#47 Reducing Stigma & Creating Healing Birth Experiences

Justine:
Hi, I am Justine.

Sarah Lavonne:
And I'm Sarah Lavonne.

Justine:
And we are so glad you're here.

Sarah Lavonne:
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.

Justine:
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 Lavonne:
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.

Justine:
By nurses, for nurses, this is Happy Hour with Bundle Birth Nurses. Some people might not realize, Sarah, that you have a lot of different hats and play a lot of different roles in your life, but you are a labor nurse and birth coach, and that birth coach part led you to New Jersey recently and you had a really interesting birth, and we wanted to talk about it on the podcast because you haven't even been able to tell me most of the details, and I know that it's going to be a really insightful story for all of us to hear of why you flew out there.

Sarah Lavonne:
I flew out there for a birth, which is rare. It was actually a scheduled C-section. People are like, "Why? How did you plan that?" I'm like, "Well, we planned it and it was a scheduled case." And this is a client that I have worked with in the past, so backtrack like five years ago, I started Bundle Birth really, first of all trying to pay my bills and I didn't for a long time. And then finally I did, and now I can pay my bills finally. And I can pay other people, which is really, really lovely. And so when I started Bundle Birth, it was like, "How do you pay your bills the quickest?" And it was taking private clients, doing private classes, getting online, doing education for families. And that's really how Bundle Birth started. And it's evolved into Nurses, but the Bundle Birth side is still there, it's still active, and I still do take private clients.
I've cut back. In the height of my days, I was doing four in-person clients a month. So that means four due dates, that means four 24-plus hour shifts. That means constantly being on call, never being able to leave. I call it LA jail. But during the pandemic, obviously I'd had a full schedule and everything closed down. And for almost three years it was off and on whether or not I was allowed in the hospital with them or not. And going virtual, I developed an entire process for providing virtual care. And what became really fun about the pandemic and doing virtual care was now everybody was virtual, literally all over the world.
And so those that really wanted in-person support like a doula, but I do and can offer my background as a nurse, my knowledge as a nurse, my scope of practice as a nurse of what I can do without a doctor's order to my clients legally, they're under contract for that. It's an awkward dynamic for the hospital, an episode for another day. And so I turned virtual in the pandemic, and that led me to meet people from literally all over the world. I had people in Barbados, in the Isle of Man, in Saudi Arabia, in Japan, in Germany, in Australia, in all over the United States, even locally in California. So my load for one of my months, Justine, I took nine due dates virtually because virtually I can do, that was too much. That was stressful.

Justine:
That's too much.

Sarah Lavonne:
And I actually, they don't know this, but I had two births happening at the exact same time, and I managed it somehow and neither one of them knew. And actually the case study that we share in physiologic birth, surprise, was one of them that was happening concurrently with another one in labor. Mind you, I never suggest that for anybody's stress level ever. It was brutal.
So in the pandemic, I met this client. She is from New Jersey, and she'd had a previous pregnancy, previous C-section, and the first birth was really challenging. It was really traumatic. She, as we know, one of if not the biggest predictor of birth trauma is having a history of mental health fill in the blank. So in her case, and by the way, I do have permission to share these details anonymously, but she does have a diagnosis of OCD and anxiety. She has been seeing therapists for forever. She is, in my opinion, what I've learned about her is that she's one of those people that is doing the work. And it's one thing to have those diagnoses and kind of half-ass the work. This one is in the work. She's done so much to manage her anxiety and OCD and all of that, but that was as a predictor into birth trauma.
She also just had a really rough experience. Her first doula abandoned her during her first birth, halfway through left or something, and there was drama there. And so she really wanted to be back. And she's one of those that just dreamt of having the birth of her dreams where the baby comes out and goes skin to skin and she has that bond and whatever. The other thing I've learned about her now working with her through two births is she really, really loves her babies and like all parents really love their babies. I think we were chatting about this very briefly prior to the episode, and I was like, "I really want them to walk away being like, let's not judge our anxious patients," because we don't know what's going on. And I think it's very quickly to make the assumption like, "Ugh, they're a bad mom, or Ugh, they're this, or ugh, how are they going to affect their kids?"
And if I've learned anything about this mom is that she freaking will, she is mama bear for her babies and her world is her children and she will do anything possible for her babies because she loves them so much.

Justine:
That's so nice and such a good reminder.

Sarah Lavonne:
So I worked with her for her second pregnancy virtually in the height of the pandemic, and she ended up hiring an in-person doula because she wanted that in-person support. And then I supplemented, met with the doula. We did a lot of work ahead of time, and what ended up happening with her second was they told her she could have a VBAC and said it was no problem. And towards the end of her pregnancy, she was with a midwifery group, which I think is very unique that this ended up happening. It sounded a lot like a bait and switch. And I want to just be very clear that I am filling in some gaps here because I was not physically present and I am on the side of the patient, I advocate for them and their experience and whatever actually happened in the room, I can picture because I am a medical professional and I know how the system works and I know how we talk about patients.
But I'm also, I'm there to advocate for the patient, I'm there to believe them and really pay attention to the impact of what happened. And so the impact of what happened was towards the end of her pregnancy, she started to get some feelers and started to get some anxiety and some paranoia that they were just kind of gassing her with the whole feedback thing and that they were setting her up for a C-section. And I will say that there were signs of that.

Justine:
Can you share some of those signs because I don't think a lot of labor nurses know that this is a thing?

Sarah Lavonne:
Oh, this is totally a thing with VBAC in particular, and it's the bait and switch. "Well, yeah, no problem. We absolutely can. We'll wait for labor. Well, yeah, you can have your VBAC, no problem. I'm so comfortable with that, blah, blah, blah. We'll set it up." But yes, I'm with the right provider and around fill in the blank, 37, 38, 39 weeks, there's talk of induction. "Oh, well, we're not going to let you do this. We're not going to wait for labor. I don't feel comfortable with that." Or it's no induction whatsoever that like, "If you don't go to labor by this date, by 40 weeks, you're going to need a C-section."
In her case, those started happening at 39 weeks. If you're not in labor by 39, that's not supportive in terms of a VBAC. We got to wait for labor a little longer than 39 weeks. And so that's a lot of the bait and switch that I do see outside of her case. "Yeah, of course, of course." And then later in the pregnancy, "But if you don't go into labor by 39 weeks, we are going to have to have a C-section." Not even offering an induction, which can be done for a VBAC. So sort of those discussions of limitations on what's quote, unquote, "Allowed" for them in their pregnancy.
I'm going to summarize a very long dramatic story that happened with her second pregnancy to get us to the third, because what I really want to talk about is what this team did so incredibly different to heal a birth story. This is a positive birth story. It's also going to be hard in the beginning, but we turned it around. And so with the second she thought she had a good team, they started doing this thing, she started getting anxious. She was talking about, I'm getting calls of like, "I'm going to switch providers." I'm like, "Whoa, we're at 40 weeks at this point." She was pushing it out. Then they're like, "Yeah, we're going to induce you."
And then what it was, I think it was an induction they were talking about and they wanted to get her on the calendar for an induction. She didn't want to do the induction, so they were like, "Fine, but you need to come in for an NST." And then the NST was bad and they were concerned, mind you, honestly, I'm asking actual details and I don't know that I fully believe that the NST was non-reassuring. I mean, I don't know about you, but I've seen shady stuff like this happen where you have an agenda and I could see her being pegged as the anxious, annoying client that fill in the blank.
And so anyways, she goes, they're trying to schedule her for induction. She refuses, so they're like, "Well, you need to come in for an NST. She comes in for the NST, they tell her she needs to go in for an induction. And then there was some sort of deceptive communication where she's like, oh, and then they wanted her to go to the hospital for the NST instead of the clinic. And she's like, "They're just going to induce me, they're just going to keep me." There was something going on where they weren't giving her all the information.
Here I am from Los Angeles trying to advocate for this. And then the doula on top of that had a relationship with the midwives, and so she wasn't feeling supported by that because she felt like the doula was trying to protect her personal relationship she developed with this midwifery team. It was a mess. So she gets to the hospital, of course they're recommending an induction not because of a non-reassuring fetal heart rate tracing, but strictly because she was a VBAC at however, whatever her gestation was, which was not 42 weeks. It wasn't even 41 weeks at this point. It might've been 41 weeks. Not going to lie, I don't remember, whatever. I can pull up the notes, but it's not important at this point.
So all this considered, they're going back and forth, back and forth, back and forth. She's been in the hospital for however long, she's feeling extremely anxious about her care team. She's feeling not supported, not trusting of this care team. Next thing we know, all of a sudden the baby is breech. And to be honest, at one point I get on the phone with the midwife and I'm like, "Listen, I need you to understand this about this patient trying to help mitigate an understanding with what's happening and who she is." And all I was asking for was, "Please see her for her intentions. She's not here because she's trying to harm anyone, she's actually very amenable to whatever the recommendation is. But if she feels like she can't trust you or she feels like there's an alternate agenda, of course she's going to go, 'Absolutely not. I got to run away. I need to flee.'"
And her nervous system was on and it was a mess. And honestly, the actual trauma probably took place prior because of this back and forth with this care team and this untrust. All of a sudden her baby's breech. In my head, I'm thinking like, "Is this baby actually breech or are they over her and they want to do a C-section?" They're like, "This induction won't happen the way, blah, blah, blah, and your baby's breech, so we're going for a C-section." The fact that I even questioned that is surprising because I feel like I'm very much, I feel like one of my powers as a birth coach is helping the client understand what's happening with the birth team and be compassionate about the birth team.
And so moral of the story, she ends up feeling forced into a C-section now because her baby's supposedly breech. And she was like, "Okay." And mind you, how did I reframe in that moment? I remember being like, "So-and-so, this is a gift to you because the back and forth, the up and down, the unknown, the fluidity, the non-rigidity of how labor is challenging to navigate, and then you add your history, you add your concerns to the picture, it makes it, there's never a good answer for you because there's nothing concrete about labor. And so let's see this as a gift. The decision is made and you're moving forward, giving birth via cesarean. Let's turn it around, let's set you up, etc.
And so that's what we did. And the actual surgery was not traumatizing, but it was everything that happened before of her not feeling supported and feeling so alone and sort of backed into a corner. So she has this birth experience the first time around, and fun fact, she did actually have a window supposedly as well. And so of course that rules her out. And with the drama and all that, in my head I thought like, "We're done at this point." But in postpartum she's like, "I really want another." And I'm like, "You had a window, honey. They're recommending, what did they say?" They came in immediately after and they were like, "You can't have more babies." There was that thrown around, which is not true by the way, after two C-sections. And even with a window, you'd be like, "Let's be a little bit more tender given her scenario and the lack of trust already." And it was this whole thing. We're unraveling all the drama.
And so supported her through that experience. And we actually did a birth debrief where we looked at the medical records and partially you realize that all of our patients can request their medical records. They don't need to be suing in order to do so. And so she pulled her medical records and wanted to review them with me and wanted to look at the notes and wanted to get some clarity, so we did that prior to this next pregnancy. And what was so traumatizing in round two that we worked through. And honestly, let me be very clear. I'm referring out to her therapist, identifying and giving her some clarity on what I'm seeing and interpreting this and that. But I'm very much saying, "This is something to take to your therapist, and I think this would be an area to investigate and get curious about," etc.
So I'm not a therapist, but I can help her process that information. And from a medical standpoint, I can say like, "This is what it says and this is what that means." And so in the notes, there were some comments made that were subjective comments by the nurses and by the midwives that she read. And-

Justine:
Can you share that?

Sarah Lavonne:
Do you want me to?

Justine:
Yeah, it's like the tea. Come on.

Sarah Lavonne:
All right, so this is patient 41 weeks, denies contractions, denies rupture of membranes. Patient states, "I am here because I need to be induced. This is ridiculous." In quotes, "Patient of Dr. So-and-so, patient refusing wheelchairs stating I have mental trauma, you don't understand wheelchairs trigger me, get that away from me." Patient screaming in waiting room, refusing to look at wheelchair, patient in no apparent distress. Ambulatory and triage area, patient continues to deny contractions or rupture of membranes. OB made aware of patient refusing wheelchair transportation, patient ambulatory with technician to OB department without distress or difficulty.

Justine:
Why did she need a wheelchair in the first place?

Sarah Lavonne:
Yeah. Well, and why is that commentary necessary?

Justine:
Right, yeah.

Sarah Lavonne:
And also when just from a patient perspective, when the patient reads this, how does it make her sound?

Justine:
A crazy person.

Sarah Lavonne:
Right. And her perspective of how it went was, "I was stressed out, I was already triggered, I was aware of that. And I said, 'No, I don't want to get in the wheelchair. I was not screaming, I was not out of control, I may be stated that I have some trauma from my,'" because she's trying to advocate for herself that, "I have trauma from my previous birth. Take me serious." But, "Patient screaming, refusing, I have mental trauma, you don't understand. I'm here to be induced, this is ridiculous." Even let's just say she said it exactly like that, are patients allowed to say that without us creating meaning and interpretation and also documenting in a way that does make her sound like a crazy person?
And what are they saying to each other when they leave her in the waiting area? "This patient won't get in the wheelchair, blah, blah, blah," when you have no idea. And her hospital trauma goes way back to her being a child, so there's a lot more going on here that we don't get and we don't have access to unless they let us in on, and she was trying to give you access to the fact that like, "This is extra hard for me," and maybe didn't do it perfectly in a way that felt really good to you as the nurse.

Justine:
I like that. Yeah.

Sarah Lavonne:
So I think this is helpful to give an idea of, I would say a more appropriate note, and this comes from psychiatry. So at some point in postpartum they called a psych visit on her, which was hard, but also she realized, and even this time around, she said like, "If you need to call a psych, I understand, I have a history. I know that I can be difficult, I'm really sorry." Saying all these things that are first of all unnecessary. And second of all, this woman has an OCD anxiety diagnosis. And so how much stigma are we creating around it ourselves when we really need to be looking at this stuff as if it's like, "What if it was cancer?" We would go, "Oh my gosh, I have compassion. Help me understand what you need, help me understand what I can do to accommodate what your needs and preferences are based on this diagnosis."
We don't do this for mental health stuff. The brain is an organ and we are responsible for it. So I'm going to read you this note just to give an example. I won't comment too much on it because we got to keep moving, but, "Patient is a G2 P0 who had a repeat C-section on this date with a healthy eight pound seven ounce baby. Psychiatry was consulted for anxiety and obsessive compulsive disorder, which was a known history." Her nurse, "The patient was asking for new unopened gauze even though the stack of open gauze was near the crib. Nurse also mentions the need for multiple new suction bulbs every time they used one and patient wanted vaccinations and circumcision done in room so she can watch. She also mentions patient was very irritable and anxious yesterday."
A psych consult was called for her requesting new gauze and multiple bulb suctions or bulb syringes. And because she was anxious and irritable with a known OCD and anxiety diagnosis.

Justine:
It just shows you how little we know about any of that.

Sarah Lavonne:
Right and just give her a new bulb suction, or wash it, or realize or ask the question, "Is there something that I can do with these gauzes? Would you prefer them to be in a plastic bag? Would you blah, blah, blah? Could we go around it?" And mind you, from the patient's perspective, I believe that the bulb suction fell on the floor and she didn't want to use it again, and so she asked for another one. But how much stigma had already been identified with this patient prior that they called a psych consult on it?
Now, mind you, and she was fine. She's like, "They can call a psych consult. I realize I am followed by psychiatry, especially if you have concerns, please." But also, it felt stigmatizing. So then the patient reports being irritable and anxious about getting another C-section when she desired a trial of labor after C-section. Fair. Whether you have a history or not, that's a fair feeling, being irritable and anxious. She mentions that the prior C-section with her firstborn was very traumatic and gave her anxiety, but during the prenatal period of her first child, she did not experience excessive anxiety.
She reports with the current pregnancy, she had flashbacks and vivid nightmares of her traumatic experience of her first C-section. She reports that she always had some excessive worrying even before pregnancy, but recalls at the start of March when COVID-19 happened, her anxiety increased. Reasonable, correct?

Justine:
Yeah.

Sarah Lavonne:
She decided to see a perinatal psychiatry in April due to anxiety and previous trauma she experienced with the first child. She mentions periods of time she was shaking, she didn't want to leave the house, and she coped with meditation and grounding exercises, which usually were able to calm her down. When these techniques did not work, she would contact her therapist to calm her down. She mentioned that when she came to the realization with the C-section, she's feeling a lot better. Patient does not report depressed mood, feelings of guilt, suicidal ideation, etc. She does report continuous checking of the door to make sure it's locked and cleaning certain household things repetitively. Husband's in the room, agreed that it was at times hard for the patient and mentions that her anxiety and mood is a complete turnaround from yesterday.
So imagine that as a note, when we talked about it, she was like, "Yeah, it's factual." It's not that we have to lie on the medical chart, but it was like that felt like an accurate representation and a non-biased representation of what was going on.

Justine:
Yeah, there was no bias in that note.

Sarah Lavonne:
No, and it's just how it was. And also, if I were to read this as the nurse, I'd go, "Oh, okay. So her wanting extra bulb syringes and gauze in the grand scheme of things with a known OCD diagnosis and a challenging previous day with a outcome that she really had worked very hard to avoid, she might be needing a little bit extra in my care planning of this patient," right?

Justine:
Yeah.

Sarah Lavonne:
So that gives you an idea. I can't find actually the other piece of the note because there's like 300 pages to these medical records and it would take too long, but the idea being that it was hard and that she didn't feel seen, safe, or soothed from her first experience. And so came to me to debrief it, felt like, I mean, her words that I was the only good that helped salvage her second birth to be any bit better than the first. And so she came and was like, "Can I have another baby? Can I do a VBAC?" And I was like, "What did they say?" And they were like, "No, they didn't recommend a VBAC."
And so we talked that through and she started talking about maybe considering getting pregnant again. We went back through, we'd already done the records and then reached out that, "Hey, I'm pregnant again and I think I'm going to do the scheduled C-section." So once again, it's like, I think when we don't have the context, easily you think based on the records or based on interactions that this woman is VBAC to no end. She'd done my VBAC class, she'd been a part of VBAC groups. She'd literally done everything she could get her hands on. She's taken some of our nursing classes, she's taken healing trauma, she took the grounding techniques class that we offer. She's really, really trying to be well and show up and make good decisions and control what she can.

Justine:
It sounds like she did all the right things and it reminds me of when we get frustrated as nurses when our patients do no education, and then our patients do all of the education. So I'm very curious how this next birth went.

Sarah Lavonne:
We prepped for it, started talking about, I navigated with her into choosing a provider and she wanted one that would be understanding of her trauma or would be flexible to her preferences in the operating room. She did toy with the VBAC back and forth, and I just reinforced and just said, "No." And I think that's sometimes what you need as a person, but I had the rapport that could say, "No, honey, we're not doing that. Push it out. I know that's what you want and I'm so sorry. Let me validate your feelings, let me see you, create a safe environment, soothe your nervous system, but we're going to have a beautiful cesarean birth instead."
And so the discussion became how do you choose a provider? How do you put together your care team? And the entire time I'm having all these meetings with her, she's putting together her preferences. We're talking through setting realistic expectations. I'm thinking to myself, "It doesn't matter that we do this unless her care team gives her the benefit of the doubt." And it tore me up inside and I'm like, "Okay, we can say this. Let's word it this way so it doesn't anyone piss anyone off, and let's remove that because that's standard and we don't want you to be seen as that type of patient. And even though it's standard, we can just trust. Are you sure it's not written? No, I'm sure." Let's just get rid of it.
So I'm really trying to set her up to be believed, to be seen for who she is, to be looked at in a good light and not be labeled as the crazy anxious patient. She has a diagnosis and that's what we went to, and that actually felt good to her. She's like, "Yeah, I have a diagnosis." I'm like, "Yes, and that's valid, and we need to see you as a whole person despite your diagnosis."

Justine:
What's frustrating is that you felt, you knew you had to do that because you knew what people were going to say.

Sarah Lavonne:
Absolutely.

Justine:
Yeah. And that's really sad.

Sarah Lavonne:
Yeah. But until we change and until we are aware of our bias, of our stereotyping, of the nuances of communication and our judgment, I can't trust that she's going to show up to the hospital and the nurses aren't going to look at her birth plan and think she's crazy and make that assumption without even knowing anything about her, which just felt so unfair to me and so frustrating that I'm sitting at her and I'm seeing her let go of things, I'm seeing her navigate her preferences, I'm seeing her express her heart and soul and her love for her family, and that she just wants a different experience. It's not that serious. Her requests are not crazy.
She had preferences that she wanted validated, and if it wasn't safe, she was like, "Okay." But how often, whether it be the birth plan or whether it be the quote, unquote, "Crazy hyper patient" that was telling you they have trauma and, "I don't want to get in a wheelchair," because they've had this days-long experience where now they're leaving their child for their first time and they have their own childhood trauma that's playing in, and they have their two previous traumatic birth experiences, or I guess in that case one previous birth experience, they're feeling alone and isolated. They have trauma from the medical system and they just don't want to get in a wheelchair. It's not that big of a deal. We can accommodate each other.
And so we navigated this whole thing. And I thought to myself, I said, "What do they do in other units?" They bring together the interdisciplinary care team and how different it might be if they could just have a window into who she was and they might be more accommodating. They might actually consider doing things in the operating room to help create this healing experience and be invested in the process to help her navigate this new birth and actually create a healing environment that is safe. Nothing she was asking for was unsafe. It was just, "See me, believe the best of me." And her worry now going into it was constantly that, "They're going to make assumptions, they're going to see me as crazy, they're going to call in the psych, they're going to blah, blah, blah."
When none of that, and I have worked with this patient and I have clinical background expertise, this patient is not off her rocker. Yes, she has a diagnosis. She is so realistic, she is so open to education. She will listen, she struggles, she shares her struggles, she's very articulate. She's honestly one of, if not the most boundaried patient I've ever worked with. And she'd be like, "I'm sorry if this is too much. I'm sorry." I'm like, "You have paid me for unlimited time." And she's like, "I'll pay you for this." I'm like, "Nope." "Do you have a moment right now or get back to me when you can?" The most boundaried human, but no one's going to see that when she walks in for her two-hour prep and they're in the room for five seconds asking her a million questions. And then she has one moment where she refuses a wheelchair and now she's pegged.
And so I thought to myself like, "Well, let's try. If we're going to do better, this may actually make a difference if they know her." And she's a scheduled case, so obviously an unscheduled C-section, maybe not. And to me, she's this unique risk factor patient. If we actually are trying to give individualized care, what if we pulled together the nurse on for that day, the doctor, the anesthesiologist? She's able to share her preferences. They validate her preference, they negotiate what's most important to her. And the whole time, honestly, the big one was she wanted skin-to-skin in the operating room. And I'm like, "Have you asked them?" And supposedly that was not a thing they've ever done.
And so I was sitting there trying to set realistic expectations like, "We can do beautiful things, there's other ways to bond." I'm trying to talk her out of it because I'm thinking like, "First of all, I'm not going to be there at this point." I wasn't going to be there because I had other clients I was on call for, and it was right after Cancun and all this stuff. I had another trip. And second of all that we can't expect something that's not done that like maybe they'll make an exception, but I want you to be ready that they're not and you still have a good experience. And she couldn't let it go. And I was just like, "Oh my God."
So what happened? She emailed, I gave her the to-do, I said, "I'm happy to help facilitate a meeting." But also, I'm the awkward doula that they're like, "Who the hell is this doula? Who does she think she is?" And she's butting in and all of a sudden there's all sorts of stigma about me and my role, so I was trying to also stay back and not piss anyone off that like, "This doula is too involved. Who does she think she is?" And so she emailed. She somehow got ahold of the manager and got the manager on an email. And luckily, this hospital has done some Bundle Birthy things, and so that did assist in the process, but I want to actually speak to that because I think there's something really beautiful about that, but I also think there's something we need to pay attention to. So help me come back to that and put together an interdisciplinary meeting for this scheduled C-section.

Justine:
Was it in person? How was that done?

Sarah Lavonne:
On Zoom. So the OB actually couldn't make it and I was like, "You really don't want to do it without the OB," but this OB, I guess is really old school and doesn't really care, like very loosey goosey. Anesthesia was there, the nurse was there, there was a second nurse there, there was the main manager person who was organizing the schedule. Her psychologist came.

Justine:
Oh, wow.

Sarah Lavonne:
Interdisciplinary. And then I ended up having to miss it, the first one because I was at a birth, but she did it by herself. And so I prepped her, I coached her, I gave her little prompting words to get her going, and she stood up for herself. She voiced her opinion, she voiced her preferences, she explained and they listened. And guess what? They all of a sudden we're accommodating her preferences. "Of course we can do this." They responded by seeing her, creating a safe environment for her to share, and soothing her nervous system. She walked out being like, "Okay, I think I'm okay." And then we ended up having another meeting with the main manager person just for me to get up to speed.
And then she asked, "If I flew in Sarah for the birth, would you let her in the operating room?" And we know that the doula in the operating room, the end of the world, it's totally an absolute no, and they get in the way and all these things. And yet because they could look at the scenario and began to see her as a whole person with unique needs for this specific scenario, that might actually not only benefit the patient, but that might benefit everyone in the room because I have a very trusting rapport with this patient, and I also know your world. They were like, "Absolutely. If she can be there, we will totally let her in the room."
Mind you, a piece of me was like, "Will they be able to hold up all these promises that they've made?" And they were like, "We're open to skin-to-skin in the OR. We'll have to see about the day, we'll have to see about the baby." All realistic. Patient's like, "Great, no problem." The fact that it was even an option that it was considered would've likely been enough. And so I actually had two births that week. They both delivered before her scheduled date, and I was going to AWHONN for convention on Saturday. Her scheduled case was on Friday. I was already flying out to that side of the world, so they flew me out. I showed up. They held up every ounce of the promise that everybody came in, the nurses came in, and they were like, "Hey, so I know that..." Already knew about her.
She felt so seen. And they were like, "Yeah, we'll do this. No problem. Do you want to do this?" They gave her every ounce of control like, "Do you want to wear the gown? No? You want to wear this? No problem. We can do this. What about this? Do you want this? Do you want this? Do you want this?" Instead of telling her anything, I literally did not see them do one thing where it was like, "You need to do this." And mind you, by the way, she did everything they would have wanted her to do. She wore the gown, she wanted this, I think it was like a bra or something. I don't remember, wanted this and that. That made her feel more, "Oh, no problem. Absolutely, sure, we'll walk you in. Your doula can come, blah, blah, blah, blah, blah."
I'm in the operating room, she had this healing birth experience. There was little nuances of, "I don't want to know what's happening in there. If I have a window, don't tell me in the moment. It's too stressful. It'll take my brain out of the game." You're working with somebody so introspective who is doing the work, and yet how quickly that patient would have been seen as crazy, or as annoying, or as whatever. But instead, every single person on this team accommodated her preferences. She did skin-to-skin in the OR, her husband did skin-to-skin in the OR, the baby breastfed in the OR.
And you talk about, and actually I'm going to pull out her text that she sent me by the time I got home because there's just pieces that you just don't know sometimes how it went. I'm going to cry thinking about just like what we can do and the power of just listening, guys. Please stop and listen. Please stop making assumptions. Please stop writing their stories because there are patients on the other side of this who have the potential for having redeeming birth experiences, bonded birth experiences, and I got to be with her in postpartum and see her in person. She's not crazy. She has a diagnosis and she knows how to manage her diagnosis. You want your nurses to show up and see you and allow you to feel vulnerable and feel what you feel and express those feelings and adjust.
If she needs freaking 500 pieces of gauzes, if that's what's going to... Gauzes, gauze or whatever they're called, if that's what she needs, or an extra bulb suction, get over yourself. I'm sorry. I am getting heated here, but because it's like when you see it both ways and too often we are seeing the opposite, that this should be the norm. And it doesn't mean we have to do an interdisciplinary meeting prior twice for every single patient, but maybe we need to do them every so often. And maybe we do need to accommodate people's preferences, and maybe we do need to explain better. Maybe we do need to ask for permission, maybe we do need to look them in the eye and give them the benefit of the doubt and stop writing their freaking stories.
So here's some of her reflections just in our texts back and forth, and of course they're going to be grateful to me because she's talking to me, but I want you to see the bigger picture of this is what it looks like to walk away from your birth intact in your brain and your body. And she wasn't fully intact because she had a C-section even. And you can even have a healing cesarean. "I'm still getting over how fast all that went and to find words to express our appreciation. We wanted to thank you literally from the bottom of our hearts. Your presence and support were more than I could have ever wished for. We hope you enjoyed New Jersey even for a short while and felt our immense gratitude for having you be with us in person."
I said, "How are you feeling about the birth?" She said, "Feeling great about it. Still foggy on some things, but that I definitely want to talk about, but I'm not feeling triggered or trauma. Your pictures helped me see so much more than I remembered. Sorry for literally crying on you for the spinal. That was stressful."

Justine:
They let you support her during the spinal?

Sarah Lavonne:
Yes. Oh my God, I didn't even say that. That was a piece of it, that she felt that separation and that isolation in her two other persons. And she was just like, "Can my husband be in there? Can they please?" And I was just like, "There's no way." I literally told her, "It's not going to happen. Let's do some work, bring it to your psychologist. It's not going to happen." And sure enough, we're there and they're like, "Sure, come on in. Which one do you want?" They let both of us be in the operating room. They put her husband towards the side and I was like, and mind you, she chose that, but it could have been him. And I was there and she's crying and I'm talking her through. But I think there's an element of like, "Yes, it was me."
So again, I do have to say that yes, I think there's a comfort in, especially if you know who I am, they're like, "Oh, well, she knows what's up. She's not going to break sterile." In fact, I was like yelling at her husband at one point. He walked by the blue and no, I was watching it happen. I'm like, "Back over here." And so yes, I have context for that, but what can we do? The question really being, what can we do to go above and beyond and adjust our own comfort zones for the sake of the patient's healing birth experience? And sometimes it might be a spinal, give me a break. You don't draper until after the spinal. What is the big deal? People stay in for epidurals. The needle's the same, there's no tube. It's literally the same thing.
To me, as I was thinking about it, I'm like, "Yeah, I suppose. What is the big deal?" And I helped her lay down and then I got out of the way. And what if we just talk to the doula? And I'm not necessarily saying that we need to let doulas in the operating room, that's not a hill I want to die on whatsoever.

Justine:
No. I've been thinking we let students, we let nursing students with barely any experience in the OR and they're fainting on the wall sliding down the wall. So I don't know.

Sarah Lavonne:
You know what? That's a really good point.

Justine:
And when you said that, I wanted to mention that.

Sarah Lavonne:
We just got to think about it. Our decisions make a difference. What we hold to, "Oh, it's just not the way we do it." These are human beings and there are ways in life. In fact, there's stupid business stuff that I'm like, "I'm just going to call and ask." And sure enough, a lot of times you call and ask, and the answer's yes because they're a customer. These are customers. And not only that, so we have a certain customer service experience that we need to provide, but also they're human beings on the most important day of their life. And so when I walked away from this, I grabbed all the nurses and I was like, and to date, I have never seen a unit center around a patient better than this hospital in New Jersey ever. And it went into postpartum. It was nuts.
And what did they do? They saw her, they listened, they gave options, they adjusted a little bit of their workflow for the sake of the patient. Now, there may be patients that are like, "It's fine if my doula doesn't come in." In this case, it was very, very important that I was there. And not because I'm some magic worker, but because of the investment that I have made in relationship with this woman for now like three years. That actually you may not even know. And these nurses, they didn't know that I've met with her, Lord, for hours upon hours of one-on-ones. This woman has paid for my time, and that has proven itself to be invaluable. She is investing in a better experience, and it worked for her, but it only worked because we were a team in allowing me to do my job and you all to do your job.
So if you are one of those nurses and you're listening to this, gosh, I hope so. I wish I could say the name of the hospital. If you DM me on my personal, I will tell you which hospital it is. So Sarah Lavonne on Instagram. I will tell you in a non-business sense because it's not that big of a deal, but I'm not going to put it out there publicly, and that's based on permission of the patient. But you did an incredible job and thank you for modeling what it looks like to be patient centered and giving, and I hope that they experienced something different and how good it felt to believe a patient and to be on their team and not have to live in such opposition and such judgment. And it really doesn't have to be that way.
My takeaway would be just see your patients, just pause at the door. Everything that we've been saying for how long like, "I am tired of it." And I still do births. The last birth I did, I was just like, "What is this? It's so discouraging." And I know that so many of you feel discouraged about wanting better and wanting to do more and wanting to see your patients and wanting to soothe them, but so often it's just those little, little micro actions that lead to macro impact. And in this case, it really changed a family's life.

Justine:
Thanks for spending your time with us during this episode 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 think about one micro way that you can adjust your own approach to your practice to see our patients better, to soothe their nervous systems, and help them feel safer. We'll see you next time.