#67 Becoming Lifelong Learners: Season 4 Finale

Justine:
Hi, I’m Justine.

Sarah:
And I’m Sarah Lavonne.

Justine:
And we are so glad you’re here.
We believe that your life has the potential to make a deep, meaningful impact on the world around you. You as a nurse have the ability to add value to every single person and patient you touch. We want to inspire you with resources, education, and stories to support you to live your absolute best life, both in and outside of work.

Sarah:
But don’t expect perfection over here, we’re just here to have some conversations about anything, birth, work, and life, trying to add some happy to your hour as we all grow together. By nurses for nurses, this is Happy Hour with Bundle Birth Nurses.

Justine:
If you’re tuning in today, you are tuning in to our last episode of season four, which I’m continuously impressed.

Sarah Lavonne:
I know-

Justine:
Every time.

Sarah Lavonne:
… time flies.

Justine:
Time does fly. The next season, season five, the plan is around October, and there’s going to be a couple of changes there, so we’re looking forward to hearing your thoughts on that. But today-

Sarah Lavonne:
Are you going to tell them the changes?

Justine:
Well, I don’t know if… Did we confirm them?

Sarah Lavonne:
Part of them we haven’t confirmed, but there’s a piece about season five that will be a little different, just in general, about you.

Justine:
I won’t be there. I will be enjoying my sweet new baby, and so I have asked and been granted some time to just step away for a little bit, and I’m really excited about that. And so I’ll miss you guys, but I’ll be back for season six. No worries.

Sarah Lavonne:
And we may pre-record some, so if you hear her, it was recorded pre-baby.

Justine:
[inaudible 00:01:42]. That’s true. That’s true. We’ll see what happens.

Sarah Lavonne:
Unless you feel super inspired or something, you’re like, “Let’s jump on. I’m dying to podcast with my newborn.”

Justine:
[inaudible 00:01:51] episode and listen to my baby in the background.

Sarah Lavonne:
Or your birth story, that would be fun.

Justine:
Oh, I did think about that. Or I have a post. I’ve been behind the scenes, I’ve been making posts for Instagram for maternity leave, and so I have a day, it was like, “Justine gave birth,” is one of the days, so I’ll just do a photo.

Sarah Lavonne:
Cutie.

Justine:
Yeah.

Sarah Lavonne:
Aw, that makes me want to cry.

Justine:
Yeah, so we’ll see how it goes down. Who knows? Who knows? Hands are open. So we’re thinking about what to do for this episode, and I think time and time again throughout every episode we realize in every season we’re like, “Man, we learned so much from each other,” and we’re constantly learning from you guys. And I feel like every guest we talk to, we, again, go a round of like, “Yeah, we just need to keep learning, keep growing.” The professional responsibility of growing in our practice, and being experts in our specialty.

And so we wanted to chat a little bit because we were talking about the things that we’ve just learned in the past few years just based on random studies we send to each other. And we have an advantage, don’t get me wrong, because we create content in classes and podcasts, so we are in it a little bit more. But Sarah and I had the personalities before we started this, separately, to just keep learning. So I don’t know how to…. I think you have to grow a love for learning, and we could talk about that too, but we just wanted to chat about things we’ve learned over the last little bit.

Sarah Lavonne:
Yeah. And I want to bring just, again, another prompting. I think when we think about ending this season, it’s like, how do we send them off for a few months? Those that are really with us in this journey, whether you’re tuning in for the first time or you really follow, it’s like I want to send us off with a message of, let’s all go be lifelong learners. And that goes for our life, that goes for our work. And especially when we’re talking about our work, that the benefit of just choosing to just claim it, name it and claim it that, “I am a lifelong learner, that I will never arrive.”

I know I feel that in me, and that feels really inspiring, and that feels really motivating that there’s so many things I don’t know. And even today we’re starting to prep for Cancun. Holy moly. I just came out of a three-hour meeting with our team, and I’m like, “I need to…” Over the next year, part of my goal is, as I determine what theme we will be learning about, and is that I’ve got to get out there and just take in the world.

And so as a lifelong learner, it’s like I’m heavily motivated, yes, for all of you to be that lifelong learner, but also for myself that it feels good to feel fresh and my mind isn’t rotting away somewhere. And so I do feel like that perspective of being a lifelong learner and just being ferociously curious has really served me as a human being in my own growth journey, but also as a professional, and as a nurse, and as somebody in the world of obstetrics. I think that is one of the most potentially underrated and undertalked about qualities that could potentially have some of the most impact on your own personal life, but also on each other.

Justine:
Speaking of learning, this should be something you add to your list in the year while you’re growing for Cancun, how do we become as ferocious as you are in learning? You have a different spirit about it. You’re so curious, and you’re like… You and I are very different in that, and so I want to help everyone. So if you tell Sarah something she doesn’t know and she asks why, she wants to know the why and she’s going to figure it out. You tell me something I didn’t know, I’m like, “Oh, okay.” I’m just done.

And so that’s really… I wonder if you can. I think of a little kid, and you’re very little kid-like when it comes to learning, which is the goal, that’s one of the reasons why I’m choosing to homeschool my son, it’s because I want him to love learning from a young age. School didn’t squash that out of you. And so I wonder if it’s possible for someone to grow that again. How do you start to love learning again? I don’t know if that’s a thing, but [inaudible 00:05:49] going to find out you are.

Sarah Lavonne:
If you know anything about the Enneagram, for Jess, who might be listening, one of our mentors, and also our executive Enneagram coach on the team, she has an Enneagram class on our site. So if you’re looking for just a fun way to learn, that would be a great place because you’re not actually going to get CEs from it, but you’re going to learn about yourself and about the people around you and whatnot.

And so I will, to start, I do have to disclaim that I… First of all, the Enneagram number 5s of the world are going to be more prone to learning, and that personality type, it’s not a personality test, but it’s like a typing system where they are ferociously curious. And I’m not an Enneagram 5, I’m an Enneagram 7, which makes me highly… I was going to say highly fun. Enneagram 7s are very fun. They’re not always outgoing, but they’re down for the party. They live with a you-only-live-once mentality.

And so I’m an Enneagram 7 wing 8, which makes me… That’s where you see the boss mode come out, where pretty organized, pretty… I can be kind of, not emotionless, but much more objective. I’m a head thinker. My head guides my decisions rather than my heart and my emotions. And in moments of strength, when I am at my best, I arrow to an Enneagram 5. And so if I’m ever uninspired, which if I look at it that way, I’m like, “Wow, I’m doing really well in life because I always want to learn.”

But there are times when I’m like, “I don’t care. I don’t care.” And then I become pretty rigid and pretty militant, and I can be very intense, and sort of snippy about things, and very rule-based, which is a 1, where I go in unhealth, and those are the poor qualities of a 1. And so I think I will just say I am… All of that said, if you want to learn more about the Enneagram, please go take that class. But number two, is that I am prone to learning, internally. And I don’t think everybody is prone to learning like that, and I think that sets me up as an advantage to the learning front. But yeah, I will consider how you get [inaudible 00:08:05].

Justine:
I wonder if it comes down to play too and rest in different ways of creative rest because even now looking into… Because I have a 4-year-old, and we’re looking into homeschool, and it’s always start with play, they should play for years, and play will be the foundation of learning. And so I don’t know, yeah. And maybe that’s why it’s fun when people do quizzes in their courses, and makes you think in different ways of learning. But anyways, we like learning, different aggressive levels with learning.

Sarah Lavonne:
Yeah. Well, and we’re the spectrum too, I think. I love that you bring that because it’s sort of how we balance each other out because I can be very intense. And when I’m training or mentoring an instructor, it’s like as the instructor, my expectation if you’re going to teach for Bundle Birth, is that you know more than the people in the class about it. And even though you might be teaching a basic class, it’s like you never know what questions are going to come up because for childbirth ed…

I remember this when I trained childbirth educators that you may not say certain things, but you need to have an answer for anything anybody is going to ask. That’s what makes you an incredible instructor. I remember I was talking to somebody who’s pregnant, who’s sort of a client right now, and he was saying… I was just like… It was very high level. And then he asked a very pointed question, and I flipped on this switch, and I was like, “Well, the studies say this, and over here, and something to consider is blah, blah, blah, blah, blah.” And it was like, it’s all fun and games.

I do this at births too, where like…. “Here’s a little massagy, you’re doing great, blah, blah, blah.” And when push comes to shove, they have a question, and I have an actual legitimate answer, and they’re like, “Whoa. Oh, there’s a lot going on in there.” And I’m like, “Yeah, you have the whole toolbox of my brain at your disposal, but I’m not going to use it unless I need it. I’m trying to just have a good time.”

Justine:
“I’ll work where I need to.”

Sarah Lavonne:
Yeah, seriously. But that is that challenge of can you answer all your patients’ questions based on… and it’s not just the evidence. And so I think that’s a good segue for us because partially when we were talking… We got going, and this is what always happens when we set up for these podcasts. We’re like, “What are we going to talk about?” And like, “Okay, I’m going to go here. I’m going here…” And then we started having these discussions, I’m like, “Wait. Hold it.”

Justine:
“Record.”

Sarah Lavonne:
“Record.” Because we want you to catch those internal conversations. And so when we were talking about it, it was like, “What have we learned?” And I was like, “I, really, in the last couple of years, have pushed into the fact that our evidence-based practice…” I want to be very clear. The evidence that we do have on things like our clinical research studies, our randomized control trials, our Cochrane reviews, those are all very valuable insight. They have a time and a place, they’re important. In fact, I want to say it publicly, I’m not going to say where, but we are moving into the land of research study [inaudible 00:10:51].

Justine:
Yeah, we are.

Sarah Lavonne:
Maybe in season five we’ll be able to tell you more.

Justine:
Oh, yeah.

Sarah Lavonne:
But I’m about to become a researcher as a part of this, and be a part of that process. And so we love an evidence. And especially, we also love evidence that fits our narrative, which means that even in our evidence, it is not perfect. And we have to be using our brains that when you look at a study, it’s like, what’s the cohort size? What was the motivation? Who’s funding it? Because also funding… We’ve got a quote I’ll say on here. Do you want the tea? To study our ish was starting at $800,000, y’all. No one-

Justine:
No other corporation has that.

Sarah Lavonne:
… no one. No one. So also remember that if there’s a study out there, somebody put money into it. Money and time are resources. And so that what’s actually going on, and also big P-H-A-R-M-A. There’s politics, and there’s just a lot more complexities than just like, “Wow, this is a really amazing research study.” And again, I don’t want to de-validate our research studies. Trust me, you come to any of our classes, we have a resource list for you. And I am constantly [inaudible 00:12:06] on reading stuff.

Justine:
I liked what you said, it’s valuable insight, and it’s not concrete evidence because you’re right. And we’ve had on our DMs, of one of the studies, and I can’t remember offhand, where the nurse told us that, no, the residents completely made that steer one way. And it was like-

Sarah Lavonne:
[inaudible 00:12:30] arrive.

Justine:
Yeah, was it? Yeah. And it was like the ones that they wanted to prove that would deliver quicker, they were super aggressive on those. And then the control, they were like, “Don’t move them.” So those kinds of studies make me mad and I’m like, “Who knows?” So again, it’s just insight. Take it in.

Sarah Lavonne:
Yeah. And I think we still are held to a standard, right? There are policies and procedures, there’s a standard of care at place that we as a licensed professional are held to. But when we’re learning, and growing, and adding to our toolbox, and taking it all in, I love a big picture approach because… And that’s what I love about our mentorship program. If you are looking for a very simple, easy format to really level up your learning, we invite you to our mentorship program, it’s 12 months, it’s like a commitment of six hours a day.

And I do think I can probably say… God, we have so many fun things in the works. I just don’t want to commit to things. It’s not that I’m trying to hide things from you. It’s like literally I just am like… The moment we say something, then we actually have to do it. But we are launching an app which is yes. People are like, “What? Another?” Yes, another.

This is different, but it is specifically helping facilitate the mentorship process so that it’s so easy, it’s on the go. There’ll be chats, there’ll be communities, there’ll be all these added features. You can clip your favorite moments from different classes and create your own library to come back to. It’s audio only. It can be video too, up to you. So it’s very exciting for our new mentorship… Not our new mentorship program, but for our mentorship program as we continue to build and expand, and make it better and better for you.

And so that’s a really great way for you to be guided in your lifelong learning of that. And so when we’re talking big picture, in our mentorship program, we found we’d teach the class and it’s like, it’s a class, you learn, and what does the study say, and what do we need to know? But then we were like, “There’s this gap of the reality of life at the bedside, and the reality of what happens when you have a doctor barking down your neck, and what happens when you have a unit culture that doesn’t fit this.”

And so we added this series as a part of mentorship called Real Talks. There’s also Real Lives, so that we can demonstrate. And we actually act things out. And I act like a crazy psycho pregnant person in a almost-naked body suit. I really went for it. I look back, I’m like, “Someday, oh god, I’m going to end up on the internet somewhere like, ‘This crazy CEO.'” But whatever, take one for the team.

So we really wanted to teach you in a way that helps you see that there’s also the reality of the experience. And I think as we look at big picture, there’s evidence… So this is my very long and roundabout way of saying that one of my takeaways over the last couple of years is really paying attention to, and considering the real life experience of what we’re learning and what we’re studying. So we may say that you may read about peanut balls in this first and second stage labor management ACOG paper, which we love so much. Actually there’s a lot about it that I do love so much. I’m looking for it.

But where it says, “Use of a peanut ball is suggested to facilitate the widening of the pelvis and fetal descent by mimicking an upright position. A systematic review and meta-analysis of four randomized controlled trials of 648 nulliparous women in spontaneous or induced labor that investigated the efficiency of the peanut ball, showed that there was no significant difference in time and labor, or incidence of vaginal delivery, or cesarean delivery. Overall, the use of a peanut ball does not appear to show significant differences in maternal outcomes.”

And so you read this, and very quickly, the people that hate peanut balls are going to say like, “No…” And yet, anecdotally, our evidence… We fricking know. I’m sorry, those 648, but… Oh my god, I have so much to say about this. Reign it in. That we know that the peanut ball helps. We absolutely know. There’s no nurse that’s been at the bedside for a hot second that can’t say that it helps support labor moving forward, it helps avoid dystocias, it helps avoid a C-section.

You’ve seen the ones, they’ve pulled the paper. Let me throw a peanut ball in. And now mind you, is it the peanut ball itself? No, it is not. But that’s where, again, my physiology brain is going to go into like, what else was happening there, and how were they influenced in those studies? And how was their hormones? What psyche were they bringing in? What kind of nursing care? Did they feel safe, supported, and informed? There’s so many other things.

So can we say the peanut ball affects it? No. But easily we read a study like this, and we go, “Well, throw the peanut ball out. There’s no evidence.” And we may even be hearing from doctors like [inaudible 00:17:12] argue it and say, “Well, there’s no risk. It’s not going to not help. So if it helps support their birth satisfaction…” Also, what’s the birth satisfaction? It doesn’t even talk about that.
We know. Anecdotally, we know that a peanut ball helps, and yet we’re reading this. And then we think about physiology, that that’s the other piece that, you’ve heard me say it before, but one of my pet peeves over the last couple of years of learning has become that we’re not studying the physiology anymore, y’all. No one’s funding that study. That is a silly, stupid waste of money and resources.
Truly. I’m not proving that there’s a pubic synthesis that softens in labor because of relax… and then the pelvic inlet, outlet, mid-pelvis shifts and changes based on the position of the patient. We know this. This is how the body works. I’m not studying that anymore, that would be so dumb. “Well, show me the study.” No, read a physiology book. Read. Read an anatomy physiology book. Grab a fake pelvis and see how it works. We already know this. We’re moving on. Okay. Deep breath.

Justine:
Okay. To help people that ask that question. I think the people that ask us that are good-hearted, and they just want you to prove it to their unit.

Sarah Lavonne:
Yes.

Justine:
Tell your coworkers, it’s human anatomy. Get an anatomy and physiology book. It’s basic anatomy. Again. Yeah, they’re not going to study cardinal movements anymore. But I wanted to say on the same… and we’ll link this ACOG first and second stage labor management. But to go continue on, they talk about cervical exams, and they say, “There’s no association between the number of cervical exams and labor and intrapartum fever before or after an amniotomy, so it’s reasonable to perform as many and as often as you need.”

Sarah Lavonne:
Oh my god. And how many studies do we have that actually do? The whole reason why that’s a thing is because we supposedly have all this research saying that it does correlate with chorio.

Justine:
Yeah. So there will be things you read that you just don’t agree with, but it’s good to know-

Sarah Lavonne:
Oh my god, it’s so hard.

Justine:
… and just to read the newest things, what’s coming out, what are they saying, so then you can… Because again, this was 2,300 people that they did this one on. And there’s millions of people that give birth in the United States each year, just in the United States, so that’s not clinically significant to me. So that would be my argument.

Sarah Lavonne:
Right. But what do we do when we’re looking at this is now a ACOG, what are they calling it, consensus?

Justine:
[inaudible 00:19:26].

Sarah Lavonne:
Yeah, it’s a clinical practice guide. Okay. But what’s the difference between a consensus statement, and a clinical practice guideline, and the standard of care?

Justine:
[inaudible 00:19:36].

Sarah Lavonne:
There might be another one in there.

Justine:
I don’t know. But they can’t even follow the one to decrease their intervention, so what if we all do this.

Sarah Lavonne:
Right. No, I know. Right. And that’s the thing, you pull out the evidence that you want, that fits your narrative. And so as critical thinkers, and as a community of professionals who are expecting and holding themselves to the highest standard of care, the point of the story is, know these things. And as things come out, and that’s also where… I think I can announce the newsletter.

Justine:
Oh, you just did.

Sarah Lavonne:
I know. I know. Here we go. Here we go. So one of our ways that we wanted to fill in some gaps is by having a monthly newsletter that talks about and gives you… I’m like, what would I want? I want someone to tell me the things I should be reading every month, and what are the new things, what’s in the news, and a little bit of education. And so we’re going to link down below where you can sign up for a newsletter. We now have a marketing team. We also have some clinical educators. We have more nurses on our team because this hasn’t been something that we’ve been able to handle up until now.

But we really do want to come alongside you and provide you with what you need to continue to learn. That’s what we’re here for. That is the standard we’re calling us all to. And so as professionals, we need to be knowing what’s coming out, this came out in January, it’s new, so that we can speak to it. But if we’re only reading this as our clinical practice guideline for our whole practice, we’re missing so much more, in reality. And so let’s be critical thinkers. Let’s read it and go, “Hold on, not Bible. What does this mean for my practice? How have I seen this play out? Is this actually what I’m seeing, or is it not? What do our doctors think? Maybe I’ll facilitate a few conversations around that,” et cetera, et cetera.

That we actually are smart, and we have brilliant brains to use to start questioning this stuff. And not questioning it in a way that’s like, “I’m going to put it down, and I’m going to fight it,” but going like, “Let me help come to the truth.” That’s what I’m after. You ask what I’m after. I want to know. I want to do it the right way. That’s my 1 coming out, my Enneagram 1. But I want to do it the right way, and I want to be sure and confident that I’m able to provide the best care when I’m offered that opportunity.

And so if there’s something that I can’t answer, and that goes back to the educator piece, I don’t actually know what doctors are reading, then go read it. And when you know that, do you want to be that person who is really insane at your job, in a good way, and just like, oh my gosh, that person that’s just like, they are the standard of what’s expected. Unfortunately, our standard has been show up to work, get by, not really know why you’re doing what you’re doing, and-

Justine:
The standard is I showed up. We literally… So my hospital and… Oh my god.

Sarah Lavonne:
Tell me [inaudible 00:22:29].

Justine:
They made T-shirts, and the back of the T-shirt said, “We showed up.” That was their logo.

Sarah Lavonne:
No.

Justine:
And the doctors were making fun of it like, “That’s your standard, you showed up?” So that shouldn’t be our standard. You’re so right. And being the person that just knows their issue. And also it’s going to help you feel less anxiety in your job. I’ve read the studies. I know it. I’ve read the book. I know it. Yeah, I’ve never experienced a prolapsed cord, but I know the steps. I know what I’m going to do. Yeah, you’re so right in that.

Sarah Lavonne:
That’s why I kept reading.

Justine:
I was so freaking scared. And so I kept reading and kept learning, and then I think it just kept going.

Sarah Lavonne:
Same. Yep. Well, and I think from a patient perspective, I apologize to the patients of the world that are listening to this because I would also be scared if that was the standard of the people trying to keep me safe. And what do you want for your family? Or what do you want for yourself? If I end up in the hospital for a random surgery, and I am freaking out about it, and it is potentially life-threatening for me, I don’t want to know. I would want to know, but I don’t want nurses taking care of me that showed up, and they don’t really know what they’re doing and like, “What’s this meant for again?” What? What? That is so embarrassing. I’m sorry.

And there will be things you don’t know. Let’s be clear. There will be things that you’re like, “Huh?” But when you go, “Huh,” then you need to go, “Well, I need to answer that question because, one, I might be asked that question. And two, that information may become very relevant very quickly, and may lead to potentially saving someone’s life.”

Justine:
Yep.

Sarah Lavonne:
No pressure.

Justine:
No pressure.

Sarah Lavonne:
So stressful. But also it’s doable. And that’s what I want people to hear that please move beyond we showed up. And if you are just showing up, you need something else. You need some spice in your life. And learning, to me, is one of the ways that you can get inspired. And if there’s a piece of you that likes birth… If you hate birth, you’re in the wrong specialty, get out.

Justine:
You must go to another one. That’s okay.

Sarah Lavonne:
What are you doing? Yes, please. There’s something else out there for you. You don’t have to do something you hate. But if there’s a piece of you that likes birth, that sometimes learning, and learning from a different vantage point, learning from a new perspective, seeing it from a new angle, getting outside your unit, learning from other passionate nurses, getting in an environment where you can connect with people on a less punitive, more meaningful, potentially, way, and just learn in a free environment, that probably is what you need.

And that’s what we all need, but it’s sort of taking that into your own hands and going like, “Okay, I need to move beyond just showing up.” And if you don’t know how to answer your own questions, by the way, all of what I just described happens in our mentorship project.

Justine:
And I was like, “You just did a mentorship.”

Sarah Lavonne:
I wasn’t really in my mind until I got going on like, yeah, that’s the framework. And when I think about what happens there, that’s exactly what it is, and that’s why we created it so that you can learn all the essential skills to build that solid foundation, or rebuild that solid foundation, or refresh that foundation because we have people of all experienced levels that join.

And then you come and you learn from other hospitals, other types of birthing units with different patient populations, et cetera, et cetera, and you collaborate together, and then really build you into a place where if you do our mentorship program, you will not be the nurse that showed up. There’s no chance. You will have the answers to most of your questions, and then we just get to build into what is the new data saying? And what’s the new standard of care? and stuff like that.

So anyway, that’s sort of our whole mission here, is education and… Well, it’s not sort of, that is entirely our whole mission, is… It’s the whole point, is education and support. And so we don’t want you to have to do that alone, it’s a lot of, lot of work. And so sign up for a newsletter. I have a whole YouTube channel I’m planning on coming back to. We have patient programs for you, hopefully by now by the time you’re listening to this, if not, coming very soon. Obviously, you’re listening to the podcast, Instagram, all the socials. And then we have all sorts of on-demand classes available for YouTube. And if you haven’t been to Physiologic Birth, it’s time.

Justine:
It’s time. Dive on in. That’s really sparking interest. That really helps. Like, oh, learning can be fun. Because honestly, I do think, though, there are… One of the things, if you’ve listened to this and you’ve been a nurse for a little while, a lot of the live classes we get offered are boring. And so I’m thinking like, yeah, they’ve just got to go. They got to go hang out when you were describing… Yeah, I want to go around people of birth. And one thing was, and we’re going to talk about this in another episode, maybe next season, is childbirth ed, and how that re-inspired both of us. It’s very inspirational, and hanging out with other birth workers, not just nurses. But yeah, I just…

Sarah Lavonne:
Well, and learning can be fun. I love that angle. And that’s where… everything that we do, we want to be fun. That’s Move Learning Retreat, which is, by the way, opening up sooner than you think. Goodness me, you better be on this newsletter. There’s so many things happening to stay up to date on. So save your money, get ready because we have lots of open sales very soon.

And so with learning being fun, that really is our mission, that there’s so much stuff out there. And you can go read the whole book if you want, and you’ll probably get some of the same information. But if you want to do it in a really community-based, interesting, practical, and, hopefully, really engaging way, that’s why we’re here. Justine, what’s something you’ve learned clinically over the last couple of years, I guess?

Justine:
Well, okay, so I was telling Sarah, actually, when I was preparing for the basic fetal monitoring class, I was learning more about late decelerations, and trying to learn how to explain that easy. And I found… Okay, I learned this in Cancun too, but I guess I was naive to animal studies, and how much we did. And obviously, we’re not still doing that on humans now, hopefully, cross our fingers.

But there was a study done in 1982, which was not that long ago, and it was on monkeys, and they would basically progressively take away oxygen and cause hypoxia for two to 13 days on pregnant monkeys. And then monkey fetuses would exhibit late decelerations before they developed acidemia, and then eventually died.

Sarah Lavonne:
Oh.

Justine:
Yeah. So it’s compromised-

Sarah Lavonne:
So that’s how we know how to fetal monitor?

Justine:
Yeah. They would compromise uteroplacental perfusion until at what point did the monkeys die, and what did their heart rates portray [inaudible 00:28:58]?

Sarah Lavonne:
What did it look like on the fetal monitoring?

Justine:
Mm-hmm.

Sarah Lavonne:
That’s how we know how to fetal monitor?

Justine:
That’s one of the ways we know what lates caused.

Sarah Lavonne:
Like…

Justine:
I know.

Sarah Lavonne:
That’s embarrassing. Mind you, I’m glad, like you said, they’re not testing on humans, which by the way, that is part of our history. But still, that’s our standard. That’s how we have a whole… And our entire practice revolves around our fetal monitoring.

Justine:
And then that too, if you actually read fetal monitoring guidelines, they all say it’s not the most evidence-based, to electronic fetal monitoring, and I’m using EFM, TOCO and ultrasound is not the most evidence-based. Intermittent fetal monitoring is the most evidence-based. And we still use EFM. And so I think that even knowing that and reading those things, it makes me less jumpy on my strips a lot of times. And just knowing patho behind fetal monitoring, in general-

Sarah Lavonne:
Everything.

Justine:
Literally everything, right?

Sarah Lavonne:
Yeah.

Justine:
Has made me. And so I was thinking too, while you were talking, and I had said earlier, we have an advantage because we create so much stuff, so we have to keep learning. But to the person listening to this, anything that inspires you, so say you’re like, “What is chorio? And why does it happen? And why does every single patient in our unit end up seeming to have it right now?” Maybe do a little deep dive on chorio, and then you can ask your leadership team, “Can I do an in-service on my unit, to all our nurses on the unit?” And so just to get little bits of inspiration and dive into some research, it can be really fun, honestly, learning new things Also… Go ahead.

Sarah Lavonne:
Well, and to that point, there are certain things in OB that I am like, “Ooh, I don’t care. I totally don’t care.” And I’m not asking the question of like, “Huh, what about this? What about this? What about this?” There’s a limit. And I’m not interested in every single answer to every question in the world. Now, mind you, I do ask big questions all the time, and I’m like, “Why? What was…” Were you on the phone with me that like we were… Wasn’t it? I can picture where I was driving.

I asked some random question where it was out of the blue like, “What are you thinking?’ And I was like, “I just wonder why I’m alive.” And that is me in a nutshell. I cannot turn my brain off. And I hope that that’s not how you live, for some of you. So while that may be an asset to all of you, and I am trying to offer that to the world, it’s also exhausting. So like-

Justine:
Why she’s alive.

Sarah Lavonne:
Yeah, there you go. And so think about what you’re passionate about, and then push into it, versus… If you’re like… and you’re a little like, “Ooh, sparky.” A little like… I feel a little excitement about that. Push into… Go where the love is.

Justine:
Go where the love is.

Sarah Lavonne:
Right?

Justine:
Yeah.

Sarah Lavonne:
That was this season.

Justine:
Oh. And it’s so easy to do that. Okay, so border baseline is you like your unit and you like our specialty. If you don’t, we think you should leave specialties, and we love you and we will love that journey for you. So if you like labor and delivery though, there’s like four or five pillars. You can like a couple of things, but what sparks your interest is coping. What sparks your interest is the O.R. What sparks your interest is emergencies. What sparks your interest is triage. What sparks your interest is bereavement. You can kind of-

Sarah Lavonne:
Antipartum.

Justine:
Yeah, antipartum, breastfeeding, whatever. Think about what gets you going, then yeah, go where the love is. Become that person on your unit, and either join the committees that are already there, start a committee, listen to the Carly episode. Talk to management about, “How can we bring this to the unit?” All we talked about on this season, we talked about it all the time, the coping things, people are making the carts, and the cabinets, and the closets. And how to decrease NTSV rates if you want your hospital to fund education. But so many hospitals these days are getting vulnerable nurses education on their unit, which is so exciting. And so we have tons of deals for that.

Sarah Lavonne:
And, I put my finger up because I was like… I don’t think we’ve announced officially, we just became a certified women-owned business. And so for a lot of you, you’re like, “Okay, yay.” Yes, they verified that I am a woman, somehow. And what that means is that then that may open us up for diversity spend, especially if you have a nonprofit hospital, it’s something to mention if you’re trying to advocate for some of our programs because certain hospitals and certain… And even in business, it looks good for businesses to spend a certain amount of their budget on minority-owned businesses, and women-owned business is very much a minority.

And so it may release some funding or grant money for you if you want to bring our stuff to you, which we just love our nurse advocates who are helping us with that because our goal is really to infiltrate and be supportive of all hospitals in the world, but that’s not the most realistic, so for now, it’s the US and Canada. And so if there’s certain classes that you’ve taken, take them for yourself, and we are happy to help you advocate for bringing your hospitals to us, for us getting to help your hospitals and support them.

Justine:
Sarah, I know for Cancun you learned a lot of things, the most things ever.

Sarah Lavonne:
Oh my gosh.

Justine:
Is there anything that stands out-

Sarah Lavonne:
Too much.

Justine:
… that you learned, that surprised you? I feel like I remember one thing, specifically.

Sarah Lavonne:
Oh, there was so much that surprised me from Cancun. I think that’s the example of being a lifelong learner. I overdid it for Cancun. That was like, I read way too much. And then it’s hard to weed it down when you’re like, “Ooh, this is…” Remember we’d meet, and I’d be like, “I learned this,” and I’d re-explain the whole thing, and you’re like, “Wow.” And I’m like, yeah, that was an hour explanation, and I only have like… I don’t know what it was-

Justine:
Nine hours or something?

Sarah Lavonne:
Yeah, like 10 hours of time. And that was a whole hour on one specific detail. But that’s also to me, the standard that I hold myself to. If I’m going to get up in front of people and talk about something, I do need to know more about it than, ideally, everyone in the room. So that’s how I feel about physiologic birth. That’s kind of my baby now, physiologic coping. I think one of the biggest, what the hells of the process is understanding the hormonal stress response in the body.

I’ve taught childbirth ed for 10 years, and hundreds of couples, so many classes, I’ve trained childbirth educators, doulas, et cetera. This is like my jam. I have a whole YouTube channel very successfully online on childbirth education and all that. And so when I talk about hormones, it’s like, it’s oxytocin, prostaglandin, melatonin, and this is also in physiologic birth, melatonin, adrenaline, and endorphin as the five main labor hormones. That’s what I was taught in all my childbirth ed classes and whatnot.

And I got into… I was reading these chemistry papers where I swear to you, I understood 15 words in the whole thing where I’m like, “This blah, blah, blah element.” I can’t even make it up. I literally was like, “I have no idea what I’m saying.” But also the abstract was so engaging to me that I was like, “There’s something here for us. I’m going to find it.” And sure enough, I would.

And what I found is that the entire stress… So there’s something called the HPA axis. I talk about this in physiologic coping, you can learn the whole thing in that class, it’s on-demand online. But in the HPA axis, it’s basically our body’s… Well, I was going to say non-pregnant ability to cope with stress, but it’s pregnant or not, it’s our ability to cope with stress. And so what happens is our fight or flight is turned on, and then it releases all these hormones through our brain, hypothalamus, pituitary. ACTH is released, goes to our adrenals.

When do we ever talk about our adrenals other than, by the way, when you have a fetus in utero, you need adrenal blood flow as a part of one of the top… the blood is shunted there along with the heart and the brain? Anyway, regardless, it’s important for the fetus. And then that releases cortisol. We think of cortisol, we think of belly fat and cortisol is bad. But cortisol helps increase our threat response. And that once our body detects cortisol, then that higher cortisol in the blood allows the hypothalamus, and tells the hypothalamus, “We have what we need, we can recover now,” which decreases it, and brings us back to homeostasis.

And so I learned this word called eustress, E-U-stress. And what that means is a helpful, healthy level of stress in the body. Because we think about stress, we’re like, “Bad stress.” And so instead it was like, “What does healthy stress look like for a pregnant person in labor?” And that began this whole cascade of reading chemistry papers, and other specialties, and pain management books, and PT, and fascial research, and biology. It was like every other specialty, anything I could get my hands on.

And what I found was there is a labor hormone, by the way, that I’ve never heard talked about ever in the whole existence of labor, birth, whatever that to me is it needs to be one of our top labor hormones, and that is our corticotropin-releasing hormone. It increases 1,000 to 10,000 times throughout pregnancy. It’s made by the placenta. And it helps us respond to stress, shuts down our neocortex, which you learn in physiologic coping is essential for not only coping, but for the physiologic birth process to happen. It increases our prostaglandin receptors on the uterus. It prepares for and stimulates prostaglandin and oxytocin release, and it helps release beta endorphin.

And by the way, within those hormones, adrenaline and epinephrine are the same thing. Noradrenaline, norepinephrine are the same thing, but they have completely different purposes. And so I now have a moral dilemma when I teach Physiologic Birth because I talk about adrenaline, and it really is epinephrine, but actually that is like… It’s still taught correctly, but there’s this whole other side to the noradrenaline side, which is also a fight or flight response, but it’s more of the sustaining stress response through labor, and we don’t really want those adrenaline releases throughout labor because they’re going to shut down all of our labor… Anyway, getting into the whole class. It is fascinating.

Justine:
So [inaudible 00:38:59] is created by the placenta. So I only have it when I have a placenta.

Sarah Lavonne:
No, no, no, no. You have corticotropin-releasing hormone otherwise, but it increases because of the placenta. So now that you all of a sudden have this extra hormone, you get a 100 to 10,000 times higher amounts to help you deal with the stress of pregnancy, and labor and birth.

Justine:
So it’s pregnancy too, so I have it in my body right now.

Sarah Lavonne:
Yeah, you do. You do. You have your own capacity to respond, and so you have… Your body is adapted to the stress of pregnancy, and so you have even more resources at your fingertips to help respond to those threats and then help with the labor process. So it has to do with the stress response, shutting down the neocortex, and then prostaglandin and oxytocin release, and setting your uterus up with prostaglandin receptors that are actually supported by cortisol, which you need that cortisol, so that extra stress in your body because of the labor is physiologic and a eustress hormone rather than a bad belly stress hormone. There’s your little mini class for today, actually. I went on one.

Justine:
You did go on one. Which we kept talking about doing a hormone episode in season four. So maybe this is just a reminder that we need to do it for season five.

Sarah Lavonne:
Sure, let’s do it. I love talking hormones. It’s so fun.

Justine:
Okay. So these are the types of things I learn personally. So I have a fascination with clouds. I love beautiful skies and clouds, and I can lay in the grass all day and watch clouds. And so my sister got me this book. I’m going to show Sarah because… well, she’s on my camera. But it’s just about clouds. And one of the things-

Sarah Lavonne:
And you’re reading it?

Justine:
Yeah.

Sarah Lavonne:
See, I would never read something like that. First of all, because I don’t have time, but maybe if I had time I would, but I’m so impressed already.

Justine:
I’m not reading it a ton. It’s my last thing I would pick up, but it is… Okay. So cumulus cloud is the one that’s really pretty white, fluffy clouds you want to jump into. You’re like, “Man, if I could just jump into that cloud, that’s the cloud I want to jump into.” I learned that because I literally highlighted it. It says it’s somewhat alarming to learn that 80 elephants weigh about as much as the water droplets in a medium-sized cumulus cloud.

Sarah Lavonne:
Whoa. How does it float?

Justine:
God, they’re so fricking heavy, is what I learned.

Sarah Lavonne:
I know. But how are they floating then? And how are they holding it?

Justine:
No idea.

Sarah Lavonne:
I need you to… See, this is my curious brain in action because now I said I don’t care, but now I very much care. How is it just not gravity, and does it have to equal a certain amount of weight before it releases, or what makes the cloud release?

Justine:
Yeah, I’ll let you borrow the book. But what I learned was that clouds are so heavy, and so now when me and Nathaniel are looking at clouds, I’m like, “That cloud is heavy. [inaudible 00:41:39] it’s a heavy cloud because [inaudible 00:41:41].”

Sarah Lavonne:
Okay. I had a breakthrough moment in Pilates. And also, by the way, I was looking at my arms, can we appreciate hard work here? Look at… I have shoulder muscles.

Justine:
Yeah, they look great.

Sarah Lavonne:
I’ve never had toned arms like this, but when I’m talking, I’m like, you can see lines in my armpits. I love my armpits right now. Anyway, so I have been on a workout journey now. It’s been like we’re coming up on two years of very consistent hard workouts. I work out at least three times a week, but probably four on average.
And I was in a Pilates class recently with a new instructor, and the new instructor when we were doing anything ab-related, she was like, “Okay, everybody look at your abdomen, and look for your abdominal fat go…” And this would be really good for diastasis, but I’ve never been pregnant, so it hadn’t related this way to me. But do you know what? Diastasis, when you flex your abs, if you have diastasis, everything pools in the middle as far as your belly fat.

So if I look down and I do a crunch, is my belly fat all kind of being shmushed to the middle or am I grabbing my abs and curling so that my abs are more flat? My belly is more flat when I’m doing abdominal work. And I tell you, my whole mind was blown. And now every time I work out, I’m paying attention to… It works your entire core. When I took that tip into place of watching for everything to pool in the middle where I’m just flexing in the middle versus this wrapping action of where it’s like I’m grabbing from my ribs forward, to a place where when you crunch, everything goes flat instead of tenting in the middle. And-

Justine:
Is it your shoulders? Is it your back? What’s powering the difference?

Sarah Lavonne:
My abs. So I’m engaging my abdominals totally different. And so now when I do ab work, I am so much more sore than I’ve ever been after doing ab workouts.

Justine:
That’s cool.

Sarah Lavonne:
Yeah. So really quick tip for-

Justine:
Remind me this in December [inaudible 00:43:49].

Sarah Lavonne:
When you go back to doing core.

Justine:
Yeah, when I just go back to doing anything, I’ve been just sitting on my butt.

Sarah Lavonne:
Well, when you’re doing postpartum, you can really do this through your breath work, even just in sitting, not immediately postpartum, but very quickly postpartum. When you breathe out and your belly comes in that you wrap your whole abs, you’re pulling from the sides to bring it in from… The motion is sides to center. And it has made such a difference in how I work out, and it completely shifted my mindset when I’m doing any kind of abdominal work.

Justine:
That’s really cool. We just both learned something, and it’s pretty easy to do.

Sarah Lavonne:
I feel like that could be a little moment of the beginning of every podcast like, “What’s something you learned this last week?”

Justine:
I know, but that makes me a little stressed. I’m going to be like, “Oh, I got to learn something this week.”

Sarah Lavonne:
Well, if we’re calling ourselves lifelong learners, but every week…

Justine:
We pace ourselves.

Sarah Lavonne:
You with a kid. I feel like that’s very simple. You learn so much when you’re around kids that are in school and learning random things.

Justine:
In Cancun, when I was finally released from my COVID jail, I… If you don’t remember, I had got COVID and had to stay in my room. So anyway, one of the last nights, a bunch of, I think it was Culture Corps and me were in this pool together, someone’s… there at the pools off the room. I said that so well.

Sarah Lavonne:
[inaudible 00:45:07].

Justine:
And we were all talking about random facts about elephants and dinosaurs and all these things. And I just looked around and I was like, “We all have children, right? That’s the only reason we know this stuff.” And everyone was like-

Sarah Lavonne:
The only reason.

Justine:
… “Yeah, I would never remember this.” Because people without kids were like, “How do you do that?” Yeah, yeah. So you just learn everything. You’re so right. So okay, I can probably do it.

Sarah Lavonne:
Like your cumulus clouds. I loved that fact. I’m looking out my window right now, and I’m like, “But why is it floating?” I have to know.

Justine:
Probably the gas is what I’m assuming, right? I don’t know.

Sarah Lavonne:
Like helium in a cloud that pulls the weight up. I have to know. I’m going to Google it after this.

Justine:
Perfect.

Sarah Lavonne:
Well, thank you, everyone for not only being here today, and dealing with our random jibber jab back and forth of all the super random stuff we’ve been learning, but thank you for just being loyal people with us and in this community of learners. Most of you that are listening, and if you’re not, welcome to the club, we would love to have you join us in any of our programs, and in this sort of community and world. When I think about what Bundle Birth is and what Bundle Birth Nurses is intended to be, my dream is that it is this seen, safe, and soothed community of just incredible humans.

Whether you feel incredible or not, we see you that way, and just really believe that you are unique, and that you have something to offer this world. And so if you’re feeling lost in that, we want to be people that tell you that you matter, and tell you that you do have so many things to offer this world, and our profession, and those around you. And so we would love to have you, and we invite you to be a part of any and all of our programs in whatever capacity you can.

Obviously, our 12-month mentorship program is really the thing. And if you’re feeling like, “I want my hand held. I want to be trained. I want to be equipped. I want to be inspired. I want to be pushed forward with some accountability and some community,” that is it for you. If you are like, “I’m not totally sure yet, someday maybe, but I need to really give that foundation to my practice,” and you haven’t been to Physiologic Birth, please come to Physiologic Birth at bare minimum, download our Motion app.

There’s a free version, there’s also a 14-day free trial for Motion that that really is all of the learning from our Coping with Labor class, from our Trauma-informed Care classes, the entire Physiologic Birth class, a lot of our physiologic coping is all wrapped up practically helping you apply that to your patients and help support, particularly for a labor dystocia. If you get stuck ever, pull out Motion. We get testimonials, literally, every single day of like, “I forgot, and then we got stuck and I was like, ‘Let me grab my motion app,’ and two hours later she pushed twice.”
It’s just constant, those testimonials. And so we want to be able to support you in that way. Be your back pocket. Be your back pocket? I don’t want to be your back pocket, but I want to be in your back pocket in that way. And then, again, with mentorship, you can be in our back pocket. We can be in your back pocket for mentorship as well. We have products to help support your life. We have products to help support your practice and your life. There’s on-demand classes. Physiologic Coping is really exciting, that will not be available forever.
And then we do have a whole lot of fun things coming in the fall. We have two Physiologic Birth classes, they’re live and online coming up in August and November. And then we do have an RNC review course coming in the fall. We have Cancun sales for our Move Learning Retreat, we’ll drop the trailer in the description box down below. There are so many things that we’re doing. In fact, I’m like, wow, that’s a lot. It is a lot to rattle off.

And so if you love the podcast, if you love our vibe, if you want to be a part of a community that really cares, and really is trying to move the dial forward one starfish at a time, join us however. And if you don’t know how to get plugged in, feel free to email us at nurses@bundlebirth.com and just say like, “Hey, this is what I’m looking for. Can you help me figure out what’s best for me?” We are here to help usher you into our community.

And everyone is welcome no matter where you stand. I know we were prepping for Cancun this week, and it was like… We’ve said in a lot of our messaging for the first one, we don’t want you to bring your best self. And my whole team who hadn’t been at Cancun were kind of like, “Huh?” They had confused looks on their faces. And really, that is a mission of us here that show up as you are. Please don’t put on a front. You’re going to get spicy Sarah. You’re going to get nerdy Sarah. You’re going to get crazy, psycho Sarah. In one of those episodes this season, I’m eating random pickles and a chunk of cheese. It’s just like crazy, psycho Sarah. I’m very spontaneous, and weird, and random.

And you’re going to see that from all of our mentors in our mentorship calls. They are an incredible community. I hope you listen to that episode this season, it is just… I’m so inspired by them, and the fact that you get to be guided and supported in your practice by such incredible, incredible women is just so inspiring to me, and just makes me feel so good for you. And so with that, please don’t show up your best self, show up as you are, and be honest about it, and honest and open, I think, to learning.

And so as we grow into lifelong learners, know that you’re not alone in that. There are other people in the world that care as much as you. There’s also people that more than you, and that’s okay as well. And so think about where you’re at now, and consider, “How can I… and what would it look like for me to be a lifelong learner? And what do I need to push into? Where is the love? So that I can follow the love in my life and in my practice.”

Justine:
Thanks for spending your time with us during this season of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com, or follow us on Instagram.

Sarah Lavonne:
Now it’s your turn to go and learn something new, and join us in this land of learning, and growth, and community, and support, knowing that it can be different, that you are not alone, and that we will be better for ourselves and the patients that we care for. We will see you next season.