Sept. 9, 2024
Suzzie Vehrs Shares Insights on Doula Support and Maternal Care
Unlock the secrets to a more empowering childbirth experience! Join me as I sit down with Suzzie Vehrs, a dedicated doula and mother of two, who made a remarkable transition from finance to birth advocacy. Suzzie opens up about her personal journey through pregnancy, loss, and the incredible power of support during childbirth. You'll gain insight into the vital role doulas play in helping mothers make informed decisions and letting their voices be heard in the delivery room. Plus, we dive into the recent legislative changes that have made insurance coverage for doula care more accessible than ever.
Navigate the complexities of hospital births as Suzzie shares strategies for ensuring informed decision-making and effective communication with medical staff. We discuss the varied policies of different hospitals, especially concerning interventions such as inductions and the use of drugs like Pitocin and Cytotec. Suzzie emphasizes the importance of having birth preferences that accommodate both an ideal vision and potential complications. Learn how doulas and labor nurses can collaborate to advocate for the mother's choices, fostering a supportive and understanding environment.
In our final chapter, we delve into practical tips for hiring the right doula and the nuances of creating a positive birth experience. Suzzie offers guidance on financial considerations, conducting thorough interviews, and the benefits of prenatal planning with techniques like hypnobirthing. We also explore how to maintain a calming environment in a bustling hospital setting. Wrapping up, we highlight the collaborative relationship between nurses and doulas and the incredible resources available on shebirthsbravely.com to further support expectant mothers. This episode is packed with valuable insights to help you feel confident and empowered as you prepare for childbirth.
Connect with Suzzie Vehrs: https://shebirthsbravely.com/
Join the Bump & Beyond Online Community for moms & moms-to-be!
Coaching offer
Kelly Hof: Labor Nurse + Birth Coach
Basically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!
Connect with Kelly Hof at kellyhof.com
Medical Disclaimer:
This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman’s medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.
Chapters
00:00 - Empowering Birth Preparation and Advocacy
06:19 - Empowering Informed Birth Decision-Making
18:18 - Navigating Hospital Birth as a Doula
32:21 - Doula Care Reimbursement and Hospital Birth
42:42 - Creating Positive Birth Experiences
48:11 - Connecting Nurse and Doula Perspectives
Transcript
WEBVTT
00:00:00.400 --> 00:00:03.483
Hello, Today I have with me Susie Veers.
00:00:03.483 --> 00:00:06.246
Susie is a doula and a mother of two.
00:00:06.246 --> 00:00:16.356
She is here today to share with us about the importance of birth prep, becoming confident about birth and finding your voice and learning to advocate for yourself in the delivery room.
00:00:16.356 --> 00:00:24.707
Susie also has insight on how to find insurance coverage for doula care after recent legislation has been passed to allow birth support.
00:00:24.707 --> 00:00:27.570
Susie, welcome and thank you for joining me.
00:00:27.570 --> 00:00:30.452
Hi, thank you so much for having me.
00:00:30.452 --> 00:00:35.256
I'm really excited to hear about all your insight because birth prep was one of my passions.
00:00:35.256 --> 00:00:45.100
I would love to hear about your take on birth prep and how you came to be a birth doula and how we can all have doulas at the bedside.
00:00:45.460 --> 00:00:50.473
Well, I came here in not a street or linear fashion at all.
00:00:50.473 --> 00:00:52.238
I started my career.
00:00:52.238 --> 00:00:54.604
I studied economics, I worked in finance.
00:00:54.604 --> 00:01:00.462
My experiences becoming a mother was not necessarily an easy route.
00:01:00.462 --> 00:01:11.689
I experienced loss at 14 weeks with my first pregnancy, a year's worth of medical complications due to that, and then my pregnancy with my first daughter.
00:01:11.689 --> 00:01:19.510
But second pregnancy was like so easy, so great in comparison to what I had been through.
00:01:19.951 --> 00:01:37.513
But her birth was wild and not what I expected at all and I realized that there had been so many things that I wish I had known before and after her birth I was like, okay, like I just wanted to close the chapter on birth pregnancy.
00:01:37.513 --> 00:01:51.620
It was not for me, but I knew I wanted to have another child and luckily I met a friend who was a student midwife and as we would spend time together and I'd hear the stories from her clients, I started to think I missed out on so much.
00:01:51.620 --> 00:01:58.614
Like there was so much joy and closeness and bonding and love and excitement in all of this.
00:01:58.614 --> 00:02:11.600
I always say it like the way I went through pregnancy and birth with my first child is if you're on a hike in a beautiful area and all you do is you stare down at your feet and think, what if I fall off the cliff?
00:02:11.600 --> 00:02:12.544
What if I fall off the cliff?
00:02:12.544 --> 00:02:13.467
What if I fall off the cliff?
00:02:13.467 --> 00:02:15.480
And then you fall off the cliff right.
00:02:15.701 --> 00:02:29.632
And so when I had Hazel, I had somebody to kind of guide me, help me understand like a broader perspective, a more holistic perspective, helped me understand what my needs were, helped me know how I could actually meet those needs.
00:02:30.354 --> 00:02:49.069
And I had an incredible experience with Hazel's birth and I had both a midwife and a doula that I was very close to and they took very good care of this younger version of myself who was coming into the experience with quite a lot of trauma to process, and it was just such an empowering experience.
00:02:49.069 --> 00:02:58.139
So after Hazel was born, when she was a year, I went and did my certification as a doula and I've been a doula for about five years.
00:02:58.139 --> 00:03:11.229
I've been a childbirth educator for about three of those and I just really, really love helping moms gain that knowledge, gain that confidence, gain that trust in themselves and in their teen.
00:03:11.229 --> 00:03:21.022
Before birth instead of after, we can heal from the difficult experiences and sometimes birth throws curveballs that we can't plan for.
00:03:21.022 --> 00:03:27.283
I don't want to paint too rosy of a picture, in the sense that if you prepare, it will always be perfect.
00:03:27.283 --> 00:03:36.151
It won't, but if you know that you're capable of meeting the challenges as they come, there's a lot less fear and a lot more joy in the process.
00:03:36.900 --> 00:03:38.163
Yeah, I couldn't agree more.
00:03:38.163 --> 00:03:55.622
There's so much flexibility and mental preparedness that is needed to be able to feel successful and powerful and joyful during the birth experience, because it is a challenge, it is a very physical experience, it's very intense.
00:03:55.622 --> 00:04:04.848
It's like for lack of a better metaphor it is like running a marathon, and it's something that you do need to prepare for.
00:04:04.848 --> 00:04:13.907
So, especially if you've never done it before, if you have no idea what you're in for, you need to figure out how you're going to rise to the challenge, no matter what comes.
00:04:13.907 --> 00:04:28.622
And it's such a good preparation for parenthood, I think, because you're going to continue to have those opportunities to rise to the occasion throughout your parenthood journey, and birth is just the gateway to that whole parenting experience.
00:04:29.564 --> 00:04:32.129
I like how you word your mission.
00:04:32.129 --> 00:04:50.427
I like that you put the power onto the birthing person, versus when I go to a doula website or when I talk to doulas, they talk about being the advocate versus helping the mom become their own advocate, and I think that is such a fine line.
00:04:50.427 --> 00:05:16.173
But it's a very important distinction, because when you're advocating for someone and they don't have a voice themselves, then are you really advocating for them, and that's something that I've wrestled with for a long time, but I wonder if you could speak to the distinction between helping someone finding their voice and learning to advocate for themselves and when to step in and advocate for them and how to make that distinction.
00:05:16.579 --> 00:05:24.485
Yeah, I think for me a lot of that comes down to I always have the goal of protecting a mom's right to informed consent.
00:05:24.485 --> 00:05:46.547
The longer I've been a doula, the more that I try to make sure that that's covered before you go into labor, because once you're in labor you should have the freedom to be able to go into labor land and to kind of disconnect from the way that we think and process so that you can be present with your contractions, so that you can be present with your breath, so that you can be present with the moment.
00:05:46.547 --> 00:05:51.283
But there are decisions that have to be made sometimes during labor.
00:05:51.283 --> 00:05:53.588
I know I was just working with a mom.
00:05:53.588 --> 00:06:03.634
I was talking to her this morning and here in Seattle where I live, we fortunately have many, many different hospitals around us.
00:06:03.634 --> 00:06:09.968
So when I go to the hospital as a doula there's like seven or eight different hospitals that I go to pretty regularly.
00:06:09.968 --> 00:06:16.136
This mom is at a hospital where the C-section rate for first-time low-risk moms is close to 40%.
00:06:16.136 --> 00:06:18.024
I know it's a very high number.
00:06:18.024 --> 00:06:23.709
I was trying to get people to drive the extra 20 minutes because there's a hospital where that number is like 20%.
00:06:23.709 --> 00:06:30.807
But the care that is common there is very much like your labor is not going to work.
00:06:30.807 --> 00:06:34.375
Let me help you, let me fix it Right.
00:06:34.375 --> 00:06:45.399
And so it's like let's intervene early, let's intervene before there's a problem, let's induce everybody, let's use as much Pitocin as we can, and if there's fetal distress, well it's just.
00:06:45.399 --> 00:06:46.862
Labor is so unpredictable.
00:06:46.862 --> 00:06:47.685
Good thing you were here.
00:06:47.685 --> 00:06:49.668
And it's this weird cycle.
00:06:49.668 --> 00:07:00.161
Medical help is so important in some cases, but some of the drugs commonly used in labor, like mesoprostol, also goes by Cytotec.
00:07:00.161 --> 00:07:02.288
It's not even FDA approved to use in labor.
00:07:02.288 --> 00:07:08.086
It's FDA approved to use in stomach ulcers and it says on the label not approved for labor.
00:07:08.086 --> 00:07:21.165
No safety data has ever been given on this, and Pitocin is on this high risk list of only six drugs for drugs that can cause harm to a mother and baby, even when used correctly.
00:07:22.088 --> 00:07:30.725
And so, with my clients, I try to help them think through like, okay, what does an ideal birth look like to you?
00:07:30.725 --> 00:07:39.211
If everything goes perfectly like you don't have any medical complications, you're just sailing through this experience, what does that look like?
00:07:39.211 --> 00:07:40.783
And we create that vision.
00:07:40.783 --> 00:07:47.802
But then we also have conversations about like okay, if something goes wrong, when would you be open to these?
00:07:47.802 --> 00:07:58.985
And let's get you a little bit of knowledge about what does it look like when you might need help and what are those situations, so you can have a logical choice.
00:07:58.985 --> 00:08:14.072
But you don't have to necessarily be thinking about everything all the way through your labor because you can let go and just be focused on that really, really perfect plan, which very often does go that way when you've planned and you're ready for the contractions.
00:08:14.500 --> 00:08:23.586
But also then, when someone is equipped with a little bit of knowledge, then they can truly make their own decisions right.
00:08:23.586 --> 00:08:42.869
Then they can truly make their own decisions right, and so I try not to ever make decisions where people only provide information and context and then, when a person has made their decision, I let them state their decision and then, if they're getting pushed back, I'll typically come in and support their voice.
00:08:42.869 --> 00:09:06.142
For example, sometimes when water breaks, moms are like I'm open to doing an induction, but I want to wait 12 or 24 hours before I start medication, knowing that most women will start labor on their own by then goes depending on the hospital we're at.
00:09:06.142 --> 00:09:10.475
Sometimes it's like great, we'll see you in 12 hours, we'll see you in 24 hours, and other hospitals it's like no, we see right away.
00:09:10.475 --> 00:09:11.561
That's what we do here.
00:09:12.062 --> 00:09:14.912
There is no choice unless you ask more questions.
00:09:14.912 --> 00:09:28.793
My strategy is to provide the information and then, once somebody has made their choice and vocalized their choice, if they're getting pushback which they typically don't, but if they do just being the one to step in and say this is what she said.
00:09:28.793 --> 00:09:30.721
Do you have concerns about that?
00:09:30.721 --> 00:09:32.024
What are your concerns?
00:09:32.024 --> 00:09:35.051
Okay, this is what she has said about that.
00:09:35.051 --> 00:09:37.485
This is what she's already vocalized to you.
00:09:37.746 --> 00:09:46.048
I like the way you word that, because I always try to encourage my clients to use the words concerned or what are your concerns.
00:09:46.048 --> 00:10:01.033
I feel like that is such a disarming way to ask questions, and I also feel like the best way to get to the bottom of what people's thought processes are is to continue to ask questions like what are your concerns?
00:10:01.033 --> 00:10:07.625
Can you help me understand what your thought process is, or what your plan of action is or what your goals are with this?
00:10:07.625 --> 00:10:16.613
And then, if we don't get to the point where we can come to a common understanding, then we can start saying things like well, am I safe right now?
00:10:16.613 --> 00:10:18.466
Is my baby safe right now?
00:10:18.466 --> 00:10:20.493
Do we have time to think about the decision?
00:10:20.493 --> 00:10:23.844
Or how long can we go without doing anything right now?
00:10:23.844 --> 00:10:27.827
Because I agree, I feel like hospitals are getting better in general.
00:10:27.827 --> 00:10:29.634
As more evidence comes about.
00:10:30.135 --> 00:10:50.115
I feel like we are starting to kind of relax and understand that not all birth is pathological, and that's something that midwives and doulas have known for a long time, because midwives and doulas specialize in low-risk, physiologically straightforward birth.
00:10:50.115 --> 00:10:52.727
I don't want to say normal, because what is normal?
00:10:52.748 --> 00:11:19.196
Right, and there's such a wide variation of what a labor can look like and still result in a healthy mom, healthy baby the baby and I just I really think that we are coming from two different sides of the spectrum because me as a, I come from the labor nurse medical side, but as a nurse I've been a part of enough physiologically straightforward deliveries or inductions.
00:11:19.436 --> 00:11:36.664
even that become straightforward because I know how to help someone move through labor and I think it's important to be able to recognize normal in all of its stages and then be able to move towards.
00:11:36.664 --> 00:11:41.173
Okay, I'm starting to see some things that may not be normal.
00:11:41.173 --> 00:12:03.605
Let's evaluate our options instead of coming from this place of all, birth is medical and then going back and trying to look for the arguments that this birth needs help, and so it's so important for moms to be able to make decisions that meet their needs, as their needs evolve and change.
00:12:03.765 --> 00:12:13.707
Nobody asks to have really high blood pressure and nobody asks for their water to break at 35 weeks or 34 weeks, like sometimes.
00:12:13.707 --> 00:12:22.288
Life throws us into these situations where we do need the medical help and we need to know how to ask for it and say like, hey, this is what happened to me.
00:12:22.288 --> 00:12:24.548
I think my water broke, but it seems too early.
00:12:24.548 --> 00:12:25.522
Do I still call?
00:12:25.522 --> 00:12:28.708
I once had a mom that had that happen and she didn't know.
00:12:28.708 --> 00:12:30.552
She was too scared.
00:12:30.552 --> 00:12:36.123
She was like I didn't want to seem like I didn't know what was going on, so I didn't call my doctor and I was like wait, wait, wait, wait, wait.
00:12:36.123 --> 00:12:46.881
I love you and I'm your doula, but let's call together and if that means your birth plan changes, then I'll still be by your side and you can have a beautiful birth.
00:12:46.881 --> 00:12:50.210
It just might take a different shape than you anticipated.
00:12:50.951 --> 00:12:55.567
Yeah, and you can still have autonomy during birth.
00:12:55.567 --> 00:13:06.013
That wasn't exactly the way that you planned, just like if the road is closed on your way to work, you can still get to work by going another route.
00:13:06.013 --> 00:13:12.379
It may be a longer route, it may not be your favorite view, but you'll still get there, right?
00:13:12.379 --> 00:13:25.942
I think probably the most unhealthy thing that I see is this attempt to avoid dealing with the fear in the hopes that it makes it go away.
00:13:25.942 --> 00:13:29.506
I think we kind of go into fight or flight in our mind.
00:13:29.506 --> 00:13:39.102
I disagree.
00:13:39.102 --> 00:13:52.964
I think it's important to mentally confront the possibility and the options and ask yourself at what point, like you said, when would that be something that I would accept in my labor?
00:13:52.964 --> 00:13:59.176
When would that tool become important for me, and then go from there and figure out how to cope with needing that tool.
00:13:59.336 --> 00:14:08.958
Yeah, I worked with a mom once who had done exactly what you said in her first birth, where she had really high blood pressure and she ignored it.
00:14:08.958 --> 00:14:11.352
Her doctor had said I really want you to come in.
00:14:11.352 --> 00:14:13.357
You need to have your baby.
00:14:13.357 --> 00:14:14.740
This is unsafe now.
00:14:14.740 --> 00:14:20.662
And she was like no birth is so natural and she ended up in this crazy emergent situation.
00:14:20.662 --> 00:14:28.436
When she reached out to me for her second birth she was like I've always wanted a natural labor but I have to make the choice for an induction.
00:14:28.436 --> 00:14:29.538
I know that's.
00:14:29.577 --> 00:14:36.850
My biggest regret was that I didn't make that choice the first time, but I don't know how to protect my sovereignty in this situation.
00:14:36.850 --> 00:14:45.495
And so it wasn't that having a doula or having somebody by her side meant that we were avoiding things.
00:14:45.495 --> 00:14:49.244
A lot of it was supporting her in, like I'm very afraid.
00:14:49.244 --> 00:14:52.716
And she did a very brave thing, which was to recognize.
00:14:52.716 --> 00:14:58.965
The same thing I've recognized in my first birth was I didn't have the knowledge to ask the questions.
00:14:58.965 --> 00:15:00.068
I knew I had questions.
00:15:00.068 --> 00:15:01.131
I didn't know what they were.
00:15:01.131 --> 00:15:21.884
I knew I had big emotions, but I couldn't verbalize what those were yet I think my midwife friend was the one that helped me kind of develop the vocabulary around that and I truly didn't have the communication skills Same with her to say, like you're telling me this, skills Same with her to say, like you're telling me this.
00:15:21.884 --> 00:15:24.289
But I believe this there's a gap.
00:15:28.029 --> 00:15:28.451
Where's the bridge?
00:15:28.471 --> 00:15:48.779
I truly don't have judgment on this for medical staff, because I look at how busy they are and, like I was one time with a mom, it was like pushing her baby and the doctor, as she was sitting there waiting to catch the baby, prescribed medication to a mom in another room, remembering her allergies, advocated for a mom that came in through the emergency room that they were trying to send home and she was like no, if my patient came here, I am going to see her.
00:15:48.860 --> 00:15:51.674
Sometimes there's just a lot going on.
00:15:51.674 --> 00:15:56.652
If a provider is not giving you the information that you need, it's not because they don't care.
00:15:56.652 --> 00:16:03.851
They just might not know you well enough to know that you're not speaking up or you're still kind of sitting in the anxiety and you haven't found the words for it yet.
00:16:03.851 --> 00:16:04.474
Those doulas.
00:16:04.474 --> 00:16:10.035
It's often like building that bridge and that communication and asking the provider can you stay a few more minutes?
00:16:10.035 --> 00:16:23.206
We have more questions, we need more information, we need to get to a place of feeling more security and safety before we can go forwards with your recommendation, which is ultimately, in this situation, what needs to happen.
00:16:24.291 --> 00:16:26.820
I agree it's an unfortunate downside.
00:16:26.899 --> 00:16:47.158
If you are wanting a hospital birth or if you're required to have a hospital birth because of any kind of illness or complication to the pregnancy, that is the downside that you're going to be sharing your doctor, or even if it's a midwife our midwives one of the hospitals I work at are the busiest ones on the floor because they have all the patients.
00:16:47.217 --> 00:16:56.831
It's a huge practice and you get one midwife and they can be delivering 10 babies on the floor at one time, like they'll just be bouncing room to room to room.
00:16:56.831 --> 00:17:14.606
And unfortunately, the downside of being in the hospital is you have the potential to become someone described at one time as like a cog in the machine and if you are requiring more attention it may slow down the whole machine and then we have to prioritize that attention.
00:17:14.606 --> 00:17:30.759
So if you are physiologically normal and safe and someone else isn't and our need to put more attention on you means that we can't put attention to this other emergency that's going on, unfortunately we're not going to be able to put that attention on to you.
00:17:30.759 --> 00:17:42.413
We're going to have to prioritize, which is sad but it is the truth and it is very frustrating for a patient that is, wanting the care that all patients deserve.
00:17:42.432 --> 00:17:59.701
They deserve right, yeah, and it's not the people in the system's fault, because if you're a midwife with 10 patients, you can only do so much and your heart can be with every single person, and yet your time and attention can only be in one place.
00:18:00.330 --> 00:18:10.218
Yeah, something that I encounter, and I'm starting to notice a shift, or maybe I'm just trying to find the birth workers who have already made this shift.
00:18:10.218 --> 00:18:28.942
I notice more doulas that are becoming more comfortable with the realities of hospital birth and I'm seeing less of what I used to see in what I guess, gave the conflict we all know can exist between hospital and doula.
00:18:28.942 --> 00:18:32.721
Was this everybody in their own corner situation?
00:18:32.721 --> 00:18:33.021
Right?
00:18:33.021 --> 00:18:38.875
So the medical aspect of birth and the natural aspect of birth, and everybody is just trying to fight their own logic.
00:18:38.875 --> 00:18:51.583
But now what I'm seeing is a lot more ability for the doula to support someone through a birth, given the resources that are in the hospital or given the obstacles that are in the hospital.
00:18:51.583 --> 00:18:51.951
Right?
00:18:51.951 --> 00:18:59.032
So if you were having a home birth, for instance, you are less likely to be monitored continuously.
00:18:59.032 --> 00:19:02.493
In fact, you probably can't be monitored continuously, right?
00:19:03.195 --> 00:19:14.859
Right, I mean I'm going to sit there and listen with the Doppler, and I have seen that at home births, where it's like I need to pay extra attention but it's not going to be the continuous, or like I wasn't sure what I heard.
00:19:14.859 --> 00:19:20.471
I need to listen in the two contractions in a row, but it's still not like wearing the monitors.
00:19:20.471 --> 00:19:24.481
You go for a walk and they fall on your foot and so then you stop walking.
00:19:24.990 --> 00:19:32.457
Yeah, and there's a give and take and it would be lovely if the midwives could do the monitoring for one or two contractions on everyone.
00:19:32.457 --> 00:19:39.813
But once you start, like you said, the cytotec we have to monitor because we don't know how the baby's going to react, the pitocin we have to monitor because we don't know how the baby's going to react.
00:19:39.832 --> 00:19:41.333
The Pitocin we have to monitor because we don't know how the babies react.
00:19:41.333 --> 00:19:58.480
We're moving away and at least the hospitals that I'm working at and the guidelines from ACOG and AWAN and all of the governing bodies are now saying that we can do the pre-induction with intermittent monitoring because it's safe and because moms are pushed back because they don't want to be unnecessarily monitored.
00:19:58.480 --> 00:20:14.909
But how do we work with when we're in a hospital having a natural, physiologically straightforward birth and still having to have the IV port not necessarily hooked up, or having the intermittent monitoring and all of that stuff?
00:20:14.909 --> 00:20:24.603
I feel like it takes a special skill set from a doula to be able to support a mom through a hospital birth versus through a home birth.
00:20:24.603 --> 00:20:31.623
If there were new people starting out that wanted to be doulas, what would you tell them about how to support somebody through that?
00:20:32.109 --> 00:20:35.778
Yeah, I don't know if my answers are perfect, but I can share what I do.
00:20:35.778 --> 00:20:38.153
Most of my births are in the hospital.
00:20:38.153 --> 00:20:40.460
I had a home birth.
00:20:40.460 --> 00:20:41.590
I loved my home birth.
00:20:41.590 --> 00:20:51.798
I occasionally go to home births super special experiences when they go well, super easy comparatively to being in the hospital.
00:20:51.798 --> 00:20:54.423
Sometimes I'm like, oh, I'm just a photographer.
00:20:54.423 --> 00:20:57.113
It's a completely different feeling.
00:20:57.794 --> 00:21:14.623
But for me, for all my clients home birth, hospital births what I do is before labor, we meet twice, and the first time we're very focused on the birth plan and we go through a checklist of every single thing that's going to happen or every choice that they have.
00:21:14.623 --> 00:21:27.853
So we will talk through okay, when you're dilatingating, when you're pushing it in the golden hour, and that's our chance to talk about, like, okay, when we get to the hospital, this is what's going to happen in triage.
00:21:27.853 --> 00:21:29.536
You're going to get an IV.
00:21:29.536 --> 00:21:32.142
You're going to typically get a cervical check.
00:21:32.142 --> 00:21:39.119
You're going to be monitored continuously, at least for the first 15 minutes to a half hour.
00:21:39.119 --> 00:21:40.643
That is part of triage.
00:21:40.643 --> 00:21:45.824
And now let's talk about what your needs are, knowing that this is what it is.
00:21:45.824 --> 00:21:54.775
Sometimes I've worked with a few moms that have been victims of sexual assault, who are like I am very worried about that cervical check, I cannot do it.
00:21:54.775 --> 00:22:01.711
And so it's at that point, before they're in labor, where we're saying, okay, a cervical check is part of triage.
00:22:01.711 --> 00:22:09.096
Now we need to come up with a plan, and I have on occasion asked people have you talked to your doctor about your abuse?
00:22:09.096 --> 00:22:12.971
Do they know that this is more triggering to you than someone else?
00:22:12.971 --> 00:22:19.944
And their doctors have noted we will not do a cervical check in their official medical documentation.
00:22:19.944 --> 00:22:21.099
So when we get to triage and we say we were not do a cervical check in their official medical documentation.
00:22:21.099 --> 00:22:54.711
So when we get to triage and we say we were hoping to delay the cervical check and often there's an agreement here, if all is going well, either until after an epidural or until starting to feel an urge to push, or somewhere later in labor, where a lot of times clients can kind of have some choice about when it would be okay for them and then having that choice it makes it so that intervention isn't as difficult, or after an epidural it won't feel the same, it won't bring them the same trauma and same.
00:22:54.731 --> 00:23:00.692
With the IV port we talk about how do you do with needles, what are the things that go through your minds.
00:23:00.692 --> 00:23:03.144
What do you do when you're in stressful situations?
00:23:03.144 --> 00:23:04.810
How can I help you through this?
00:23:04.810 --> 00:23:06.556
Is it going to be distracting you?
00:23:06.556 --> 00:23:08.761
Do you need to know everything that's going on?
00:23:08.761 --> 00:23:17.313
A lot of hospitals have like special IV teams that can come in with a little ultrasound machine and that can get it right on the first time.
00:23:17.313 --> 00:23:20.438
Is there something that we can do to make this easier for you?
00:23:20.438 --> 00:23:25.164
And so sometimes the conversation isn't necessarily.
00:23:25.724 --> 00:23:26.852
You know a lot of home births.
00:23:26.932 --> 00:23:29.900
Moms are opting out of a lot of things, and that's fine.
00:23:30.119 --> 00:23:43.378
I want to opt out as much as I can, but I can't opt out of everything, either because of the location they're at or because of the life situation that their pregnancy and birth is happening within.
00:23:44.221 --> 00:23:57.540
And in those cases, when we talk about it before and we've gone through literally everything from start to finish, then it's like this weight off of their shoulders and then they can get practice talking with their doctor about it.
00:23:58.089 --> 00:24:05.551
Sometimes I will go with them in very special cases and have that conversation with them and say, like we're trying to meet you halfway.
00:24:05.551 --> 00:24:08.196
These are her needs, how can you help us?
00:24:08.196 --> 00:24:31.221
And sometimes it will be the doctor that will say you know what I see that you're trying and this is how I can help you, and we'll come up with kind of a new alternative that's more helpful to the specific person but maybe not the same, as, like we do a cervical check for everybody, and I don't think it would be possible for a hospital system to write a rule that would truly take into account everybody's needs.
00:24:31.221 --> 00:24:51.704
So from my perspective, it's really trying to help people get that individualized care within the parameters of what does good care look like, because we never, ever, ever want to sacrifice getting attention when it's needed due to any philosophies that may or may not be applicable in a specific moment in time.
00:24:52.227 --> 00:25:00.972
I think that's a really good point, that it isn't possible that all the rules that hospitals come up with are essentially to keep people safe, maintain lower liability.
00:25:00.972 --> 00:25:10.371
Right, we need to have standardized care so that we know that we've got evidence behind what we're doing, but also hospitals are attempting to have patient-centered care.
00:25:10.371 --> 00:25:12.878
So how do those two things come together?
00:25:12.878 --> 00:25:42.993
That's a difficult job, especially if you're working in the hospital and taking care of multiple patients, and so we need people that understand how to help with patient-centered care, that also understand how hospitals work and how to work within the confines of what hospitals can offer, because we can't necessarily offer a home birth environment, or even some can't offer the birth center environment, just given the infrastructure.
00:25:43.074 --> 00:25:51.960
There are more and more hospitals that are getting on board with that, but how often are old hospitals upgrading to new buildings?
00:25:51.960 --> 00:25:56.516
Probably not more than every 20, 30 years, so we're going to be a little behind the times.
00:25:56.516 --> 00:26:00.325
There's so much that you have to consider cost-wise, you know there's not as much real estate times.
00:26:00.325 --> 00:26:15.038
There's so much that you have to consider cost-wise, you know there's not as much real estate in some areas, and so then you have space that you have limitations, and so when you go to a hospital where there's going to be multiple people birthing on one floor, there's going to be limits to what they can offer we would want to offer a birth pool to everyone.
00:26:15.349 --> 00:26:18.641
We want to offer an environment that looks like your home to everyone.
00:26:18.641 --> 00:26:20.490
To everyone.
00:26:20.490 --> 00:26:22.434
We want to offer an environment that looks like your home to everyone.
00:26:22.434 --> 00:26:24.719
We would love to offer one nurse, one midwife, one doctor, one doula to each patient.
00:26:24.719 --> 00:26:38.737
That requires a lot of money that isn't necessarily available and insurance companies aren't necessarily going to pay for, and we have to also offer certain levels of technology in order to keep the high-risk safe.
00:26:39.260 --> 00:26:55.913
It's a totally different animal than someone that's giving birth at home because they are physiologically healthy and their pregnancy is 100% low-risk, and so far we have not seen any kind of indication that we're going anywhere towards medium to high-risk.
00:26:55.913 --> 00:27:12.141
It's completely different and I think it's so important to have an understanding of what that means and how to help have the birth that someone wants, given those confines, and, as nurses, to make that happen.
00:27:12.141 --> 00:27:20.432
We are trained about the medical and the physiological aspects of birth and then what to do when things are medicalized.
00:27:20.432 --> 00:27:23.038
We are taught how to handle a postpartum hemorrhage.
00:27:23.038 --> 00:27:26.353
We're taught how to help resuscitate a baby.
00:27:26.353 --> 00:27:30.742
We're taught the emergency situations, and that is what is emphasized.
00:27:31.029 --> 00:27:33.439
And that is so critically important.
00:27:33.690 --> 00:28:36.011
It is, and so, then, to be able to support the people that are there for the emergencies no-transcript help dads or partners and also they are not an expert in supporting somebody through low-risk birth right and to have somebody that is trained in supporting someone in low-risk birth at the bedside is amazing, and I wish that hospitals would employ more doulas so that we could have somebody at the bedside all the time, and so there is less conflict when we do have somebody coming in from the outside that may not know how our hospital system works, and so you would have to go research each hospital, and I think it's so important.
00:28:36.432 --> 00:28:44.218
You have a perspective that I haven't had a chance to look into, and that is how to get a doula through insurance.
00:28:44.218 --> 00:28:55.445
I think one of the biggest barriers to getting doula care is that birth can be so expensive for people, even if you have adequate insurance coverage.
00:28:55.445 --> 00:29:00.691
There's a lot of money that goes into birth insurance coverage.
00:29:00.691 --> 00:29:01.573
There's a lot of money that goes into birth.
00:29:01.573 --> 00:29:11.000
So to have that extra cost of a doula is sometimes a little bit of a challenge for some couples, especially when you're considering how much money you're going to be putting forth for a baby all of that stuff.
00:29:11.000 --> 00:29:18.756
So now that there is the option at least the Medicaid option are all insurance companies now getting on board with doula care?
00:29:24.309 --> 00:29:24.589
Yeah.
00:29:24.589 --> 00:29:31.821
So that's a fabulous question and I completely agree with you because when I think back to my own pregnancies and births, there is no way.
00:29:31.821 --> 00:29:37.096
I remember very clearly one day when I was sitting at my office I worked at an investment bank at the time.
00:29:37.096 --> 00:29:43.560
Later I became a stay-at-home mom in the gap between my kids and so we were much more financially strapped before my second one.
00:29:43.560 --> 00:30:09.478
But I remember having a conversation with me and there were two other people on my team and their wives were pregnant and my friend Travis was like we just got a doula, we're taking these classes and they were kind of like super into all the natural things and when I heard how much it cost, I like almost died and I was like there is no way I would ever pay that for any of this.
00:30:09.478 --> 00:30:18.498
So I do find it a little bit ironic that like that was my first thought when it came to doulas and my first exposure was like why would anyone pay for something that expensive?
00:30:18.780 --> 00:30:21.794
Not every insurance company covers doulas.
00:30:21.794 --> 00:30:23.858
Hopefully that will change.
00:30:23.858 --> 00:30:29.702
I hope it becomes much more accessible and not every state covers it in their Medicaid programs.
00:30:29.702 --> 00:30:37.852
It is something that's been ongoing where more and more states there's a handful of states that are currently reimbursing doula care coverage.
00:30:37.852 --> 00:30:57.569
There is a handful of states, like mine, where it has been approved by the legislature to cover doula coverages, but the programs are being built out and then there are states where it's being considered and there's states where it's not even being talked about at all.
00:30:57.569 --> 00:30:59.936
So it really does depend on where you live.
00:31:00.484 --> 00:31:06.273
There's also a lot of employers that are offering reimbursement programs for doulas.
00:31:06.273 --> 00:31:11.906
I know in my area like Boeing just added a program through their HR.
00:31:11.906 --> 00:31:13.329
Microsoft.
00:31:13.329 --> 00:31:15.233
There's a handful of companies here.
00:31:15.233 --> 00:31:20.349
So if you're unsure about can you get help paying for a doula?
00:31:20.349 --> 00:31:23.458
Call your HR if you work for a larger company and find out.
00:31:23.458 --> 00:31:31.791
Some people are surprised when they found out like, oh, my company does pay for a doula, I just have to submit a form and then I get reimbursed.
00:31:31.791 --> 00:31:35.988
Should we go over like the states that are actively?
00:00:00.400 --> 00:00:03.483
00:00:03.483 --> 00:00:06.246
00:00:06.246 --> 00:00:16.356
00:00:16.356 --> 00:00:24.707
00:00:24.707 --> 00:00:27.570
00:00:27.570 --> 00:00:30.452
00:00:30.452 --> 00:00:35.256
00:00:35.256 --> 00:00:45.100
00:00:45.460 --> 00:00:50.473
00:00:50.473 --> 00:00:52.238
00:00:52.238 --> 00:00:54.604
00:00:54.604 --> 00:01:00.462
00:01:00.462 --> 00:01:11.689
00:01:11.689 --> 00:01:19.510
00:01:19.951 --> 00:01:37.513
00:01:37.513 --> 00:01:51.620
00:01:51.620 --> 00:01:58.614
00:01:58.614 --> 00:02:11.600
00:02:11.600 --> 00:02:12.544
00:02:12.544 --> 00:02:13.467
00:02:13.467 --> 00:02:15.480
00:02:15.701 --> 00:02:29.632
00:02:30.354 --> 00:02:49.069
00:02:49.069 --> 00:02:58.139
00:02:58.139 --> 00:03:11.229
00:03:11.229 --> 00:03:21.022
00:03:21.022 --> 00:03:27.283
00:03:27.283 --> 00:03:36.151
00:03:36.900 --> 00:03:38.163
00:03:38.163 --> 00:03:55.622
00:03:55.622 --> 00:04:04.848
00:04:04.848 --> 00:04:13.907
00:04:13.907 --> 00:04:28.622
00:04:29.564 --> 00:04:32.129
00:04:32.129 --> 00:04:50.427
00:04:50.427 --> 00:05:16.173
00:05:16.579 --> 00:05:24.485
00:05:24.485 --> 00:05:46.547
00:05:46.547 --> 00:05:51.283
00:05:51.283 --> 00:05:53.588
00:05:53.588 --> 00:06:03.634
00:06:03.634 --> 00:06:09.968
00:06:09.968 --> 00:06:16.136
00:06:16.136 --> 00:06:18.024
00:06:18.024 --> 00:06:23.709
00:06:23.709 --> 00:06:30.807
00:06:30.807 --> 00:06:34.375
00:06:34.375 --> 00:06:45.399
00:06:45.399 --> 00:06:46.862
00:06:46.862 --> 00:06:47.685
00:06:47.685 --> 00:06:49.668
00:06:49.668 --> 00:07:00.161
00:07:00.161 --> 00:07:02.288
00:07:02.288 --> 00:07:08.086
00:07:08.086 --> 00:07:21.165
00:07:22.088 --> 00:07:30.725
00:07:30.725 --> 00:07:39.211
00:07:39.211 --> 00:07:40.783
00:07:40.783 --> 00:07:47.802
00:07:47.802 --> 00:07:58.985
00:07:58.985 --> 00:08:14.072
00:08:14.500 --> 00:08:23.586
00:08:23.586 --> 00:08:42.869
00:08:42.869 --> 00:09:06.142
00:09:06.142 --> 00:09:10.475
00:09:10.475 --> 00:09:11.561
00:09:12.062 --> 00:09:14.912
00:09:14.912 --> 00:09:28.793
00:09:28.793 --> 00:09:30.721
00:09:30.721 --> 00:09:32.024
00:09:32.024 --> 00:09:35.051
00:09:35.051 --> 00:09:37.485
00:09:37.746 --> 00:09:46.048
00:09:46.048 --> 00:10:01.033
00:10:01.033 --> 00:10:07.625
00:10:07.625 --> 00:10:16.613
00:10:16.613 --> 00:10:18.466
00:10:18.466 --> 00:10:20.493
00:10:20.493 --> 00:10:23.844
00:10:23.844 --> 00:10:27.827
00:10:27.827 --> 00:10:29.634
00:10:30.135 --> 00:10:50.115
00:10:50.115 --> 00:10:52.727
00:10:52.748 --> 00:11:19.196
00:11:19.436 --> 00:11:36.664
00:11:36.664 --> 00:11:41.173
00:11:41.173 --> 00:12:03.605
00:12:03.765 --> 00:12:13.707
00:12:13.707 --> 00:12:22.288
00:12:22.288 --> 00:12:24.548
00:12:24.548 --> 00:12:25.522
00:12:25.522 --> 00:12:28.708
00:12:28.708 --> 00:12:30.552
00:12:30.552 --> 00:12:36.123
00:12:36.123 --> 00:12:46.881
00:12:46.881 --> 00:12:50.210
00:12:50.951 --> 00:12:55.567
00:12:55.567 --> 00:13:06.013
00:13:06.013 --> 00:13:12.379
00:13:12.379 --> 00:13:25.942
00:13:25.942 --> 00:13:29.506
00:13:29.506 --> 00:13:39.102
00:13:39.102 --> 00:13:52.964
00:13:52.964 --> 00:13:59.176
00:13:59.336 --> 00:14:08.958
00:14:08.958 --> 00:14:11.352
00:14:11.352 --> 00:14:13.357
00:14:13.357 --> 00:14:14.740
00:14:14.740 --> 00:14:20.662
00:14:20.662 --> 00:14:28.436
00:14:28.436 --> 00:14:29.538
00:14:29.577 --> 00:14:36.850
00:14:36.850 --> 00:14:45.495
00:14:45.495 --> 00:14:49.244
00:14:49.244 --> 00:14:52.716
00:14:52.716 --> 00:14:58.965
00:14:58.965 --> 00:15:00.068
00:15:00.068 --> 00:15:01.131
00:15:01.131 --> 00:15:21.884
00:15:21.884 --> 00:15:24.289
00:15:28.029 --> 00:15:28.451
00:15:28.471 --> 00:15:48.779
00:15:48.860 --> 00:15:51.674
00:15:51.674 --> 00:15:56.652
00:15:56.652 --> 00:16:03.851
00:16:03.851 --> 00:16:04.474
00:16:04.474 --> 00:16:10.035
00:16:10.035 --> 00:16:23.206
00:16:24.291 --> 00:16:26.820
00:16:26.899 --> 00:16:47.158
00:16:47.217 --> 00:16:56.831
00:16:56.831 --> 00:17:14.606
00:17:14.606 --> 00:17:30.759
00:17:30.759 --> 00:17:42.413
00:17:42.432 --> 00:17:59.701
00:18:00.330 --> 00:18:10.218
00:18:10.218 --> 00:18:28.942
00:18:28.942 --> 00:18:32.721
00:18:32.721 --> 00:18:33.021
00:18:33.021 --> 00:18:38.875
00:18:38.875 --> 00:18:51.583
00:18:51.583 --> 00:18:51.951
00:18:51.951 --> 00:18:59.032
00:18:59.032 --> 00:19:02.493
00:19:03.195 --> 00:19:14.859
00:19:14.859 --> 00:19:20.471
00:19:20.471 --> 00:19:24.481
00:19:24.990 --> 00:19:32.457
00:19:32.457 --> 00:19:39.813
00:19:39.832 --> 00:19:41.333
00:19:41.333 --> 00:19:58.480
00:19:58.480 --> 00:20:14.909
00:20:14.909 --> 00:20:24.603
00:20:24.603 --> 00:20:31.623
00:20:32.109 --> 00:20:35.778
00:20:35.778 --> 00:20:38.153
00:20:38.153 --> 00:20:40.460
00:20:40.460 --> 00:20:41.590
00:20:41.590 --> 00:20:51.798
00:20:51.798 --> 00:20:54.423
00:20:54.423 --> 00:20:57.113
00:20:57.794 --> 00:21:14.623
00:21:14.623 --> 00:21:27.853
00:21:27.853 --> 00:21:29.536
00:21:29.536 --> 00:21:32.142
00:21:32.142 --> 00:21:39.119
00:21:39.119 --> 00:21:40.643
00:21:40.643 --> 00:21:45.824
00:21:45.824 --> 00:21:54.775
00:21:54.775 --> 00:22:01.711
00:22:01.711 --> 00:22:09.096
00:22:09.096 --> 00:22:12.971
00:22:12.971 --> 00:22:19.944
00:22:19.944 --> 00:22:21.099
00:22:21.099 --> 00:22:54.711
00:22:54.731 --> 00:23:00.692
00:23:00.692 --> 00:23:03.144
00:23:03.144 --> 00:23:04.810
00:23:04.810 --> 00:23:06.556
00:23:06.556 --> 00:23:08.761
00:23:08.761 --> 00:23:17.313
00:23:17.313 --> 00:23:20.438
00:23:20.438 --> 00:23:25.164
00:23:25.724 --> 00:23:26.852
00:23:26.932 --> 00:23:29.900
00:23:30.119 --> 00:23:43.378
00:23:44.221 --> 00:23:57.540
00:23:58.089 --> 00:24:05.551
00:24:05.551 --> 00:24:08.196
00:24:08.196 --> 00:24:31.221
00:24:31.221 --> 00:24:51.704
00:24:52.227 --> 00:25:00.972
00:25:00.972 --> 00:25:10.371
00:25:10.371 --> 00:25:12.878
00:25:12.878 --> 00:25:42.993
00:25:43.074 --> 00:25:51.960
00:25:51.960 --> 00:25:56.516
00:25:56.516 --> 00:26:00.325
00:26:00.325 --> 00:26:15.038
00:26:15.349 --> 00:26:18.641
00:26:18.641 --> 00:26:20.490
00:26:20.490 --> 00:26:22.434
00:26:22.434 --> 00:26:24.719
00:26:24.719 --> 00:26:38.737
00:26:39.260 --> 00:26:55.913
00:26:55.913 --> 00:27:12.141
00:27:12.141 --> 00:27:20.432
00:27:20.432 --> 00:27:23.038
00:27:23.038 --> 00:27:26.353
00:27:26.353 --> 00:27:30.742
00:27:31.029 --> 00:27:33.439
00:27:33.690 --> 00:28:36.011
00:28:36.432 --> 00:28:44.218
00:28:44.218 --> 00:28:55.445
00:28:55.445 --> 00:29:00.691
00:29:00.691 --> 00:29:01.573
00:29:01.573 --> 00:29:11.000
00:29:11.000 --> 00:29:18.756
00:29:24.309 --> 00:29:24.589
00:29:24.589 --> 00:29:31.821
00:29:31.821 --> 00:29:37.096
00:29:37.096 --> 00:29:43.560
00:29:43.560 --> 00:30:09.478
00:30:09.478 --> 00:30:18.498
00:30:18.780 --> 00:30:21.794
00:30:21.794 --> 00:30:23.858
00:30:23.858 --> 00:30:29.702
00:30:29.702 --> 00:30:37.852
00:30:37.852 --> 00:30:57.569
00:30:57.569 --> 00:30:59.936
00:31:00.484 --> 00:31:06.273
00:31:06.273 --> 00:31:11.906
00:31:11.906 --> 00:31:13.329
00:31:13.329 --> 00:31:15.233
00:31:15.233 --> 00:31:20.349
00:31:20.349 --> 00:31:23.458
00:31:23.458 --> 00:31:31.791
00:31:31.791 --> 00:31:35.988