#69 The Power of Physiologic Birth

Sarah Lavonne:
Hi, I am Sarah Lavonne, and I’m so glad you’re here. Here at Bundle Birth, 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 person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life, both in and outside of work. 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.
Many of you have heard some of my story. I started in L&D. That’s the only job I’ve ever done as a nurse. I started in East LA in a very medicalized system. That training for me was like the best training ground. I will say that those high risk units, you never know what you’re going to get. Low prenatal care sort of really I feel like shaped my practice. And I saw every major obstetric emergency within my first year to year and a half, which is so amazing.
And so when I look back on my practice and how I was trained, one, I went through nursing school in the US, which is a medical model of care and very much trained in Western medicine as we all likely have been. And then I went and I worked in East LA in a very high risk unit and was sort of trained, I’ve heard people say like the wild, wild west. It wasn’t quite the wild, wild west, but it was very much medical model of care with residents. Everybody was AROMed, everybody was checked every two hours, like early AROM, even before we had any evidence on that.
And we just sort of did whatever we thought to speed things up. I had the doctors that would call and say, “Have the ears out by 8:00 AM,” or, “Hold them off all night.” They’re nine centimeter multip and it’s 1:00 AM. And they’re like, “Yeah, I’ll be in at 8:00.” I’m like, “No.” And so coming from that environment, and then I decided very early on, I looked at my student loans and many of you have also been there where I was like, “I’m going to be in debt the rest of my life.”
And so when I looked to get a second job to help pay off my student loans, I really wanted an opposite experience. And so I went to a very popular hospital in Beverly Hills. It’s where all the celebs deliver. And I became per diem there. And I worked there as a floor nurse, started teaching childbirth ed, helped revamp their program, started teaching specialty ed, became a peer mentor, blah, blah, blah. The rest is history.
But as I was a floor nurse at that hospital, it was a very, very different environment. At my first hospital, it was predominantly Hispanic, Spanish speaking. I speak Spanish. My Spanish was probably better when I was working there than it ever was living and growing up in Ecuador. And they really, the patient population just really didn’t come in, very educated. And they sort of were like, “Yes doctor, whatever you say, doctor.”
And then I went to a hospital that was much more affluent, much more picky, much more preferenced. I came from the first environment that said birth plans were the devil and it was a ticket to the OR. And at the second one, everyone came in with a doula. Everyone came in with a birth plan. Everyone had private doctors. They were pretty educated, they had high expectations, and customer service was paramount at that place.
And so I really loved the contrast of the experience. If you are considering getting a second job somewhere else, that for me was such an important contrast to show what is happening in other places. I know that through our mentorship program, if you’re needing to spice up your life or whatever, I find that even currently I stay up to date and sort of aware of what’s going on in the country because of our mentorship calls, and because of so many of you that are in our DMs and filling us in, and all the polls we run and everything on Instagram and whatnot. And so really found value in that other environment.
And the other piece was when I was looking at what birth was, comparing the two environments, the birth at my first place was either extremely medicalized or you had the grand multip that came off the street. And I don’t think I… Well, that’s not true. I maybe delivered three babies myself at the second hospital. And at the first, it was like every week I was delivering a baby because these babies would come in and they would just fly out.
And while we had high epidural rates, we also had these families that were large, meaning lots of them in the family. And so I got to see physiologic birth in a different way at the first hospital than I did at the second. Whereas at the second, it was like if people came in that didn’t want an epidural and wanted the physiologic birth experience, it was because of their education and because that was the experience that they chose a lot of times, rather than first hospital being a lot more stigma against an epidural, and leading to back pain and all of that.
And so when I look back on my practice and how it had developed, I had all of those varying experiences and was piecing together my viewpoints on birth. And when I looked at the medical side of things, and then when I looked at the physiology of things and when I looked at myself and I was like, “I want to be the best nurse I can possibly be and I want to own this.” And I looked at the nurses that I looked up to. What I looked up to was the nurses that connected with their patients well, that were the ones that got the awards and the patients loved, and what were they doing and what was working for them. But also had these tricky tools that they’d walk in and it would be Pitocin fingers, whether they check them or not. And they were able to assess the patient and get that baby out vaginally.
And there were those ones on both of my units that we would call and say, “Ah, I need help. I don’t know what’s going on.” Now, mind you, very rarely was I ever taught what was actually going on or what they were doing or what the tricks of the trade were, but it got me very curious. And so then I started teaching childbirth ed and was piecing together the home birth community and getting more involved with birth in the community, whether that be home birth, birth center birth, or hospital birth. I’ll be clear, I’ve only ever done one birth center birth. I’ve actually never been a part of a home birth.
Someday that’s something that I would love to experience, but it’s sort of like a liability thing that freaks me out. And so I typically, even in my private patients to date, I don’t take home births. I don’t take birth center births. And that’s just basically a decision that I made because there’s so many birth coaches out there that love that environment, and I really feel like an expert in the hospital.
And so while my experience physiologic birth is very much physiologic birth in the hospital, I was learning from the experience of home birth midwives and going to panels, speaking on panels, going to conferences, teaching in and outside the hospital, childbirth education program where I had people in my class that were having home birth, birth center births, and hospital births all in the same place. I was working with the dual community. I was on a dual advisory committee trying to help us bridge that gap. I was on a patient experience committee at my hospital, looking at the patient experience and what patients wanted and talking to them. I was teaching childbirth classes and just piecing it all together.
And then I quit my job and I decided that, well, I’d always said that if I ever knock on wood, lose my nursing license, which I did not. But if I ever left the hospital or if I ever wasn’t going to be a nurse again, I would love to be a doula because they get that connection. They get to do all the fun stuff without needing to do all the charting, getting yelled at in the back room. And so I had decided that I would quit my job and I was going to try to make change.
And so I started as a birth coach. That was really how I had intended to pay my bills. And it took me a while to build a client base and build a reputation for myself. I started a YouTube channel and everything was patient facing. And as I became a birth coach, what I began to see now given the previous experience of what my viewpoint, what my experience with seeing birth was, I started laboring with people at home. And I was seeing and hearing from people even before they were in labor of what were the signs leading up to labor, and what were they experiencing there? What were their anxieties? What extra education did they need? And I’d make a YouTube video on that.
And as I was laboring with people at home, I was seeing the stages of labor that I had taught about for so long actually in action, particularly that early labor piece, and seeing the tools that worked and maybe didn’t work, seeing the preparation that worked or didn’t work. And I was watching physiology unravel in front of my hands.
At the same time, I also was now limited. And remember, I come from an extremely medical model of care. I love me a high risk. I love me a two IVs. I love me an emergency. Throw me in the OR, triage, all the chaos, a hemorrhage, which is crazy that now I’ve become physiologic birth person. But I really liked that stuff. I really liked the medical stuff.
But now being a birth coach, my hands were tied. And all of a sudden I couldn’t up the pit. I couldn’t call to advocate for pit, I couldn’t advocate for AROM. I was at the bedside. And also, let’s be clear, selfishly, I was there from beginning to end. And I’m sorry, but I don’t want to be in labor with you for three days. And I know my clients didn’t want to be in labor for three days or induced for three days. And by the way, I am there from beginning to end. And so I started looking at the big picture, and what is going on in the body and what control do I have as a birth coach, and what control does the patient have?
And again, I already knew about the five P’s of labor. I’d been teaching on that for years. I’d already been teaching coping with labor classes. I had an online one that I was selling with Bundle Birth, still am. And then I was teaching that in the hospital setting and outside in the community. I was training doulas on coping with labor.
And so I was piecing all this stuff together and developing this practice of helping speed up labor, helping support clients to birth the way that they want, ideally vaginally, helping them avoid trauma. I was seeing the crazy things happening in the hospital and the different types of nursing care out there, the different types of OBs, the different types of hospitals.
I’ve been going all over LA and there’s lots of hospitals in LA, and seeing the different birth practices and continuing to piece it together. Then we started building this following. Justine popped on the map, and we started building this following online. There wasn’t a lot of influence from you guys, but we did actually, this is so sneaky. We got access to an email list of a bunch of L&D nurses. Don’t ask me how. I’ll take that one to the grave. And we were like, “You know what? Let’s ask them what they need.” Because I had been formulating this training in my head and was like, “I think this might fill a gap that might make all the difference for us as nurses,” and how often we feel so disempowered. We feel so out of control. We feel like we’re just succumbed to the system. And I was like, “I am done with that.”
And so I’d been formulating this class. We got access to this email list. And so we put together this survey, and we sent it to 22,000 L&D nurses. I will say that we only got probably three emails of like, “How’d you get my email? Remove me immediately.” And I was like, “All right, take one for the team, but it’s here to help you.”
And so we pulled and got almost 800 responses, which if you look at clinical studies, that’s a solid sample size and basically asked, “What is the current practice? What are you doing? What are you not doing? Are you actually assessing for station of the baby? And how are you making clinical decisions and making recommendations to your patients? What do you feel competent in versus what do you not feel competent in?” And the good news is I had already been formulating this class, which has become the Physiologic Birth Class and has been refined over the last few years, and updated every single time I teach it. But what happened through this survey was it confirmed everything that I had been seeing, everything that I had suspected and really shaped what I focused on when I put together the Physiologic Birth Class.
And so it was, let’s see, it was the summer of 2019 that I remember saying, “I think I have this class in my head, and I think it might be the key to completely changing the game in obstetrics.” And that’s really one of the ways that that phrase has come about for us. It’s one of our mottos here at Bundle Birth Nurses, and it started with Physiologic birth and it has wed into everything that we do with the goal of reducing cesareans, reducing poor outcomes, helping families have trauma-informed experiences.
One of our taglines for the family side, which by the way keeps sending them our way. We are about to launch a whole new childbirth education program that combines the Physiologic Birth Class with my childbirth class for patients. One of our taglines is healthy Parent, healthy baby, healthy birth memory. And so I’d already been preaching that.
And then when I thought about the families that I’d been teaching and them walking into the hospital, that nursing care matters so incredibly much and very quickly empowers or disempowers them. And so during that summer, I’d been putting that together, the survey results came in, and then I started the outline and I started to put it on paper. And Justine had popped on the map. She’d been running an Instagram for nurses and had maybe like 6,000 followers or something, and we were like, “Let’s convert it to Bundle Birth nurses. Let’s make this a thing.” And so she sort of jumped on board and I was like, “I have this training in my head,” and she’d agreed to do it with me. Mind you. Then we launched and got pregnant, and she was so sick that she pulled out. And so I was like, “Ah, okay, now I’m stuck.” And so I ended up doing it mostly by myself until the very end, she popped back in and then has been here to stay ever since.
But it was that summer that we decided, and I had sort of outlined what I’d been seeing in the class and she was like, “Yeah, let’s do it.” So we looked up a spot in downtown LA. I’d found this website called Breather, and it has these conference type rooms. I was recently on the website. It’s changed a lot since then. But we found this super cool venue that overlooked the city in downtown and it could house 46 people. And I was like, “Okay, if we could get 46 people there, we can pay for the class and we’ll cut even.” But I was having visions of taking this on the road and training hospitals all over the place.
And as I was putting it together, and again, so we sold maybe one ticket in September with a plan of the class being in January of 2020. Keep that in your mind.
And so we sold a couple of tickets and I was literally texting every friend that I ever knew. We made a flyer, which now that’s where the joke has become. If you’ve listened to us and followed us, it’s this ongoing joke between me and Justine that I’m flyer girl, but we have so many flyers in our units, and many of you have seen our flyers, and that’s one of the reasons why we’ve come to us. So we posted this flyer and people started registering, and I was then committed to finishing this class and getting this class on paper.
But then the best thing happened, and actually it was in this order that I came across, which I knew it was there. And actually I had taught for CMQCC while I was in the hospital and had done something on reducing primary cesareans while I was a manager at the big hospital in Beverly Hills.
And so I knew about CMQCC and their vaginal birth toolkit, but I hadn’t fully connected the dots. And when I opened up CMQCC, their toolkit to support vaginal birth and reduce primary cesareans, which basically if you don’t know what this is, this is nationally recognized. It was written for California. So it’s California Maternal Quality Care Collaborative, which is a multi-stakeholder organization committed to ending preventable morbidity, mortality, and racial disparities in California maternity care. And so it combines, there’s doctors, there’s nurses, there’s techs, there’s doulas, there’s midwives that all pull the evidence and say, “Let’s make recommendations based on what we know in the evidence.” So this isn’t just like them making up their mind. It’s like a let’s pull it all together, and what do we know based on the evidence?
And so when we look at that particular toolkit in reducing cesareans, they give these five steps that are the main things that say that the evidence shows that if we do these five things, then we will reduce cesareans in our country, and we know the numbers are too high. And why does that matter? Because it leads to increased morbidity, mortality.
I say this in the class. When we look at just mortality for a C-section versus a vaginal birth, mortality for a vaginal birth is 3.6 people per 100,000 births, versus a C-section is 13.3 people per 100,000 births. And so I think we normalize this idea of a C-section. It’s major abdominal surgery, but it’s like no big deal. We see it all the time. It’s rarely complicated, but often the complications in the deaths are happening not even on our units.
And so I also would be amiss to not mention the racial disparities because there is a significant difference between mortality between white versus Black white deaths are 19.1 per 100,000 versus Black is 55.3. And so this gets into a whole lot of all of the things that we could go into. I think what I want to point out is that this is an opportunity for us in preventing a C-section, to really assess our bias and take responsibility for the fact that 50 to 80% of those deaths are considered preventable, and that prevention comes from us.
And so I’m reading this as I’m prepping this class and I’m just totally heartbroken over this stuff. And just like my brain, of course, I’m such a problem solver and I’m such an obsessor, and somewhere in there I think I can help, which even this last year I’ve been questioning myself of why am I doing this and what am I doing this for? And this is so much harder than I thought it would be and all of that, but here we are and it’s working and you guys are taking it and running with it, so thank you for that.
But when we look at mortality for the two and then let alone the morbidity and the long-term complications that come with a C-section versus a vaginal birth, we know that that discrepancy exists between the two and that they are more complicated. And so if we’re going to make a difference in our profession, reducing C-sections is one of the ways we can do this. This is why nationally, there’s all sorts of national organizations and goals. Healthy People 2030, World Health Organization, CDC, everyone’s on the same page. We’ve got to bring these numbers down and we spend the most in healthcare with the worst outcomes of all developed nations. That’s embarrassing. I’m sorry, but why are we not freaking out about this? Especially with the ethnocentricity of the US.
I did not grow up here and I grew up in South America where everyone knew that the US is the most ethnocentric people in the world, yet we suck in our outcomes. So let’s be better.
So anyway, I started asking these questions and then I found CMQCC. And when we look at those five things. Remember, this is the evidence of how to reduce cesarean. The outline is there, the book is there. And I’m going to talk about another resource we have for reducing cesareans as well.
One is improve the quality of and access to childbirth education. I’m like, “Ding, ding, we’ve been doing this. Send them our way. We’ll take great care of them.” Number two is improved communication through shared decision-making at critical points in care. And that shared decision-making is the foundation of what Bundle Birth nurses do. That’s #TeamUnderwear. That’s all of our not letting them do things, giving them power and autonomy over their body. Great.
Number three is bridge the provider knowledge and skills gap. I’ll explain in a second, interesting, what gaps are there? Number four is improve support from senior hospital leadership and harness the power of clinical champions, which is now happening.
I’ll mention that maybe later if I have time. And then five is transition from paying for volume to paying for value, and that is mostly outside of our control. Again, I’m putting together this class and then I find this number three, and I’m going to read you this. I read this in the class. This is the core of what makes me so excited to be in this industry and doing this class and providing this to all of us is bridge the provider knowledge and skills gap.
And it says what we need to do is improve the content of professional education and continuing education to support a “wellness approach to obstetric care for the majority of women giving birth, including a redesign of standard curriculum to include principles of physiologic childbearing and a greater focus on reduction of routine interventions for low risk women.” And so when I found this, I was just like, “Oh my gosh, this is exactly what we’re doing.” We’re literally responding exactly to that call and that evidence-based piece. And so if you’re advocating for the class, start there.
And then the other resource I want to just pull out, for those of you interested in the evidence behind all of this, there’s also AIM, A-I-M has a safe reduction of primary cesarean birth patient safety bundle. This is more of a nationwide effort.
And so in their readiness action point, they say that we need to develop provider, patient community, and unit culture that values promotes and supports spontaneous onset and progress of labor and vaginal birth, and understands the risk for future pregnancies of cesarean birth without medical indication. They need to provide education to pregnant people and families related to their options for labor and birth through the perinatal cycle. And with an emphasis on informed consent and shared decision-making, very aligned with CMQCC.
They need to facilitate multidisciplinary education to healthcare team members on approaches which maximize the likelihood of vaginal birth, including assessment of labor, methods to promote labor progress, labor support, coping mechanisms, and pain management, both pharmacologic and non-pharmacologic pain management, and shared decision-making, and then train people on trauma-informed care. All of which we are doing now, which is so exciting to me and just confirms that, okay, we can do this. So I found these to sort of support the effort going forward.
Now, mind you, there are other programs out there, all of which are incredible, and we are all in it together in promoting and helping to reduce cesareans, and really lead to better birth outcomes. And what that means is healed families both emotionally and physically. Keeping people intact, helping them with the start of their family and their bonding going forward.
And so whatever program you find, please find the one that works for you. What I found for me personally was I wasn’t finding anything out there that was specific to nursing care and the power that we have at the bedside.
I also found that many of the programs out there didn’t really understand the flow of the nursing unit, or the flow of the hospital, or what we’re up against, and all the varying components that got in the way of really promoting a physiologic labor and birth.
And also, many of the techniques taught were prenatal solutions, which was helpful for my birth coaching journey, but not really helpful for when I was training labor and delivery nurses.
And so I really took it upon myself to read everything I could get my hands on. I tell you, the books that I have read are the most boring books on the entire planet. You do not need to read them if you come to our class because I was like, “I’m going to figure this out. I want to be the best nurse and birth coach I can be. I want to reduce C-section rates. I want to help to use my hands, and my assessment, and the things that I can offer my clients as a nurse and birth coach to help them and increase their chance of a vaginal birth.”
And so I developed a practice for myself that I started testing in practice that actually you may hear at some point, maybe even in the Physiologic Birth Class about the history of the Lavonne Circuit and where that came across that happened at an actual birth with an asynclitic baby. She’d been pushing for hours, and I was like, “Ah, I got to figure out a solution for her.”
And the real answer was that I knew the physiology of the body. But here’s the deal, I did not know that as a nurse. I was not taught as a nurse, what are all of the mechanics of labor? What has to align and why? What is the pelvic floor doing? What is fascia and how can that contribute to anything? How do our hormones influence the labor and birth experience? And by hormones, I also mean the psyche side of things. We always think that’s so woo woo and like, “Oh, that’s so the doula,” right? But I was now the doula and being like, “Okay, I’m seeing them stressed out and then they relax and their body relaxes.” And so I had to get an answer. I had to put it together. And I was being given lots of opportunities to do so because I, as a birth coach have attended hundreds of births now as a birth coach. A little less now because I’m a little more busy. But back in the day, that was pretty much how I was paying my bills.
And so I developed a practice, I put together this class, and I remember getting, it was December before the January class, and I remember looking at Justine who was pregnant at the time and was kind of back in the picture and sort of going through the class and being like, “Imagine if this class was the standard of our practice. Imagine if every single nurse, doctor, midwife, if all of us were on the same page, what a difference that this would make in not only our outcomes but in patient experiences and then the way that we practice and give birth in the hospital setting.”
And that’s really all I want. The reality is that the hospital is extremely scary for people. They avoid it like the plague. You’ve seen the TikToks probably or the Instagrams of, “They’re out to get me,” and that hurts my soul. I know that’s not any of our intentions, but unfortunately it has this bad rap, and rightfully so because it’s not always a safe place to give birth, especially for our minorities.
And so all of that, I was just like, “I want more.” Because also keep in mind that none of us want bad outcomes and none of us want that reflecting on us. All of us are being morally injured by the experience as well. And so for the sake of the future of our profession, again, big dreamer over here, I just was so excited about this class.
And so we put it together. We sold it out at 46 seats. There was a wait list, and so I was like, “Let’s add another day.” So we added another day and found another venue, and actually we lost our venue the night before. And so we had to change venues. It was lots of drama.
Anyway, did this two time in-person Physiologic Birth Class. And what I saw happen in that class was nurses feeling like they finally had the answers, that they finally had control, that they finally could take their experience of being a nurse, apply it to the patient, and immediately, practically apply what they learned and help reduce those cesareans, and also get those vaginal births and speed them up and get them through and move on. Because again, all of us want those good outcomes.
And so these nurses walked away feeling so excited to go back to work. And that was one of those side things for me, I’ve struggled with burnout various times in my career. I remember, and I’ve said this before, that there was a time when I didn’t ever care if I ever saw a vaginal birth again.
And so to get to a place now where I love it again, that’s what I want for so many of you, and that’s why we’ve developed so many of the programs that we have because I want that for you so incredibly badly. And sometimes, something like feeling empowered, or feeling like you’re not so alone, or feeling like you know exactly what you’re doing and you can strategize your way through any scenario through labor and birth and know that when you walk away from your patient, you can tell them that they did everything possible to have that vaginal birth. And if they need a C-section, then you did everything possible to get that vaginal birth. And a C-section is exactly the next best step for you. That feels so much better. And that was the result that I was not expecting.
And the testimonials that were coming in was like they went for a C-section, but I felt so good about it. I didn’t go home feeling that residue. And I felt like this training equipped me and met me exactly where I am, and helped me to give me tools in my toolbox that were applicable specifically to my practice throughout all various scenarios in labor, including induction, including epidural.
And that is where my caveat for our Physiologic Birth Classes, when we say physiologic birth, a classic definition of a physiologic birth is going to include no medical interventions whatsoever. So it’s spontaneous and onset, it’s powered by the body. No Pitocin, no induction, no epidural. It’s just giving birth in the fields.
And so while again, that is the classic definition of physiologic birth, but how I’ve adapted that for the hospital setting is really my definition of physiologic birth is when all of the intrinsic physiologic processes that are naturally present in the birthing person’s body work together to birth the baby vaginally and safely. And so that is really what we want. We want a vaginal birth and a safe birth, and we want our patients making every decision for themselves, being fully informed in their decision-making. If they elect for an induction or they are forced into an induction thanks to a medical reason, or they elect for an epidural, that we can still keep them on track for that vaginal birth and that safe birth, that feels really empowered and feels really as natural as possible. And so that is my definition of physiologic birth and what we teach in the class.
And so we taught those two classes. It was the most rewarding thing ever. I had envisioned, “Let’s take it on the road. This is what I’ll do. I’ll travel all over the country teaching this class. How are we going to get there?” I was so excited. That was January of 2020.
And then as we all know in March, the whole world shut down of 2020 for the Covid-19 pandemic. And I really was, I just sort of put it on the back burner and just was kind of like, “Ah, I got to recover and I got to figure out what’s going on.” I took a bunch of virtual clients from all over the world, and guess what? I turned it virtual, and I started practicing what I was teaching in the class, the practice that I had developed and seeing what I could do both audibly and over FaceTime, and with the partner’s help, and how to empower the partner, and how to enlist and work with a medical team that was there with hands-on, without even using my hands or even being present in the room.
And so I can’t tell if I want to give something away that comes from the class. Maybe I won’t. There’s one particular birth I can think of where she ended up having a fully physiologic birth experience, sort of unexpected. She was open to an epidural and I was only ever on audio. And I asked the right question. And because, here is the key, and this is what I want you to take away when you’re thinking about your practice of physiologic birth. And let’s be clear, you as a labor and delivery birth professional, whether a nurse, a doula, a midwife, a doctor, whoever you are, a manager, educator, doesn’t matter. The expectation would be, would it not that we are absolute experts at birth, and birth on its own. I would bet that if I were to just ask a pregnant person on the street, “Would you expect your nurse to know birth really well?” They would go, “Yeah, duh. Isn’t that what you do as your profession?”
And so this is sort of my call to all of us that it would make sense as birth professionals that this would be something that we know inside and out, up and down, to the point where you don’t even need the techniques that we teach because you understand so deeply what’s going on in the body. You can assess every area of the body. And if you don’t know how, this is why you come to our class, that you can assess every area of the body, and know where there might be restriction, what might be the cause of slowing things down, how and where the baby needs to go in order to rotate through the pelvis in a physiologic way and get them out vaginally, that this wouldn’t even be something that you need a formula anymore, that we are so good at it.
And it matters because these patients need us. And I can hear many of you in my head as I’m saying this, of like, “Well, they need to come in educated and they need to come in prepared.” Well yes, this is true, and this is where feel free to send them our way. And I mean, this is part of what we do as well, and I am very passionate about that. But also, we can’t control how they show up to you. What we can control is how we respond when they show up.
And as a baseline, for me, I know the expectation for myself, and really the expectation I would have for this community is that they are showing up to competent nurses, nurses that know their stuff, that care about them, that are willing to try, and that have tools in their toolbox. And so when I look at the big picture of what this can do, what this can do for us, imagine a world where we all are functioning out of physiology.
And this really begs the question of how we’re trained, right? There’s a medical model of care and then there’s more of a midwifery model of care. And this is where a lot of times when I watch birth documentaries, or I see what’s going on in the community, or read research articles, or I read news articles in particular, a lot of the solution to the problem of the morbidity mortality crisis in the US is midwifery care. And while I love me a midwife, I’ve wanted to be a midwife. I have friends that are midwives, and I am always so excited to work with midwives.
The reality is that the system doesn’t support the midwifery model of care. They don’t support midwives. The number of midwives I know that have gone to school and can’t find a job, and would prefer to work in a hospital because the system doesn’t support it.
And so if we’re going to be realistic, who are the people that can have immediate impact on their experience, and who can promote this midwifery model versus this medical model? And again, they ebb and flow, and I’ll explain it there in a second, to a place where the patient gets care that is patient centric, that prioritizes their needs, and that helps promote a vaginal birth. Isn’t that just a lovely thought? That’s us changing the game.
And so what is a midwifery model of care versus the medical model of care? You can read this. My quick definition and what I tend to focus on when I’m talking about it is the medical model of care is very much assuming that the body breaks down with its goal of prevent and treat, versus the midwifery model of care is much more hands-off and much more trust in the innate ability of the body and says, “I’m here watching for things to shift and I will intervene when I see a complication arise,” versus I’m going to get ahead of the problem and prevent and treat.
And again, I want to be very clear, I’m not opposed to either one. I think that there’s a beautiful potential for marinating the two together, where of course we want to prevent and treat. But also specifically for birth, it’s like birth is not a medical process until it turns medical, and then we medicalize it, and then we respond, and we keep patients safe. But when intervention is unnecessary, how quick are we to throw them some pit? No big deal, not understanding what we’re doing to the natural innate capability of the body, let alone the patient experience.
And so that really is the focus of our Physiologic Birth Class is to rein it in. And as we think about this idea of physiologic birth for us as professionals, is the call to really know the physiology of birth. If you don’t want to come to a class, I will link some books that are my recommended readings to get you started down below. There’s probably three. Supporting a Physiologic Childbirth is a great one, Gentle Birth is another. And then The Labor Progress Handbook are probably the three ones that have been most helpful for me. The Supporting a Physiologic Childbirth and Gentle Birth ones, Gentle Birth’s a lot easier to digest. But read a book, look up an article, understand what gets in the way of the labor, and then have some tools to fix it.
And so what has happened with this Physiologic Birth Classes is that it has grown to now thousands of people that we have trained. And so Justine actually was the one, I blame her entirely. She was like, “Let’s put it online. What if we just make it virtual?” And I was like, “Absolutely not. It is way too hands-on. There’s practice. And we did stations at the live one and it was so helpful and impactful, and I love the human touch.”
Plus I’d never really taught virtually before. I had done hundreds of childbirth classes and then nursing trainings and stuff, but I was very intimidated by online. And so it took her at least a year of working me over. And then we did end up hiring my assistant who has now turned marketing associate who has a broadcasting degree. And so she helped us set up the tech.
And so now, we did eventually in 2021, we turned it online and we now have three camera angles, and really shaped the class to be ideal for a virtual setting. And now, people do ask all the time about doing it in person. And I’m just like, “Honestly, unless I’m in a small group of 20 people, it probably has the same impact as doing it online,” because we have so many different camera angles. And because when you’re dealing with that many people, it’s just so much harder to do the hands-on stuff.
And so that really is where we started, and we put it online. And now to date, we’ve trained a very large. I don’t want to out anybody, but there’s 16 locations in Southern California that is a system of hospitals that have all been going through our programs for the last year. They’re up to 80 to 90% at some of their facilities. We’ve worked with, like I said, hospital networks, individuals, midwives, OBs, and then many of you nurses that have been to our Physiologic Birth Class.
If you have not been to our Physiologic Birth Class, please come. It is such a fun day. I promise to keep you alive for eight hours. And really, again, with the goal of it just helping to reform our practice.
Now, what I will say is that so often, we think of Physiologic birth, and very quickly it becomes these positions. And we’ve been doing hospital business recently, and everyone’s like, “Yeah, we just want more positions and there’s not enough position.” I’m like, “First of all, we talk about positions a lot and the physiology behind the positions a lot.” One in the virtual setting, it’s not the most helpful to me to talk about it forever. But also, there’s so much more that goes into physiologic birth than just the positions. And I know it’s hot and sexy, and it’s something we can control. And it’s one of those things that does have evidence for our nursing practice of things that we can do to help, and we do need to understand the body in that way.
But this is also why we developed the Motion app. And so throughout the course of teaching the class, now, goodness, 16 times I think we’ve done. We do four a year. What I found was people would walk away and go, “Okay, I get it. I’m so excited.” And then they go to the bedside and they’re like, “Wait a second, but this patient is this way, and I think the baby’s this position, but what do I do next? And how do I incorporate all of this into our practice?”
And so basically, I took my entire brain, my entire practice and the evidence. There’s over 350 resources that went into this thing, and we put together Motion for you. And that really was our effort at helping to support your practice, to take it practically to the bedside. Literally, you have it on your phone and you plug in the patient details, and it tells you exactly the positions to help the exact clinical scenario that you’re in. That also includes dystocias. So if labor has slowed, there’s pushing options, there’s stuff for OP, stuff for asynclytic, stuff for a deflexed head, and it is specific.
So if you’re in there and you’re at, one of the big questions for Motion has been like, “How do I know to turn them left or right?” And in the class, we talk about the baby rules of how the baby rotates, and then how the pelvis works. And they interchangeably work together. I’ve formulatized this for you so that it is so brainless. And mind you, I usually encourage you to think about it on your own and then spot check with the app.
But if it shows a left-facing position, it means you need to be left-facing in there, right? Versus you’re like, “Is it which side?” It’s the side pictured in the picture. And you can imagine how complex this algorithm is in the back, to really help take what you learn in the class and practically apply it to the bedside. Now you’re only getting the asynclytic stuff and all of those specific details taking into effect all of this stuff, including there’s an entire helping them cope algorithm, there’s trauma-informed care stuff, you can track your stats all in Motion.
And so the journey of physiologic birth for me has been this idea of what can change look like and what is the power of education for us as educators? Those of us that are educators, that is the impact that we can have on our profession. But really, none of it matters unless you take what you learn and we all collectively together decide that we are going to be better and use the tools that we have.
You are not alone in this. You are not out there trying to figure it out on your own. And you can. And you absolutely can get my reference list and read all of the resources, but we make it so easy for you with the goal of let’s expedite the change. Let’s utilize the research that we do have of what to do to decrease cesareans, and decrease cesareans, right? Let’s change outcomes. Let’s take our practice into our own hands and critically think our way through.
And that’s what I want for all of us. No matter how you get there, that when we start with a physiologic birth perspective, our patients benefit, the administrators benefit, us as nurses benefit. And I talk about this in the class, but for the birthing person, their experience is better. They feel more supported, they feel more involved. For the baby, when we promote physiologic birth, they have less chance of iatrogenic harms that are related to augmentation, induction, instrumental vaginal birth, neonatal respiratory distress, and neonatal lacerations, all are benefits of physiologic birth. And we improve their attachment with their parent.
For us, there’s a potential that we have more engagement and support that we can offer these people in labor and increase our satisfaction with our jobs, which I don’t know about you, but I want to keep loving my job. And then if you’re an administrator or an OB, the evidence really shows that when we promote physiologic birth in the hospital setting, we have improved performance on measures likely to be linked to payment as payment reforms roll out. We have a possible reduction in adverse events and related liability claims or payouts due to reduced use of oxytocin. Which by the way, we have a Shifting the Pitocin Paradigm class that you can come to if you’re trying to decrease that in your unit, which we should be. It’s high risk medication and used only as needed and a potential for a reduction in staff turnover.
So there are benefits to all of us, right? Imagine a world where a patient walks in and they are listened to, they’re called by name, that their preferences are respected. That if they want the physiologic experience, fully physiologic experience, that you have the tools to help speed up their labor, help support their baby to twist and turn and deliver vaginally, to avoid the OP babies, to avoid pushing for four hours, to decrease the chance of vacuum and forceps delivery, decreasing lacerations, that it all starts here.
And so when you think about walking out of here, I want, and this is my challenge, this is my wrap up of my super long rant that I hope you found helpful and just interesting, especially reviewing my history of how we got here. But I would love for us to walk away and go, “What can I do right now to increase my knowledge of birth?” We are all a work in progress. I just recently was preparing the Buzz newsletter for November. Newsflash, this is being recorded prior to November. And there was this quote, I’m going to find you that it sort of took me back for a second. And I was like, “Wait a second. Wait, what does that mean?” And the quote was, “The greatest enemy of learning is knowing,” by John Maxwell. And so that is the quote for the Buzz Newsletter. So if you saw it in there, then there you are.
But when I think about that, it really kind of stopped me in my tracks because I was like, “It’s so true. The moment we think we know something, we stop learning.” Even for me, with physiologic birth, I challenge myself every single time I teach the class to go and look up the recent research. I was just in the Labor Progress Handbook earlier this morning and reading some things on there and going, “Oh yeah, that was how that works.” Or, “Oh yeah, there’s that position here and there.” Because as we know that our learning and our knowledge is one of our biggest weapons to changing the game and obstetrics. The more we know, the more we can apply, the more our patients benefit, the more our units benefit, the more better outcomes we have, leading to all the things that we want.
And so leave here, I hope very inspired to learn more about birth, to know your stuff, be an excellent nurse. And in order to be an excellent nurse, understanding the physiology of birth is a great place to start.
Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you liked 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. Now it’s your turn to take what you’ve learned today, apply it to your life, and learn about the physiology of labor and birth. Don’t let your knowing be your enemy to your learning. We’ll see you next time.