#2 Let That Shift Go

Sarah:

Our role in responsibility as labor and delivery nurses is enormous. Think about this. You get to enter into the most important, if not one of the most important days of these ies’ lives. And for us, it’s easy, especially if you’ve been doing this for a while to walk in and be like, Ugh, there’s something else happening outside the room, or I’m not getting along with my coworker, or I didn’t get the raise that I wanted, or I just had my annual eval and now I’m like totally thrown by it. But when you walk in those rooms for these families, this is a milestone on the timeline of their life. And so I think if we recognize that, and we’re gonna have a conversation about that today of our responsibility as labor and delivering nurses, what responsibility do we have? How much is our responsibility? How do we provide care that holds space for the individual giving birth, and also gives ourselves grace along the way, rather than putting so much pressure on the outcome for these families while still respecting the process.

And so today, what I want us to talk about, me and Justine are just gonna have a quick conversation about our responsibility as labor and delivery nurses. And how do we carry the weight of the importance of our job? Because, if I had a cut on my face that needed stitches, I will probably remember going to the emergency department and saying, yeah, like this one day I cut my eye or my face because this, this, this happened, but I’m not gonna be able to picture the doctor. I’m not gonna tell you likely how many stitches I had. I’m not gonna tell you what day of the year it was, or the time that I got my face stitched, I’m probably not gonna have 300 photos in my phone about it. But for this specialty in nursing slash medicine, that is the case. And that feels like a lot of weight and something that we say around here a lot is like, you need to take your job seriously. Know your why. Like, one of the quotes we have is that you have the power to make or break their birth experience, no pressure. Right. And that is absolutely true, but how do we carry that weight while still giving ourself grace along the way?

Justine:

That is so much pressure when you think about it? I think so. And I’ve had this pressure. Yeah. But I think we’ve learned, and we’ve taught that you can make or break a birth experience by a phrase or a word, it’s not, you’re not breaking an experience if you’re patient that you really tried to help to get delivered vaginally goes to C-section. Right. So you’re not breaking it. So I think that it’s important for us to realize how easy it is to make or break an experience.

Sarah:

Well and how easy it is also to take all of it on ourselves. All of it, you know, and that, that C-section is the perfect example. We had this on a mentorship call the other day, where it was like, I just, I can’t let go. We had that entire conversation. I can’t let go of this experience. I could have maybe done more or I went home and I looked this up and I didn’t realize this could have happened. And that’s where I sort of wanna make the distinction and give ourselves grace that we are responsible for our attitude, our action, our, um, interaction, our expertise, like knowing the knowledge to be able to respond, but we are not responsible for their body doing it or not doing it in the way that they want or we want, or the doctor wants, right. That we can support it along the way.

But ultimately if slash when the patient goes to C-section, if you know that you have applied yourself, you have done everything possible to get there and give your all to provide whatever resources you have, education support, whatever that looks like. It’s not your fault that they went to C-section, it’s not your fault that their baby was having decels you know, or like, oh, I could’ve fixed it. Or like, maybe if we would’ve tried this position, or maybe we didn’t try, blah, blah, blah. Like you don’t have control over what’s happening with the quarter placenta. You know, you don’t have control that they went to 42 weeks and they didn’t come in for an earlier induction. Not that I’m necessarily supporting that, but that could have been an option. And they chose to wait to 42 weeks and therefore their placenta is super calcified and the baby didn’t tolerate labor, you know, fill in the blank. So, and I think, I think that distinction for me helps separate it in a more logical, more like concrete way that I’m not responsible for how their body responds to labor. I’m responsible for how I apply myself to their birth.

Justine:

Yeah. And I think, and on the flip side too, you’re not responsible for the census or staffing. Yep. You were not. That’s a good one. It’s not your fault that you have two laboring patients, but it doesn’t mean that you can’t do anything. And I think that sometimes when we get those two patients, it could be super overwhelming. I know I went on a little rant on IG the other day, IG I’m so hip, Instagram the other day and talking about this and that it’s not our full responsibility and do the best you can. And then I walked in and I had two patients and I was like, okay, Justine, you gotta do the best you can. Yeah. And I did. And I didn’t feel, and one was, um, more heavy on interventions and one wasn’t and I was getting pulled in a lot of directions, but honestly, I can tell you the last, like three years, I would say, I have never, I haven’t walked away from work thinking I could have done more. I’m not out there doing positions all the time, every 20 minutes, putting them on their heads, like trying to rotate these babies. We, you know, we don’t fix, what’s not broken here at bundle birth. I am not trying to overwork myself, but I still do the best. I just do the best I can for each individual patient.

Sarah:

Well, I think we need to let go of some of that, of like, when you’re feeling overwhelmed or you get home and it’s usually off shift where you’re like, Ugh, I wish this. Or, Ugh, I didn’t, you know, they’re like, they pulled the papers for C-section and they’re probably going to a C-section and I didn’t turn them every 30. I turned them like every hour and 15, you know, like, I, I think that a lot of that we take on so much. And, you know, if you had two patients and you were running between the two and you weren’t sitting chit chatting at the nurse’s station for eight hours of your 12 hour shift, like, I, I don’t know that that’s your fault either. You know? And even if you did, I think that if we think about it logically, like some babies just come out, you literally could lay them on their back or like, think about our cardiac patients that like, they don’t even push, you know, and the baby just falls out eventually, you know, it takes a long time, but they come out eventually or they don’t. And so

Justine:

Birth works.

Sarah:

Yes, exactly. And so you sort of have to let the body do what it can do. And when you think back and it’s like, I could have done should have done X, Y, Z. The question really is, did I apply myself? Did I give my all, did I, you know, do what I could that day? And your all may look different from one day to the next. And I think that’s okay. And I think we need to give ourselves a lot more grace when it comes to our “all.”

Justine:

For sure. Your day three of three, your all looks very different right than the first day. And that’s okay. Like you said.

Sarah:

Right. But, but when the, you know, when push comes to shove and they recheck, ’em four hours later, and they’re still six centimeters and the doctor identifies it as OP, did you apply yourself in that circumstance? Have you applied yourself prior to have the skills which come to our physiologic birth class, if you haven’t, but also like, okay, now it’s on, I’m fixing, what’s broken again, never saying that to a patient, but in your mind, for the sake of the phrase, it is something is upset. There is something getting in the way, let me use my nursing skills to assess the situation and provide some “interventions.” We’re not talking AROM. We’re not talking necessarily pit maybe, but some nursing interventions, simple things to help support their labor forward.

Justine:

So, Sarah, what does it look like? You mentioned earlier that like, we don’t want them going home, holding all this weight of birth memories on them. So say you have listeners right now that are like, yeah, but this it’s my reality. It’s what I do. When I go home, I just obsess over it. What are some suggestions you have on how to help them get through that?

Sarah:

Well, I think a lot of times we don’t necessarily know what’s going on in our head. Other than that we’re obsessing, right? Like I’m obsessing. I can’t let it go. Right. And instead of sitting there, I would suggest, you know, there’s a few options, but one of them would be journal it out. What’s in my head. And so the question then becomes, what’s the story that I’m telling, am I saying the story that I didn’t do enough? Am I saying that it’s my fault that they had a C-section am I saying I didn’t fill in the blank? I didn’t educate right. I didn’t advocate in that scenario and what, and I feel upset with myself about it. I feel regretful. I feel shame in that scenario. I feel uncomfortable with the care that I provided so easily, like, even if you can identify that, then the next question to me is a quick tool and there’s lots more we can go into on this.

If you want more, let us know in the description box or the comment box down below, but it’s it, what is the truth of that is that truth, right? That I cause the cesarean. Can you say with a 100% certainty that you cause the cesarean, the answer is no, by the way it always is. And that circumstance, right. You know, and if you said, like with a hundred percent certainty that I didn’t give my all then, okay. You didn’t give your all, what did you give? What didn’t you give? And it’s sort of like to break that down. And then to me it’s always about growing forward and it feels really icky to walk away. I have lots of cases where I’m like, Ooh, I should have, you know, I should have known this or I should have tried this, or I didn’t advocate right. Or like, Ugh, I should have stood up for them in that circumstance and, and said, blah, blah, blah, that, by identifying that to me, when you write things, not even to me, this is a proven point, but when you write things down and you say, okay, what can I learn from this? This is your, your critical event debrief you have in your mentorship packet, but that you walk through and say, what am I gonna do? Different? How do I wanna practice different? And then you choose to not do it again. Yeah. You know, you don’t, you know, better when you do better. What’s the Maya Angelou, like once you know better, you do better. Yeah. Um, and sort of it’s, it’s like giving yourself that grace of in the moment. And that’s the question it comes back to in the moment, did I do the best I knew I was or could do?

Probably yes. Yeah. It’s always retrospect where you’re saying I could have done this, but in the moment, did you give what you knew to give and did you do the best you could with the knowledge and information you have at hand in the front of your brain? Yeah. So then how do we move out of that story? Extract the truth? The truth is I did the best I could in that moment. The truth is I felt overwhelmed by that circumstance. The truth is I haven’t done the education to be ready for that OP baby or for that shoulder dystocia or whatever. And so then what leads to the next action? What’s my, what’s my response to that. And when you sit that’s to me, where we get stuck and stagnant and ultimately will lead to a lot of dissatisfaction in your life and work.

And so as living your best life, it’s okay. But then what’s my next action that leads you to your next action. Your next action is, let me go back and let me review shoulder dystocia. Let me go back and let me learn about what a retroperitoneal bleed is. Let me go back and review my vital signs or what I’m looking for in a PPH or how to do this. And let me try this skill. Let me next time practice this and that. Let me write down what I would’ve said to that provider in the moment. And then you review that for yourself so that we can continue to move forward. No one is expecting you to be perfect. No one is expecting you to be like excellent stellar nurse that could have never done anything different. None of us are that way. Okay. So if you kind of like, let go of that expectation or even recognize what expectation you have for yourself and then continue to move forward. That’s where, to me, you end up growing and being better and, um, sort of perfecting your skills so that you don’t have so much regret at the end of your shift.

Justine:

I love that with all writing this down and like putting this all to memory, do you think, would you recommend if they are still for lack of words obsessing over it and especially like a certain birth or a certain event, what do you feel about them going to the provider and talking them through it and having their own little?

Sarah:

Absolutely. I think, I don’t think we talk enough with our providers. I think there should, there’s like too much of a hierarchy. I think there’s too much of fear of our providers. And while some of that might be reasonable, um, just based on like personality types. Yeah. And what’s happening in your hospital. I think that, so often we write the story about that, oh, this provider doesn’t wanna teach me that, or they won’t have a good conversation or whatever. But if we approach our providers from a learning perspective. “Hey, I’m kind of obsessing about this case. Could we debrief it together? I don’t know how you felt, but I felt really fill in the blank. Overwhelmed. I felt really out of control. I felt like really confused by why you made that decision. Could you help me understand? So that in the future circumstances that are similar, I can be better.”

In the moment, especially that’s, that’s especially like a, a sneaky therapeutic technique for a provider is when you actually disagree with what was done, you know, but it’s like, sort of with other things, maybe there’s the study, maybe there’s information out there that they’re functioning from, that they feel really confident about in terms of how they’ve developed their practice. They likely have been doing well. I don’t wanna say likely they maybe have been doing this longer than you. They also have a completely different frame of reference. And so in order for us to work better with our providers that we are working with, I think it’s important for us to understand each other. And the only way to understand each other is to actually ask. But there’s the way to ask in a way that’s like, help me understand this. Or I remember this circumstance you did so amazing. I thought this went so well. Can you help me understand, you know, why you made that decision in that circumstance for my own learning later, et cetera.

Justine:

Yeah. That’s huge. My own learning later. I’m still learning. I just wanna learn. Yep. Yeah. I love that. So if you learn anything from this episode, I hope that you learned that you are not responsible for an entire birth memory. That feeling can feel very overwhelming to think that it is you and it is up to you to be that bundle birth nurse and make sure every patient walks away whole and with no trauma and a perfect birth memory, but it’s not all on you. And we wanna make you understand that it’s not all on you. We hope though that if you do go home at the end of the day, worried about things or stressed about different cases, different deliveries that you take some time to reflect on it. Why do you feel this way? Why did this outcome affect you so much? Was it because of a certain order that was made that you felt like you didn’t say enough for? Was it because you didn’t know the information? Was it because you felt like you didn’t have the skills to help that patient in that specific scenario. And then from that grow from that, we want you to be continually growing and changing because it’s up to you out there to change obstetrics. No, no pressure,

Sarah:

No pressure

Justine:

Grow and change and collaborate with our teams. The better, the better outcomes our patients are gonna have. And so reflect on that, grow from that. Talk to your providers, talk to your team because all in all, we want you guys to be able to separate work and life and live your best life. Thanks for spending your time with us during this hour of happy hour with bundle birth nurses. If you enjoyed this podcast, it helps us. If you subscribe, rate or lead a raving review and share this episode with a friend, if you need more from us or want more from us, head to bun, birth nurses.com or follow us on Instagram. Now it’s your turn to take what you learned today, apply it to your life and give your best self as you take care of your patients. We’ll see you next time at happy hour with bundle birth nurses.