I wish I had 10 years ago, because it would have shortcutted a lot of this learning, I think we're learning from so many different genius minds and experiences, voices and stories, that we really get a lot of expert information without having to live it without having to go through don't have to become a childbirth educator, you don't have to have a traumatic birth. You don't have to get burned out before you get this information. And it's I'm excited for the radical change that it's going to bring to the standard of care of labor and birth nursing. Alright, Paula!

Paula, RNC-OB  47:17  
hey, I'm excited about the application of concepts. So I feel like recently, you know, trauma and trauma informed care as an approach. I have heard people call those buzzwords, right, like they're all of a sudden everywhere and why it's the why is this important. And so I feel like most people going in might have some idea about what trauma informed care means, or at least like the theory of that, you know, approach that is person centered, we do get stuck on the like, Okay, what does this mean for my behavior, right for my participation as a labor nurse in the system, to shift my own practice, which is like when I have control over to to be trauma informed, right? Like the embodiment of that. So I'm, I'm super excited about how the way that we're building this program, is working towards giving people a blueprint for their own process of that embodiment of a trauma informed approach to care. I mean, and labor and delivery care specifically, which is it. So I mean, it's just so nuanced, just from our conversation, right? It doesn't feels like one of the things that I've been missing. And, you know, my own, like research and study is that is our voices that are speaking directly to that. And like that, that role of the labor and delivery nurse.

Maggie, RNC-OB  48:47  
So, yes. Oh, I'm just so excited to be doing that with you all. And thank you for coming on, and just sharing more about your experiences and helping us to all just think more critically about the way we're showing up and holding the space for those in our care.

Mandy, RNC-OB  49:02  
Thanks, Maggie. 

Paula, RNC-OB  49:03  
Yeah, thank you.

Maggie, RNC-OB  49:05  
Well, I hope you enjoyed that conversation with Paula and Mandy, as we're just sharing a lot about our personal experiences and kind of how we're traveling this journey as nurses, trying to do better, trying to improve the care that is needed by the person who's actually seeking it, trying to expand our horizons. And if you loved listening to us go on about this, you will absolutely love the new course we've created. I'm really proud of what we are cultivating in the Trauma Informed Birth Nurse program. And I will be sharing more about that in the show notes, as we said, and you'll see it posted up all over the place. So we'd love for you to let us know what you're thinking about that or what you would like to see from more trauma informed care. As we all continue to hold space. We love to connect on social media. We are Your BIRTH Partners across all platforms. So find us there. We really appreciate it if you'd give us a shout out there, share it with a friend or colleague and let's get talking about this and seeing how we can shake stuff up and create a better world that is more inclusive and collaborative and actually leads to equitable care for everyone. Till next time!