Bianca Sprague: Guardian of the Birth Experience

Transcript

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Hello, today I have with me Bianca Sprague.

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Bianca is a doula currently in Nova Scotia and she founded the globally recognized Bebo MIA doula program.

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Bianca is here to share her inspiration for becoming a doula and how training as a doula helps banish the bad mom fears and makes you feel like a better parent.

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We are also going to discuss the rising need for doulas and how doula care transforms family experiences.

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Bianca, welcome and thank you for joining me.

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Thank you so much for having me.

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I am so excited to hear about your experience that led to this amazing program and how you help birthing parents and people that are wanting to become doulas to make that transformation in their life.

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Yeah, I have a lot to say about all of those topics.

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Oh, I'm so excited.

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Let it roll.

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How did this start for you?

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Let's start from the beginning.

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Yeah, okay, well, that's an excellent way to start.

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My plan was always to be an OB-GYN.

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As long as I could remember I saw my sister.

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My mom had an illegal home birth back in the mid-80s and I watched my little sister being born and it was transformative to watch how powerful and I mean I get a little nervous about it now because she was essentially a free birthing be back, I sweat a little bit when I think about it and it was great and it was magical and I felt changed from the experience and so I always thought OB-GYN.

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I don't know why, especially because there wasn't an OB-GYN present at that birth, but to me it was like the logical next step and I ended up getting pregnant, probably eight years earlier than I planned because of a health scare.

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I've also since learned to ask more follow up questions, but my daughter's here and I really I mean I could talk a lot about my birth.

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I found it really frustrating to I had to work too hard to have an uninterrupted experience and I felt really confident with what I was doing and I couldn't get midwives, so I couldn't have a home birth at the time and so I was birthing in the hospital and I still had a reverence for the hospital system because I imagined my life there and I was in my mid-20s and so it was complicated.

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But my experience birthing I was so shocked that I was like, why are you all bothering me?

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Like, why do you keep turning my lights on, why won't you leave me alone, why do you keep pulling me out of the bathroom, why do you keep putting me in the bed?

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And I was having this almost like clash of what I imagined births, which was this home birth that I witnessed.

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That was profound, a reverence for the space I was birthing in.

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And yet my experience was like not syncing up because I realized it's not the environment to have an uninterrupted, physiologically intact birth.

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So I got as close as one could as an unsupported, no family 26 year old, and it was really what happened to me after, because I was mostly irritated that I had been messed with in my birth, that they just they didn't understand what my goals were.

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And I had a really traumatic immediate postpartum because I had an unmedicated birth that was really long.

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It was for like 52 hours of active labor into transition and pushing like really long.

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But I was doing it.

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I felt really powerful in what I was doing.

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And it wasn't until the actual the OB-GYN came in and he did an unmedicated repair.

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He was so.

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He thought I had an epidural, because everybody in the hospital I birthed with.

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They have about a 99.9% epidural rate.

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Even though I was flagging like I'm unmedicated, he was not listening.

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He was very aggressive.

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He used instruments at the end, even though I requested not for the delivery of my daughter.

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I had significant tearing and then, as I say, the baby was taken, like it wasn't what I imagined of, being put right on my chest and I had a repair with no freezing and so that was like a million F-bombs of garbage so that part I can like loop on, and that they just like.

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The door was open and tons of people were in the room and I felt suddenly like really vulnerable again.

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I was really modest up into this place and so I didn't have that modesty feeling when I was in labor.

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But once the baby was out, obviously your hormones are different You're like back in your body, your front to low kicks back in, and so I felt that's really where the violation started.

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And then when I got home I lived in an unsafe partnership which I was very clear I needed to get out once my daughter was born.

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But I remember feeling so confused because I knew for sure I didn't want to be an obi-kind, because that relationship to birth was like I would never do that to somebody else.

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And so then I was like no, what do I want?

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What do I do now with my life?

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And I remember pacing with my daughter, feeling such rage and such confusion and knowing that I had a role of being her mom.

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It was like it was an important role.

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I understood that.

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I also felt confused because I didn't know her and I didn't.

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I mean now I've worked with thousands and thousands and thousands of parents over the last almost 20 years and so I know all of it is normal.

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But at the time I was like why do people get so excited and like fall in love with their babies?

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I felt like a deep responsibility for her and to her.

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But I was like I don't actually really know her.

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I don't even know if I like her, I don't dislike her.

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But I was like this is a person I don't know that I'm with all the time, and so I remember feeling a lot of shame around that.

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And then, as she got like a tiny bit older like we're still in the weeks measurement I felt like just such extreme loneliness in that, because you know, after days your friends stop coming, people stop texting and calling, they drop off the gift.

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That doesn't make sense because 20 year olds don't know what to take their friends.

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So I got like weird stuff that's not cleaning my house, making me meals, taking the babies so I could shower, like those are the things anybody here wants to celebrate their friends.

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Do those things.

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But I that's really what is needed support, support, support and support, more than just those first days.

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And so I had this like swirl, and it launched me into this creativity and this.

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I had to solve it.

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I had to solve it and it felt very, very urgent and so I started a business.

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Do as I say, not as I do go back to bed, get people to love and support you.

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Do not start a business.

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But that's what I did, because I also did have an urgency of, you know, getting out of domestic violence, and so I actually fell immediately in love with my business.

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So I went out and I did a doula training and I struggled for a while with my ego being like, well, now I'm just a doula and I was going to be the surgeon in the room, and so I struggled.

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I struggled for a few years actually, with that concept until I was like you know, my job is to protect birth and this is.

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This is important.

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And as Gray was that's my daughter as she started aging with my business, I had these new, new, unique challenges is that I felt really passionate about my business again.

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I felt deeply responsible for Gray and she was with me and I co slept and work everywhere and I was feeding from my body and I thought I was like doing all of the markers, but I also really struggled because I didn't like making applesauce, I didn't like going to lessons, I didn't like baby droppings, and so I actually thought I was a bad mom and so I was like I'm doing all these things that are like the hardest versions of parenting is upholding attachment parenting, attachment science based parenting, not the intensive mothering model, not the like hyper helicoptering.

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So anybody, I'm really intentional about the language I'm using, because there's a type of quote, attachment parenting that is actually, I would say, probably not in the best interest of the parent, nor the child or children.

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But I was deeply committed to raising my daughter and in honoring her as a human, at the same time honoring myself as a human, and which is really hard to do and in this water we swim in and so but I I very quickly my client roster filled like very, very rapidly and I just threw myself into that community and I just started talking to parents.

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What did you wish you had?

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What are you suffering with, what?

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What makes you so sad?

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Because I had so much and I kind of initially wanted to make sure I wasn't just really whiny.

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What's wrong with me?

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Like start with self validation and move forward, like does anyone else hate this?

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Like raise your hand and just if you hate this, because I mean the work of mothering and the and the relationship of mothering are the two buckets and they've been collapsed right.

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So we think being a mom or being a parent for any queer gender expansive folks, that it is signing up for swim lessons and remembering the shoes are too small and booking pediatrician appointments and buying birthday things and dropping off cupcakes at the bake sale like that is not mothering, that's just you're wearing me out, just talking about it.

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I'm going to raise my hand and say I hate it too.

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I hate it, but we call that being a mom, and I was like that's not, that's a job.

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Being a mom or being a parent is like sitting and making eye contact with your kid.

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It's listening to them, it's playing in a way that you're like intentionally playing with them, not like okay, which doll do you want me to hold or which Legos do I get to touch and then where do I have to put them?

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Like really like watching your kid explore and discover and instilling values and all of that stuff.

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And I want to pause if anybody's like, oh, it's time for that exactly.

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Yes, you're right, you're right, and that is.

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That is parenthood.

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But unfortunately, due to, you know, the patriarchy, capitalism, like fill in the blank.

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We think all this running around, busy work that our children watch, and they watch who's doing it and they watch who's not doing it, and then our children, being raised as boys, see that their dad doesn't do it and their mom does, and then girls watch it, and we're just going to make these clones.

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So I started really looking at this intentionally being like I do not want this, I don't want to do it, so I'm I'm going to protest and not do it and I'm going to do the things that I do really like and I all honestly I didn't know how to really like show up for gray and love my business, so I mostly just like avoided one and did more of the other, and so I felt a lot of grief.

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I still feel tons of grief about that that I was like I will not do the work of mothering, but I also didn't fill it up with the relationship party there, because nobody else showed me how to do that part.

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I thought being a mom was just a lot of tasks.

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And then you chalked it up at the end of the day and you were like I was a good mom because I did that list and so I started getting really intentional about that part and learning more and trying to do better.

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And on it spoiler alert, if anyone's like in the underteens I'm I'm only getting the hang of it now that she's a year and a half away from going away to university.

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So it took a very long time and that was with me a hundred percent of my waking hours being doing this work, both personally and professionally.

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So I just, if anybody just wants to take this as an intention and it will kind of kick it off there.

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So my business started just shifting and growing as a, I was problem solving for parents and problem solving and healing for myself and I started, you know, really understanding empathy because I've listened to my clients.

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And then I'd go home and be like I'm not doing that at home.

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It like lit up these places that I was like I patiently listen to my clients, I never doubt them, I never challenge them, I never be like, but last night you did this, like I'm just like here's where we are and this is real and I'm gonna love you through whatever.

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But yet I'd go home and do the opposite and so I.

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It was a really great.

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There's probably one of my favorite lessons of this work of listening and not challenging and seeing that something great wanted yesterday, it's different today and not to like get her.

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Gotcha and I and these gifts just started happening as I was working with families and figuring out how I could change the face of not only keep them protected through their birth, but also change their experience as parents, so that we don't just keep cranking out these exhausted, not present, not self-care and I don't mean self-care in the sense of massage and pedicure.

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I mean that can be if you want, but like, truly it's taking a breath and seeing how you feel about your life and your day and seeing rest as valuable and critical and like sleep, y'all is critical.

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We always list what it keeps us alive and we list like oxygen, food, water, but I'm like, and sleep is that critical as well.

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And so these were these beautiful gifts that just started kind of unwrapping as I was going through this simultaneous journey of raising a kid and growing a movement that was protecting parents yeah, that is so amazing.

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Wow, I feel all of that.

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So how do you start like?

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Are you currently practicing as a doula as well, or are you training doulas mostly?

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yeah, I've gone in and out of retirement three times.

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I've come back out of retirement serving clients only because I really want to see what happens in another province, because it's a completely different system and I think, just the curiosity in me, I want to, I want to practice in this system that I'm currently living in so but I I train full time, but I did.

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I had probably a six or seven year period where I was training full time and practicing full time and I think it's important that folks who are teaching in a field also stay as fairly active in the field, because stuff changes.

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I mean, I still in the parenting side of it.

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I've pretty much stepped back outside of you know, talking about mental health and bringing joy back to parenthood.

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But there's products that people will post and they're like what do you think of this?

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And I was like I haven't been in the kids story in eight years.

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So yeah, I don't know about that.

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But as far as seeing practices and trends and what are doctors doing, what are midwives doing, what happens with GP specialties, our nurses fighting back on a certain concept that doctors are, you know, digging their heels in, these are the things that you can only see what's happening currently, if you're very active in that space.

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Yeah, I agree, I am at the point where I'm like, oh, I need to take a step back from the physicality of nursing.

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But I always say I have to do at least one day a week because everything changes.

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Everything changes.

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You leave for a week and you come back and everything changes.

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So I totally see where you're at and you do you mainly do hospital or are you doing homebirth and so I personally my personal brand, I position myself as almost exclusively hospital births and I do that because the type of clients.

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I have two main types of clients.

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One is like really type a professional women, and so they do a lot of like how do I do this?

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And fast, and I, they need, they need somebody that's like, yeah, yeah, totally type A, love a checklist and getting in there, and then I'm like, okay, so you can't, actually this is a magical thing you're about to do and you can't.

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Requires magic.

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Yeah, requires magic.

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And so I do a little bit of a bait and switch.

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But I'm because I'm also super type A and I do things fast and I talk fast and I love a checklist, and so I'm like, yeah, we'll do it, like fast, fast, fast, and then I go in.

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I'm like, okay, so, so this is how we have to do birth together.

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So that is my one demographic.

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And then I serve queer clients.

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I try almost exclusively but and then just kind of like pepper in straight folks and so I serve lesbian two parent families and it's my specific demographic and there tends to be a belief when you've had a long, high intervention fertility journey which queer people have to have because we're queer, so that there tends to be a more leaning towards hospital birth, because somehow they've had a like it wasn't easy in, so it's not going to be easy out.

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We also do a lot of work to check in before we choose our birthing location to be like you know how did we land in this place?

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You get to do whatever you want.

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And so, because of those two demographics, I find I have chosen to protect in the space that actually requires the most protection.

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Home births don't require as much.

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I think they're magic.

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I love my home births.

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That I've done.

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I've done lots and lots of them.

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But I want to make sure people are safe in a system that, for a multitude of reasons policies there's never enough nurses and they expect nurses to do the job of 15 people, which is inhumane.

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And so, because of that, there's a lot of role for somebody, the need for somebody who's trained in reproductive health to have that continuous care.

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Well, in addition, when you bring somebody in, a peer support person that you know well, the additional people that come in, like I feel like I'm invading someone's space and sometimes, if I haven't really gotten to know them I mean I have 12 hours sometimes, sometimes less, because it just depends on the turnover if I've taken another patient I feel like it is so much better to have somebody there that knows you, that you've developed a relationship with and that's not always your OB, because that's, you know, the practice is routine, that as well.

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Yeah, also that you'll see them at the end.

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Yeah, and it might not be your OB.

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You guys, I had an OB Dr H, we'll call him who followed my pregnancy back in 2006 and 2007.

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And I practiced in the same hospital.

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Most of my clients birthed at this one hospital in Toronto and I had attended probably 80 births before I ever saw the OB who followed me in a rotation.

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So not only did I not see him at my birth, I took about well 80 births at least Before I ever saw him again.

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And I actually thought I dreamt him because I was like how I've been at this one hospital so many times, 80 births at one hospital, because there's I don't know 10, 15 hospitals in Toronto that you could birth at.

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And I was like, oh, he's real.

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And friends.

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That is normal, so you've got to love the practice.

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Yeah, it's not your doctor walking in the number of times I've said that to people in consults and they're like so you probably won't see your doctor and they're like what it's like?

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Yeah, there's 18.

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Unless you have a specific agreement with that doctor.

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If that doctor has said I will be there, no matter when you give birth, I will drop everything, I will come back for my vacation.

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I will do all of these things.

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Unless you have that in writing, you are not getting your doctor, it's just you will not see your doctor.

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I mean that I do want to fly here in Canada when you have your family doctor who's got an obstetric specialty so they can attend.

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You will always see that doctor because I've had any of my clients with it and the care is actually really wonderful.

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I always it's probably my favorite is actually working with GP over all the types of people who will catch baby.

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But I've seen like a couple of them that have literally rushed home from their cottage or come in in a suit or come in like clearly not intending that their client would be in labor, because they come back for all of your birth.

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That's amazing, yeah, because general practitioners are declining.

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The rate of general practitioners are declining in the United States.

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I don't see it as much, but I know that they exist.

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I just have never actually worked with one.

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But we do have some private practice physicians.

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But then again, I mean they're going to try to get there for your birth, but they will find practices to cover them.

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So unless you schedule an induction, and still because if you have a five day induction your doctor's not staying for that, I'm sorry.

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Yeah, it's nice to see someone familiar and because I was so active I'd so so many clients with, like in my 20s and 30s, I love the relationship I had with the nurses because I would come in and they would just like hat tip and like tell me what room I'm in, and then they just knew Bianca will call me when any of these things happen and because the less people coming in and out of the room, we actually see better outcomes.

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And so because I had had that trust with the staff at the hospital, it was really great because I was like could truly provide that uninterrupted, continuous care, because they had that trust with me and so they knew if any of these things happened and I would be charting, you know, for my clients and it was, you know, just the way I did my practice.

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It was really really nice for my clients and so word of mouth was great because people would be like, oh, bianca was like pretty much the only one there the whole time, which is atypical for a doula.

00:20:34.636 --> 00:20:58.279
But it was because of this foundation that I had built and so they knew just keep that door closed and don't open it, especially because I had a really, really high unmedicated birth rate with my clients, mostly coincidentally, just because they felt like safe and calm, and they were surprised that it didn't have the sensation because we stayed out of that fear, the fear, tension, pain cycle, and so they were like, oh, I thought it was going to be way worse than that.

00:20:58.279 --> 00:21:00.751
I was like, no, that's that, was it, that's birth.

00:21:01.054 --> 00:21:22.006
Yes, I want to go back to the fear tension pain cycle at some point, but you can doggone it whenever you want, yes, but I want to touch on the importance of doulas that are specifically prepared to take on everything that entails a hospital birth to serve their client rather than an agenda.

00:21:22.006 --> 00:21:39.210
And I recognize, because I don't always love the way that we do things in the hospital, but I feel very empowered to make sure that the way that I try to exert change isn't in an argumentative way.

00:21:39.210 --> 00:21:47.148
I have, in the past, been argumentative, I have, yeah, and that we've all done it.

00:21:47.531 --> 00:21:49.103
I have been called out on that.

00:21:49.103 --> 00:21:52.068
Yeah, Because in the beginning I was very outspoken.

00:21:52.068 --> 00:21:55.140
I'm still someone outspoken when I need to be.

00:21:55.140 --> 00:21:58.170
I mean, I have an entire platform now so I feel less obligated.

00:21:58.170 --> 00:22:11.196
You could do whatever you want Right, but I find that in general relationships with current births and current providers, that doesn't have to happen in the room that isn't the space for that.

00:22:11.217 --> 00:22:14.390
No, we don't need to be doing this in front of the patient Right now.

00:22:14.390 --> 00:22:35.198
We just need to be focused on this person and how to have the best birth with the people that are in the hospital, with the hospital policies, and work with all of that in order to give the most uninterrupted care possible and keep people in this normal cycle scope, you know, so that everything looks copacetic, so that nobody wants to come in the room and change things.

00:22:35.739 --> 00:22:37.040
Yeah, yeah, For sure.

00:22:37.040 --> 00:22:37.662
I love that.

00:22:37.662 --> 00:22:42.099
You said that so just like it's going to sound like a really nice plug for my doula training.

00:22:42.099 --> 00:22:46.210
But the reality is most doula trainings are a crash course weekend.

00:22:46.570 --> 00:22:55.337
And that was one of the problems that I solved because I went through that but I had my pre-med done and so I was like that was not enough If I didn't have that invitation.

00:22:55.337 --> 00:22:58.210
That is not enough to go into a medical field.

00:22:58.210 --> 00:23:02.496
Even if we do not have to do medical care, you do need to know.

00:23:02.496 --> 00:23:06.461
If somebody's talking about blood pH, I need a doula to know.

00:23:06.461 --> 00:23:08.884
If their client looks at them scared, what does that mean?

00:23:08.884 --> 00:23:12.210
I want them to know all the tests, all the procedures.

00:23:12.210 --> 00:23:15.210
I want them to know how the hospital equipment works.

00:23:15.210 --> 00:23:17.803
I want them to know what the terms mean.

00:23:17.803 --> 00:23:19.210
What is slang in the hospital?

00:23:19.210 --> 00:23:26.210
I want them to know how to work with hospital staff because we're in their house Doulas and doulas out there listening, we are in their house.

00:23:26.210 --> 00:23:28.518
We might not like their house, but we're in it.

00:23:28.518 --> 00:23:31.776
Right, and that is not the like what Kelly just said.

00:23:31.776 --> 00:23:32.436
It is not.

00:23:32.436 --> 00:23:36.445
The platform to make change is not in the birth room with a client.

00:23:36.445 --> 00:23:37.106
That's where you protest.

00:23:37.127 --> 00:23:38.150
That's where you let it write.

00:23:38.957 --> 00:23:40.210
That's where you do your thing.

00:23:40.210 --> 00:23:42.198
You take it to the administration.

00:23:42.198 --> 00:23:55.045
You do all of that after the birth, and so in my training it's a four month while you're in school, and then it's about a year and a half after that of your practicum and your certification package.

00:23:55.045 --> 00:24:08.041
Because I want people to know the magic of birth and parenting and fertility, I want them to understand the medical deeply and feel confident, so when they go in there they don't have this like I don't know where I fit in this space.

00:24:08.041 --> 00:24:20.210
So they, like very clearly know their scope and their role and then how to take care of the informational, emotional and physical care of their clients, including, you know, a deep understanding around mental health and how that plays into our physical health and experiences.

00:24:20.210 --> 00:24:23.497
And so it's such a comprehensive training.

00:24:23.497 --> 00:24:43.210
And it came from the fact that I watched how doulas worked in a way that I was like, oh we, I wish people were better trained, because I don't want them going out and doing this in the space, because then people talk badly about doulas, like most doctors and nurses are like, oh, we don't really like doulas because XYZ and that's not going to serve, like we can't have somebody who's there to protect.

00:24:43.210 --> 00:25:03.170
It creates the optics of like somebody is really good and somebody's really bad, and that's not going to work for protecting birth and the role of every person that they've committed there, even though sometimes it's gotten a little complicated with, you know, when we've got a fiscal involvement and the tiges involvement, it's backed up the waters.

00:25:03.170 --> 00:25:12.210
But we all claim to be there to protect the birther and the baby, and so if we could hear one another, we can do way better for them.

00:25:13.454 --> 00:25:14.578
And so the doctors.

00:25:14.578 --> 00:25:17.210
Unfortunately, as it became a surgical specialty, they lost the magic.

00:25:17.210 --> 00:25:21.210
The hospital loses the magic because the hospital is there for sick people, not for birth.

00:25:21.210 --> 00:25:26.525
And so you know, knowing these kind of elements, we do need somebody in there.

00:25:26.525 --> 00:25:28.210
That's like it matters if the lights are on.

00:25:28.210 --> 00:25:32.210
It matters if we're debating in front of a client slash patient.

00:25:32.210 --> 00:25:41.190
It matters if people are chatting about something else, like there's a person coming into the world right now I don't care that your car didn't start this morning, like, take it out in the hall.

00:25:41.530 --> 00:25:47.715
And so I had to learn what worked, what didn't, what made me feel good after, like when did I walk out and be?

00:25:47.715 --> 00:25:47.936
Like?

00:25:47.936 --> 00:25:49.784
Everybody won in that situation?

00:25:49.784 --> 00:25:51.210
The conversation stopped.

00:25:51.210 --> 00:26:13.846
Nobody felt shame and my client didn't have their birth interrupted, and so it took me a lot of trial and error and obviously with humans it's infinite number of possibilities but a general concept, theory, kind of method of how we can keep our ego out of the space as healthcare practitioners truly serve our clients as well as correct and commit to change.

00:26:14.269 --> 00:26:34.184
We all need to be committed to change, but I know as a fiery younger person those are actually the markers of why I retired to a couple times was because I did it the wrong way and I either stayed quiet when I felt like a lot of shame when obstetric violence happened or I popped off in the time that I was like that was their birth.

00:26:34.184 --> 00:26:36.190
That wasn't my activist platform.

00:26:36.190 --> 00:26:38.210
Grab your megaphone and take it some other place.

00:26:38.210 --> 00:26:43.801
Now I will always literally use my body and force if there's human rights violations.

00:26:43.801 --> 00:26:45.736
That's like that's a no go for me.

00:26:46.210 --> 00:26:58.982
So if my clients have said please stop touching me or you can't do that, and somebody continues to do it in any capacity, that's where I'm like deeply committed to be like they actually said stop, because anywhere else if somebody says don't do that to me, we have to stop doing it.

00:26:58.982 --> 00:27:07.210
But we have to be working as a team and I think it's really important that you highlighted that, because as a younger person also did the same thing.

00:27:07.210 --> 00:27:12.941
But like we cannot debate stuff, we cannot lead, guide for change.

00:27:12.941 --> 00:27:14.627
These are sacred moments.

00:27:14.627 --> 00:27:15.210
These are one time.

00:27:15.210 --> 00:27:21.210
It's that one time these parents are going to be birthing that child and meeting them and meeting them.

00:27:21.210 --> 00:27:23.558
They're meeting their baby.

00:27:23.558 --> 00:27:25.406
That's important, that matters.

00:27:25.807 --> 00:27:30.210
Yeah, and even though, like, even if it's like the hundredth time for me, that doesn't matter.

00:27:30.210 --> 00:27:51.375
I want to validate that for you, because there are times that I've popped off, there are times that I have not said stuff, there are times that I didn't even know, like that, I've just been so trusting of the people that were above me and quote unquote or the people that were more experienced than me that I didn't even realize that there was another way to do things and that it was just like.

00:27:51.375 --> 00:27:52.157
This is how it's done.

00:27:52.157 --> 00:28:12.837
I mean, I remember my first cervical exam when I was pregnant was incredibly painful, but for me I didn't feel violated because I wanted to know where I was at and when I went in to become a labor and delivery nurse, people that I was working with.

00:28:12.877 --> 00:28:34.499
Now this has changed significantly, but this is like eight years ago not a lot of time, but eight years ago they would come in and sometimes they'll still say it, but then I try to reframe it I need to check your cervix, and then they would proceed to check the cervix and patients would express the need to stop, and I was taught to just go ahead and get it done to minimize trauma.

00:28:34.499 --> 00:28:35.740
That was what I was thinking.

00:28:35.740 --> 00:28:38.093
Yeah, which getting something over with.

00:28:38.093 --> 00:28:39.738
And I mean there is a delicate balance.

00:28:39.738 --> 00:28:44.961
You can stop and say I'm almost there and this is going to be very uncomfortable.

00:28:44.961 --> 00:28:53.210
But if you want, if you truly want to know where your cervix is at, if that is your desire, or if you want to have that information so we can decide how to proceed, then may I proceed.

00:28:53.210 --> 00:29:01.607
But continuing without consent it's not good, yeah, I mean.

00:29:01.909 --> 00:29:04.428
And then it's full trauma, like anytime.

00:29:04.428 --> 00:29:28.657
Somebody just continues doing something to me when I say stop, it's violating and most of the things I'm going to say we, because it's the field of reproductive health injustice, even though I'm passionately on the other side of this, but like the idea that most of the things that happen, they all feel urgent to healthcare providers in the hospital and so I'm like we actually never need to touch a subject Like truly.

00:29:28.719 --> 00:29:29.664
I know that people say like I don't know.

00:29:30.958 --> 00:29:31.644
But we don't.

00:29:31.644 --> 00:29:41.453
And so when we're in the OR, if somebody says, I can feel that there's an immediate action, because that means the freezing is not working, like you know, and we jump to action because we don't want that.

00:29:41.453 --> 00:29:49.654
But literally outside of that, there's not a single thing that we couldn't just stop and be like okay, well then we just not going to know.

00:29:49.654 --> 00:29:51.593
Or like okay, then we don't get the IV.

00:29:51.593 --> 00:29:56.977
Or like okay, then, like there's, there's nothing and nothing is that urgent.

00:29:56.977 --> 00:29:58.644
Yeah, that's not, that's urgent.

00:29:59.026 --> 00:30:02.476
And unfortunately, the nurses are truly getting the brunt of it.

00:30:02.476 --> 00:30:17.656
And so, kelly, as a nurse, I see you and I see how it's actually policy that goes down to administration, that goes down to the president of the hospital or hospital system, that goes down to the board, that goes down to the doctors that go, and then it drops down.

00:30:17.656 --> 00:30:32.576
And so all this urgency, all this risk of litigation, all this busy work, all this charting, all this client care, all this responsibility lands on women mostly, who are put in this caring role, who are the least paid of the, of this hierarchy.

00:30:32.576 --> 00:30:40.644
And then doulas are considered quote below them and we're paid an eighth of what a nurse is paid, and we never know when our shift is going to end.

00:30:40.644 --> 00:30:59.996
Nurses are like, well, it's done, bye, like I could be, like I might go home tonight, I might not be home for two days, and so this is the system, and really we're having these like complicated urgent feeling, sometimes opposing goals, with a birthing person in the room, and it's because of all of these other pressures.

00:31:00.664 --> 00:31:05.885
And so I watch nurses and I'm like, oh, this sucks, because I'm feeling mad at you right now, and it is.

00:31:05.885 --> 00:31:10.296
I very quickly can pivot to be like it's not you, it's your charged nurse, who's then got this nurse?

00:31:10.296 --> 00:31:12.568
Who's then got this doctor, who's then got this policy?

00:31:12.568 --> 00:31:19.277
And all of it is is pulling in the wrong direction from what we should be honoring around birth.

00:31:19.277 --> 00:31:23.915
I mean, all of it pulls in the wrong direction, even from what the World Health Organization recommends.

00:31:23.915 --> 00:31:43.750
All of it's pulling against ACOG, and in Canada that's the SOGC, which is the governing bodies for obstetrics, and so when we truly step back, we're not even following the guidelines that are evidence based, that are outlined, and so, anyway, I could go off on like a million tangent, but well, there are ways to.

00:31:43.910 --> 00:32:06.257
I guess what has taken me the eight years of practice or maybe less, because I think I realized this a couple of years ago and that's why I'm doing this right now is there are gentle ways to establish trust with the charge nurse, with the medical provider, whether it's the midway for the OB, with the patient, to be able to start to find out what the patient wants.

00:32:06.257 --> 00:32:12.164
Because if the patient wants to go up on the pit and get the baby out, okay, that's your choice, right, that's their choice.

00:32:12.605 --> 00:32:23.416
But if that's not their choice, well then there are specific questions that you can ask in a way that is not threatening, so like if the baby looks great, you know, you can say, well, what's the urgency here?

00:32:23.416 --> 00:32:32.336
You can say they want us to keep going up on the pitocin, but they're contracting every two to three minutes and the baby looks good and we've progressed from four to six centimeters.

00:32:32.336 --> 00:32:32.865
Like what?

00:32:32.865 --> 00:32:34.873
Maybe we can just hold off, let's just check.

00:32:34.873 --> 00:32:36.729
Why don't we just check in a couple hours?

00:32:36.729 --> 00:32:38.294
Yeah, you know or don't.

00:32:38.294 --> 00:32:46.972
And then when patients are saying when are you going to check me next, then my answer is well, you let me know when you feel some pressure, I'll watch the baby for science, that you're ready to deliver.

00:32:46.972 --> 00:32:50.171
And if a baby delivers in the bed, who wonderful?

00:32:50.171 --> 00:32:52.714
Yeah, totally, that's what they're supposed to do.

00:32:52.714 --> 00:32:53.876
We're here to have a baby.

00:32:54.417 --> 00:33:02.832
Yeah, and it's interesting because I teach my clients just like questions, to be informed and I never care how people birth.

00:33:02.832 --> 00:33:10.133
Like literally there's a menu that's so long you tell me what you're choosing, there's literally no best way to birth.

00:33:10.133 --> 00:33:15.549
There's the best way for that person or the ideal way for that person and I learned this the hard way, y'all.

00:33:15.931 --> 00:33:16.311
Oh my God.

00:33:16.311 --> 00:33:38.116
I thought in my mind when I started, obviously like home birth was the best birth, and it wasn't until I like I'm laughing, I feel a lot of shame about it but it wasn't until I had a couple of people that I encouraged them to stay until it was too far for them to go and they birthed at home, and it took not one but twice of this happening of my clients.

00:33:38.116 --> 00:33:42.211
After being like, I feel tons of grief that I birthed at home.

00:33:42.211 --> 00:33:43.431
I wish I got to the hospital.

00:33:43.525 --> 00:33:48.605
I really wanted to birth in the hospital and I feel really sad and I'm struggling and I'm seeing a therapist Now.

00:33:48.605 --> 00:33:50.492
I didn't like push them to that point.

00:33:50.492 --> 00:33:52.791
They also had three or two or three midwives there.

00:33:52.791 --> 00:33:54.846
They had a partner there, Like I was, but I was.

00:33:54.846 --> 00:33:56.691
I contributed Part of the team.

00:33:57.192 --> 00:33:58.134
We're almost there.

00:33:58.134 --> 00:33:58.694
Do you know what?

00:33:58.694 --> 00:33:59.616
Do you know what?

00:33:59.616 --> 00:34:00.546
We're at?

00:34:00.546 --> 00:34:04.990
Eight centimeters, you know, even though we were so close to the hospital that they could have got there and they could have pushed.

00:34:04.990 --> 00:34:05.813
That's what they wanted.

00:34:05.813 --> 00:34:12.710
They wanted to birth in the hospital, for whatever reason, and it's none of our business, it's there and it's how they felt in that moment.

00:34:12.710 --> 00:34:21.929
And it took two times of clients being like I hated my birth because I didn't get to go to the place I wanted to go and I was like the hospital.

00:34:21.929 --> 00:34:36.677
You birthed at home and they were like I wanted the hospital and I learned in those moments that I do not know what's best for anybody and what I would have deemed best for me was it's not.

00:34:36.677 --> 00:34:40.472
And so people would feel grief from unmedicated births, which everyone is like.

00:34:40.472 --> 00:34:41.355
I had an actual birth.

00:34:41.355 --> 00:34:42.117
Some people feel grief.

00:34:42.117 --> 00:34:46.416
You had a guest on your podcast that felt a lot of grief about her unmedicated birth.

00:34:46.605 --> 00:34:59.496
That it was just a precipitous labor and she had the baby, and that an elective C-section is the most empowering amazing things, unmedicated, to a certain point, just nitrous birthing in the water, not in the water.

00:34:59.496 --> 00:35:08.106
There's an infinite number of births and I think that it took me a while to learn that, standing back and letting people birth how they want.

00:35:08.106 --> 00:35:17.534
But unfortunately, when you go in the hospital, the likelihood of you having a very cookie cutter birth is just so profound.

00:35:17.684 --> 00:35:40.851
So I do teach my clients to ask questions, not to be challenging, but to like get information, as you should when we're going through anything about our body and our children, and so I know in I think every hospital in Toronto and I've supported birth in I don't know 18 different hospitals in my career and when client, when they're like so we're going to put an IV to start pit, or oxytocin, pitocin, centocin you might have heard all of those terms.

00:35:40.851 --> 00:35:43.117
Everybody listening Kelly knows all about it.

00:35:44.509 --> 00:35:46.014
So that was where all of you listening?

00:35:46.054 --> 00:35:46.594
not for Kelly.

00:35:46.594 --> 00:35:50.715
And so when they're like we're going to start pit and my clients go, oh, tell me about that.

00:35:50.715 --> 00:35:51.726
Like what?

00:35:51.726 --> 00:35:51.806
Why?

00:35:51.806 --> 00:35:58.074
What are the benefits, what are the risks, the number of doctors, doctors, you guys that are like, well, everybody gets pit.

00:35:58.074 --> 00:35:59.170
And then they look at me.

00:35:59.170 --> 00:36:04.364
And then the doctors always look at me because they think I'm the one that's going to, like, mess up the system here.

00:36:04.364 --> 00:36:06.851
And I'm like, guys, do you like that answer?

00:36:06.851 --> 00:36:07.574
Are you ready?

00:36:07.574 --> 00:36:09.331
Do you remember what pitocin is?

00:36:09.331 --> 00:36:10.871
Do you have follow up questions?

00:36:11.304 --> 00:36:26.956
Because everybody gets pit is not a good enough answer to do a medical treatment, especially when we now know Dr Michelle O'Don's research on what's happening to our brains with prolonged exposure to pitocin, when we have just been using it so fast and loose for extended period.

00:36:26.956 --> 00:36:32.257
It's one of the contributing factors for our struggling for vaginal or pelvic births.

00:36:32.257 --> 00:36:36.936
It's one of the reasons why we're having issues with feeding from our body or milk supply.

00:36:36.936 --> 00:36:38.610
It's why we have a rectile dysfunction.

00:36:38.610 --> 00:36:47.514
All of this is literally this atrophying of our brains from having this synthetic version of oxytocin, which is like fascinating research.

00:36:47.514 --> 00:36:53.192
And so when I look at these doctors, I was like there's actually a lot of risk for you saying, well, everybody gets it.

00:36:53.192 --> 00:37:03.083
It does have really great perks in that it leaves our system really quickly and we can turn it off and if the baby doesn't like, there's some good things that we other things.

00:37:03.083 --> 00:37:05.570
Once that trains on a station, we're a little more on it.

00:37:07.025 --> 00:37:18.695
But everybody getting something is not a reasonable because, for sure, pit is going to probably be a full stop barrier for somebody having an unmedicated as far as pain management birth.

00:37:18.695 --> 00:37:25.672
And I've had clients who, for their reasons, can't have narcotics or choose not to, in which case the epidural is off the table for them.

00:37:25.672 --> 00:37:30.275
So I have seen pitocin used without any other pain management.

00:37:30.275 --> 00:37:38.512
But I think people need to know, just so you know, if you start pitocin, you will probably almost 100% need an epidural.

00:37:38.512 --> 00:37:43.128
And so when we're saying it casually, like well, everyone gets pit, let's just get that IV started.

00:37:43.128 --> 00:37:49.885
That's where having a doula there to just slow it down, to be like should everybody have this?

00:37:49.885 --> 00:38:04.596
Because it's not advised for every birth, or to walk in and get pitocin, it's not advised for every birth, or to get even an IV put in, or to get regular cervical assessments to birth on our back, like there's all these things that all the governing bodies are saying that that's not the right thing.

00:38:05.085 --> 00:38:08.476
But it's very interesting to see the practice based care that happens.

00:38:08.476 --> 00:38:12.007
Just because it is, it's passed down right, like that's what?

00:38:12.007 --> 00:38:17.572
Yeah, so I was trained, and then that's the next person trained and I mean it takes a very long time.

00:38:17.572 --> 00:38:18.951
Look how long we had twilight birth.

00:38:18.951 --> 00:38:20.911
Look how long apesiodomies were regular.

00:38:20.911 --> 00:38:21.606
Look how long.

00:38:21.606 --> 00:38:23.753
Like it took decades.

00:38:23.753 --> 00:38:30.670
I mean I bet you didn't learn that active labor in nursing school, active labor shouldn't start until after six centimeters.

00:38:31.125 --> 00:38:40.284
We adjust, actually, because I went back to nursing as a second career, so I graduated in 2013 and they just started talking about the change that was coming.

00:38:40.284 --> 00:38:47.371
That was active labor at six centimeters, so it was just like right on the cusp, but it didn't actually happen in the hospital.

00:38:47.672 --> 00:38:52.233
No, no, it's hard to find.

00:38:52.233 --> 00:38:54.050
I correct people all the time.

00:38:55.664 --> 00:39:03.030
One of the things that I like to distinguish is the difference between an IV port and actually getting hooked up to something.

00:39:03.724 --> 00:39:30.871
Oh, please explain that to everybody so while it is important to walk in the room and say, may I start your IV, you're going to get some pushback by your superiors as a nurse if someone says no, because that is kind of just part of the first steps is getting the IV port so that if there is an emergent need for medication that goes in the IV.

00:39:30.871 --> 00:39:36.050
That can stop whatever negative things might be happening in your labor.

00:39:36.050 --> 00:39:40.394
We have that access earlier rather than later when it's an emergency.

00:39:40.394 --> 00:39:48.244
But that does not mean that you ever have to have something hooked up to it if everything is going well.

00:39:48.244 --> 00:40:01.512
So if you come in an active labor you're contracting, doing all of the things progressing, going to have your baby without any interventions, having that IV port there doesn't mean we're going to do anything.

00:40:02.605 --> 00:40:16.036
We may want to offer you some pitocin in the IV after the fact maybe, which can be declined if your uterus is doing the things that a normal uterus will do after delivery.

00:40:16.036 --> 00:40:19.913
You may also, if you are unmedicated, have the option.

00:40:19.913 --> 00:40:23.773
Well, I guess unmedicated you wouldn't really need the IM pitocin.

00:40:23.773 --> 00:40:33.536
But if you wanted to avoid extra fluids then you can request the IM pitocin, which is when it's injected into the muscle, that's the protocol here, but how did the IV?

00:40:33.577 --> 00:40:33.978
port.

00:40:33.978 --> 00:40:35.001
Oh is it.

00:40:35.021 --> 00:40:35.804
Oh, that's good.

00:40:35.804 --> 00:40:41.777
Yeah, I am a dose of pit at the birth of the posterior shoulder.

00:40:42.065 --> 00:40:43.909
Oh nice IM pit.

00:40:43.909 --> 00:40:45.072
Oh gosh, that's so good.

00:40:45.313 --> 00:40:45.494
Yeah.

00:40:46.304 --> 00:40:58.804
Because the amount of fluids that we give people I mean it's one of the hospitals I work at we give over the four-hour period a 500 ml, which I'm not as concerned about that, but like to give two.

00:40:58.804 --> 00:41:04.628
We used to give two bags of pit and just bolus it and they had like 20 or 30 million units in it.

00:41:04.628 --> 00:41:06.063
That's too much.

00:41:06.619 --> 00:41:08.507
Yeah, and there's a lot of interstitial fluid.

00:41:08.507 --> 00:41:09.784
We have so much puffiness.

00:41:10.440 --> 00:41:18.965
I mean so when we talk about the IV Puff is probably with breastfeeding, oh, there's so many things, and just people feel crappy, like you're just your puffy, yeah, puffy itself.

00:41:18.965 --> 00:41:27.708
And so, like the IV is a really great example because I tell my clients that I mean I obviously teach them the difference between port and then a line being like actually running.

00:41:27.708 --> 00:41:37.989
But if somebody's like has had an uneventful pregnancy, they've been regularly monitored and they have no intention of having like they're going in, you know, spontaneously.

00:41:37.989 --> 00:41:39.585
So somebody went into labor.

00:41:39.585 --> 00:41:41.061
Naturally they don't.

00:41:41.061 --> 00:41:45.726
They don't plan on having an epidural and not in like I'm going to try, but they're like epidural is not part of my plan.

00:41:45.726 --> 00:41:51.304
That's where we see those like falling down, where people like I don't want the port in because they can be uncomfortable.

00:41:51.304 --> 00:42:13.869
You lose mobility, yeah, and so there's especially a lot of the birthing positions, because if you're unmedicated, you want to be able to be on your hands and knees, you want to be able to be holding the edge of the tub, and so that, depending on where the where the site is, and so those are the moments where we can, as a team, come together and be like I'm hearing the pressure from your charge nurse and this is because we were in a practice-based care rut.

00:42:13.869 --> 00:42:18.144
We're in practice-based because there's emergency situations, we'll go down to the ER.

00:42:18.144 --> 00:42:25.722
They never have ports ready for them and they see, really they see crisis situations Like there's.

00:42:25.722 --> 00:42:31.286
People are used to crisis care in a true emergent situation and the rest is a convenience thing.

00:42:31.286 --> 00:42:40.106
And then for my clients, when they're like, oh, I plan at this point to have my epidural, then I'm like part of your triage will be putting your port in because it's part of your plan.

00:42:40.106 --> 00:42:43.608
You've chosen this, and part of having an epidural is you have an IV.

00:42:44.139 --> 00:42:57.148
And so I think that if we could start coming together on all the sides of like the vested interests and really stepping out to be like why is this important?

00:42:57.148 --> 00:43:08.349
Because what's happened in obstetric care specifically is that there's so much risk mitigation and they just keep adding up, and so all these things are to mitigate all these risks.

00:43:08.349 --> 00:43:18.487
But really the act of doing 15 things to mitigate risk for sure leads to risk, and so that's why we have all these really great tools, but birthing outcomes have never been worse.

00:43:18.487 --> 00:43:28.365
And so if we step back and we're like, all right, everybody, so we're doing all these things to avoid harm, yet for sure birthers are saying I felt trauma.

00:43:28.365 --> 00:43:29.208
These things happen.

00:43:29.208 --> 00:43:30.670
I felt pain, I felt scared.

00:43:30.670 --> 00:43:33.005
I didn't get to choose it, things got away from me.

00:43:33.380 --> 00:43:36.128
So we're having that universally reported.

00:43:36.128 --> 00:43:44.126
Very few people are leaving their births being like that's great, they're like my baby's alive and I should be grateful, and that cannot be the threshold.

00:43:44.126 --> 00:43:45.304
So we're looking at this.

00:43:45.304 --> 00:43:56.387

Bianca Sprague: Guardian of the Birth Experience

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