Bridging the Gap Between Community Birth and Hospital Birth with Jodilyn Owen and Arya Pretlow

Transcript

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Hello, today I have with me Jody Lynn Owen, lm, cpm, and returning to the show is Aria Pretlow, msn, cnm, ibclc and all the other past and future acronyms that I will put in the show notes.

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Both Jody Lynn and Aria are midwives, which is a profession that specializes in what is known as the perinatal year, which includes the pre-pregnancy, pregnancy and six weeks postpartum.

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Jody Lynn, in particular, specializes in community-based clinics through strategic partnerships and health systems.

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She focuses on bridging gaps in health care and the delivery of health care services for all.

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She is also the co-author of the Essential Home Birth Guide.

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Today, jody Lynn and Aria will be discussing the qualifications to be able to safely deliver at a birth center or at home and the reasons that would require a pregnant person to change to a hospital birth.

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Jody Lynn and Aria, thank you so much for joining me.

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So happy to be here.

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Thank you for having me.

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Yeah, thank you.

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I am excited because, having only worked in the hospital setting, I always wonder what it might look like to have delivered at home or to even fathom that and just kind of the thought process of meeting all of those qualifications.

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And I feel like I am not alone in that, because most OBGYNs that I work with feel like a home birth or state that they think a home birth or a birth center birth is inherently unsafe and I feel like I want to challenge that and figure out where we might be able to work together and meet in the middle and plug people into where they belong.

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So could you all enlighten me.

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I want to give a plug to my licensed midwife, certified professional midwife colleagues, in that they are the experts of low risk, normal birth, and we have to keep in mind that there is a difference in worldview for lack of a better word between people trained as medical doctors, even from those of us trained as nursing professionals.

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Right, like the nurse, process is not the same as the MD perspective, is not the same as the midwifery model of care, and so we look at constantly assessing is this still normal by like agreed upon standards of normal physiologic pregnancy and markers for health?

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Is it still low risk, again based on agreed upon standards of care?

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And we look at this is normal until it isn't and I remember learning in midwifery school and nurse midwifery school in the medical model it is never normal except retrospectively, after it has happened.

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They might say that was a normal low risk delivery.

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But we look at it as this is currently normal and low risk.

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It has the potential to remain that way and we are going to continue to assess for warning signs because none of us wants to have to transfer an emergency, but also, until there's a warning sign, it's still normal and low risk.

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Yeah, I agree.

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So that's the first thing is like a fundamental difference in the perspective of are we assessing in the moment and making that call, or are we withholding that assessment until afterwards and then saying that was quote, unquote, normal?

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Yeah, there's a lot of the mindset of preventing an emergency.

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Yeah, we're not even interested in preventing emergencies.

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We're interested in preventing anybody from being outside of the care they need all of the time.

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There's a certain vigilance that comes with this work.

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We're both acting on presumption of health and presumption of capability.

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We trust babies to show us when they're not well, and I think one of the there was a couple of things you said that really kind of lit up in my brain.

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One of them is that there's a presumption in by license midwives that the people who are pregnant know their bodies and know their babies and that if we give them the space and access to communicate what they know, they will.

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So in the hospital system and in this sort of standard medical system which I will try very hard not to disparage it's not what I'm after and it's not what I'm about.

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We're really close with very hardworking OBs who listen hard to their patients and who respond beautifully, but there's a lot of data system-wide that that doesn't always work, and one of the advantages of being where I am is that I have a lot of time and I have an expectation of access and communication.

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One of the things that our patients sign is that they accept responsibility to communicate with their providers.

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That's not something you sign when you go into OB care.

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You don't have to accept responsibility to communicate.

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But what we do in those visits we have hour-long visits and what we do over and over and over again is build confidence in the person that they will be heard, they will be believed, be believed and they will be responded to and that they know their body best and they know their baby best.

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And there's lots of data to back that up.

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There's a lot of data that says somebody who calls and says I don't feel my baby moving quite like they normally do, it's one of the most accurate predictors that something isn't right.

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And our job outside of the hospital is to pay attention to all of the little data points and there are a lot of little data points, but there's still data points and then to act long before we're looking at an emergency.

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I don't even really remember the last time I transferred because of an emergency.

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The reason we transfer people into care prenatally or during their pregnancy or postpartum is because we're seeing something happen that we're concerned about and in the very best world we have OBs around us and nurse midwives around us in hospital systems that we can call and say this is what I'm seeing.

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Here's my three data points.

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And they will say send them over.

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And they don't blink.

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And the challenge right now, of course, is the stress on the healthcare system.

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So we'll make those calls and they'll say we wish we could help you, but our first appointment is three months after her due date.

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So that's for real and that makes everything feel very difficult for everybody.

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And the other thing that I think we have to think about safety.

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And what does safety mean to people?

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How would you define safety?

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And there's a perception of safety.

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There's absolute safety and there's relative safety.

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And for many communities, the perception of safety in the hospital and the absolute safety in the hospital that's being measured now quite regularly.

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It's just not there.

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So we have part of what we're dealing with is a lot of people who are terrified of the hospital.

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They don't really qualify for an out of hospital birth, but they are so afraid of the hospital and they have seen their sisters and their aunties and their best friends get harmed in that system.

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And it's not always that somebody dies.

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There's a lot.

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There's way too much death in this country in maternal and child health, but sometimes it's just the way that people are treated and it's just so demeaning and so demoralizing.

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And making it through that process, I think, is part of the challenge that the healthcare system is facing right now.

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We just have to do better for people.

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Yeah, I agree with all of that.

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Even when we are trying to do our best in the healthcare setting, the reasons that you brought up are what make it challenging the rushing people through labor because we have people on hold that are having medical induction scheduled, that maybe their medical reason isn't as urgent or emergent as this other medical reason and latherin's repeat.

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So, yeah, it's very frustrating.

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And then to have to practice in that way when you have somebody quote unquote taking up a bed who maybe came in in natural labor and has slowed down but wants to go natural, and then you have this person on hold because this person came in in labor and qualified to stay, and then what do you do from there?

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You try to encourage that person to speed their labor along so that they no longer take up a bed or don't push because we have to go back to an emergency C section.

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But you're complete and plus two hang on.

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It's sort of a birth at the hospital.

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The OR, those are intentional but they happen.

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Patient education pieces I've ever heard and I've been at a lot of births in the hospital, and she said to the patient I want you to know that we're all here doing our JOB's, as to get caught up in what our bosses are telling us to do and the pressure we feel from our colleagues to move quickly and get things done.

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But this is your birth and what you need is important and you can stop us by telling us what you need.

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And I thought it was just one of the most breathtaking sentences because she acknowledged the tip of working in that space and reactivated the voice of the patient and made a promise to her in that moment I'm going to listen to you and we'll slow down if you need us to slow down Slow.

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So birth is slow and I think that's you know.

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It's slow and there's great physiological pauses in labor that happen and they're just real.

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So part of the reason that somebody will, we get a lot of people who've had a prior hospital birth, who were in, and when we tell them, you know, tell us more about that.

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What are you thinking about?

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Can you describe what you're looking for?

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They do mention what you just said, which is they had a feeling that they were being pushed along and they want more space and they want to be with their family and it's a really big day for them.

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It's the last day of their pregnancy, but it's a really big day, it's a really important day and they want to be in it.

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Yeah, I agree with all of that and that's how I feel as well.

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And I just want to throw out there that when you are a new nurse on labor and delivery and trying to do all the things and trying to navigate the pressure from your colleagues and trying to wrap your head around this thought process that everything is an emergency and everything is high risk until it's not especially if you're at a high risk center it's really really hard to step back and have that attitude that you just mentioned from that nurse, and so it's important that patients know that that's what their nurse hopes to say one day.

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If you have a new nurse that's rather green or seems stressed out that day, but that is the truth we can slow down.

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When you say that's what you need, it's the more experienced nurses playing defense like oh, I didn't go up on the pit because of meh, meh, meh, meh, meh, meh, meh, just because you know that that is where your patient is at, that the patient is adequate, that the labor is moving along and everything's fine and you don't need to go up on the pit just because and you don't need to do the interventions, just because this is what a normal labor looks like and we are.

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Yes, we are concerned about the patients coming in, but it is a balance of taking care of that person that is right in front of you versus thinking about the people that might be coming in.

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So everyone is encouraged to feel empowered to speak up when they need to.

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I think that with more experienced nurses you also have the benefit of a degree of gravitas amongst the providers, right?

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So if a nurse with whom the MDs and the CNMs are familiar and they're like, oh yeah, that nurse, I rely on that nurse, I trust that nurse, we have been in many, many, many, many bursts together and so, okay, I you know, maybe that provider would have preferred that something got moved along for any number of reasons, who knows what.

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But they fundamentally trust the professional judgment of that nurse and that nurse then feels also empowered to behave in the autonomous manner that her license I'm saying her, because most of us are hers but that their license affords them.

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And I think, in my experience at least and observation, a newer nurse does not yet feel that not only confidence, but you literally do not feel that you are an autonomous provider in the hospital system.

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And so, even though you're trained that way and taught that way, when you get in practice there's a lot of hierarchy and it's it's a lot of feeling like you got to somehow prove yourself, even though you don't know what the benchmark is.

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So, how do you, how do you prove when you don't know what?

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What's the rubric?

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Well, the benchmark is suddenly you have all the magic tricks that the providers are like oh, she's going to use her woo woo and make that baby cry Right, which really was a birth ball, yeah, and just weird positions.

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It actually was literally holding the person's hand and being nice to them.

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That's magic.

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But you have to have the time and space right.

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You can't have two other people on pit and be like I'm in here holding this person's hand because you've got high risk patients now, and so also there's that right, Like with all the staffing shortages and the turnover, frequently you're going to have more newer nurses than experienced nurses, because the rigors of the profession also injure us physically and otherwise.

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It is not sustainable for a lifetime profession.

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Yeah, that is true.

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I mean, there are unicorns and we've worked with them, right, but like I don't know how she does that Since she was like 20.

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I don't, I don't know.

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I'm thinking of a certain 69 year old nurse that's talking.

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Right, All the props I love and I'm like dude, I don't know how you.

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I think that's one of the things also when you look at you know out of hospital, birth and what's so hard to fathom, and I've worked with a lot of obese who never knew what.

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They just thought it was this you know people dancing in skirts and howling at the moon or something.

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You know that.

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That was the different intense and intense and candles and, you know, bringing in.

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I think one of the things that I found effective in that communication and just education around what is midwifery and what is out of hospital birth is I bring in all my bags and I open them all up and they'll always be like Tony, look at it, it's a hospital in a bag and it is.

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It's.

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Every single thing that is in the L and D room is at a home birth.

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We have.

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We have all of the resuscitative equipment and IVs and oxygen and everything other than an OR.

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We do not have an OR and we do not have an anesthesiologist, although I have one that continually begs me to come to a home birth to do an epidural.

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But we know that that's not safe or possible, but he just really wants to help.

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He just really believes in the thing.

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So still in my adulthood, when I would walk into a hospital room and into labor and delivery room and it looked like a hospital room, you could see the medical equipment.

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Now everything is tucked away in cupboards and where I'm sitting down, the birth center is like that Everything's tucked away in cupboards but it's all there All the medication, all the antihemorrhagics, all of the things that we need are here, instruments that have been autoclaved, all of it.

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So we have all of the same instruments and supplies.

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So then you start to ask what is the difference?

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And the main difference in terms of communicating around safety is that we do not have an operating room down the hall, and I think that the number of times that hospital-based births you see somebody needing to be run down the hall, it's high.

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So that's what people and you only really need one to have it stick in your craw and think I never would do this without an OR.

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And that's where our expertise comes in.

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Our expertise is prevention and our expertise is paying close attention and I think one of those things that you talk about as a nurse in the hospital, where the demands on your time are so heavy, you're so heavily engaged in all of the things around the patient care and outside of the hospital we don't have a pressure system like that.

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It's slower.

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To say it's one to one is almost an understatement, because you really are with this family through almost all their whole labor and we don't go to the sleep room, we don't go to do clinic.

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I mean, I've done that in the birth centers.

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Sometimes we'll pop over, but even rarely, because I just want my brain on what's happening.

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We don't leave them, we're theirs, we're their champion.

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And if you can imagine if your healthcare provider was the person when you lean back, they have their hands on your back, they're going to catch you, you can lean into them and they will support you.

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You can look into their eyes and be afraid in a moment and have them look at you and tell you I know, I know, I know what you're feeling, it's normal, you're okay and you are not alone.

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And that kind of care is extraordinary.

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And even the very best nurses that I've worked with in the hospital aren't really allowed to engage in that kind of care.

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And the best doctors, I think nobody goes to medical school to run around a hospital like a chicken with their head cut off.

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Nobody, everybody goes to medical or nursing school.

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I would think most people let's say some people probably go for the power, but most people the vast majority of healthcare providers you will ever meet got into that profession because they saw themselves contributing to the health and well-being and comfort of another human through using skills, education, talent, time, ideas that they would learn in school and be able to bring into their community or bring into the hospital room or bring into the lives of another person and then they can't enact that, they can't manifest it and it is washed out of them deeply carefully, systematically scrubbed out of them so that by the time they are holding license they don't really resemble who they were in the beginning.

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And we have to do so much work to unwind providers and let them see their space and availability and time to be able to do what you meant to do.

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Now that you have this license, this education, this power, you can bring this to your community and that is what midwives do.

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We don't work in that system.

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We have certainly have a hierarchy in this world.

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I don't think we are free from eating our young and all that kind of stuff.

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But there's a lot more leeway if you are really bent on being a provider who acts from kindness, who approaches people as if they matter and who believes what people want is crucial to their health and to their health story, and that is really different than being in that system.

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So there's sort of this duality of your question of who qualifies for out of hospital birth and part of it is that you have to entirely reimagine the providers that that person is with.

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And if you take the best doctors and the best nurses and you set them free, that's who they're with.

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It's, it's the best people, but they're allowed to be their best selves.

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We want you to follow guidelines you got to follow guidelines but we want you to think, and you know I've been in at Burson hospitals where sometimes Birthing mom would say, oh, I really just want to try and do this without medicine, and a nurse would throw her hands in the air Ah, I came to work for a reason.

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Today we get to do it.

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We're really gonna do something special.

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And that idea of engaging with somebody in a physiological way, working through something that is physiologically normal, healthy, robust.

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If you, I always tell people, put on your vagina goggles and walk around any major city.

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Most of us it's changing now, but most of us arrived through a vagina.

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Most of us survived the process of allowing somebody to arrive through a vagina and most of us survived that process Over the history of all of time.

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And then our job is to be really highly, highly trained to make sure that if something isn't right At any point, we don't wait, we don't blink.

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There's no ego.

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We're going to our friends, we're gonna take good care of us in the hospital.

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There's not an adversarial relationship.

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We have to work for each other, be for each other, and then the whole system works.

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Yeah, I really like how you described the scrubbing of the actual motives of healthcare providers, because I feel like even the new nurses that I Train, or people that change specialty, hoping that labor and delivery is the place where I can be that person, and Then receive a rude awakening when they realize that they cannot have that time For that relationship that they want to build with that person and they they can't have the time to make the birth as special as they wanted to.

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We can still make it special.

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It's just a skill set, trying to sit it into that tiny little sliver of time, trying to, and I just I want to.

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There's a couple things that come up for me.

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First of all, the sheer level of documentation that has to happen in the hospital setting.

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I am spending most of my time clicking buttons and not helping the patient, and I have to click those buttons because if I don't click the buttons then if something happens and I didn't click the button, then I lose my license and that's just the ugliness of what we experience in the hospital setting.

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And so when you have somebody sign the consent saying that they are taking responsibility To communicate, that is a huge part of what's missing in the hospital setting.

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We absolve people of partnering with their own physiology when they walk into the hospital, because it is assumed that the provider is the one telling them how this works.

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And the other thing is that even when you go into the room, you know and you want to be a part of that natural birth or just really hold that patient's hand, you have that first experience where you're in there and you get stuck and your other patient needs you, or the charge nurse is saying you have another admission, or you know you're gonna cover someone's lunch or whatever it is, and then suddenly that service that you wanted to provide, that Relationship that you wanted to engage in, becomes something negative in the eyes of everybody else on the team.

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Because we are Working as I mean, we're working as a team, but it's a very short staffed team, no matter how you slice it.

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Even when we're optimally staffed, based on a one standards, it's not the same as the one-to-one that you would get with a midwife and a doula that is there, with the midwife and your Family and all of those people that can help support you.

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It's just not the same.

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And so when you have that first experience, when you are trying to be that person for that, that patient that is birthing, and you suddenly have to rip away that care that you were hoping to provide, that you had promised to provide.

00:23:28.826 --> 00:23:36.375
The shame and the sadness in the Hurt for both you and that patient is something that can never be forgotten.

00:23:36.375 --> 00:23:46.383
And so then what nurses tend to do is they just dig deeper into that documentation process, into the team quote-unquote mentality.

00:23:46.383 --> 00:23:54.887
Where I'm not serving my patient, I'm serving the floor, I'm serving my co-workers, I am working to keep everybody here safe, and that's it.

00:23:54.887 --> 00:23:56.337
That's all you have.

00:23:56.818 --> 00:24:22.460
And so if you manage to be in this profession for longer than a couple of years Because most of the time that's the number if you manage to be a nurse in labor and delivery for the long haul and you start to learn how to provide those services and to get in there and have that short-term relationship where you are being that person for that patient momentarily, it can get beat down and then come back every single time and Still be that person in that room.

00:24:22.460 --> 00:24:28.115
If you become that magical unicorn you know it's it's still not the same, it's still not enough.

00:24:28.115 --> 00:24:38.945
It is still not what you would get in a home birth where you have that one-on-one person that has gotten to know you for your entire Pregnancy and will be there after and everything, you get that person for 12 hours.

00:24:38.945 --> 00:24:45.025
If that, because of the teamwork that we have, you might lose that person.

00:24:45.025 --> 00:24:57.243
And who knows when that's gonna happen, because maybe the other patient is delivering and you lose that person that you had that bond with and suddenly Everything is just, you know, thrown up in the air.

00:24:57.243 --> 00:25:01.994
And that's not to say that there's not going to be another spectacular human being that walks in the room.

00:25:02.635 --> 00:25:25.243
Because, honestly, when you look at the places where in the hospital, where they say that they get the best care, where we have the highest Patient satisfaction, most of the time it is labor and delivery, but that is all relative to what it could be and Unfortunately we do not have the resources, we're not given the what we need to make that happen, like on so many levels, like physical resources.

00:25:25.243 --> 00:25:28.615
You know, do we have clean pads to give to this patient?

00:25:28.615 --> 00:25:29.657
We don't have time.

00:25:29.657 --> 00:25:30.239
We have.

00:25:30.239 --> 00:25:35.801
We may have three patients on pitosa and even though that's really unsafe, we may not have had lunch that day.

00:25:35.801 --> 00:25:38.720
We may, guys, this is every day.

00:25:38.720 --> 00:25:40.479
I mean, this is three days a week for us.

00:25:40.479 --> 00:25:50.154
This is our entire career, so how many times are we going without lunch and those kinds of things when you have someone that's that beaten down and going through that and they're still coming to work every day?

00:25:50.154 --> 00:25:51.243
It's not the same.

00:25:51.243 --> 00:25:52.654
It's not the same service that they can provide.

00:25:52.855 --> 00:25:58.768
This is number one why I tell all of my patients to bring a treat to their nurse, like something in your bag.

00:25:58.768 --> 00:26:01.821
Any box of frangoments, whatever it is.

00:26:01.821 --> 00:26:04.208
Give you, give a little, we spring oranges.

00:26:04.268 --> 00:26:05.049
Thank you.

00:26:05.049 --> 00:26:06.836
Yes, something sweet, but also healthy.

00:26:06.836 --> 00:26:08.621
That's not going to make us Don't know.

00:26:09.303 --> 00:26:12.675
Yeah, I've had lots of nurses as Patients.

00:26:12.675 --> 00:26:35.214
I had this bizarre run where I had an inordinate amount of doctors and nurses as patients and the nurses all said they were there because they didn't trust the doctors, and the doctors all said that they were there because they didn't trust the nurses, so they were all choosing out of hospital births, and I would like if you all could just get together and combine your resources and get activated to solve these problems.

00:26:35.214 --> 00:26:36.152
They would be amazing.

00:26:36.152 --> 00:26:51.826
Yeah, there's something I want to say is that when you talk about team and we think about who's the team and I know that there's pregnant people Listening to this podcast right now this is what I want to say right now they are growing and feeding and nourishing and nurturing their baby with nobody's permission.

00:26:51.826 --> 00:26:59.486
They didn't come to prenatal visit where I said you're allowed to feed your baby now, or you're allowed to grow the baby, or Please let your placenta continue to develop.

00:26:59.486 --> 00:27:01.674
I affirm it's okay, you can do that.

00:27:01.895 --> 00:27:28.259
The main team in this story is the parent and the baby and their relationship with each other and the Perfection to which they engage with each other and are for each other all the time, every night, every day, 24-7, from the moment of conception, and then they come into care and we start talking and using language that divides them and we start Saying things like, oh, only your baby would do this, your baby's not cooperating with this, or why can't you know All of the language there?

00:27:28.259 --> 00:27:42.575
That's just built into the system and people just you see them like Sinking under that language, and we have resident physicians that rotate with us and when they're in visits, I always teach them two things because of what you just said, and its nurses can do the same thing.

00:27:42.575 --> 00:28:00.880
There's ways to ask one or two questions that light people up and make them feel that you believe they are an expert in something and that Gives you credit in their eyes, instead of acting like we're the ones who can solve all the problems and we're the ones who have this Idea of responsibility.

00:28:00.880 --> 00:28:02.965
It's not something we give to people.

00:28:02.965 --> 00:28:06.788
It's something that is taken from them in most healthcare systems.

00:28:06.788 --> 00:28:24.165
But they arrive with responsibility For themselves and their babies and then we slowly suck it away from them until they believe they can't do anything without Somebody saying yes, I'm allowing you to get up and use the bathroom Whatever it can be something that I'll allow you to have a drink of water, things like that.

00:28:24.165 --> 00:28:37.469
Well, we intuitively have been drinking water and using the bathroom our whole lives when we needed to and all of a sudden, for this one day, all of that disappears and what I teach the residents is that, during labor, to say, tell me about your baby.

00:28:37.588 --> 00:28:38.511
And then just be quiet.

00:28:38.511 --> 00:28:47.768
People will talk for half Hour because babies have schedules, they have wake schedules, they have sleep schedules, they like to play, they like Somebody's voice, they love this song, they love this, they love that.

00:28:47.768 --> 00:28:57.017
People will tell you a bunch and Right after the baby is born, when you go in and do that new-born exam Maybe it's been a couple hours Tell me about your baby, what do you notice?

00:28:57.017 --> 00:28:57.959
And just be quiet.

00:28:57.959 --> 00:29:01.548
Because they will have observed and gotten to know their own baby exquisitely.

00:29:01.548 --> 00:29:17.705
In the first moments and the first moments after birth, babies arrive ready to engage and ready to play and Ready to be a part of our world, and parents notice them and Just activating them as experts and just listening.

00:29:17.705 --> 00:29:19.914
It takes two minutes, literally two minutes.

00:29:19.914 --> 00:29:26.098
So when you do have three patients, if you have two minutes, one of the best things you can do is just ask them Tell me about your baby.

00:29:26.098 --> 00:29:29.049
You're the expert, you know this one and it changes everything.

00:29:29.049 --> 00:29:29.953
I love that.

00:29:29.953 --> 00:29:35.347
Yeah, we don't have to be perfect, right, and I think we, you know, outside the hospital, we're not perfect either.

00:29:35.347 --> 00:29:42.318
We just have more time to make up from from the things that we we wish, that we we could or we want to.

00:29:42.318 --> 00:29:46.769
But the other thing is that we start talking like this and people get goo goo gaga.

00:29:46.769 --> 00:29:48.734
I mean that care, get me over there.

00:29:49.175 --> 00:30:04.507
And I think one of the things we wanted to talk about today was this idea of Well, who can come to this care and exploring wherever you live and starting to call some midwives and you go and meet them and you talk with them if you have a chronic health condition.

00:30:04.507 --> 00:30:14.862
There's most chronic health conditions rule you out of being safer out of hospital care Hypertension, uncontrolled diabetes, insulin, controlled diabetes.

00:30:14.862 --> 00:30:24.190
We can care for people who have diet control diabetes or Metformin controlled diabetes in Washington state, but is that the best place are?

00:30:24.190 --> 00:30:24.711
You know?

00:30:24.711 --> 00:30:25.575
We we don't know.

00:30:25.575 --> 00:30:37.922
So we follow the baby and we want to see how that baby is growing and make sure that the best guess that we have About the size of that baby is going to be safe for out of hospital care, because the other thing we don't have here is Vacuums or forceps.

00:30:37.922 --> 00:30:44.824
So we you know we all have to train to use them, but we don't have them here and we never use them and you wouldn't want to midwife using.

00:30:44.824 --> 00:30:55.102
So I think like just Knowing that if there's a chronic health condition, if there's something going on that makes it difficult for you to get to visit, so you need limited prenatal care.

00:30:55.241 --> 00:31:07.255
Midwifery out of hospital birth care is safest with full course of care and we have all the time people walking into the birth center with no care and then we help them get what they need and navigate into the system the best we can.

00:31:07.255 --> 00:31:12.827
So there's so many things that can come up during pregnancy that disqualify people for care.

00:31:12.827 --> 00:31:26.904
But the way to discover that is to start talking with midwives about your own health history and and your own goals and your own expectations for your birth and to know that Physiological birth is really different than birth in the hospital.

00:31:26.904 --> 00:31:31.060
The pain is different, the process is different, the timing is different.

00:31:31.060 --> 00:31:49.734
It's different when you've spent nine months preparing for birth and you go into birth Confident, you walk in like a boss and I've worked, you know in the part of the world where there was no fear around birth, where girls are at the births of their big sisters and their cousins and their aunties and other women in the neighborhood.

00:31:49.734 --> 00:31:58.021
So by the time they arrive to birth, they've seen it, they know it's possible, it's shorter, it's faster, it's, it's it, I don't know that it's easier.

00:31:58.021 --> 00:31:59.686
They still have to labor and they still have to birth.

00:31:59.686 --> 00:32:07.989
But birthing without fear which is the name of a book, of course, but birthing without fear is a really different experience.

00:32:08.269 --> 00:32:15.674
When you are allowed to like this, it's a squizzic cocktail of hormones that is in your body and that cocktail is allowed to do what it does.

00:32:15.674 --> 00:32:30.723
It protects us and it moves us through Laboring and birthing in a totally different way than when people have their hands inside our bodies and there's machines beeping at us and people who we don't know coming in and out.

00:32:30.723 --> 00:32:35.315
When the burden is on the provider to be the person who is your continuity.

00:32:35.315 --> 00:32:41.251
That's very different than the burden being on you, being continuity for 10 providers.

00:32:41.251 --> 00:32:43.460
You're in relationship-based care.

00:32:43.460 --> 00:32:52.795
You've developed trust, you've developed a sense of who you are in relation to this provider and how you might be activated in this birth to succeed.

00:32:52.795 --> 00:33:02.380
And you know what, any moment, if you say, hey, whoops, this not for me, I really just want an epidural, that person's gonna be like, okay, let's go, that's fine, you're allowed to.

00:33:02.380 --> 00:33:04.465
Unless there's a head in my hands, we can go.

00:33:04.465 --> 00:33:08.321
Yeah, at which point?

00:33:08.522 --> 00:33:35.684
I love that relationship-based care is such a huge difference and I think even in what I have seen in CNM, training is oftentimes, if you're gonna be in a hospital-based practice, you're gonna be in a multi midwife practice, and while we still may follow the midwifery model of care effectively, we now have to follow the same kind of rules as far as what are those awful things that they figure out how whether you're fiscally working right, rvu.

00:33:38.695 --> 00:33:41.660
Straping ratios Q&A.

00:33:41.660 --> 00:33:44.219
Every hospital has a different one.

00:33:44.219 --> 00:33:46.683
All the awful things yeah.

00:33:47.266 --> 00:33:58.880
So you still might have a different midwife seeing you at every visit and Not know which one's gonna be on call, because they have a call schedule Right when you go into birth.

00:33:58.880 --> 00:34:08.708
And so, even though you're still gonna have that overall midwifery model and approach, it's in order to function in a hospital setting for for the provider.

00:34:08.708 --> 00:34:21.735
The setup of the whole clinic experience is much more similar to Kind of a standard OB office than it is to an out-of-hospital based provider office.

00:34:22.076 --> 00:34:26.134
Well, plus, you have a OBGYN overseeing, so anytime the OBGYN gets uncomfortable.

00:34:27.175 --> 00:34:35.909
You mean, like in the hospital in general, yeah, and not to mention all the nurses who I love us, and also, oh my god, just keep your eyes on your strip for a little while.

00:34:35.909 --> 00:34:36.795
Like, is that a diesel?

00:34:36.795 --> 00:34:38.239
I don't know, let's find out.

00:34:38.239 --> 00:34:42.023
Right, I know, like, why, like, wow, there were.

00:34:42.023 --> 00:35:07.588
There were a couple things that came to mind in the last minutes of conversation that I wanted to bring up, but there's a beautiful book called breath becomes air, and the was written by Paul Kellen nithi, and so he was like a young neurosurgeon resident on the verge of finishing when he was diagnosed with brain cancer and Much of the book so he passes away.

00:35:07.588 --> 00:35:08.875
The book was finished posthumously.

00:35:09.356 --> 00:35:36.896
The book is about his process of coming to terms with his own humanity as a provider, now that he is a patient, and really dissecting the ways in which the process of becoming a healthcare provider Dehumanizes us, and then, of course, we not intentionally to some extent dehumanize our patients, because that's part of the Psychological work.

00:35:36.896 --> 00:35:42.494
That sort of has to happen in order to do the work that we do, in order to operate on someone's brain.

00:35:42.494 --> 00:35:46.510
You probably have to just think of it as a brain and not as.

00:35:46.510 --> 00:35:51.139
Oh my god, there's a whole person in consciousness and all of the things I don't know.

00:35:51.139 --> 00:35:54.034
Our new brain surgery, and that, I think, is very similar.

00:35:54.295 --> 00:36:00.596
We were talking about just the dehumanization of nurses, right, and I joke that Only.

00:36:00.596 --> 00:36:01.840
It's not actually funny.

00:36:01.840 --> 00:36:05.148
The nursing diet is basically the starvation diet.

00:36:05.148 --> 00:36:07.594
We talk about working three twelve hour shifts.

00:36:07.594 --> 00:36:08.918
It's never only 12 hours.

00:36:08.918 --> 00:36:15.036
You also have your commute and it's not like you work three on four off or even one on one off, right.

00:36:15.036 --> 00:36:25.027
So in a seven-day week you might actually work five or six shifts, depending on how things just get scheduled over the course of a two-week scheduling period.

00:36:25.027 --> 00:36:38.688
So you're hungry, you're thirsty, you're ridiculously stressed, you're under all the pressure from all the directions and that's not a way to set people up to care with a capital C.

00:36:38.688 --> 00:36:39.215
It's.

00:36:39.215 --> 00:36:43.443
It sets us up to survive and to focus on the survival of our patients.

00:36:43.443 --> 00:36:45.648
And but that's also like baseline, right.

00:36:45.648 --> 00:36:50.590
It's like, of course, everyone wants a healthy parent and a healthy baby.

00:36:50.590 --> 00:36:52.215
That, like we shouldn't even have to say that.

00:36:52.215 --> 00:36:55.844
That's just yes, but it can be so much more than that.

00:36:55.844 --> 00:37:16.244
But we also need healthy environments to support that process, and that includes the environment in which the Support staff, all of the licensed providers supporting that family and the environment in which we're working, and I Haven't seen yet that hospitals have figured out how to do that and the other thing.

00:37:16.364 --> 00:37:20.697
So I trained as an LM before Nursing school.

00:37:20.697 --> 00:37:34.398
So when I showed up as a new nurse and thankfully got like labor and delivery, when I was trying to figure out what kind of job to apply for as a nurse, I knew I needed to work as a nurse for a year before I could apply for frontier nursing University CNN program.

00:37:34.398 --> 00:37:35.222
That's their rule.

00:37:35.222 --> 00:37:45.762
I was like, okay, I just Need to meet this requirement In a way that I can actually Survive, put maybe even thrive, who knows right.

00:37:45.963 --> 00:37:54.135
So a dear friend from midwifery school was like because I was thinking maybe, maybe it's the emergency department, maybe what I need is just something that's like it's just quick.

00:37:54.135 --> 00:37:55.177
I knew I didn't want meds.

00:37:55.177 --> 00:38:04.719
Her like I feel like it needs to be either all about the women or all about the babies, didn't really want peas, I didn't know what to do with myself and she was like so sweet, it was such a lovely thing to say.

00:38:04.719 --> 00:38:13.054
She was like I think that you know you really have to protect your midwife heart and Maybe emergency department is not the place to do that.

00:38:13.054 --> 00:38:37.494
But what none of us could fathom was the degree to which a labor and delivery unit destroys your midwife heart and Because you can't function as a midwife In the way that I was trained in that environment and I remember my preceptor because I was in like the new grad fellowship program, right, my preceptor was so frustrated with me because I wanted to spend time with the patients.

00:38:37.635 --> 00:38:44.121
I was like I don't care about how you get that out of that machine, I'll figure it out, but what I?

00:38:44.402 --> 00:38:47.994
We have this person here who needs us and I want relationship.

00:38:47.994 --> 00:39:24.018
I got into midwifery for the relationships and she was like I know that you are frustrated and when you have all of these Logistics down and you can Admit a person within 20 minutes instead of an hour because you actually ask them all of the questions and listen to their answers, dare you, when you can actually, I know when you can do all of these things to make you a functional member of the team not including the family, right, but like the professional team then you can start having relationships with the patients again.

00:39:24.018 --> 00:39:27.793
And so then when I got to that point, I suppose some might argue.

00:39:27.793 --> 00:39:33.355
I never really got to that point because I was still actually asking all of the questions and all the answers, taking a long time.

00:39:33.355 --> 00:39:36.150
To admit people, I would spend most of my time.

00:39:36.150 --> 00:39:42.155
I don't know if you remember I hardly was at the nurses station because I wanted to be in the rooms with the people.

00:39:42.726 --> 00:39:58.512
But you have the skills to do so, and then I would come, I did, and I would come out, though, and the attitude that I would encounter from my fellow nurses who didn't have those skills or that interest, was that I must be a slow, dumb nurse because I'm in the room forever.

00:39:58.764 --> 00:40:16.492
But actually I was in the room providing midwifery care, not CNN care, not OB care, but that relationship I was in, there being the L&D nurse that they hoped they would get, because there is still this idea that like I don't need a doula, I'm going to have an L&D nurse.

00:40:16.492 --> 00:40:19.474
Like they get their very own special nurse to put in their pocket.

00:40:19.474 --> 00:40:27.414
And we know that's not what happens when you get there, but I feel like the general public doesn't know that still.

00:40:27.414 --> 00:40:55.860
And so I was engaged in that relationship with the capital R and that caring with the capital C and doing all the nursing obligations and all the systems and pushing all the buttons, but trying to actually connect with people in the short amount of time that I had with them, because that's the part that I needed in order to maintain any sense of self, frankly, and certainly professional self.

00:40:56.405 --> 00:41:11.097
It was really really hard, very, very frustrating and very interesting to me that tension between the attitudes just based on, again, my entree to this work was as a community midwife.

00:41:11.097 --> 00:41:28.018
Right, like you hang out in their living room hanging out with their mom and their mother-in-law who's cooking some big food to share with everybody, and you're having meals, and then you're checking on them and you're hanging out with them and they're telling you stories between contractions and you're walking up and down the hallways.

00:41:28.018 --> 00:41:31.876
You just are in their space, welcomed into their home.

00:41:31.876 --> 00:41:35.896
It's an incredible honor and one that I miss.

00:41:36.246 --> 00:41:37.463
There's something about that.

00:41:37.463 --> 00:41:54.518
We talk a lot about territory, terrain and environment, which are concepts that have been studied really well by the UK midwives, where midwifery is normal, but understanding how territory, terrain and environment impact a birthing person and impact their team.

00:41:54.518 --> 00:42:02.117
So when you're in the hospital, I'll tell people bring one thing that's so bizarre that it makes everybody stop and ask you what's that?

00:42:02.117 --> 00:42:02.985
You know?

00:42:02.985 --> 00:42:04.309
A picture, a family photo?

00:42:04.309 --> 00:42:05.253
That's just crazy.

00:42:05.253 --> 00:42:18.284
Or put a picture of your cat or some stuffed animal that you lost, something that humanizes you and stops people and say, oh, tell you, what is that on your table there and you get to tell a little story about your home.

00:42:18.284 --> 00:42:20.873
It brings people into your worldview.

00:42:21.686 --> 00:42:29.918
And for us, where we are at the birth center and we do our clinic visits in the same rooms that people birth in.

00:42:29.918 --> 00:42:32.469
So when we're sitting in there, I'll tell them.

00:42:32.469 --> 00:42:35.717
You know, when we're preparing for birth, I'll say you know you're going to come in here.

00:42:35.717 --> 00:42:39.155
All the furniture moves, the art comes off the wall.

00:42:39.155 --> 00:42:41.112
You can hang up whatever you want.

00:42:41.112 --> 00:42:44.295
You're going to make this room your space.

00:42:44.295 --> 00:42:45.731
You use it like a hotel room.

00:42:45.731 --> 00:43:02.284
You're definitely still on our floors, but you have to work so hard to make this room, you know, look and feel and as much as possible smell like you, because that's where your sort of innate comfort comes from, is a sense that this is my environment.

00:43:02.284 --> 00:43:04.992
And I said nobody's going to walk through the door like we own the place.

00:43:04.992 --> 00:43:11.094
We knock and say you know, is it okay, unless you're pushing or something going on that we need to run in.

00:43:11.094 --> 00:43:16.072
But that's really where we're in there most of the time, and when we're not, everybody's really respectful.

00:43:16.072 --> 00:43:28.704
You'll never have something happen like I've seen in the hospital, where the person who is responsible for checking the thermometer, the temperature on the little mini fridges in the rooms, just walks in while someone's pushing and it's like that's his job.

00:43:28.704 --> 00:43:34.663
So he's just like in and out, students in and out, providers in and out, somebody in and out, in and out, in and out.

00:43:34.663 --> 00:43:35.264
There's none of that.

00:43:35.264 --> 00:43:44.237
So you're not disrupted and we know that safe physiological birth relies on you disrupting yourself and not other people disrupting you.

00:43:45.065 --> 00:43:49.204
So even when people need something in labor, we prepare them ahead of time.

00:43:49.204 --> 00:43:52.572
If you see a straw in your face, it's because we think you need more liquid.

00:43:52.572 --> 00:43:56.503
But we'll rarely say to you do you want something to drink what would you like?

00:43:56.503 --> 00:43:57.085
And here's a list.

00:43:57.085 --> 00:43:58.851
We do that all ahead of time.

00:43:58.851 --> 00:44:03.905
But if you ever look up and you say I need something to drink, talk as much as you want.

00:44:03.985 --> 00:44:05.657
That's not disruptive to your process.

00:44:05.657 --> 00:44:10.905
What's disruptive is all of us coming in and like, oh, just move, like that, oh, I just need to do this.

00:44:10.905 --> 00:44:11.949
So I just need to hear that.

00:44:11.949 --> 00:44:18.505
We tell them ahead of time we're going to listen to the baby every half hour and this is how we do it.

00:44:18.505 --> 00:44:19.510
You never move.

00:44:19.510 --> 00:44:31.929
We move to you, and my hardest patients are nurses who are in labor labor way and then they move their bodies every time they see us to make it easier for us and how much we have to work with them in that moment.

00:44:31.929 --> 00:44:35.869
No matter how much we do ahead of time to tell them don't move, you keep doing what you're doing.

00:44:35.869 --> 00:44:40.657
We do bendy, twisty yoga moves to get to be able to hear the baby and get the Doppler there.

00:44:40.657 --> 00:44:44.655
So that's just a very different quality of interaction.

00:44:45.005 --> 00:44:59.978
And I do want to say there's something about what, aria, I think I mean I've told you this to your face, but I'll tell you now on this podcast that there's something about being a licensed midwife working in a setting with well, I'll just speak to Aria, because you're very human.

00:44:59.978 --> 00:45:21.119
That makes me feel safer and better and I can do my job, knowing that the things that we need around because no person is just a pregnant person and we have discovered this quite acutely over the course of your PhD studies that people have so many other things going on.

00:45:21.119 --> 00:45:27.773
They have anxiety, they have UTIs, they have yeah, I don't know an ache in their elbow.

00:45:27.773 --> 00:45:41.061
But having a team around us in the birth center where people look up and everything they need is right there and they don't have to traverse these wild pathways between providers, has been a real game changer.

00:45:41.061 --> 00:45:48.418
And I think when we're looking at, when people are going and looking at birth centers, make sure your whole team is lined up.

00:45:48.418 --> 00:45:57.199
It's rare to find everybody you need in one birth center or in one midwifery practice, because our scope is really hyper focused.

00:45:57.199 --> 00:46:01.045
We are highly, highly trained on just that time.

00:46:01.045 --> 00:46:05.317
I want to be pregnant, I am pregnant, I'm having a baby, I was just pregnant.

00:46:05.905 --> 00:46:24.411
But people aren't only that thing and today, in today's world, most especially post COVID, most of the population arrives to pregnancy with a non pregnant challenge or issue or health concern whether that be physical, mental, emotional, it doesn't matter.

00:46:24.411 --> 00:46:28.896
All of that impacts your pregnancy and being able to access all of that care is really important.

00:46:28.896 --> 00:46:31.873
But people have to be the authors of their own story.

00:46:31.873 --> 00:46:45.967
And if it's not set up for you beautifully, like you walk in a place and all the providers you need are right there, then you have to do that work for yourself and you have to expect to advocate along the way for yourself, no matter how much your midwife is like.

00:46:45.967 --> 00:46:53.719
I want you to have this thing, whether it's like something for your itchy skin, something for your mental health, something for your anemia.

00:46:53.719 --> 00:46:55.318
I want you to have this.

00:46:55.318 --> 00:46:56.585
I'm going to write all the referrals.

00:46:56.585 --> 00:46:57.704
I'm going to bang down all the doors.

00:46:57.704 --> 00:46:58.186
I can't.

00:46:58.186 --> 00:47:06.018
As a patient, you have to push into that system and get that care so you can stay safe for your out of hospital birth plans.

00:47:06.664 --> 00:47:14.295
There's a lot of work people have to do right now to be present in the health care system and when you are pregnant you can't pretend those things don't exist.

00:47:14.295 --> 00:47:20.954
We push and we push and we push ourselves through and I'm speaking primarily to the people who identify as women.

00:47:20.954 --> 00:47:35.101
We push ourselves through in extraordinary ways, past our own health issues, past our own sicknesses, past our own needs for mental health, past our own wants for the things that we want in our lives.

00:47:35.101 --> 00:47:40.253
So we are serving and working for others, and that is something I wish wasn't true, but it is true.

00:47:40.253 --> 00:47:42.090
So we have to acknowledge it.

00:47:42.224 --> 00:47:55.320
And then we arrive to pregnancy and all those things come crashing down and you have about nine months to get it all taken care of and it takes a long time to get appointments and a long time to get the right kind of provider to help you.

00:47:55.320 --> 00:48:21.117
And one of the things that I found extraordinary about working with you is that people would come in for their pregnancy and have three other issues and we could put them on an appointment with Ari and Ari knew they're pregnant and we have this time where they're activated in their health and you would level them up in a thousand ways Because you're an amazing health educator and an amazing provider and you would see the whole person there.

00:48:21.117 --> 00:48:40.005
So midwives and out of hospital birth, I think are safest when we are partnered with people who want to think like us, who look at the world like us, who want people to show up and engage in their health and be activated, to learn and to do more and be more.

00:48:40.005 --> 00:48:41.047
And you're just learning.

00:48:41.047 --> 00:48:54.639
And that is also where we get a generational page turn, because this is somebody who's coming in with the story of their mother and their grandmother in their body and they are writing the story for their baby in their body.

00:48:55.344 --> 00:48:56.851
But they can write a story.

00:48:56.851 --> 00:49:13.815
It's not authored and you can change your health and you can change the way that you engage with all of the things in our environment, the way we move and the way we nourish ourselves and the way we connect With others and the way we deal with isolation and loneliness and anxiety.

00:49:13.815 --> 00:49:24.079
We can change all of that and what I can speak to as a provider who got to see what happened when people could access that care with Aria care I cannot provide.

00:49:24.079 --> 00:49:25.670
It's not in my scope of practice.

00:49:25.670 --> 00:49:28.614
It was just a completely different pregnancy outcome.

00:49:28.614 --> 00:49:29.764
I don't think it matters.

00:49:29.764 --> 00:49:31.905
Are you with an OB or are you with a midwife?

00:49:31.905 --> 00:49:33.853
Are you in the hospital or out of the hospital?

00:49:33.853 --> 00:49:37.396
Use that time in your pregnancy to level yourself up.

00:49:37.396 --> 00:49:46.298
Find providers who are interested in you and interested in learning about how you want to be in the world and who will help you get there?

00:49:46.298 --> 00:49:48.170
None of us can do it alone.

00:49:48.873 --> 00:49:49.074
Yeah.

00:49:49.074 --> 00:49:50.771
How do we make the health care system learn that?

00:49:50.771 --> 00:49:52.050
How do we find more Arias?

00:49:52.304 --> 00:49:58.257
Well, I think it brings up something that's very interesting also, which is thank you so much for all of that.

00:49:58.257 --> 00:49:59.608
You know I love.

00:49:59.608 --> 00:50:00.873
This was my dream come true.

00:50:00.873 --> 00:50:09.278
I wanted to come back to Seattle, work with my LM friends and help them keep their people in scope.

00:50:09.278 --> 00:50:11.733
And most people don't have a primary care provider anymore.

00:50:11.733 --> 00:50:15.054
The primary care offices are closing left and right.

00:50:15.054 --> 00:50:20.117
We can't stay in business because insurance won't pay us and neither will patients.

00:50:20.117 --> 00:50:23.931
I still have to feed my family, right, like it's a problem.

00:50:23.931 --> 00:50:25.811
It's a problem in our whole health care system.

00:50:26.164 --> 00:50:46.338
So if you don't have a primary care provider and you're pregnant and you let's say something super run of the mill you have herpes, you have, you have genital herpes and you you learn or maybe you already knew that 36 weeks the recommendation is you start some antiviral medication and then the midwife is like who you want to go to for that?

00:50:46.338 --> 00:50:54.574
And you're like provider right, who, what Right, or or something that's a little bit, maybe easier.

00:50:54.574 --> 00:50:56.251
You have a UTI, right?

00:50:56.251 --> 00:50:59.014
Okay, you go to your midwife, she doesn't have.

00:50:59.014 --> 00:51:10.014
So in this case, like the LM, scope does not include diagnosis and treatment of things other than, like you are pregnant, you are postpartum that the tear is, whatever degree, right?

00:51:10.014 --> 00:51:11.590

Bridging the Gap Between Community Birth and Hospital Birth with Jodilyn Owen and Arya Pretlow

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