Doulas: Collaborative Care & Advocacy #053

Where do doulas fit into birthcare and the collaborative care team model that we envision as the standard in the future? Doulas are the space holders. If there is any role in the birthteam that is built around holding space, this is it!

So what can we learn about the unique qualifications doulas have to hold space and how that can extend and create a bridge for all members of the birth team? We have invited Traci Weafer, doula and educator with more than 2 decades of experience supporting birth in a variety of settings and roles, on to unpack holding space as a doula.

In this episode we want to explore the question: is holding space antithetical to taking action as an advocate?  Spoiler alert, no!  So how does the role of a doula, a non-clinical birthworker weave these elements together?

Join as we explore:

~gaps in our current birth team relationships

~assumptions and biases from various birthworker roles that fuel animosity

~"scope of practice" and how that language impacts doula relationships

~biases around what makes a "good" or "bad" doula

~holding space for the birth, and not just the birthing person

~advocacy as an element of holding space

~improving hospital and community doula relations

~enacting the human elements of trauma-informed care

~moving past patriarchial roots in birthcare to earn trust

and so. much. more.

Full shownotes with extra info & resources: https://www.yourbirthpartners.org/doulas-advocacy

Transcript

Doula-Collab, Advocacy #053

[00:00:00] Maggie, RNC-OB: 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.

Welcome back to the podcast. As we continue our series around holding space, we are digging into what it looks like to hold space from the perspective of a doula. So, you know, I think this is one of the things that there has been so much talk about. What it means to hold space and scope of practice, quote unquote, and you know, all these things, all of these kind of rules that we try to put in place around what it means to show up as a birth worker and to [00:01:00] support your client.

And, you know, I think with, in that sometimes we lose sight about what does it mean to, to advocate as you hold space, how is holding space really an active, not a passive thing. And where are the, where are the rubs? Where are the, where are the parts where theis doesn't fit into the birth care system narrative that you know, has been created.

So to really explore and dive into all of this, I have Traci Weafer coming on, who is a doula childbirth educator with more than two decades of experience supporting birthing people. And we'll be diving into all the nuance around these relationships. What collaborative care looks like, or at least what we dream it could look like in the future, understanding that at times complex relationships between nurses and other hospital staff and doulas and working on our own stuff so that we can have collaborative care relationships that best support the birthing person and their needs. So I am excited to [00:02:00] bring you onto the show. 

Well, welcome to the podcast, Traci. I am just so glad you are here and we're going to get to dive a little bit more deeply into doulas and their roles as part of the overall birth team. And dive into some of the nuance beyond that relationship and how it comes across. So if you'll just tell our audience a little bit about yourself and what brought you to this work. 

[00:02:20] Traci, Doula: Oh, wow. So that makes my brain exploded every time somebody asked me about that. So I'll keep it. I'll try to keep it nice.

And thank you for this opportunity. I appreciate you. And I appreciate what you're doing here. So I am a doula. I'm a childbirth educator. Um, I'm really just an all around consumer advocate in birth and. You know, just really diving into what it means for me and what my responsibility is in the birth room.

And even in prenatal, sometimes as far as being an advocate, I'm a evidence-based birth instructor and a spinning baby parent educators. So I just all around, you know, [00:03:00] birthy type person. 

[00:03:02] Maggie, RNC-OB: Yeah. Oh, that's a lot of hats and I think you were them all very well.. Yeah. 

[00:03:06] Traci, Doula: Well, yeah. 

[00:03:07] Maggie, RNC-OB: So thanks for coming on here. I will start off this whole season. We're talking about holding space and what that means. So we were just asking all of our guests, first question, what does it mean to you to hold space? 

[00:03:15] Traci, Doula: So for me to hold space means to listen and dive deeply and intimately into my client's lives. I warned them pretty quickly that I can't do my job well, unless I know them well, but that means.

And that means to separate myself from what they need. That means, you know, bias checks and making sure that. You know, emotionally and physically, I'm a hundred percent in order to do that. So holding space for me just means that I am a hundred percent, so I can be a hundred percent for them and their need and whatever that need is, which is going to be super individual, you know, different client. 

[00:03:57] Maggie, RNC-OB: I want to pick up a thread from that you just touched on, [00:04:00] you know how that means you need to like, be aware of where you're at. Can you speak a little bit to like how that has perhaps evolved in your practice or if that was always really present?

[00:04:08] Traci, Doula: Yeah. I mean, I think it's always been present for sure, physically, for sure, because I have never, I have never, no, I'm not going to say never.

I, that was not a priority. Like the physical wellbeing was not necessarily a priority in my life, so. So stamina and all of that was, kind of, I was hit in the face pretty quickly with that. And then just the mental part and emotional part of not taking into account what I was, um, what I was getting ready to do, because, you know, I started out postpartum and then postpartum care.

And then I was a midwife assistant for six years. You know, I was in my comfort zone until I started doing hospital births and wow. That [00:05:00] was such a switch physically and emotionally. So, you know, mentally it it's, uh, hit me pretty hard. Uh, so, you know, just taking responsibility and stepping back and saying, okay, what does this mean?

Getting really real with preparedness you know, on, on that side and then mentoring. So coming kind of full circle with that and trying to pass down as much as I can cause I'm, you know, we're not going to be around forever, so we should pass this stuff down. We know it's, it was evident that other people were kind of doing the same thing, but it was, you know, surprising to me that it was not being taught a lot in like trainings and, um, you know, a lot of organizations we're not touching on the hard parts of, of this, they were just saying, Hey, let's just go and do position changes. And, you know, not tell somebody that they might be up for 36 hours or so.

So yeah, that, that was. [00:06:00] Yeah, that was a rude awakening that I'm trying to help other, you know, newer doulas be aware of even before they commit to work, um, is just identifying what you really need to do for yourself before you can be present for your clients. 

[00:06:17] Maggie, RNC-OB: Yeah, that's beautiful. Absolutely. You know, one of the things, and I think you probably started touching it there. Where do you see gaps in the way the typical birth care system kind of acknowledges the role and power of doulas as members of the birth team? 

[00:06:33] Traci, Doula: A gap that I, well, I see many, but, you know, I see a gap that I really see as far as all of us on the birth team. So you have, you know, you have your doula that was, you know, that was hired or chosen or picked or appointed.

And then you have, you know, your nurses are those who manage, um, most of the labors. And then you have your provider. That you know, that you're collaborating with on the medical [00:07:00] side. And then there's other kinds of obscure people around too. But I think the gap is not understanding each other's profession so that we can work well together.

And, you know, back when I first like really started paying attention to, you know, advocacy and what my role responsibly was to my client to figure out communication and, and getting the team to jive a little bit better. I started like doula-ing, everyone. And I've thought to myself, I don't, I don't know a nurse's job.

I don't know the ins and outs of the pressures and the, the logistics and, you know, in, in all of these and all of these things. You know, going back to re you know, taking my personal responsibility, um, getting to know those professions helped me be a better doula, but what I'm not seeing is well, and I think it's on both sides, you know, [00:08:00] nurses and providers.

I don't necessarily, and I'm not saying all, but I would say for the majority are not, you know, they're just coming in with a perspective of, oh, they're a doula. And then they come with their own assumptions and biases or whatever, just because of rumors or maybe they didn't work, work well with some. So there's a wall that's that's built.

So the gap is assumptions, biases on both sides on both sides that, you know, because you have doulas over here that really believe that providers and hospitals and, and, and nurses should automatically do these things, but they're not taking in consideration the mental, the physical, and the training part of who they are in, in a broken system.

And then, you know, and then the other side, you know, providers and nurses and, and all of those staff, people are not taking in consideration that the. [00:09:00] Birthing person has this extra support person or advocacy person that they should be paying attention to or learning their role so that they can collaborate with or work well with, for, you know, just focusing on the birthing person.

So that's the, just the relationship gaps or the conversation gaps that I say, just because of everybody being frustrated and everybody thinking that the other person just needs to do. You know, do right. Whatever that means. 

[00:09:34] Maggie, RNC-OB: Yeah. I really, without so much, I think, I mean that in a nutshell is why Your BIRTH Partners started, why this podcast exists is from, as a nurse, having those conversations with people and realizing that absolutely there are outliers, but most of us, we want, we want the birthing person to be happy.

We want the birth to go well, we want all of these things are ways of going about that can be very, very different in our approach. That can be very different. But [00:10:00] yeah. We often, I think, you know, we end up just so siloed that just like you're saying people on any role within it get kind of stuck in their little rut and their assumptions and their biases.

And it's hard to bust out of that. And a lot of that depends on like the culture that you run it, whether it's, you know, the hospital unit you work on, or it's the, kind of the, the group of community birth workers that you found, some of those make it very difficult to kind of like reach across the proverbial aisle.

And make relationships and create that it can become very antagonistic, which helps literally no one. And so I, that is a huge passion of mine is seeing like ways that we can improve that and have better dialogues across the disciplines. So we understand each other better and are able to like see the reality piece of it and get rid of some of those, like the preconceived notions, the kind of like comical almost charicatures that we create in our heads about what each of these roles do. So, Ooh, it's a big one. I, you know, off of that, what do you think is. You know, maybe I feel like there's a lot of nuance around [00:11:00] what scope of practice means for doulas. So could you maybe speak a little bit, and I know, you know, our audience spans perfectly across all these disciplines.

Can you speak maybe a little bit into like, kind of, what are some things that you've seen happen when people talk about scope and where it should be and what doulas should be doing? 

[00:11:15] Traci, Doula: Oh man, you, you just opened the flood gates to scope. Wow. So, you know, foundationally. I think we need to go to the term and how it's being used and how it's being abused.

You know, the, the term scope is for licensed people, people who have licenses, you know, nurses have licensed, this is your scope. Don't go out of it. And doctors too, w you know, lawyers too. So everybody that has a license has a scope. So the confusion is, is this dual is, do not have scope. And, you know, because we are not licensed, we are not regulated.

So in, in this conversation and it's, you know, it's because the only scope, if you will, that we have [00:12:00] is, you know, we don't do anything clinical, you know, we don't, we know all of these things, but we don't do anything clinical. We don't medically diagnose those kinds of things. So the abusive part that I see of the terminology of scope is when.

You know, when somebody wants to say that a doula is doing something wrong, they say, you know, stay in your scope, which, you know, what does that even mean in the grand scheme of things? So when, you know, when, when somebody doesn't understand a doula's job and they get frustrated with the doula, then they're going to throw out.

The scope terminology. It's just the suppressive narcissistic way of keeping the doulas in line, um, and gaslighting them into thinking that they're doing something wrong. So there is a ton of confusion around, wow, what can I do? What can't I do as a doula, but then you've got this power [00:13:00] structure of providers that don't necessarily like doulas for all kinds of reasons.

And then nurses that are like, I don't know, And their job. So we're just going to kind of bully them, not even kind of sometimes bully them into thinking that they're doing something wrong. So, you know, that's where I see the whole line of, of scope, this abusive terminology that. That even doula organizations and doulas have used even in horizontal violence at times also, you know, we're not supposed to be doing these things.

We're supposed to be doing these things, but all of it's a distraction, Maggie. I mean, all of this is just a distraction in, in not taking personal responsibility for ourselves. Period, you know, cause if we're trying to attack somebody else and what they're doing, then we're not taking responsibility for our own stuff.

I could go for days on this. 

[00:13:58] Maggie, RNC-OB: Yeah. That's, it's so interesting too. [00:14:00] Like, I think we've talked as, as a nurse to like scope of practice, like you said, it's a legal term, you know, it's not even something that like, we create us as nurses or physicians or midwives or anyone who has a license, you know, and it's this whole, like, you know, what would a reasonable and prudent nurse, you know, you name it, do in this situation, which I think obviously, like there's a huge range within that, but we try to make it very limited.

We want to put like walls around this. Yeah. Is much bigger than that. Uh, and like you said, I think that's all, you know, we all have different personalities and different ways of existing in the world. But I think for people who thrive in well controlled environments where they feel like they understand the black and white way to do it, that makes them feel like, okay, I understand your role is the things you're allowed to do.

Birth is not black and white. So. That inevitably we end up rubbing there because providers, nurses, and birth workers, anyone, you know, who has that, who wants things to just, okay, we just, you do this, you do that. And then it doesn't work. [00:15:00] And so inevitably then they end up feeling like, well, someone here did something wrong, someone here did something outside of what they were supposed to do to make this all go.

Right. When it's so much beyond any one person, you know? And I, I feel like that we've talked so much on the podcast about like that letting go of control is such a big part of holding space to, you know, like we have to be able to keep that, that piece of like, oh, that's right. I have to like be here existing in this like responding and, you know, reacting and moving within the space.

But. I don't get to just say, like, if you just do this, Tracy, then you'll be a good doula. So then we'll have a good birth and I'll be going there. Like, that's just not reality, and that's like hard for us to still like people listening to me. Probably like, of course, that sounds silly. But so many of us operate.

We like, we fall into that kind of way of feeling like, okay, if I could just do this, right, 

[00:15:48] Traci, Doula: the only, you know, scope. You know, again, you know, is the only scope of doula has with their client is, is what the, what the client and doula relationship is. And you [00:16:00] know, that, that's what the breakdown that we, we said at the beginning was, you know, you know, nurses not understanding what a doulas job is as far as the relationship and is, you know, is there a threatening part of that, you know, Let's let's cancel out the animosity and let's just all work together for the, for the good of the, you know, of the client.

And it might be, you know, just building that trust or it might be trying to break down some of this, you know, and, and you touched on it. What is a good Dilla? What's a bad doula, you know, I hear. So much, you know, and well, I worked with some really good doulas. Well, what does that mean to you? Does that mean, you know, does that mean that you did all really work together for it through conversations, you know, with empathy and compassion and you got the job done?

As far as what was needed for the birthing person, or did that doula help you get that client to comply or was that doula really good at getting that [00:17:00] client to, you know, to breathe and to not freak out? You know, what does good even mean in the grand scheme of things? So we, so we have to go back to foundationally checking our bias.

When we talk about, you know, all of this stuff and. You know, it's hard to, to do that when you're going in fresh. And I think that that's why doulas kind of gravitate to what their comfort zone is. Like. I'm only going to do home birth. I'm only going to do birthing center birth. So they shy away from a lot of these hospital births because they don't know how to break down.

That animosity. If, if, you know, if that's what's happening or tension in the room, because you have to know how to do that, you, you have to know how to come in because we're the ones that. Can do that. We're the ones that can't hold the majority of the space and the room hold space for the [00:18:00] client hold space for the nurse hold space for the provider, or whoever's coming in into the room.

We have a pretty significant role in that we should be able to hold space for everybody, honestly. 

[00:18:14] Maggie, RNC-OB: Um, Hmm. Yeah. It's frustrating. How far away. We get from just approaching it like that. Absolutely doulas have like, you know, unique skill set and certainly most get like more kind of training and practice in like just the art of holding space of like that.

Yep. Here I am. I'm like supporting you in doing this, whereas so much of like training for nurses and other providers ends up being about the, the medical clinical kind of side of it. So we don't get to emphasize as much on that, but it's also like, The approach of all of us were thinking about that. Like if all of us just walked in feeling like, okay, right.

Because obviously as a nurse, I feel like part of my job is to hold space. So what if you were viewing that for like holistically, you know, it's the whole space you're holding that hold space. And if we were all doing that, like how different it would feel, because I [00:19:00] also feel like absolutely it's wonderful when.

Doulas can come in and feel like they know, they know how to do that. They've honed some of those skills. They feel ready to like, okay, Hey, we're going to ease in here. And like, you know, read the room, understand this whole, that still advocating for our client, working as a team with everyone. But it's also not the job of the doula or the job of the birthing person to present themselves in a certain way that is acceptable to the hospital staff.

And so I also feel like obviously as us, as those of us who work in hospitals, where we understand the power dynamic. It's way, way, way over to the hospital. And everyone included within the hospital. We have to do more of the work of being opening and accepting and, and having those conversations and whether that's something you have in front of the birthing person, you asked to do it like step up for a second and just like, Hey, let's talk through a couple of things.

I wanna understand that. And making it all feel, then I'll have to be so clinical. Like we can just be humans as well and have those conversations again, like with the birthing person or without, depending on what you know is going on. Like, just to understand who else is in the role and like who the team is that we also need to [00:20:00] like extend the olive branch a little bit more to, to open up that space and create one that feeds.

That doesn't feel antagonistic and it feels like we're open to having discussions. So I think there's plenty ....

[00:20:09] Traci, Doula: And I think that, you know, hospitals and, and nurse managers and, you know, clinical educators and all those people, you know, I think that they need to start reaching out to their Dillard communities and, you know, Hey, how can we work together?

How can we do workshops of just getting to know each other? And you know, it's not about. And it's not about certifications and it's not about, it's just about those that are out there serving their communities and coming in with these families and, you know, learning how to have organic conversations of, you know, Hey, tell me, tell me what's going on.

You know, tell me your, your deal breakers. Tell me what I need to know about you. I mean, if we're going to be trauma informed, we just need to be human informed. I feel like. 

[00:20:59] Maggie, RNC-OB: [00:21:00] Yeah, there's so much, we've talked obviously a lot about trauma informed care as, you know, holding space as a big piece of it, and it really, every time it comes down to like, just, just be human, like just try not to be, we don't need to be robotic and clinical about the way we're doing stuff and like going down the checklist.

Pause and put on your regular face and then like try that instead. I, I think too, there's that piece in, because you know, I get it. Obviously I have been the nurse at, you're just, you're incredibly busy. You're rushing from one thing to the next and things are not going smoothly for any number of reasons that are within an outside of your control.

And you're finding yourself in like a situation where you're trying to work with whoever it might be a provider, who's got a different plan. It's, you know, a birthing person who just, wow, like they're wanting some things that are not standards the way you do things. And so you're trying to figure out, like, how does this work with an, all the things that I feel like I'm supposed to be doing?

We take it personally. Maybe when these difficulties come up then in, in our flow. And so I've seen that a lot as [00:22:00] you know, with other nurses who are reflecting on the relationship with doulas, that they feel like what ends up coming? Like, well, it's the doulas fault. Right? Right. You know, like the doulas being difficult, the doula is making this hard.

And so I think that's one of the things too, that we have to be aware of. And absolutely maybe, I mean, maybe the doula is having a terrible day and they really are making things harder than it needs to be. Okay. Sure. That's totally possible. But I think it's about like also like taking a moment to like, reflect on like what's going on with us.

Like, okay. Is it really about that? Or is about the fact that I have like two patients right now and really, I should have one because I can't do my job taking care of both of them. Like, is it, you know, is it about like everything else that's going on behind the scenes? I feel like so much stuff we talk about has to do with it's changing the whole way that we, that we staff and attend birth and how we like look at that piece of it that helps us to work as a collaborative team.

Okay. And get past some of these issues, the rub. 

[00:22:51] Traci, Doula: Yeah. And I think the deal is it's just easy. It's just easy to make the doula the scapegoat of, of, of all, you know, of all [00:23:00] tension are all things that are, that are happening because you know, that's not a staff member, you know, that's not somebody we can write up.

That's not somebody that, um, you know, I can actually book, you know, it can't, it can't go to it. Somewhere, and it can't stop with me. So I have, I can't put it off on the birthing person, cause that would make me inhuman. Right. So I have, I have to get that, that oppressive waterfall to go somewhere and it's, and it's going to go to the doula, you know, which.

Which is that is so common. And it's been through my 23 years, 23, 24 years of, of doing this work. And it's always been that way. So if it's always been that way and how can we break that? You know, we have to go back to definitely our biases and our own work and our own. Why am I thinking the way that we're thinking in and you know, one of the workshops that I do, we absolutely go through.

Why do I feel the way that I feel? Why do I think [00:24:00] the way that I think, and you know, bias in itself is not bad? You know, I just want to throw that out there. We use that word is, you know, bias. You know, we want to run from it, but no, I mean, it's an accountability word to me too. Understand where, why are we acting the way that we're acting and why are we trying to blame anybody for anything let's personally take responsibility.

And that's just tough. You know, that that's tough for all of us. I mean, we, we do have to recognize that we're all trying to work. Within this system that was, you know, built for business and built on, on, on some, you know, really tough things that we're trying to navigate. And we really just need to resign the fact that we're doing that together.

Magnate. I mean, whether or not we like each other as irrelevant, right? I mean, I'm not here to make friends. I've met a lot of really great people. In the grand scheme of things, we are here for the birthing person for on my [00:25:00] side, on your side, you know, and we just need to come, you know, to, to this birth on that.

Hey, yes, we're going to have a great jump today. So, and I say jump because, you know, Nemo comes to mind and, and Crush and you know, little guy and he's like, Hey, we're going to have a great jump today. And that's how I approach every birth, whether or not. You know whether or not, I feel like there's there's tension or animosity in the room, or, I mean, I'm not like, I, I don't feel like I'm, well-liked.

When I walk into a room every time I walked in a room, of course, you know, is still as well. A lot of times, you know, work with the same people over and over again. Um, but not every time, you know, especially with new nurses. So, you know, if, if we can just go in. Focused on that birthing person and the other side too, and [00:26:00] then saying, Hey, I don't know you, but just have a clean slate every time I think is going to tear down some walls.

I mean, we can really do some amazing work if we just take responsibility for our stuff. 

[00:26:14] Maggie, RNC-OB: And it's that simple and that hard, right? Like, that's right. That's it. Let's just go do it, like break in this. Yeah. 

Yeah. Mm. I want to pick up a thread too. We've talked a lot about like an advocacy holding space. I think oftentimes the way we have learned to think about those words in like the birth space, we feel like they are at odds with each other.

Like you're either. Holding this kind of mystical space as if you're like almost an ethereal kind of creature holding the space, or you're like being in there taking action advocating. Can you explain a little bit about how you see that working as your role as a doula? 

[00:26:54] Traci, Doula: My philosophy, which is different from other doula philosophies. Um, because [00:27:00] there, you know, there are, you know, in the doula world, there are doulas who only do labor support and are only there for, you know, the kind of what we thought, you know, holding space was going to be at the beginning of, of doula dumb or, you know, when that construction that complex happened.

But then as we've grown through time, you know, the advocacy part. To me has been like fundamental because, you know, I was seeing that communication was breaking down and, you know, birthing people were not able to, to answer or speak or, or come out of there, you know, labor land, so to speak, to have conversation and even not.

Affected in their space. And so I, you know, I'm thinking, of course I need to be having conversation. Like this person has hired me to be with them to hold space for them, which means that they need me [00:28:00] to have conversations or relay information or other people say amplify their voice, you know, in that space.

So that they can labor, you know, or, or maybe they physically can not speak, um, because there's a difference between personality and being non-confrontational and then trauma responses. And we have to be aware of those. Um, you know, so I think the breakdown of that. The system wasn't or, you know, staff is, is, was not prepared for that.

And so when, when doulas were starting to come in and holding conversation and even being more vocal with their clients, you know, even having conversations in front of staff members, they were like, wow, wait, what? Like, you know, and that's where the whole stay in your scope thing. I've heard the most.

We're educators we're this is the things we were supposed to do. So if the system is not [00:29:00] good at some things, which, you know, we can talk about informed consent or getting consent obtaining consent. First of all, forget if it's informed or not just get it right. Just present the question. Um, You know, that was not happening.

And so when doulas were coming in and starting to do some of those things and advocacy, um, the advocacy word started or started being this cuss word of, oh, these are things that doulas are, you know, really should not be doing. But, but I feel like. That's a foundational part of just good care. If, if a deal is there and holding space, that's part of me holding that space is to make sure that all of those things are happening.

It was through really great conversations and, you know, I have a system and I know how to communicate well. And I think that that's, some of it is, is knowing how to have organic conversations and it not being [00:30:00] necessarily a script, but understanding where the other person is coming from. With perspective and being able to hold those, those conversations.

But yeah, the advocacy word has definitely kind of titled waived the 

[00:30:14] Maggie, RNC-OB: yeah. Yeah, it's hard to like how advocate became like a, you know, a dirty word, like as if that's not what all of us should be doing in any of our role in, within healthcare, within life. Right. You're supporting someone else and not like part of that should be making sure that you're advocating for their wishes.

And I think maybe that's that like you're advocating for them. You're not advocating for yourself. And absolutely. We get tripped up on that. I know. I mean, many years ago as a new nurse, I started to like understand some of the ways that I felt like, oh, this is the way. Birth seems to like, go well when we do these things.

And so like, yes, if I could, if I could just get each person to tried this position or, you know, wait this long to do X, whatever, you know, like all of these ideas, it can be easy to like [00:31:00] push for that, whatever that means for you. Like, you know, someone who had a really traumatic birth and then felt so much better after they just got their epidural right away, they might see someone coming in, who's showing discomfort and they're like, let's just get the epidural right now.

Cause then you won't have that. You're not going to have that feeling. These come up in all different ways for people who have all different kinds of like their own personal birth ideology. Right. But I feel like that can, I think that's what people maybe shy away from part of that advocacy feeling. Is that feeling like, is this you talking as you, or is this you like helping to amplify that?

I see it happen with any role, you know, I firmly believe like the birthing person is the expert. In their life, in their care, in their birth, in their child's care, like the whole way through, you know, but with so many others of us who are also experts in, in our work, in our field, there ends up being like rub there, maybe between those.

I don't know if you could definitely see if you could speak to that piece of it a little bit and how you see navigating [00:32:00] those waters. 

[00:32:01] Traci, Doula: So w I mean, for me, I have kind of developed this way of making sure that the nurse knows and is welcome on this team and, you know, Like really fundamentally just building it from the ground up.

As soon as I walk in the room and I never take advantage of nurses that I even have done births with over and over and over again, I do it every time, you know, I go in and I just build that, you know, crash the, the animosity, if it's there, even if she doesn't like me or doesn't like doulas or whatever, it's not gonna matter.

You know, we're, we're here for, for that birthing person, you know, and just making sure. That that's there, you know, first and, you know, because speaking, you know, there's so many doulas too, that are being trained, not to talk to staff or you don't advocate. And I think that that's just [00:33:00] a breakdown of, you know, of that's what builds animosity.

That's what, that's, what happens. You know, if you don't have the conversation, you know, nurses are feeling like there's something secretive going on, you know, there's something, you know, she's not in the team. Decision-making process to, you know, she feels left out. She's going to feel like her job's not being valued.

Like she's, I mean, she's managing this birth. She's the one that should be, you know, in this, in this process also. Um, so communication is like my key factor in an advocacy period. And. You know, definitely not me making these decisions. And I wish that that was kind of understood. Um, that's kind of one of those oppressive abusive lines that I hear a lot is doula should not speak for, you know, I don't have power of attorney.

I speak for them. So I, I, I wish [00:34:00] kind of those things would go away in a perfect world because that's not what's happening. So I feel like doulas have the pressure of having to build that trust foundationally also when they go into the birth room, which I think is, uh, actually unfair is the system or staff wants.

You know, the, the trust from us. So I feel like we should be risking reciprocated on that respect of the trust from, from them and, and understand that we are not making decisions. We, we are, we are conversation facilitators. We are, you know, we do know now, not all of us, of course, experience level. You know, very experienced, still is, do know what's going on medically, you know, they do have like the evidence background.

They do understand, you know, the biomechanics of baby rotation and all of that kind of [00:35:00] stuff. So. To understand that. And to, you know, for, for me to facilitate, facilitate a conversation of saying, Hey, you know, this is kind of where we are. I'm hearing that this is medically what's going on, you know, Hey, how do you feel about that is better than pulling out.

Something and saying, Hey, here's the evidence. Can we look at, you know, can we look at this because I never want to question the knowledge or where a nurses in her experience or where she is too. So having those conversations, and honestly, I'm not a fan of saying, can you give us a minute? Can we talk. I'm not a fan of that.

I am a fan of everybody having conversation around the birthing person who was on the team and me facilitating that in a safe space still. So I will position myself in the room so that I'm holding space for my clients. So they feel safe, but that the staff person is also able [00:36:00] to say what they need to say.

Um, because. They're the medical people that are managing their, their, this birth. There's there's no real reason why we can't all have a organic conversation and get the needs met of, of the client. Now, is that always. As easy as I make it sound. Absolutely not, dude. Absolutely not. It takes practice. It takes time.

It takes experience and it takes all the, all the work that I was saying at the beginning to be able to do that. Um, you know, is the nurse always loving that? No, but I don't care. I'm there for my clients. Um, and sometimes nurses will excuse themselves, you know, Hey, I'll give you all this. Because they need a second, they need to step out.

Right. But, um, but I don't separate that. You know, if, you know, if my client wants a second, that's different, but I'm not somebody that's going to [00:37:00] differ. I'm not a doula. That's going to default to that to just stop the conversation. Um, I'm not going to do that. I feel like everybody. Everybody has a word.

That's my foundational like philosophy on dealing with people. Everybody has a voice, everybody has worth. And that means the nurse. That means the provider. It might not always, we're not going to not necessarily agree. And just because you're in on this conversation, doesn't mean my client's gonna do what you ask do, but we're going to have, we're definitely going to have a conversation about. 

[00:37:31] Maggie, RNC-OB: Yeah, I feel like that's just, I mean, that's so much of, like you said that whatever word we're, you know, informed consent shared decision making any of these words we use, which I know anyone can have different feelings about them and what they mean, but mostly it means. The birthing person gets to make their decision because it is their body and they get type consent about, and that they understood the options that were available out there from all of the people who they have chosen to be part of their team, whether that is their doula, it's their provider.

It's anyone else who is involved in that? You know, I feel like there's [00:38:00] so much of that, that we need to just keep remembering that like the plan of care, consent, like these are conversations. They are not always moments in time. You know, we want it to be this. Right. Boom, right there. Right. And I think it was, as we realized that that's just not how it, that's not how most of us make decisions in life.

[00:38:18] Traci, Doula: One of the, one of the, you know, one of the situations that I always bring up is, you know, yes, we can. We can stop the chaos or we can slow down what's happening. Cause just like you said, these are moments and these are not just been been boom. You know, we, we want to say that they are, maybe they are when we don't really know how to advocate, but if I see a nurse coming in the room and she's heading towards some gloves that are sterile, then I'm going to automatically think that she's getting ready to go into. my client's body So I'm going to start that conversation before those gloves were even unfolded, you know, and I'm going to use names and I'm going to make eye contact with that in our song to say, Hey, it looks like you're going to be doing whatever. Can you please explain, you know, stuff? [00:39:00] Because you know, you, you have this mode of I got to do a checklist. I'm being asked to go get the, you know, cervical stats, um, from, you know, managers or doctors or whatever. So there's tunnel vision. So, you know, it's not just about saying, Hey, Hey client, I see her going for the sterile gloves, which is what a lot of doulas, you know, are comfortable doing.

But what if that client is laboring to where she. Speak, she can't have this conversation. We have got to know how to do it, and it's okay to do that. And foundationally, I think, um, advocacy should include that and that's not disempowering a client and that's, you know, that that's just what has to happen.

And I see it be very productive and very beneficial. Um, even with. I'm experiencing a provider that has never had conversation or never [00:40:00] felt like they owed a conversation to a doula. And of course, I'm just going to be that, um, very, uh, verbal doula that is, you know, Hey, what do you do in there? Hey, what's going on?

You know, Hey, did you know, did they say that they wanted that because I haven't really heard a consensual conversation and I'm not questioning their, their medical approach. At all. Um, you know, I'm just saying, Hey, can you kind of explain to me what's, what's going on. I'm curious. I would love to know why you, you are doing what you're doing, you know, or whatever.

It's just stopping the chaos. It's just, you know, it's just making sure that everybody is on the same page. And of course, you know, when things can get, have a lot of tension, then a doula in advocacy needs to know when, um, It's escalated to where, you know, Medical things need to happen. [00:41:00] Medical things just need to happen.

Right. But you've already laid that foundation of expectation of care. And if you lay that expectation of foundation to care, to center your birthing person, then when it escalates, then you're not going to have all of the. Wait, what are you doing? Are you consenting? Have you done this or have you done that?

Um, it's just, it's smooth. And of course your birth in person's like, yeah, if anything's wrong, let's let's go because the trust is there. 

[00:41:28] Maggie, RNC-OB: Yeah. Yeah. I feel like it's something that like, we talk so much, we think so much that we have like trust. Like if someone, I guess I think I've heard it in conversations on a unit where someone, a birthing person is not just automatically going along with whatever plan was suggested to them, you know?

And there's this feeling of like, oh, well, why don't they trust us? Right? Like they came here to the hospital, they, they were going to this doctor, what, what do they expect? What do they want? You know, I feel like so much of that is like, we have to. We just have to recognize it like, [00:42:00] oh, right. Like trust is earned.

Trust is built like, yes, absolutely. They picked you out of a, however many physicians and midwives, whatever providers that were available to have a baby in this area. But that also doesn't mean that like you have them for every single thing that you think they should do. And I think it's like that, you know, the, the patriarchal roots of medicine are strong in our training and how we, we learned to think about those in our care.

And I think those are things we have to like actively work to, to get rid of. And it doesn't make us, you know, I think we've only had this conversations. People get very defensive. And I have to! Cause it's hard to like confront the parts of yourself that you realize like, oh, that's actually not a good thing.

So that like doesn't feel good. But I think it's realizing that like, oh right. Like they don't automatically trust me just cause I'm a nurse here at the hospital. Like sure. They don't necessarily, think I'm a bad person. And like, yeah, I guess they've been doing this for a while, whatever, but like, that doesn't mean that they automatically need to just go along with whatever I've said. Cause, cause I met you five minutes ago and I'm your nurse this shift. So [00:43:00] here we go. Like that's not, that's not fair. That's not a fair way to try to like establish relationships. So it has to be earned through these conversations through taking the time to pause and listen and, and that is hard work.

Like no one said that the job of being a birth worker in any of these roles providing birth care was easy. Right? No, it takes it's, it's hard work. It's hard work physically and emotionally and mentally to establish rapport with folks to get through these conversations, to have these relationships, but it's worth it to do it, but it is hard.

And so I think those of us who maybe think that it's supposed to just be easy, if we could just get people to do it our way, and people would just listen or just trust us like that, isn't that isn't the work, you know, like that's not, that's not the way it is that it is best done. And that, you know, when we, when we act like that, We have these confrontations with staff, we have this animosity, we feel like people are just so difficult. Now everyone wants to do things a different way, you know, and we ended up taking all that and like creating this negative culture around it. Instead of just realizing like that it's, it's hard and worthwhile [00:44:00] work to establish these relationships, to talk through consent and that most of us like you're an oven age, by the time you're a birth worker you've learned to talk and do things at the same time.

So even in an emergency, you are able to, for the most part, if it'd be like the full lengthy explanation, but your. This is what's happening. "Hey, I saw XYZ on the fetal monitor. This is what I'm concerned about. I would like to try to do this," like, Ooh, that didn't take that long. Was that five seconds, Tracy?

Not even like, it's just that you don't have to just plow through people, you know? And I think that's where we just have to keep reminding ourselves that like, even when we are concerned about something, if we're feeling activated by something that's happening in that birthing process, like we need to be aware of that and then still keep connected by the breath.

Mm. Well, I could literally sit here and we could just have, keep having this conversation all day, but is there anything else you'd like to leave our audience with as we kind of wrap up? 

[00:44:48] Traci, Doula: Oh, that's a, that's hard. Like, I don't even know. Like I don't, I don't know. I, I think, you know, as far as advocacy and personal responsibility, you know, and just trying to focus [00:45:00] on, on the birthing person, do this again, honestly, but foundationally let's think about.

Where we're working and that system, you know, of all the isms let's foundationally, think about that, you know, and then personal, personal work, you know, bias, work, mental work, physical work, being a hundred percent, making sure that all of that. Being taken care of because healing is a continuous process, all of, and even bias work, continuous process.

All of that is in check. Every time we go into a birth space with a birthing person surrounding our focus around them, you know, that's actually my keeping your power workshop for, and that's for everyone, making sure that we're, we're just having organic conversations coming out of the scripts and just talking and being honest.

About things so that [00:46:00] birthing people have a voice, first of all, a voice, and then to hear their voice and to, to, uh, know their worth. And so that trauma can just hit the floor and not even be a thing. And so that they're psychologically whole coming out of the other side. We can, we can work very well as teams and change some lives.

And I'm saying it. It's been fantastic. And, you know, that's what I want. I want this to ripple and I want, you know, I want to, to, you know, rule the birthing room world with, you know, great teams. And I think that we can do that. Definitely. 

[00:46:41] Maggie, RNC-OB: Yeah, we can. And it's happening. It is, like you said, there are models of it.

It does work. It just takes time for everyone to. Examine what they need to do to change, to, to make that happen. Yeah. Well, thank you so much for taking the time to dig into this all with us. I really appreciate it. 

[00:46:58] Traci, Doula: Absolutely appreciate it. [00:47:00] 

[00:47:00] Maggie, RNC-OB: Oh, well, you know, this is one of those conversations that like almost every episode on the podcast, there is just so much more to dive in.

To really get into the meat of all this and to understand how this translates into practice. You know, I think some of the things that Traci had talked about today feel like, oh yeah, like good ideas. You know, that saying that like, wouldn't that be nice? And I think the reality is understand that like, yes, it would be nice and it eats happening at places.

So if you finding yourself in a community, in a practice setting, That, this seems impossible that having these kinds of conversations with clients that having this sort of collaborative care relationships with other staff feels like it's unachievable. That that is a reflection of the culture of your community, your unit, and does not reflect the possibility that exists within collaborative care.

And you know, so much this conversation together with Tracy. The goals and the mission of what want your workforce to be about. We [00:48:00] want to bring up conversations that hopefully you can then have in your community, as you can even explore this and see, how can we steams show up in your practice? What do you need to change to have this be a reality?

How do we better support folks and act as advocates? All of us, no matter what our role is within birth care, how do we constantly center the working person as the expert in their experience? Use our professional roles and our education and everything that we work for to support that and to help to inform their choices without making them for them or demanding that they do something in a certain way that best matched up with our birth aesthetic and.

That you enjoy, as we would love to hear from you about what struck you about this episode, what jumped out at you, you can reach us best on social media, where your birth partners across all platforms. And we would love to hear more about what you thought and you can reference the show notes. We'll include some [00:49:00] extra leads for digging into more of this and the trainings I had Tracy mentioned.

She offers we are so excited to continue to create more inclusive, collaborative birthcare with you all rooted in autonomy, respect.