Doula Micah Burgess on Enhancing the Hospital Birth Experience through Teamwork!

0:01 Hello, today I have with me Micah Burgess. Micah is the mother of six, she is a doula in Waco, texas, and she is the host of the podcast My Doula Micah. Today she is here to talk about teamwork in the delivery room. Micah hello, thank you so much for joining me. Hey lady. Happy to talk. I'm so excited. We have talked about this collaboration for a while. I know It's fucking happening. I'm so excited We have a common goal and that is working together in the delivery room because we want moms to succeed at this birthing process, however it looks. But that requires a lot of teamwork and a lot of coming to the same page between the nurse, the hospital, the doula, the mother, the family member All of those people need to come together and set aside all of their stuff and work together to help the mom on this goal of birthing It's child.

0:58 So, because you're a doula that comes in and helps guide what that support might look like, i'd love for you to elaborate on what the role of a doula is, because I don't think a lot of people know. I think people have assumptions they don't know. And also Kelly. You may not know this, but a lot of people still think that a doula and a midwife are the same thing. They don't know the difference, and so a midwife actually delivers your baby. If you hire a midwife, they would replace your obstetrician, but a doula is simply a chopper's labor. Coach Literally means servant. I don't do anything medical, i'm not going to deliver your baby. I don't want to deliver your baby.

1:39 I have a job, and when people hire like a modern day doula would be someone that helps prepare a family prenatally about, maybe, what to expect. Typically, my main clientele would be women that are wanting to have a more natural childbirth experience, and so we go over a lot of what that looks like and what that means. A lot of people think that doulas only support home birds or birthing centers, and that's not true. I literally built a thriving career here in Waco, texas, and my specialty was natural hospital birds And it's very rewarding, very rewarding, and I think that there's a lot of different kinds of doulas, if I was going to be honest, which I didn't realize until I really got on Facebook and started getting to know other doulas and other Facebook groups, and so the approach is different.

2:32 The thoughts are different. Some doulas really only want to go to home birds or birthing centers. They're not comfortable supporting a woman in the hospital. And then there are some doulas that are very adamant about having your baby a certain way, that there's a right way to do it. And I think what I have found, not only just in my career but also as a mom of six that at the end of the day, birth is birth. Yes, i have a goal maybe going in a birth plan. I want a birth experience a certain way, and that's great. But what I'm really learning is that having a positive birth experience is the most important thing And I, early in my career, realized I'm going to leave my agenda as a doula at the door.

3:22 This isn't about me. This is about the laboring mama and what kind of experience she wants and needs at the end of the day. And there's a huge difference in delivering at home and delivering at the hospital. There's a really big difference And I think it's important for a family to understand the difference And I think it's important for a doula to understand the difference. So I talk a lot about that on my podcast, yes, and I listened to that and I loved it, and I loved your book. By the way, too, let's go ahead and plug your book. Yes, i was rolling, rolling with laughter. So I really I love that you're talking about putting the agenda at the door and really working together, because the hospital has policies that they abide by.

4:10 A hospital birth is going to look a little bit more medical, or, if it's not medical, it's going to. We're going to offer you things that are medical, that are put in place to ensure safety is available in the context that the hospital understands safety, which is the medical context. So things like an IV port will probably be put in. You don't have to be hooked up to it. You may be offered fluids or medications through that IV, which can be declined if it is not medically necessary. There's, additionally, some other things that may be perceived as inconvenient, such as being hooked up to a monitor for certain periods of time so that we can ensure, in our medical way, the safety of the baby based on medical studies that are considered evidence based practice.

4:58 Right, and I'm saying it in that way because we don't really do studies on natural birth. Right, we don't do randomized controlled trials on women laboring naturally Right. So the only thing that we know as a medical community is the way that the medical community has set things up, of course, and women have birthed babies for the since the beginning of time Yes, some successfully, some not so successfully And the goal of the medical community is to use science in the way that we understand it and have studied it, in order to improve outcomes, and sometimes we're successful. And, yes, the goal for the medical community is for there to be a safe delivery for both baby and mom.

5:44 All of that came about, i mean, honestly, there's been doulas way before there were doctors. Oh, yeah, because I mean, when a woman went into labor before there were hospitals and doctors, i mean it was her friends and her neighbors that showed up Exactly To help her. Yeah, okay, so this is the idea of having a support person in the room, somebody that's going to help you physically. Let's find a good position mentally. Hey, you're doing so good This next contraction. Let's breathe through it together Emotionally. I know you're so tired and you're ready for this to be over. Come here, girl, let me give you a hug. I mean, that is essentially what I do in a lot of respects And because that element has been removed once the medical aspects hospitals, obs came into play, and I think one of the things I really try to do with my clients is educate them on especially what the role is of a labor and delivery nurse.

6:39 Most people don't understand their job and what their role is And they're surprised that the nurse wasn't hanging out with them for hours And I'm like well, first of all, the amount. You can't even imagine. All of the paperwork, all of the things they're required to do. They have to, they have to fill out all of those things And, trust me, none of them want to. They would not prefer to hang out with you. Okay, i have lots of friends now that are L and D nurses that they'll come in and they're like, okay, i'm hiding out in here for a while And they literally sit down and prop up their feet and we talk and my clients are involved in the conversation. It's super laid back. I mean that they would love for every person to look that way, but it that's just not possible.

7:23 They have more than one patient, more than likely, that they are taking care of. They answer to like three different entities. They answer to, first of all, they are the upholders of hospital policy. That's not even really the doctor's job. That is the labor and delivery nurses job. She also answers to the OB. The OB decides what's going to happen, what kind of cares, the nurse updates the OB. So the nurse is answering to them and answers to the patient. That's a lot, that's a lot of hats to be juggling, and so I just don't think people fully understand that role, and so, in my opinion, that's where it's really great to have a doula there.

8:05 If you're wanting somebody that has been to births before that is going to try to help you accomplish maybe a more natural childbirth experience, you're mostly what women are looking for. They want to be calm, they want to feel in control, they want to know how to attack this contraction and how to breathe properly. They'd like to find the best position so that they're comfortable, but it's still working well for them to have consistent hard contractions. They want somebody to remind them that they're giving births and not dying. They want somebody to maybe advise them on okay, we could go this route or this route. What's the plan here? What's the great advice? And so I really want my clients to understand all the ins and outs of that And I prepare them for the things that they will be faced with, the decisions that they're going to be making upfront, so that they're not surprised when the labor and delivery nurse comes in and says, hey, we have not gotten a good read on baby with the monitors for about an hour now, and it's mostly just because you're up and about moving around.

9:11 Hey, let's find a position where you're comfortable and I can still be hearing baby. We're getting closer and closer to delivery And we want to make sure baby's still doing well, and the truth is, the baby's heart rate is the best indicator if everything is okay or not. It just that's your best indicator, because we can't look inside there and really see. And so What should happen? what I want to see happen and what I've worked really hard in my community to have happen is I Want to work with that L&D nurse. Great, yes, let's do it. Let's find a good position. I will literally hold that monitor in place, if you want me to, so that you can walk out of the room and know We're gonna get a good read on baby.

9:53 I want you to be able to get that. This is a benefit to my client and to your patient when you and I are Collaborating on the best way for you to get your job done. Listen, kelly, i want you to do your job well. I Want you to do your job well, and what I have found is that when I let you do your job Well, you let me do my job well, and what I have been trained in is Natural job, birth and comfort measures, and here's how we breathe through that and that's what I have been trained in, and so When you see that I am not standing in your way on doing your job, then you don't stand in my way and doing my job and what I have found is we don't run into each other, we don't trip over each other, we're helping each other.

10:40 There's not Tension in the room, we're not combating. There is actually nothing to be fighting about. Anyway, you could tell I'm passionate about this topic, i know you are and so am I. You're just voicing all of my, my thoughts and feelings. I just think that it's a beautiful dance when a labored and delivery nurse and a doula can work together And I love those experiences 100. And I love that experience with the mother and you know, i honestly, because I can't be in there every second of the birthing process I need someone there that is going to help that mother get through it. Otherwise it's all kind of on her. I can, i can Put someone in a position that's comfortable for the moment.

11:23 Yeah, but because you need to maintain a dynamic pelvis Sometimes, you know you need someone that's there constantly in order to make that happen, and I can try to teach the other support person what to do. But you know, everybody's kind of just learning right when this is all happening. So to have somebody there that understands all those comfort techniques that can change the atmosphere of the room to something That's calm, whether it's with the, the essential oils or the fairy lights, or you know I love coming into the rooms that are just like have this vibe right. Yeah, i also love someone that's there Helping to reposition the patient when it's appropriate. Yeah, and like you said, it is important to get those data points, which is for mothers in labor, at least in the early stages of labor.

12:08 For the Most part, that's a 20-minute segment of what we call a reactive strip, which is moderate variability, and we'd, we'd love to have two accelerations in that baby's heart rate. So we want to see a nice wiggly heart rate and, like some, some jumps that tell us that that baby's neurological system is intact and Still that the baby is just, you know, rocking through this labor. And that's all we want, that's all I care about, is to be able to put that data point in the computer so that Everybody is reassured that everything is going well. Yeah, and then, honestly, sometimes the data point of having How we have progressed is somewhat helpful, yeah, however, yep, most of the time moms can tell us that Let's think it to that point where there's so much pressure, right, that we know a baby's gonna come out.

12:56 Yep, you know exact. As long as the baby's safe, does it really matter, right? It's gonna come out at some point, exactly, exactly, and I think you know again, because I don't do anything medical, honestly, i'm glad it really does free me up to do my job. I am not watching the monitor, i don't have to, you are, i don't have to do that, thank goodness, you know, and so I'm. I'm glad because it really doesn't enable me to do what I am there to do, and what I really want is when a laboring mom is Calm and is successfully breathing through her contractions beautifully, she's not traumatized, she's not scared, she's progressing well.

13:41 That benefits Everybody. I mean, that's one of the things that I'm. One of the OB's that I worked with here in town It was like, hey, micah, what you're doing for women makes my job easier, and so that's exactly what I want. I want to bridge the gap Yes, for my client between me and the medical team, because I want my client to know hey, we are all team, sarah, everyone in this room Wants you to have a positive birth experience, and I remember this one OB telling me we were having a conversation. I had gone to his clinic one day so we could actually have a conversation. It's hard to have a conversation with an OB in the labor and delivery room. He's yeah, right, and so he and I were having a conversation in his clinic and he was like listen, i don't care how she wants to have her baby, i'm not trying to mess with her birth, i don't care how she wants to do it.

14:33 I just want to make sure that I'm being able to check the boxes and that I'm overseeing and watching. Because What I learned is that if, if the you know emergency door is at a 10, like we're knocking on the door, if we got to get this bomb into a C-section right now or we're gonna lose baby Nobody, including me, we don't want to get anywhere near that door, we're not, i don't want to get to attend. And so, typically an OB, maybe if we're getting to a three or five, it's gonna start talking and mentioning Hey, i'm noticing something or I'm concerned, potentially, about something. An OB might be communicating some thoughts, some concerns, some wishes to be considering, and I think They communicate that in plenty of time to help maybe the mom get adjusted to the fact that maybe we might have to Do an intervention here, and so we want to have that conversation sooner rather than later.

15:32 So what I learned is okay, they're not saying you're done, but the panic I think, oftentimes with a mom or even a doula, because it was even brought up Yeah, have this feeling that, wait, you're trying to stop me from getting what I want, and that what I have found is that that's actually not What's happening. It's it's a conversation, and so I've learned how to Put some strategies in place in the birthing room so that there can be a conversation, so that I can hear what he's trying to say, what he's concerned about, and so I teach my clients how to ask good questions. Oh, wow, okay, you're concerned about that.

16:12 So, wait, are we in an emergency situation right now? And he's like no, no, there's not an emergency. Okay, great, good. What happens if we don't do what you're saying right now? Well, nothing's gonna like happen if you don't do it. I just want us to be sinking along those lines Okay, great, perfect. Thank you for telling us that We don't wanna get to that point either. Are we cool to still keep doing what we're doing? Yeah, y'all can do it as long as mom and baby are fine. Y'all can do this as long as you want, perfect. So those questions and that cooperation, acknowledging what's been said agreeing. We don't wanna be an emergency that communicates to the medical staff.

16:53 I'm not trying to knock on emergency door either. I'm not gonna ignore if there needs to be a medical intervention and I'm not leading my client in that way either. So then that brings a relief and a reassurance to the medical staff that I'm not there trying to mess with their job. Right, they're not trying to mess with my client's birth. They're happy with me doing what I'm doing. So now we're establishing this trust. Now the next time I come in I'm trusted a lot more. Then, after I've been there for a year and they know I'm not cutting the knees off of these OBs and say don't be a doctor ourselves. I mean, i am not the medical provider.

17:34 I'm actually not gonna say that I am going to give my client all of the options. I am gonna let them know what all their options are so that we can have that discussion. But I'm not there to try to change hospital policy. I think if you're a doula, and that is what you're trying to do, you're in the wrong line of work. There is a spot for you somewhere if that's what you're passionate about, but at the end of the day it's not helping the client that you're working with right now. Yeah, if your goal is to try to change hospital policy, are there some things that need to be changed? I probably yeah. As a person who's more natural childbirth friendly, yeah, i would love to see some things updated or changed, for sure, but that's not why this mama hired me.

18:20 Right, yeah, and there's my. I work at a couple different hospitals and I have worked at other hospitals and I've noticed that the policies are slightly different in every single one And there are things that I wish that I could do at certain hospitals, but it just doesn't work with the workflow And the thing that I have come to understand is that nothing stays the same. So if I don't like something, i just kind of decide I'm gonna wait a minute, might mention it, i might mention it a couple more times, i might just keep talking about it And eventually I found especially if it's something that is evidence-based practice or if it's something that is being researched, they're starting to compile good data on it, i might start mentioning it.

19:02 But it does take a while for things to change in a medical setting because you have to have a lot of good data. There's not a whole lot of experimentation that happens at the bedside, right, right, right. So if you have a tiny little research trial in one area of the world that's a small population and there is data that suggests that one of these interventions might have an outcome that you are not interested in, i'm not gonna say bad outcome, because bad for one person may be fine for the other. If that's what we're looking at, probably in the hospital, it's not gonna be something that is going to be a policy. We're gonna go with the bigger trials, all the information compiled together.

19:47 It may not be that way forever, but that's how it is for right now. There are things. You can decline, certain things And, depending on what that thing is that you're declining, you're either gonna get very little pushback or you may get a lot of pushback, and it has a lot to do with, without mentioning certain specific interventions, it has a lot to do with, again, how much data is involved. So I think it's really important to have that conversation when we walk in, because if I am admitting a patient and I'm lucky enough to have the doula there when I'm admitting the patient because oh, my goodness, that's awesome We can all talk at that beginning in time and not necessarily later on when we're five centimeters and really working through things.

20:36 I love to have that conversation ahead of time because then, for instance, if somebody says, oh, i don't want vitamin K, because there was this study of 200 people in Switzerland that had later in life, at age 40, all the babies that had vitamin K had cancer. Let's have a conversation about that. One trial because I'd like to talk about babies that didn't have vitamin K in Tennessee had a huge incidence of brain bleeds in a six-month period when there was this trend of declining the vitamin K, and it's all. I feel like in this world there are no facts Like what is a? fact, actually Everything's fluid. It's evidence. You may present the evidence to me and I may present the evidence to you and I'm gonna talk about my concerns and you're gonna talk about your concerns.

21:21 And if the hospital policy says something, for instance that I have to have a waiver, for you to decline this medication boy, i'd really prefer to do it at the beginning. So, for instance, back to vitamin K, because it is a medication that is recommended at most hospitals by most Nick users special care, nurseries or whatever you have at the hospital you're gonna probably need to decline in writing and also may need to have a conversation with the neonatal provider because we have to have that medication in within an hour. it's so much better when you do that before you give birth rather than waiting and having that conversation later. Now, if you come in and you're 10 centimeters right, sure, sure We're not gonna have that conversation right now, but I've had that conversation.

22:08 unfortunately, even though I've had full conversations and read somebody's birth plan. I have had situations where I am hanging blood on a mom who is passing out and the last thing she says to me before passing out is I am declining the vitamin K And I'm like whoa, that's not what I wanted to hear. Yeah yeah. So you know it's like it's hard because we come from a place where we've seen those kinds of things and it's triggering as providers, and so we really, really try to, we try to work with you and we try to work with your desires, because I want you to have the beautiful, perfect birth that you want, but that involves having a healthy mom and a healthy baby.

22:50 I really don't think anybody comes in desiring the birth process to be better than the birth outcome. I think many, many, many women would like for the birth process to be just as successful as the outcome, which is a healthy baby right. And we really, you know we're women. I want what I want you know what I'm saying? Yes, I get that, i get that, and so let's shoot for that, why not? Let's try to check all the boxes. You know, i'm certainly not opposed to that. I want you to have the experience that you want to have. I will say this as a doula, you know a lot of my training.

23:30 I did go to a lot of homebirds, but my career was primarily in the hospital. I really felt like that ended up being my calling. Women really need help. If you want to have a natural birth in a hospital, that's hard, you know. It's a totally different bird than if you're at home, and my approach as a doula is completely different at a home birth than at a hospital. And so I guess what I would say is you know a lot of my clients who are having their babies in a hospital. They want a more natural experience, and the plan is to deny just about everything, and it's not even that the L&D nurse kept bugging them about it.

24:11 It's that because of the challenges, because of the things we're working around, because I've been stuck in a hospital room for 18 hours, i'm done you know what. I'm saying And that is totally fine, and I feel like a huge part of my job as well is to I want to empower my clients that their choice, no matter what their choice is Is there power to choose? It is. If there are power to choose, after 24 hours stuck at 4 centimeters, no sleep and no food, to go ahead and have the epidural. I'm going to celebrate her choice and say, heck, yeah, you need to sleep because you're still going to push a baby out.

24:55 Let's avoid a C-section. I think this is the right move. Do you understand? So what happens at the babies here and now? she feels good about her choice and not guilty about her choice. That's helping nobody, y'all. That's helping nobody. To make a mom feel guilty or not encourage her to embrace the choice that she made. It's fine, it's okay, it can be good. And I am personally not one of these people that, hey, as soon as you walk in the door, hit me up with the epidural and everything seems to be going fine. I don't want people to do that. I mean that's a strong medication, it is.

25:36 But the fetal in your back, i mean that's a big deal. I mean, let's think about that a little bit longer. That just happens to be my bit, that just happens to be my preference and what I think works. That doesn't mean if a mom ends up getting an epidural, who originally wanted to go all natural, it doesn't mean she failed, doesn't mean she's not strong. It just doesn't mean any of that. And so I really want my clients, at the end of the day, to always feel like, when they look back at their birth, i'm so thankful for my birth. It was hard as hell, no doubt about it. I can't make that part go away, y'all. I'm not a magician. It's going to be hard, it's going to be hard, but it can be inspiring and monumental and good.

26:18 It can be a good, positive experience, even though it was hard And even if you went with plan B and sometimes you guys, plan B is better than plan. A. And that would be my encouragement to any doulas that are listening right now. Yes, we have an idea and we know what our training is and we want to help promote a more natural experience. Yay, yes and amen all for all of that. But at the end of the day, when you look at this mama and she is absolutely 100% mentally, emotionally done her body's gone through the ringer is your choice going to be what you think is best or is your choice going to be to support her and now what she needs to get through the birth?

27:04 What is your choice going to be? And I would say that the birthing experience it goes with a mom for a very long time forever actually. And even if everything didn't go exactly the way she wanted it to, we still want every woman to look back and go yeah, but you know what it was good. I don't regret this or that. Now, if you're someone who has not been informed and you feel like you walked in and you didn't know all the things, that you feel like you should have known and you would have chosen differently, okay, that's one thing, and maybe you felt that way. Maybe there is a doctor in your area that is known for high C section rates and kind of bullies his way through.

27:50 Okay, maybe you do have one of those, but I'm just saying in my experience that's not the standard care. That's not the standard. There is protocol and what is just hey, this is how we normally practice things, and unless you are someone coming in saying, actually, i'd like to do it a little bit different, then you're going to get standard procedure. Yeah, exactly, that is so true. And then I think that kind of piggybacking on that the trauma comes from, when you feel like you've failed because you chose plan B. So it's not that you went with plan B, it's because you feel like that's a failure. And then your brain does things to make it feel like a trauma And I just don't think it's necessary.

28:34 And I may have my own opinions about what interventions would be best for the mom. I don't feel like I have an agenda, but when I feel like something that we're offering is going to improve the outcome, i feel like I start to have some feelings there, because I want a healthy mom and a healthy baby too. And what is frustrating is when I perceive that the pushback is coming from the fact that, because this was my plan, i don't want to do that, and I have a hard time sometimes impressing on people that that wasn't my first choice either.

29:15 But here we are, and so how are we going to deal with the current situation? Do we want to continue the way we had planned, or do we want to maybe modify that plan a little bit to possibly ensure a better outcome? And I'm not sure how you, kelly, personally, proceed or what your hospital, the ones that you work with, how you all proceed in this, But some of my favorite nurses when it looks like things are about to shift and that the patient is not going to end up following the birth plan to the letter of the law okay And that it looks like there might need to be an intervention in some way, shape or form, some of the best nurses and again, if you're an LD nurse and you're listening to me, i'm going to suggest that when you have the conversation, remember this is a woman that is having one of the most monumental experiences she'll ever have in her entire life And she wants it to be perfect.

30:19 She wants it to go the way she wants it to go. And so when a labor and delivery nurse acknowledges hey, listen, sarah, i know what you wanted was this, this and this, and you have done such a good job to try to achieve that. I am so impressed by you And, man, if this over here wasn't happening, you would absolutely be able to have what you want. I want you to have that, but I care about you, i care about your baby. I want you to hear a couple of things that I want that I'm going to say Here's a couple of options And let's talk about these. Ask me the questions that you want to ask me. Tell me what your concerns are. I'm only bringing it up because I think it might be what's best for you and baby.

31:04 I want you to get what you want. Trust me, you know what I'm saying And I think when a labor and delivery nurse now relates to that mama and communicates, i know how badly you wanted this. I want it too. However, let's have an adult conversation. Let me share with you some thoughts and give me the pushback, give me the concerns. Tell me what you're thinking. Let's get to this decision together. Right Now she feels like and knows you are on her team, you are for her, and, as a doula, when that conversation comes up, i'm like, yes, kelly, tell us what are the options, what are the concerns, and then it definitely relieves that mama and feeling like she's going to have to fight for something.

31:53 No, no, no, we're just going to have a conversation about these options, and I have found more times than not that once that conversation has been had, the mom will tend to man. It's not 100%, i'm sure it's not, but it is a very high percentage She will say, yeah, that does make a lot of sense And I want what's best for me and baby. I'm not willing to take that risk that you're talking about And let's move forward because we can still work with that. This isn't the end of the day. This doesn't break everything. I can still have what I want in this birthing experience inviting and initiating something that maybe I wasn't thinking before.

32:38 You know, women are relational. We want to talk, We want to listen, we want to communicate. Yeah, i feel like to work as a human being which I will acknowledge that I am And then I have feelings. I feel like when I walk into a room and I feel like there's a vibe that's kind of closed and decisions have already been made and we're going to be defensive, there are times that I have a hard time kind of getting through. Yeah, i've been successful before, but as everybody is different, it sometimes is challenging for me. Yeah, what are some of your suggestions when you have an environment where you walk in and the air is just thick with defensiveness?

33:23 Yeah, and that's something I really try. I mean I try to avoid. Yeah, i mean, the very thing I do when I walk into the birthing room is, especially if it's been a long time since I was a new doula in a place. I mean, i'm very well known in my community. Everybody knows who I am And just so you all know the result of what I'm about to encourage you guys to do the result of that has been. When I walked in, i am greeted by the L&D nurse. Hey, i'm so glad you're here. Here's what's happening, here's where she's at. What do you want to do, Micah? What are your thoughts? That's what it's given me. That's what it's given to my clients.

34:04 That is the benefit I'm being asked. What do you think? What do you want to do? They pretty much let my client and I do our thing And as long as baby looks good, they don't really care what we do, because they know I'm not trying to jeopardize care. They know that I'm not doing that And so, coincidentally, my client pretty much gets what she wants, because there's no listen dress intention. That is not going to help your client. That is counterproductive in labor. It's not a good fit. So, as a new do-ler, as someone who is trying to establish themselves, trying to work together and establish this teamwork, the first thing I do is introduce myself to the L&D nurse.

34:52 I am not going to dodge her. I want there to be communication right up front. Hey, kali, i'm Micah. It is so great to be working with you. How's she doing? What do you think? Are we on track? How's baby look? I want you to know that I welcome the conversation. We need to be a part of this process together And I teach my clients how to ask the questions themselves because at the end of the day, they are the patient. They are the only ones that can choose for themselves. It has to come from them. If they're married and their spouse is in there and their husband has an opinion and a thought, it actually doesn't even matter what he says.

35:32 He's not the patient. It has to come from the patient. So we've got to teach women how to communicate and how to effectively ask questions so that there can be a conversation. So I think that's personally what works best And I think that if there is a room that is thick with tension, then, as a medical provider, when you try to have that conversation, introduce yourself. Hey, i'm so glad that you're here. Let me know if there's anything that you guys need. Mama looks great. I feel really positive about her being able to achieve her goals. Let me know what I can do. Help set that tone right away.

36:15 Even though it feels thick with tension. You'll be surprised how that can help bring it down. One really small thing that I would do is I didn't ever buzz for a nurse unless there was an emergency. Look, i got legs. I walked myself out there to the nurse's station and say, hey, when you get a chance no big rush, we're looking for a couple of extra pillows Or she's got ice and water. Is that something I can grab? You know? hey, whenever you get a chance, i think she's. You know she's needing to go to the restroom. I mean, now they trust me enough to unplug her and walk to the bathroom with her and plug her back up. I mean, now they trust me to do that, but before I would communicate hey, she's going to run to the restroom real quick, or?

37:00 y'all cool if I unplug her real quick and then we'll get. We'll get back where we need to be. Just talk, just communicate, you know. And same thing for the LD nurse Hey, let us know whatever she's thinking. I think volunteering things up front that maybe they think they might have to fight for would be super helpful. Hey, if you want to get in the shower, let me know. I'll wrap up that IV port and the water is an amazing thing. Wait, what You just suggested, a shower right at the beginning. That's awesome. It lets them know we've got. We've got some things we can work with here. I'm all for your comfort measures. You know what I mean. I think volunteering those things up front are very, very loud to Adula and a woman who wants a natural birth.

37:47 Yeah, and if it's a natural birth, like as in, we don't have to medicate anybody because there's no reason to do an induction. right, right, those. usually. we have so many options, like we could even be off the monitor for 40 minutes every hour, which is wonderful. Wonderful. At that point I'm just like go live your life, you know, do all the things you need to do. But if we don't, then yes, absolutely We. We're going to, we're going to do whatever works to be comfortable, but if we're on some of those medications that require constant monitoring, that gets a little hairy. We do have the portable monitors, yeah, and sometimes they don't work as well. So sometimes they work well Sometimes. I mean, in my opinion, this is where Adula's training comes into play, and this is something that I actually teach in my mentorship program, and all the do list that I've mentored is look, you need to be really good at your job and know how to work with monitors and being hooked up, because there's definitely a way to work with monitors And you need to help.

38:45 I mean, if that is the case and they're on medication and they're going to need constant monitoring, you need to shift your perspective. As Adula, we are now on plan B, right, it is not. It is no longer an all natural bird. That's fine. Now we're on plan B. What are the best ways for me to help my client get comfortable on these monitors? Yeah, and you need to know how to do that and do it well, and there are many options, and so do those things, use them. You know it's not a wha, wha, it's not a moment and you don't do anything now because you feel thrown off your game. That's not going to help your client at all.

39:25 Nope, go to work, get to work Yeah. Another thing that I think is really important I like to hear from my patient. I like to hear what my patient wants, And I've had situations and this is kind of goes toward like what you're talking about with the dad answering the questions and the that kind of thing, Like whoever's in the room. I can also tell when the mom has had a conversation with me at another moment before anybody else was in the room and said that she's good with all these things And we've talked about if maybe something on her birth plan wasn't part of hospital policy, what are our other options, and we've all come to the same page.

40:08 But then other people come into the room and maybe start throwing out their opinions strongly enough that the vibe is mom kind of just does this nodding, and that situation where you're kind of like I'm not fully believing that this is what you want. But it's just real things are getting weird. I think that probably my weakness is navigating that situation. Yeah, totally, and my answer, first and foremost, is hey, there is a way to avoid all of that. I mentioned this just a second ago. In my mentorship program.

40:48 I am teaching doulas the three very strategic things that I did intentionally so that my clients could have the best natural hospital birth that they possibly could. I did three very strategic things, and one of the things is what we're talking about right now, and the other one is it's all about your mindset and the preparation before you go in And coming in with your dukes up already is actually counterproductive. It doesn't work. The doulas in my area years ago that had that approach. They're no longer around. They got so frustrated with the system that they're not doing what they love anymore and they're helping no one.

41:33 I guess that's what I would say. Is, you know, it may not be going down exactly the way that I would want my personal birth to go. So what? And it may not be. You know, maybe this mom has fantasized about a home birth in her backyard, delivering by the creek. Okay, that's a beautiful thought, a beautiful moment, that can be a beautiful birth, but that is not what you chose. We're here in the hospital now, so we got to lay that one to the side and let's try to have the best experience that we can have here. Let's do it unmedicated, let's do it without interventions, absolutely 100%.

42:16 We got a few things. We got to navigate around. I don't have a creek, but I got a shower. Yeah, you know, you can't walk around, you know around the block or put your feet in the grass. Let's walk the halls. Yeah, i mean, we can accomplish a lot of the same goals, but it is not going to look the same, and so I think we do our clients a disservice to not prepare them well mentally, in a mindset that, yeah, you're going into a hospital room, we can't change that part, but you can wear whatever you want to wear. You don't have to wear that hospital gown Now. You'll put it in half. If they have to, great, then wear your gown. Fine, bring your wonderful pillow, are you okay?

42:57 if blood gets on that, fine, bring your pillow. I don't really care, make it your own. There are so many things you can do, but there are things that are going to potentially be hurdles And we don't have to fight through those hurdles. Let's have that conversation and let's get through that immediately. And you know, i know that there are going to be plenty of people that are listening to this, whether it is an L&D nurse, whether it's a doula or an expecting mom that might really disagree with my approach, and that's okay. I don't need everybody to like me or want my approach, but I do know for myself and my experience that at the end of the day, the person I want to benefit the most is the laboring mama who is looking to have a positive birth experience, and we're going to figure that out.

43:51 We're going to find a way for her to have that positive birth experience given her circumstances, and that's what I want. And I have pretty much 100% success rate of clients who say I had a positive birth experience and I would do it exactly the same And they ended up with a C-section. So that to me, is more empowering and helping a mom and her perspective and to adjust, to be in reality about where she is and how it's going to go down, but then preparing her for what are her rights.

44:34 I mean, listen, patients' rights are right in the lobby of every L&D floor. If you want to know what your rights are, go read them. You have a lot of rights And when you know what your rights are before you come in, then you realize there's nothing to fight for Exactly The rights you have. You hold all the cards period, and so I think that disarms people right away, which is why my clients and I don't go in with our Dukes up. We know the things that we don't have to fight for. We know what those are, and then we know the things that are going to require conversations and a collaborative effort. Let's do this together. How is this? what's going to work best for mom and baby?

45:14 And I just have found that that is what produces the biggest benefit to my clients that we'll be delivering in a hospital setting. I agree And I want every doula in the world to take your mentorship program. Thanks. It's an online mentorship that I've just shifted to. It's very rewarding, it's intensive I love it And it's a little bit different than what's being offered out there right now in terms of trainings. Yeah, Yeah, amazing. Social media stuff. My doula Mike, I've streamlined it really well. That's my website, That's everything. So yeah, reach out. Awesome. Well, micah, was there anything else that you wanted to add? I don't think I have anything. I think we've covered pretty much everything, and I know we're going to get to the end of the slide We covered, so much ground in this episode.

46:00 I loved it. I loved doing it with you And I appreciate everything that you do, kelly. I love my L&D nurses and thank you for all that you do, and if you are not feeling appreciated, then know that you got a doula over here in your corner Giving you the thumbs up, high five hugs every day welcome.