49. Women Centered Maternity Care in the Hospital Setting with Doula Deja Ramos

Have you ever questioned how much control you will have of your hospital birth? I wish you didn’t have to worry about this, but being your best advocate is so important. Having a support person and/or doula is also so beneficial to having your best birth experience! 

In this episode, I talk with Deja Ramos, aka Doula Deja, and dive into the most important aspects of prioritizing your values and advocating for yourself during pregnancy, labor, and birth. I would love for you to feel empowered to make informed decisions aligned with your preferences and values and challenge conventional norms!

Key Takeaways:

• Understand your values: Identify values and prioritizes that will guide your decision-making
• Advocate for yourself: Don’t hesitate to ask questions until you are comfortable moving forward to be sure your opinions are heard throughout the process
• Request time: Ask for the time needed to process information before making decisions and emphasize the importance of informed consent
• Challenge routine: Question the necessity of routine procedures and promote a personalized birth experience
• And so much more!

You can learn more about Deja and connect with her at: www.douladeja.com

🌸 Connect with Beth

Website - www.familyfocusedmidwifery.com
Instagram - @family.focused.midwifery
Pinterest - bethconnors_cnm
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👋 WHO AM I?

Welcome, friends! I am Beth, a certified nurse midwife, doula, and childbirth educator. My philosophy is rooted in autonomy, informed decision making, and positive mindset to help expecting parents plan for a beautiful, stress-free birth. I am here to provide value to YOU through tips and practical advice, either to guide you through pregnancy or to help you prepare for childbirth, postpartum and beyond. There’s no fluff here - only info that adds to your positive experience and saves you stress and uncertainty.

Transcript

Hello everyone and welcome back to episode 49 of Your Birth Bestie podcast. Today I have a special guest, Deja Ramos, also known as doula Deja from San Mateo, California, who has been a birth doula since 2010, certified by DONA. And it's also a certified childbirth educator since 2020. When working with families, Deja dives deep into a family's values and priorities to get to know how to best support them and ultimately guide them to a fully informed, autonomous pregnancy, labor, and birth experience.

There are so many beautiful takeaways from our conversation about centering women in their own birth experiences, doula support in the hospital setting, integration of the doula role with hospital staff, and so much more. So I hope you enjoy it as much as I did.  Hey there, I'm Beth Connors, a midwife and mom of two, but also your birth bestie.

In this podcast, we'll dive deep into everything you need to feel confident, prepared, and in control from baby bump to delivery room. From practical tips to personal stories, we'll cover it all so you know exactly what to expect every step of the way. Let's get into it.  My name is Deja Ramos. I'm a DONA certified birth doula and an ICEA certified childbirth educator, and I've been doing birth work in the San Francisco Bay Area for more than 13 years. 

Awesome. That's a very long time. So I know some doulas after a couple of years, they are not able to continue because of the schedule and all of the on call responsibilities, all the things. So that's amazing. Um, can you share with us a little bit about your journey into becoming a doula, serving moms in the hospital specifically, I would love to learn about, and then, um, what inspired you to help women? 

In the hospital system.  Yeah. So I've wanted to be a midwife. I've wanted to catch baby since I was 14 years old, which was really hard to explain at the time. Um, I can really only describe it as a calling, honestly. Um, so after high school, I set out to become a CNM certified nurse midwife, but I found the path to earning a bachelor's in science at BSN and nursing wasn't a great fit because it was so broad, right?

I had to, there was Training in all of the areas of nursing and I really was just interested in labor and birth and and that and then I also found that the pressures on nurses and nurse midwives working in the hospital to shift work, the patient load, the focusing on the machines and not trusting intuition.

I didn't really fit my desire to care for and focus on one woman's birth and really putting her at the center. So I left.  I left my college education with an associate's degree just to kind of get out and get a paycheck and start saving to put myself through a certified professional midwife program.

I'm lucky enough to live in California that does have licensure for midwives, which means that I can pursue midwifery directly and ultimately practice independently through that program.  Um, I heard about dual work in  2009, I think. Okay. Um, and decided to pursue certification. Uh, it took me about 18 months to two years to get that finalized.

Um, and having that birth work as part of my life in some capacity has allowed me to really slow down my, my race to become a midwife. So I can live like a little bit with the benefits that come with having a salaried job. So I also have a full time job, uh, working in the tech industry. Um, I started working for this company about 13 years ago, which is a coincidence, uh, and so it's really, it's been, it's been a side career or an additional, um, path that has really been, uh, enjoyable, which helps me keep my, um, It makes my decision to stretch out my journey a little bit longer that much easier.

I don't know that I actively chose to support hospital births specifically. Um, actually it was, I think it was only recently that I encountered doulas who actively don't attend births in hospitals. When I set out, uh, to become a doula, I would take anybody that would have me. That's kind of the work of the, of a start of a new doula.

And I, I quickly found myself comfortable in the hospital environment. Um, I'm, I'm open to seeing clients who seek and deliver anywhere, but I think my community's lack of birth centers, and then just the demographics we have a pretty highly educated and highly paid demographic or population, which means that I think that they seek hospitals because they feel safest there. 

So I do think that there's some self selection going on, uh, as well. Women who choose out of hospital birth settings are already working with care providers, offering that personalized care that feels supported and centered on them. Whereas, uh, somebody choosing a hospital birth because they feel like it's the safest route, or maybe it's the only route that they know about because that's where all their friends have given birth, uh, quickly find themselves on a conveyor belt of sorts.

Uh, recommend, proud recommendations, pressure to comply. Um, and not the time and space to feel seen and heard. So I think those women are more likely to seek out the support of a doula to fill in that gap and help make sense of the, all of the,  um, all of the recommendations that go along with that. Yeah, I think when you talked about centering women and their birth experiences, I think that's like the key of, you know, midwifery care and doula care.

And that's, we were talking about before, um, how that's often missed in the hospital, even in the midwifery model because of the hospital system. So, um, I kind of wanted to talk to, I think we were emailing back and forth about like nurses or like providers looking at the monitor, the contraction monitor, um, you know, in between each contraction.

And that is such like. Reality that happens. Um, I found myself doing that in the hospital as a labor and delivery nurse. Um, but it's really not at all what women need. So I would love to hear kind of what you do as a doula when maybe that's what's happening in the room.  Yeah, I mean, I think most of my work as a doula comes prenatally because as, as the labor is unfolding, we kind of have to take it one step at a time.

So I, I start prenatally to help my clients define and describe what I call their values and priorities. Not that I've made up those words, but those are, those are, that's a catchphrase. My clients who may be listening to this will definitely have heard me say, um, which really boils down to what's important to them and in what order, um, you might think.

I think it's obvious, right? Healthy mom and healthy baby. Those are the most important thing. And, and I tell my clients, like, those don't count. That's the title of the essay. We want to dive a little deeper. Let's get more personal than that. Um, so for example, I've had clients who wanted to have a second pregnancy pretty quickly.

So it was important to them that they, their birth set them up for a smooth recovery so that they could have their babies close. Um, others who are navigating traumas or put their mental health at the top of the list, or VBAC is a really good example. VBAC clients seeking to have that vaginal birth. Um, they, that, that value is very high on the priority list for them. 

Um, and then when there's more than one value, you have to prioritize them. Someone who values their mental health and laboring without pain medication. We'll need to have those in an order so that when they approach, say, prodromal labor, which will test both, they need to know which one comes first. And sometimes the priorities change as the circumstances change.

Recently, I had a VBAC seeking client who developed pelvis dysfunction in her pregnancy. And so she had to prioritize her long term health over a vaginal birth and ultimately have a repeat C section so that she didn't further injure that pelvis.  Um, so this is the structure upon which to have those conversations and then they can navigate their way through their pregnancy, but also then through their labor and delivery experience.

There's certainly a passive way to go through the process of Pregnancy and birth in our system and many women take that passive route, either because they feel safest there or because they don't know there's another way. Um, I don't think that one is better than the other. But I do think that no one shouldn't know what their options are.

I tell my clients, secret menus are for hipster restaurants, right? There shouldn't be a secret menu in your care.  Um, so when we're in the hospital room, sometimes it's about changing the language, right? Somebody walks in and says, it's time for your, and I helped rephrase that sentence and This is something you can choose.

Do you want to choose this? Um, and that helps them recognize that there's a choice and options being presented, but it's hiding in the shadows of this routine. Uh, so we, for, you know, it's changing the languages as care providers or, or the hospital process is kind of taking off without them. Selling things out, slowing things down, reminding them that they have time, right?

If we're not in an emergency situation, you know, even just asking for five minutes to discuss or ask for an hour to do something different can be really powerful, um, and so it's, it's about that advocacy, and I'm not speaking on behalf. Of my clients, but it rather I usually speak directly to them and say,  do you want to take a little time to talk about this?

Do you want to try some other things for an hour? Um, just to give them that language. They can turn back to the care provider and say, I'd like to take a little time to talk about this.  And then I'm really, really empower my clients to make choices. Rather than going along with and that isn't to say refuse.

That's to say to choose. So even if they're choosing to do what is routine, making that choice is really powerful psychologically, because if something precipitates from going along with the routine, you might look back and think, look what happened because of what they did to me. But if you chose. 

Routine you choose chose that routine action, then what comes out of that, um, it's a psychological I decided to do that. And this is what came from that decision. I think that's really powerful.  Yeah, and putting that perspective to, or like the preparation when they're, you're meeting with them prenatally and making sure that they know their choices, they're talking through them before and, you know, ahead of time because that's a hard conversation sometimes to have in the moment when things are either going not as planned or something difficult is coming up.

So yeah, that preparation beforehand, um, and making sure that moms always know that they have a choice. And  yeah, that's just the most important thing I always talk to expecting parents about is Yeah. Thanks. That's like the way to reduce like a negative birth experience is even if everything goes  not according to plan, as long as it's something that you chose and that you were informed about, like you can still have a positive experience and be, you know, in an emergency C section, like people, that's usually like the biggest fear.

But if everything leading up to that point was your choice and you're informed and it was the right thing to do for you, there's really no like regret or trauma about that. Um, and that's such like a beautiful thing about the experience is that it was all  their choice. So I love how you said that too. I, um, I had a couple not too long ago that were very excited, and they crossed the 40 week threshold and their care provider identified a risk on which they hung the induction hat, right?

They recommend an induction.  We talked, they, we, I gave them lots of questions to ask, which was just like, take in this information, and, and then we can make a truly informed decision. So they learned that the risk that their care provider was concerned about was more an impact on delivery than continuing the pregnancy.

And add to that, their Bishop score was low, which their OB shared with them was, was going to set them up for a more challenging induction. Although I will point out that the OB had to be pointedly asked that, as opposed to offering that, which I think was really, um, Uh, concerning, right? That the OV didn't think, oh yes, your bishop score is low, yes, that it's going to be more challenging.

But anyway, we discussed the options, their priorities. She wanted to labor without medication and she wanted to avoid a C section if it could be avoided. And she felt that this particular recommendation was going to put both of those values at risk, and that there wasn't enough risk  to waiting for spontaneous labor.

So she was empowered to make that choice. Cut to a few days later, her labor began on its own. They were thrilled.  She labored beautifully, but eventually the baby was showing signs of distress and her labor progress.  told us that their baby may not have enough, like, reserves to, to safely wait for vaginal birth. 

So they discussed the options with the OB and ultimately elected for a C section.  But I'll never forget the first thing that my client said when the room was finally clear of all the people as they were prepping for surgery is she turned to me and she went, bummer.  It was like, just disappointed, but it wasn't devastated.

This wasn't tragic. This was not her vision. She had successfully navigated to avoided induction because it increased her risk of a c section and the c section came out of it and then ultimately c section came to her anyway. Um, but ultimately it was the safest for her baby.  She felt empowered to push back against an induction and then she also got to reflect on her experience as being a summary of her choices. 

So I mean, I thought that was, it was such a, it was such a beautiful, she just looked bummer.  That's such a positive, like ending too, like for a difficult. You know, decision to have to make and not what you want it to happen. So yeah, I think that is just a perfect example too, of having it be your choice and still having an amazing experience, despite what happens.

So, um, when you kind of mentioned to like asking for more time and, you know,  Asking for, you know, longer before the induction, um, I'm curious to, to know about like the collaboration between doulas and medical providers. I know a lot of times, um, that's like a question I get from moms is you're not my medical provider, but like, how do you kind of fit in into like the medical model?

Um, so I guess you can kind of explain how your approach is collaborating with providers and nurses in the hospital setting.  So I benefit from working in a region that has really embraced doulas, although that wasn't true when I first started out.  Um, and it has, it's evolved in our favor, although there have been sort of bumps along the road.

Some doulas have gone rogue and that sort of soured the hospital staff on doulas or the pandemic which turned back the clock in a lot of really unfortunate ways but I do feel like the progress has been, progress has been steadily forward.  I don't benefit from being a strong regular at the hospitals in my area because I don't attend a lot of births each month.

Um, I don't get to run into friendly, like, familiar faces. But I have some doulas in my circle who are, you know, attending three and four births each month. So they are seeing these same hospital staff over and over again. And I think that that, um, familiarity really can help, um, a doula be part of the birth, be seen as part of the birth team.

Um. Without that, I try to make it clear to the nurse or the doctor or the midwife as soon as they walk into the room that I'm there to facilitate their work by anticipating what I, what they need, having informed my client what's to be expected, and then helping them ask the questions they need to to make their decision in a safe and empowering way.

Um, I feel like when medical professionals see me use a term like tool instead of evil intervention, they see me more collaboratively. Or when I'm helping my client navigate a decision and not voicing opposition, um, but rather reflecting the concerns of both the care provider and the client in a balanced way.

Or then when my client chooses a tool, I'm there to step in, support, encourage, and navigate, so that those, those medical professionals can see me as truly part of the birth team. I'm there to help her have her best experience, or the birthing person have their best experience. I'm not there to, uh, say no, and I'm not there to act on behalf of. 

Yeah. And I feel like that's a typical story when I was first starting as a labor and delivery nurse was, Oh, this mom has a doula, you know, she's going to refuse everything and be this really difficult patient and, um, a lot of pushback. And that's not the case. Um, but just because you have a doula doesn't mean like this is for both providers, you know, birth workers and, um, Mom's like, just because you have a dual, it doesn't mean you're going to be seen as this difficult patient.

Um, do those can really just facilitate, like you said, make everybody's job easier, make labor easier for moms and more comfortable and more, you can be more confident. Um, but for providers and nurses too, like you are an extra set of eyes, extra set of ears, like, you know,  the clients. Better than they do because they had just met that person.

So yeah, being that person to facilitate everything just makes everything run smoother. And I wish more people knew that. I feel like we're starting to understand that more. I'm in the hospital, but. It's still I do see people like, you know,  isn't it, isn't it interesting that you said this, this person is going to be seen as a difficult patient because they're going to question all the routines.

Right. And, and I feel like that's what needs to change in order for  birth, birth experiences to be truly empowering and hospital situations, which is to say, The hospital doesn't shouldn't be no, no hospital staff member should be looking at a patient as being difficult because they are asking questions or because they are choosing their own approach,  because that's that imposing the hospital's values and priorities on to this patient when in fact, this patient is. 

An adult with agency and autonomy, and they've come to you for care, but that doesn't mean you're removing all of their, um, their ability to make decisions for themselves and their, and their baby. I think it's really it's really telling that and I and it's not just you that said it I've heard it a number of times like a difficult patient.

And it's used to be a trope amongst the doula community that  labor and delivery nurses pushed epidurals because they're made their patients that much easier to handle they knew that they weren't going to be getting up. out of bed, they knew that they were just going to be rolled over every half an hour, and then eventually they were going to push a baby out.

Um, whereas somebody who's moving around, that, that monitor is going to need fixing all the time, and they're going to, you know, they're going to need water, and they're going to need food, and they're, you know, they're going to have all these needs. Um, I don't necessarily think that's true, actually. I, I feel like these stories on both sides do everyone a disservice.

This idea of, oh, OBs are just scheduling inductions so they can get to their, um, their holiday party, or they're, they're pushing a C section so they can make their tea time. I don't think that serves anybody. I want to come from a place of trusting all care providers as doing what they believe is best for their patients.

But, um,  but I do hear that language a lot of difficult patient. That one grinds my teeth a little bit. It does. Yeah. Because when you're in the hospital and you have multiple patients, um, people will, like you said, put like pushing epidurals. I don't know that I've seen it like necessarily that exact situation happen, but I mean, a lot of times it leads to intervention, which leads to epidurals, which leads to things that.

Make the hospital system more efficient for that reason. So, yeah, for somebody to question intervention is, I guess, more difficult because it's less efficient. Um, but it shouldn't be like, shouldn't be frowned upon. It should be the standard of care. Everything should be individualized. Like we said, patient centered.

Um, everything should be questioned. Everything should be informed on. Um, and that's not what I saw in the hospital either was just like forthcoming information for the sake of giving information. It was always something that needed to be, um,  like prompted. So, and that's just, I feel like nobody's fault.

It's just that the system. Being busy and, um, having a lot of patient, you know, it's not an excuse, but it's just kind of the reality of it that I feel like we just need time to  kind of pause, ask for more time, ask for, ask questions, and that's just a good point for parents to be  prepared to do and for doulas that have that role as well to facilitate that, um, just to make it safe, safer and, um, more autonomous. 

I think you could zoom out and, and, you know, you could continue to pass the, the buck of blame up and up all the way out to the medical system in the United States with, with its for profit approach, which creates these, you know, a factory makes more money when it makes more things. Yeah, hospital is trying to make more money and how do you make more money you get patients through it faster.

And I think that that's doing everyone a disservice and there are certainly there are people in this country who are. Pushing it back against that from a position of of leadership. And I think that that's I'm hopeful that that's the wave of the future. Yeah, I agree with that too. And I'm, I'm at least where I am starting to see more midwives in the hospital setting.

Um, and the midwifery model and. I mean, I don't think obese are evil people either. Um, they're working with what they have and what they believe. And just a lot of times the narrative is often against them. So I think everybody can be more collaborative and, um, yeah. Well, and they're working, they're working, having been trained in a system.

that sees birth in a certain way, same way that midwives are working trained in a system that sees birth in a certain way. And, and you, you mentioned midwives  in hospitals, and we discussed a little bit before we started recording that, that there really is a difference between a midwife working in a clinical setting and a midwife working outside of a clinical setting.

And what those differences can come down to is training. Um, and, and so I think that we have to start with what are we teaching? Oh, bees. What are we teaching midwives both in and out of hospital about what birth is and what birth can be and what looks like. I mean, I think that it's really telling that I know be could theoretically become certified as an as an obstetrician without ever seeing an unmedicated birth.

So they don't know what it can look like they theoretically could come into this work not knowing what it could look like truly physiologically safe, they are trained and, and, and rightfully I mean not maybe not rightfully so but but certainly thank goodness that they recognize and can act in a truly emergency situation.

But if you see every situation as emergent, you're going to be steamrolling something.  Yeah, and it's also like that fear to that something is always going to go wrong because that's what they usually see is those high risk moms with. You know, terrible emergency situations. So then that kind of becomes their normal and then becomes like medically managed, kind of like we were talking about.

But, um, yeah, for me, when I graduated from midwifery school, that was something that I didn't, I didn't have like physiologic, um, I mean, we learned about physiologic birth, but not necessarily like how to support physiologic birth, um, in the way that like even doula trainings have. So when I decided not to go back into the hospital as a midwife, I went and learned a million things about, you know, to increase my education and fill the gaps there.

Um, I mean, it's, it's in the textbooks for midwifery, but that wasn't necessarily the focus. A lot of it was, um, the medically managed midwifery model, um, because. Certified nurse midwives are in the hospital and are also taking care of a lot of higher risk patients. Um,  so it kind of got overlooked. I feel like because there was, you know, these more important medical emergencies that we needed to learn how to be trained on and then kind of pushed aside the low risk physiologic, um, Like labor position changes, you know, and how to really learn about the pelvis and how it moves through each stage of labor.

And I just feel like that is something that I recently have really done a deeper dive into. And I wish I would have done that during midwifery school because of all the different ways that we can support labor, um, even not even support labor, but support pregnancy to have an easier labor and then in labor and early labor to have an easier, um, pushing stage and.

Easier postpartum. So that is just a huge part of low risk birth. That is actually overlooked in the midwifery system that I was in. So, well, and I think part of that too is, I don't know what the statistics are like in your area, but here where I am, I think the latest one I heard is 90 percent of first time moms in a hospital get an epidural.

Yes. Yeah. It's huge. It's huge. Yeah. And that changes, that changes the, and I don't think that, I think, I think epidurals are an amazing tool that I think people who choose to have them should have them, but that means that we need to be looking at how do we support people with an epidural that doesn't just become a cascade of, of other needs, right?

How do we support an epidural within that physiological mindset of supporting birth, supporting the birth process with that maybe limitation? I try to tell my clients that an epidural doesn't mean you can't move. Yeah. It just means you, you can't always move independently. Right. We need to move you more actually.

Yeah. We need to be positioning you more in different ways. Yeah. Yeah. And maybe you need, maybe you need a nurse and a doula and a, and a partner to help kind of change, help you change your positions. But I've had, I've had clients with epidurals deliver on their hands and knees. I've had clients with epidurals,  had one up on walking around, although her nurse nearly had a connection.

Um, I'm not here to tell anybody no. Right.  So, uh, you know, I think that it's  it's unfair. I don't think we can point the blame at any one particular angle. I think that what we've what we're seeing here is the culmination of all of these factors that are leading to care providers that don't see don't get training in supporting physiological birth because the births that they're seeing are not physiological if they're being trained.

Thank you.  If epidurals are being utilized and then add Pitocin to that, and then, you know, maybe a vacuum or forceps deliveries from there, or even a C section, because we aren't, we're looking at an epidural  labor the same way we look at a spontaneous labor when they need more, they need different support. 

Exactly. Yeah. And I've seen it time and time again too, where like the outcome isn't given or the, the, the laboring person doesn't give it isn't given as much time. Like it's the first time mom that needs all this time to labor. And then they, they have an epidural, whether they, you know, they chose that for themselves.

Um, and then the clock kind of starts and it just takes longer. Sometimes they have first babies and interventions and then like the C section happens and, um,  Looking back, I  think clocks and labor are, are the first thing we need to demolish,  abolish, demolish, whatever.  I think that I think that.  A clock, and that starts in pregnancy.

Two clocks in pregnancy have no, have no, um, place either. We need to look at clinical presentation and make decisions based on clinical presentation. Just being 40 weeks does not mean anything is wrong. Being 40 weeks and seeing reduced fetal movement or being 40 weeks and seeing high blood pressure, now we're seeing clinical presentation that says maybe we need to step in here.

Um, Being that you've been in labor for 24 hours does not mean anything, but maybe that your baby is showing signs of losing gas, um,  or you're developing a fever, things like this that are clinical presentations that actually tell us we need to step in.  Yeah, I think that I think the clocks are one of the most damaging things that we've added to.

to pregnancy and labor. And that was a hard thing to it for me. Um, when I was becoming a midwife was just realizing how often we were like checking moms to see what, um, like doing cervical checks to see how their labor was progressing and then learning more about that. It just felt very strange. And then, yeah, I learned more about it.

And I'm like, this is just something that we don't need to be doing. And we're doing, you know, checks every two to three hours and then mom feels a little bit different. So that's another check. And then, okay, well, that check didn't seem maybe right. So let's have another provider just double check. And it's like all these checks and checks and checks.

Um,  You know, especially if their waters are broken. What do we know about  risk of infection time?  The reason why we used to think it was so closely associated with time is because when you're doing a check every three hours, yeah, you're tying times to checks. Yeah. But if you, if you leave, if you leave it alone,  we don't develop, we don't develop choreo the same way that we do when we're doing checks every three hours.

I tell my clients that.  Even a vaginal exam is something they can make a decision about and that's in pregnancy and in labor, right? And if somebody's asking to do it You want to know what they intend to do with the with the information that they're gathering If it's just for the chart, the chart doesn't need it.

The chart does not support their health Yeah, if it's because they're trying to decide about getting an epidural great You're gonna do something with that if it's because you've been you've been on Pitocin for 12 hours and we want to make sure that we're not spinning our wheels in the mud. Yes There's something we're going to do with that.

But just for the chart,  it's not a chart.  The chart has no claim on that information. Yes, exactly. Oh, I love that. Um, I think that's just like the biggest thing with, with  hospital birth is just the rush and the chaos and the mind game to that. Moms are put on this clock and then they feel like they have to rush and there may be like what's wrong with my body if I don't have a baby in my arms and it's been 24 hours.

So having that expectation set to with parents  in that pregnancy stage and the prenatal appointments is just so important because labor can take days.  Well, I talked about I talked about labor time I'm like this. You have to reset your the speed at which your clock runs and labor because labor time is crazy.

Yeah, if you, you, if you thought about doing anything for 12 hours. Even if it was something like sitting in a car, or, you know, like 12 hours is a long time in the rest of the world, but 12 hours of labor is nothing. 12 hours of labor goes by, you know, pretty quickly, and it doesn't mean anything's wrong, and it's a perfectly normal span of time.

Um, and I think it's powerful to help reset that. I, the number of times I've seen on social media somebody heading into the hospital to have an, to start an induction, and they're like, gonna have the baby today.  I just shake my head and go, I, you know, I kind of hope you don't, not because I don't, I want it to take a long time, but because if you did, that meant  something, you know,  everybody's not ready for it.

That. Yeah. Yeah,  for sure.  But I also, I talk about words. I'm, I really feel strongly that words mean things. So I don't, with my clients, I don't use the words intervention or unnecessary. Those are, those are crossed out words in my vocabulary because I feel like they're disempowering  because they're judgmental.

I think interventions, Um, can be reframed as tools because they're a tool with, with the opportunity and time for to understanding. And I think unnecessary is, is judgmental. So we call it chosen. You know, I chose to have an editorial or I chose to have an induction. Um, I think,  uh,  I love this. So. I often hear people saying, Oh, I had to be induced.

Oh, turns out that induction was unnecessary. But I have an illustration of a story that I think really, really shapes this one. So I had a client who adopted a little girl shortly becoming pregnant herself was of course,  um, the little girl's birthday was within the client's term window, because of course,  and my client really wanted to make sure that her little girl could feel at the center of her birthday.

So, as the, as her, um, As the birthday approached, the client made the choice to be induced so that she could be home and recovered in time to have a birthday party for this little girl who had had a not so great childhood up to that point.  Induction was unnecessary when you, when you look at the world of inductions.

And in fact, when she went in for the induction, she was already three centimeters and they almost they tried to send her home and said like, Oh, you're going to be in labor in the next couple of days anyway. But she really wanted to make sure that she was home for this little girl's birthday, for her adopted daughter's birthday. 

And what a brave choice. That's not, that's not cavalier, that's not crazy, that's brave. Because she was choosing what, what was ultimately a more challenging labor  to prioritize something else in her life, to prioritize a different value.  Yeah. That's a really great story because it is ultimately comes down to choice and we can't judge people for the reason why they choose something because for her, that was the perfect choice for her.

So no, that's a great example of informed choice and informed decision making and doing what's best for her. You and your baby and your family. So it's so personal. It's so personal. So don't, you know, I'll tell, I'll tell your listeners, don't let anyone judge your birth story, right? A client of mine chose an induction and she went through that challenging birth.

And on the other side of it, six months later, a friend of hers actually asked her, what, what, how do you feel that you had an unnecessary induction?  And I thought,  Wow, first of all, that's a horrible thing to say to anybody, but second of all, I ended up spending an hour on the, on the phone with that client, helping her work through that she made that choice.

She knew it was going to be a more challenging choice, but she did it because she had XYZ information in front of her. Yeah. And so it wasn't unnecessary. It was chosen. So words, words are powerful.  Yeah. I love that too. I love the interventions and tools instead of interventions and chosen instead of unnecessary.

I think I'm going to use those because I do find myself, you know, I try to avoid it, but I don't have good words to substitute those as, so those are perfect, perfect ways to say that. Um, so I guess, yeah, to end this episode on this interview, is there any advice that you have for pregnant moms considering a hospital birth in terms of having that personalized birth experience and advocating for themselves to have that experience that they're looking for? 

Yeah, well, my first is ask questions, right? And, and if you don't know what to ask, start with the question of why.  Um, and, and ask as many times as it takes until you fully understand, right? Medical professionals study an entirely different language for six years. And sometimes they forget they have to translate all the way back to English. 

And so don't feel, don't feel dumb or discouraged from asking, I'm sorry I need you to go over that again, I'm sorry you said this word, what does that mean? And, and. It's not you being difficult. It's you being empowered to make a choice that you will feel good about on the other side, because ultimately if you, if you  go along with if you just passively to routine because you didn't know there was an option there, it will affect how you reflect on your birth experience. 

And then one of the most powerful things you can ask for is time.  Um, even if you are fully on board with the decision that's being made, take time. So a really common scenario is you're at a  40 week appointment and they are, they see something that concerns them and they're recommending an induction right now.

Go directly to the hospital. Do not pass go. Do not collect 100.  I tell my clients.  You know, it's okay to go home. It's okay to, on your way to the hospital. Yes, that's your plan. Yes, if you agree with that, and you're going great, go home. I gotta feed my cat. Whatever it is that you need to tell yourself, I need to go home, because going home, packing your bags, taking a shower, eating a meal, taking a walk or a nap, even just for an hour or two. 

Well, make going to the hospital feel truly of your choice, right? It's your agency.  So,  and, and it may sound so scary when they're in the, in the, in the clinic room telling you, you need to go right now, but if your appointment had simply been two hours later, because it was on the schedule for two hours later, we'd be in the same spot. 

If it was truly emergent, they'd be calling an ambulance.  So take time, ask questions, and it's, you know,  it's about making sure that you come to the other side of your birth journey, feeling really good about your position of agency and control. We can't say control. I try not to say control because you can't control it, but agency and autonomy.

In this process, that will be so impactful. I mean, I think that, um,  you know, we can't control the physical outcome of birth, but we can do things to influence the psychological outcome of birth. And, and frankly, I think that's longer lasting than the physical outcome.  Thank you so much for tuning in to the podcast today.

If you are pregnant and interested in connecting with me to find additional resources and support, like we talked about today, about informed, autonomous, and evidence based birth, there are links in the show notes with more information on how to work with me. I provide in person and virtual birth doula services.

I have an online birth course called Fearless Birth Academy. And I also really enjoy meeting with families one on one for personalized confidence calls or birth planning meetings. And I would love to chat with you soon if this is something you'd be interested in. So please don't hesitate to reach out if you're interested or have any questions.

I am here to help pregnant moms like you take control of your experience with education and continuous support. So again, thank you so much for being here and I will see you again next Tuesday. Bye everyone!