Defining Holding Space through the Complications of Birthcare #055

In this episode we are taking a look back over our season of asking ourselves and our guests what it means to hold space through the complicated parts of pregnancy, birth, & postpartum.

We set out to answer this question because so often when complications arise we see so many policies, procedures, and personalities emerge that do not center the patient or their needs through the complications.  

We believe our ability to hold space for birthing people is critical to recreating a standard of trauma-informed collaborative care that serves folks well.  While some of us are natural space holders, others of us have to work hard to cultivate this skill.  No matter where you are on this journey, our guests from this season have insights to share with you as you consider how you want to show up for those in your care.  

Tune in as Maggie shares her reflections of walking with our guests through these conversations in season 4 and a compilation of all of their answers for your crash course in defining holding space and learning to put it into practice!  Prepare to leave inspired.

Transcript

[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 here.

Hello, and welcome back to the podcast. I am just so excited to be sharing this last episode of season four with you all. Throughout this whole season, we have endeavored to answer the question. What does it mean to hold space for the complicated parts of pregnancy birth and postpartum. And I am truly just awed and so grateful for all of the guests, all 15 of them who came on this season to explain to us what that means to them, how that shows up in their practice.[00:01:00]

Things that they have done from when they first started things they have learned along the journey and things that they want to put into place as they continue to practice. And as we continue to think about what we want birth care to look like.

And as I've reflected on the season of the podcast, and we prepare to close out and take a break so we can focus on some of our other programs.

I just have so much gratitude for all these folks for sharing their unique perspectives for giving us their insights for sitting here as I pepper them with questions, to try to understand how we make this all look different. So much of my journey personally, as a nurse has been trying to answer this question, what does it mean to hold space?

How do I show up best for the individual who is in my care? What do I do when things are complicated? When things are not going to textbook? [00:02:00] When so much of our healthcare system is set up to make it really difficult to hold space when we have so many challenges and roadblocks to sitting with someone and hearing what they need and then adapting the care plan around them.

And also I continue to struggle with my desire to, to fix things for people. And so, so much of getting to be a part of these conversations on the season of the podcast has just been a breath of fresh air. As I keep hearing from more folks about how they are holding space

and I consider what, what is my role in, in birth care? as a nurse, as an educator as any of the caps that I can wear, what does it mean for me to be involved in birth and how do I want to be there for those in my care. With each of these episodes, I have [00:03:00] had more to reflect on and I imagine the same is true for all of you out there listening as well.

We have been honored to hear from several social workers, nurses, therapists, doulas, lactation consultants, birth workers, and folks who care for birth through an array of roles and education, backgrounds, and practices. And so as we close out the season, I am excited to bring to you Your BIRTH Partners' crash course in holding space. Here, you will have compiled all of the answers that our guests gave to us this season, as they defined holding space, what it means for them, what it has meant in their practices, what they see it meaning for their clients, what it has meant in their own lives.

I hope as you listen to them all give their definition. It helps you to solidify your own definition of holding space and [00:04:00] how you want to show up for folks who are in your care and how you want to see our birth care system change to have trauma informed care and holding space as the baseline and the new standard of care.

I will now bring you onto clips from the past season. Thank you so much for being here.

We start this reminiscing off with two marriage and family therapists, Allison Lieberman and Yvette Osorio practice around supporting have structured their practice around supporting families through the transition from pregnancy into postpartum, and then continuing on as they grow as couples and parents.

[00:04:41] Allison, LMFT: You know, I think holding space, at least for me, is being able to be that one person in this person's life, whoever it is, that's seeking treatment for whatever the issue is at hand, to be able to sit there and be okay with sitting in whatever their emotions are, [00:05:00] whatever their feelings are, whatever they're experiencing and not trying to fix the problem.

and just being the person that they need you to be in that exact moment. And even as therapists, I think we struggle with that sometimes because we too want to fix things. but I think really just being able to sit in that and let that person experience, that is a big piece of that for me. 

[00:05:22] Yvette, AMFT: Yeah. Yeah. I kind of to just go on, on what you're saying, Allie, I think part of that also is it's just being there to witness what's happening for the client.

Right. And sometimes that's a mom, sometimes it's a dad. Sometimes it's a couple, the who's going through something that has no one else to be that support for them. And so I think that's kind of very much the role we try to take on whenever we're seeing our client. 

[00:05:47] Maggie, RNC-OB: Next up we hear from Tracy May. Tracy is the mother of two micro premies, and a tireless advocate for NICU families as they navigate the transition of NICU life and into parenthood.[00:06:00]

[00:06:00] Tracy, NICU Advocate: Yeah. I think probably some of the most pivotal moments that allowed me to get just, I mean, there's a heaviness on your heart that you can't describe. And if I think back that to, you know, some of the NICU workers and nurses and doctors to, That held space. It was really just that it was every baby has their own timetable and they do things differently, but it was just, you know, I can remember vividly just sitting at their bedside and this was before our setting, before private rooms.

And so it was all out in the open room. So when you were having a bad day, everybody knew you were having a bad day. When you having a great day, everybody knew it. but just having nurses come over and just, you know, almost placing our hand on your shoulder and they're, not even saying anything, but you knew they were there and that allowed you to just almost have this sense of calmness come over you to the point you felt like sharing.

Like here's what I'm struggling with today. Here's what I don't understand. Here's what terrifies me. and then that could open the dialogue, but rather than, you know, just [00:07:00] having somebody come in and starting that conversation, and maybe it wasn't where I wanted to start the conversation or. a conversation I wasn't ready to have, but that holding space just allowed it's just that sense of calmness come over that really, you know, finally started letting some of those bottle of anxiousness feelings, kind of letting them loose a little bit.

[00:07:21] Maggie, RNC-OB: Next up we hear from Paula Richards and Mandy Irby, as they give their perspectives as labor and birth nurses and nurse educators Navigating how to hold space in our hospital birth care system. 

[00:07:33] Paula, RNC-OB: 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 the, even that, that phrase holding space is something that I have been familiar for quite some time. And, 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, how does, how is that defined was going to use that term for a class of primarily nurses [00:08:00] and the person that I was collaborating with, actually put me on the spot and was like, dude, not everybody knows what that means. So I'm going to need you to break that down.

So I guess to me, like without, you know, cheating and looking at notes and prepping 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 a 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. 

[00:08:58] Mandy, RNC-OB: I like that, Paula. [00:09:00] 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? Right. I'm too old for a vibe, but a vibe is like, I think it, a vibe gives space for everyone's unique, one way of holding space and two person you're holding space for and with a little bit about. Paula and I are friends. Well, we're all three friends outside of this one recording, but 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 [00:10:00] others and show up for others. 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. 

[00:10:16] Maggie, RNC-OB: Next we hear from Lola Brognano, who is a licensed clinical social worker who structured her practice on serving those with perinatal mood and anxiety disorders, navigating perinatal loss and grief and coping with birth trauma.

[00:10:29] Lola, LCSW: that's a lot, you know, holding space. I kind of find it to be similar, to kind of like companioning, right? Having that, that compassionate presence physically, emotionally, spiritually, and being willing to go down whatever road you might be going down with that person. You're willing to go there with them on that, on that road. And it's, it's holding space. wholly, holistically. Right? 

[00:10:55] Maggie, RNC-OB: Coming up next, we have Krysta Dancy. Krysta is a licensed trauma therapist [00:11:00] and birth doula who structures much of her advocacy work now around caring for folks who've experienced birth trauma and PTSD. 

[00:11:09] Krysta, MFT: I knew that we were going to talk about this. I was like, oh, asking a therapist, what holding space is?. 

[00:11:13] Maggie, RNC-OB: Right. [laughter]. 

[00:11:13] Krysta, MFT: I have a master's degree in holding space. You know, for me, holding space is a lot about, it starts with believing people. And I think that's a really important first step, which is I may not understand. I may not know what I'm looking at, but I start by believing you. I start by believing that you're having a human experience and that you are the expert on what that experience is.

And the default is I believe you, to me, that's a really important foundation for the rest of holding space. Right that I just start with the assumption of, I believe you. and then from there it has a lot to do with, therefore I believe you're the expert on this. Therefore, I believe your truth is what matters here.

What matters is your perspective and experience and not mine or my take on it, or my interpretation of it? Not that you know, [00:12:00] how I'm feeling is completely absent, but if I'm holding space for somebody, it's centering their story, their experience, their needs being held right with empathy. 

[00:12:10] Maggie, RNC-OB: Next up, we hear from Sam Abbott, Sam is a registered dietician who specializes in nutrition coaching for those who have polycystic ovarian syndrome.

[00:12:19] Sam, RDN: I think for me, really recognizing and understanding that how someone experiences PCOS is gonna look different for each person. So the things that they're concerned about, the symptoms that bother them, how. The things that they're worried about. Long-term, you know, for some people, their focus and fears are around fertility. For others they are exhausted and they just want someone to help them have a little bit more energy. Some of my clients really, really struggle with, disordered thoughts around food and poor body image. So really holding space when I'm working with a client for their own personal experiences and also [00:13:00] understanding.

That their own experiences are valid. You know, we shockingly don't have a ton of research about PCOS outside of fertility. And I think it's really important to remember that our patients and our client's experiences are valid. You know, when they're sitting with us in a room and sharing their experiences, they're not lying or being dishonest or exaggerating. That is actually how they are, are experiencing a syndrome. 

[00:13:28] Maggie, RNC-OB: Next we'll hear from Cheyenne Scarlett. Cheyenne is a childbirth educator, doula in training and perinatal researcher. 

[00:13:40] Cheyenne, Researcher: Holding space can be. Like literally creating a space for someone to talk or creating, an opportunity that didn't previously exist, allowing people to, to share their story or share something that's important to them. so literally creating a space for that to happen [00:14:00] or just figuratively, just being open to listening and, you know, taking in information that.

You know, you might be hesitant to, to listen to either, you know, usually it's for personal reasons that people don't want to sort of feel attacked or feel threatened by what somebody else is saying, even if that is their, their own truth. Right? So literally creating opportunities and spaces, and also just figuratively, just being quiet and listening to somebody.

[00:14:33] Maggie, RNC-OB: Coming up you'll hear from Parijat Deshpande, who is an integrative health strategist for those who are experiencing a high risk pregnancy or trying to conceive after high risk pregnancy.

[00:14:44] Parijat, High-Risk Pregnancy Specialist: I think it means leaving literal space. So time, energy, attention, you know, all of those things, leaving it empty for them to fill. I think we're very [00:15:00] quick to want to fill in gaps in the story. If we hear, I think we all, as patients for any number of reasons have gone to a medical professional and said, I have X, Y, Z thing happening, and they fill in the gaps for us and we lose the, Ability to express our lived experience of it. Right? So if I'm living with chronic pain and you're living with chronic pain, our actual experiences of, of that can be very different and that can be very important for us to be able to convey. And so I see that as allowing the ability to leave a vacuum that the client or the patient fills in for us and our job then is to be able to one tolerate that vacuum, which is a skill that has to be learned because we're very quick to want to fill that it is uncomfortable at first. And then the second piece is to then be able to, without judgment accept whatever they fill it with.

And I think when we can do that, The person on the other [00:16:00] side can feel so seen. And so validated simply in just knowing they have that space to fill it with whatever they need to fill it with. 

[00:16:12] Maggie, RNC-OB: Next up, we'll hear from Jen Molina. Jen is a full spectrum birth worker and the founder of a birth worker collective United in Birth. 

[00:16:20] Jen, Full Spectrum Birthworker: Holding space for me means just kind of being there for people in however they want to show up. So this is something that I reflect a lot because I work closely with king yaa and I feel like they are very good at holding space in terms of like facilitating and things like that.

It's just sometimes literally just like kind of pausing and seeing like the things that, that people bring up and stuff like that. And so, so I think for me, like at this point in time, that's kind of what that looks like. There's a lot of listening and also fighting the urge to [00:17:00] fix and like give people advice on like, whatever it is that they're talking about, because most of the time people don't want that, you know? Yeah. So I think that for me, that's kinda like what holding space looks like. It's just, it's just as simple as that. It's just kinda like being there and seeing like what comes up for people and like, Not judging them for like, whatever it is that they may be feeling or however it is that like, Things may be presenting themselves and validating people in whatever experiences or feelings they may be having.

[00:17:37] Maggie, RNC-OB: Next up you'll hear from Dr. Phyllis Sharps. Dr. Sharps is a PhD prepared nurse with specialty education and expertise in maternal child health will be sharing from her 50 year career supporting perinatal care.

[00:17:49] Dr Sharps, PhD Nurse: So I think pregnancy is, is a very interesting time period in a woman's life. and why I was drawn to that and nursing is, because I love the health of [00:18:00] women, women, and young infants. And I feel that when you empower and improve the health of women, you're improving the health of the family and the community.

We have a lot of, I think, myths around pregnancy that it's a happy time and, people are very delighted. And yet for that, for some women, that's not the case. And for me, holding space is. about thinking that not all women come to the pregnancy space or the labor and delivery space or those early months postpartum or after the baby is delivered, may not be a happy time, both for the mother and in the family that the baby's coming into. So as nurses, I think we need to make space for all of those, those types of families and babies and circumstances and provide, right now equity is very important. Providing care that encompass all women, no matter what their [00:19:00] circumstances is, without being judgmental and, bringing biases and prejudice that may care, we provide women and just kind of getting in touch with where you are as a provider, as a nurse, as a doula as a companion, you know, what's in your head or your feeling on your background about women and how are you able to either put those things aside or do you use them in a way that really supports women going through now? Even if it's, it's the happiest of woman and the happiest of all times. Yeah. Many women enter with fear, they've heard stories. They've had a previous birth that didn't go as well. there is a lot of, you know, just anxiety and ambiguity and I think that that's what we have to think about when we're, making space and including everybody 

[00:19:56] Maggie, RNC-OB: coming up, you'll hear from Naya Weber, Naya is an international [00:20:00] board certified lactation consultant operating in private practice supporting thoseon their infant feeding journey. 

[00:20:06] Naya, IBCLC: Yeah, that's a great question. For me, holding space usually means just listening to the family and validating their concerns and their experiences as a lactation consultant. Oh, one thing I forgot to add in my intro is I work outpatient.

So I see families after they've been discharged from the hospital or birthing center, you know, not just that immediate postpartum period. Throughout the first year or even years of lactation, but as a lactation consultant, I'm often one of the first providers that has had a chance to sit down with the family after birth for an extended period of time.

There's a lot to squeeze in our visit, but I always try to leave some room to ask the family about what the pregnancy was like, what the birth story was like. Obviously. From a physiological perspective, the birth story can play a role in how lactation goes, how it's established, but parents often need someone to just sit and listen to their perspective, whether they felt heard or listened [00:21:00] to in the labor and delivery room, whether the pregnancy was difficult or again, conception was really challenging.

I have noticed that if pregnancy or birth or conception seem to be particularly challenging, some parents feel almost like an added pressure to make body feeding work for their baby, but it's almost like, okay, this is the, this is the one thing I can control after stuff that was really beyond my control.

And I feel like that's true to a point. To get back to your original question. I think it's just listening, validating and not trying to fix the problem, but letting the family feel their feelings and that includes partners and non-birthing parents as well having to see, your loved one, go through something traumatic or seeing them in pain or complications postpartum or, or post-birth can be really traumatizing for partners as well.

And obviously. If it gets to the point where there's a lot of tears shed, it's obvious that they're not ready to talk about this yet, because that happens too sometimes to stay within my scope of practice. I typically [00:22:00] do refer on to some great mental health providers, some great counselors that we have locally, that, that focus on this, this really crucial period in a person's life 

[00:22:10] Maggie, RNC-OB: coming up next, we have Traci Weafer. Traci is a doula childbirth educator and all around consumer advocate. 

[00:22:18] 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 to listen. 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, 

[00:23:00] To close out this conversation, we have Desirée Israel, a reproductive psychotherapist, and certified breastfeeding specialist and herbalist who also is trained as a doula, and currently works primarily with people from preconception pregnancy postpartum and also birth workers.

[00:23:14] Desirée, LCSW-C: So holding space can mean a lot of things, but for me, it's active listening. And then as a clinician, you value silence. So a lot of times in session, You think you want to fill this space with conversation and dialogue, and sometimes it's just paying attention to, what's not being said and not just even body language, just, you know, Respecting the space, respect in the silence and holding that space for the person that you're talking to.

[00:23:50] Maggie, RNC-OB: Well, thank you so much for joining me in this trip down memory lane. As I got to rediscover relisten [00:24:00] and reflect again on what it means to hold space and be inspired by all of these birth care change agents who are out here redefining what it means to show up and care for people during the complicated parts of pregnancy birth, postpartum and parenting.

So I hope you are feeling as inspired as I am, and we would love to hear from you what struck you, whose definition is making you rethink holding space, making you reconsider, how you show up in your practice. You can find us at your birth partners, all across social media. We are most active over on Instagram.

We would love to hear from you there. And we look forward to more conversations with you when we come back in season five and continue to dissect how we show up to create inclusive, collaborative birth care communities, rooted in [00:25:00] autonomy, respect and equity. Till next time.