Join us as we explore empowering in-hospital birth practices with Angela Anderson, a dedicated certified nurse midwife with nearly three decades of experience. Angela emphasizes the importance of trauma-informed care, informed consent, and shared decision-making to ensure respectful and empowering birth experiences for all. We discuss innovative practices such as water births, the use of nitrous oxide for pain relief during labor, and family-centered cesareans that enhance maternal and newborn outcomes. Angela also shares insights from her work on the Simply Birth Program, which creates a supportive, home-like environment within the hospital setting. Additionally, we reflect on the empowering messages from the recent 'Barbie' movie, linking them to women's rights and the advocacy work in midwifery, ultimately inspiring hope and change in maternity care.

Angela Anderson, a certified nurse midwife with nearly three decades of experience, shares her profound journey into the world of midwifery, emphasizing the importance of empowering birth practices that respect women's autonomy. Growing up on a sheep farm, she developed a passion for birth that led her to a fulfilling career in midwifery instead of traditional obstetrics. Anderson highlights the midwifery model, which views pregnancy and childbirth as natural processes and prioritizes the preferences and autonomy of birthing individuals. This episode delves into innovative practices in childbirth, such as water births and family-centered cesareans, which aim to create a more supportive environment for mothers and newborns. Anderson also discusses the Simply Birth Program, which provides a more home-like atmosphere within hospitals, allowing for personalized care that honors the birthing experience. The conversation focuses on how these advancements contribute to better maternal and neonatal outcomes, making birth a more empowering experience for families.

A significant portion of the discussion centers around trauma-informed care and the necessity for healthcare providers to engage in respectful communication with patients. Anderson emphasizes informed consent and shared decision-making as vital components of a positive birthing experience. The episode addresses the trauma that women often associate with childbirth, even when the medical outcomes are favorable, underscoring the need for debriefing and support in the postpartum period. Anderson advocates for a culture shift in maternity care, where providers prioritize understanding and addressing the emotional and psychological needs of their patients. The episode concludes with reflections on the impact of the Barbie movie, which resonates with themes of women's empowerment and the importance of advocating for respectful maternity care. Through her insights, Anderson inspires listeners to recognize the transformative potential of compassionate care and the ongoing need for advocacy in maternal health.

Takeaways:

• Angela Anderson emphasizes the importance of empowering women through informed consent and shared decision-making in childbirth.
• Innovative practices like water births and family-centered cesareans enhance the birthing experience for mothers and families alike.
• Trauma-informed care is crucial in maternity settings to ensure women feel safe and respected during childbirth.
• The Simply Birth Program creates a home-like environment within hospitals to promote natural, empowering birth experiences.
• Angela's work highlights how vital it is to debrief and support women after traumatic birth experiences.
• The conversation reflects on how cultural narratives, like those in the 'Barbie' movie, can inspire women's empowerment and advocacy in healthcare.

Companies mentioned in this episode:

• Intermountain Health
• Utah Women and Newborns Quality Collaborative
• UWINK
• Authority Magazine
• Utah Health and Human Services Department

Good afternoon.

Rather, if you could just introduce yourself and give a little bit of a backstory for our listeners, that would be great.

It's morning where I am here in Utah.

So thank you so much, Lucinda, for giving me an opportunity to talk a little bit about some of the things that I'm passionate about.

My name's Angela Anderson.

I'm a certified nurse midwife, and I work clinically at Intermountain Health, which is a healthcare system that encompasses seven states these days.

But I practice clinically, attend births in Salt Lake City, Utah, and been a midwife for almost 29 years, coming up on 29 years in January of practice.

And I am also the advanced practice provider director for certified nurse midwives in Utah.

So I have a dual role there.

I became passionate about birth as a child.

I grew up on a little hobby sheep farm in Ohio and just was surrounded by birth in the lambing season in particular, and so knew all my whole life that I really wanted to become involved with birth and then ended up coming to midwifery in a different way instead of choosing the traditional obstetric goal.

But it's been a wonderful career and I've really enjoyed my years of caring for women and families.

And I do want to just acknowledge really quickly that not all people who give birth or choose to parent identify as women or mothers.

But for our conversation today, I'll use these terms, and out of disrespect to people who feel differently, of course.

Thanks for saying that.

Can you explain mid.

Did you say midwifery?

Yes, midwifery.

So midwifery or midwives?

The midwifery model is really centered on the beliefs that pregnancy and birth are normal life processes and should be treated as such with respect for the woman's autonomy and preferences.

And midwifery really doesn't just focus on pregnancy and birth completely.

We actually treat women across the lifespan, which includes during the teen years and all the way through menopause.

But I think for the article that I wrote, we were really talking about improvements and innovations in the childbirth space.

Yes.

And I appreciate you so much.

Just not only did you come forward and respond to these questions, but I was really blown away, not only by your years of experience, but the research, the field research that you've conducted, and then the action that you've taken based upon that.

Thank you.

You're very kind.

I.

This interview or the article that I wrote in Authority magazine we wrote together, really gave me such a wonderful opportunity to talk about all the things I'm passionate about.

I felt like it was tailor made for me, which was fantast.

Apart from my clinical work and my administrative work, I'm also the R.

Perinatal Quality Collaborative Board Chair, which is the Utah Women and Newborns Quality Collaborative, which we fondly refer to as UWINK as a cute little acronym.

And we just have this incredible group of dedicated volunteered volunteers, providers and Department of Health folks or Health and Human Services nursing staff all across the board who are really engaged in working on improving outcomes in our state.

And being able to mesh that with the clinical care that I do has just been such a satisfying place to be in my career.

Because we've been a little bit behind in accepting water birth as a practice in the United States, where definitely other countries, the UK in particular and Scandinavia, have really appreciated that water births can be a nice offering, especially for low risk women.

And we knew from focus groups with our patients throughout the Inter Mountain Health system that they were interested in this and they were interested in this in the safety net of the hospital setting, where out of hospital birth is actually pretty prevalent.

In Utah, we tend to be one of the top five states for women choosing to give birth outside of the hospital.

But we were hearing from our patients that they would like to have this option within the hospital as well.

So we ran a study for those years and really were able to show that we could provide this service in a safe way for both moms and babies and that we really had high satisfaction.

Then the pandemic hit and we had a little bit of a little bit of a step back to try to implement this as a regular service.

But we are now offering this as a regular service in one hospital with plans to expand to other hospitals.

And I think that was a really nice example of how we took what women and families were telling us and then applied more of a research eye to it and being able to show that we could do this in a safe way.

To me at least, and many of my friends and colleagues, that is almost like unheard of really.

And that's interesting about water births being more widely used or normalized in the uk it seems like using nitrous oxide during birth is also more of a of an overseas practice.

Some of the kind of the hallmarks of the patient centered choices we're offering Water birth is one, but which is still being rolled out to different hospitals in our system.

But nitrous as an offering for labor is in several of our hospitals now.

It's a nice adjunct for relaxation and relief during labor.

We also have family centered cesareans, which is when someone needs a cesarean birth.

And as long as mom and baby are doing well, we hand the baby over the surgical drape.

Right.

To do skin to skin with mom in the operating room.

And so the cord is draped over that surgical drape to do that delayed cord clamping, which we know improves outcomes for babies.

And it's just keeps this moment as a family moment as opposed to the long tradition of us cutting the cord quickly and handing the baby off to the, to a resuscitation team and the baby comes back to the mom and family who are in the operating room.

But this keeps it, it keeps it more family centered.

And people who experience this, and especially if they had experienced cesareans in the more traditional way, have just raved about what a difference it is to really feel like they have that moment of skin to skin while the delayed cord clamping is happening.

And we've been able to show that we're able to maintain sterile technique.

And the risk of infection hasn't increased by us doing that.

And that's again, we're implementing this hospital by hospital.

We have to assess where providers are engaged and wanting to do this.

And then I think we can prove it in one place and then start to expand it to other places as people get comfortable with the ideas.

I have to say that I.

So I have twins are 17 months old.

Are you getting any sleep?

This time will pass.

That's what I've heard and what I've heard.

But yeah, I had a cesarean and they were, I was high risk.

And twins is a complicated, A complicated pregnancy and a complicated birth.

Right, exactly.

And I definitely did not have that skin to skin with either of them.

And I, I'm sorry.

Thank you.

I really just can't, can't imagine the difference it would have made for me to have had that.

Yeah, yeah.

It really is a lovely bonding moment.

And of course, the things that have to be there are that mom needs to be doing well and babies need to be stable.

So if a baby's preterm or there's something else happening, then we can't provide that.

But hopefully we're able to provide that in the future when mom and baby or babies are stabilized and catch up on that skin to skin time.

Maybe just With a little bit of.

A delay for that to be prioritized or at least thought about.

Yeah.

Is so important.

And I can't take credit for those.

This kind of came from, you know, a different influence outside.

But we, we just have such an incredible team of obgyns, midwives, maternal fetal medicine, of course, our nursing staff, all working together to make these things come to fruition.

Another thing that we're doing that is more widely accepted at this point is our simply birth program, which is a birth centered type environment, or even, you could say more of a home like environment in the safety net of the hospital setting again.

And the nice thing about this is that there's childbirth education geared toward it.

The rooms look a little more homey and nicer.

We have big tubs where women can really get immersed during labor.

But when somebody comes in enrolled in the assembly birth program, everybody knows the education they've had.

Everybody knows that this is their goal.

And so we're working together for this goal.

And although, you know, the Midwest remodel, for the most part we give bedside labor support and we try to give that care anywhere.

In the case of simply birth, everybody on the care team is aware of this is the goal.

Sometimes in the middle of labor, a woman will decide, I'd like an epidural.

I think I'm not going to proceed with this plan.

Things change when you're in the middle of it, and that's okay too.

We 100% support women in the choices that they're making in this space.

And being in the hospital, you can pivot to that, right?

You don't.

We've got an anesthesiologist down the hall and we're.

You can make that change in your decision and move on in a different way.

But still, with that kind of support for autonomy and preferences, it makes such.

A enormous difference for the woman to be.

For the birthing parent, to feel listened to, feel heard, to feel like she has power or is empowered in some way, because you have to be.

You have to go on to be a mother or a parent.

And it's hard to go on to be a parent if you've just had this very disempowering, traumatic experience.

Right.

That's a very good point.

I.

I like to joke with some of my patients that labor just tends to be one long day and then you have to raise.

Right.

That's the rest of your life.

That's the hard part.

But it is.

Everybody remembers their birth stories.

I can think of so many births that I'VE attended where there have been grandmothers and even great grandmothers in the room.

And during the process of labor, people share their birth stories.

80 year old women are sharing their birth stories.

It stays with them forever.

And I feel like we are lucky and honored as providers who work in this space to be invited to one of the most intimate events of a woman's life, of a family's life.

And we need to treat that as sacred.

And we need to be sure that they are listened to and respected and that we engage in shared decision making as opposed to telling people, you know, what they need to do and how they need to be.

And sometimes people make choices that we as medical providers feel uncomfortable with or don't feel is medically safe, depending on the situation that's happening.

But truly, if we are giving people the information to make those decisions, the decisions are theirs to make.

A lot of women perceive their birth as being traumatic, and that's even when things go well.

And I think listening to women and respecting women and engaging in shared decision making makes a huge decrease in that perception of the birth is traumatic.

And if somebody does experience their birth as traumatic, then we really need to try to help them process that and debrief if something happened.

If they have a hemorrhage or something was scary in the birth, we need to sit down and talk to them, debrief what happened, bring their family, and give people resources to cope with that because it's a tremendous event.

And as I said, people remember their birth stories forever and we want to try to make them as positive as possible.

You're.

I just respect and admire you so much and you're so sweet.

Thank you.

That's so important.

That's so important.

And I don't think I realized until after my traumatic birthing experience.

And then someone explained to me that it should be sacred.

It should be the most empowering experience of your life.

You're here, you are pushing life into the world.

And you, you shouldn't leave the hospital feeling confused, feeling like what just happened or something was done to you.

No, I agree.

Or defeated.

Right.

I feel some.

Yeah.

Shouldn't feel defeated.

You should feel.

And sometimes complications happen.

We can't prevent that.

And sometimes there is a need for a cesarean birth.

Right.

But if we can do our best to really listen to women, listen to their concerns, make them feel heard and understood, and educate, tell people what we're doing and why we're doing it, what the rationale is, every step of the way, we should never be doing things to people without explaining why it is that we're recommending these things.

Right.

And of course, we need to be asking for consent for every kind of procedure.

Anytime we touch somebody, we need to be asking for permission.

Our Uwank organization has just put together a really nice set of resources for perinatal trauma, and we think it might be the most comprehensive set of resources in our country.

Australia also has a really nice set, but we looked, we did a big search across the nation to see if anything else existed, and we didn't see it.

And so our incredible team at the Utah Health and Human Services Department has put together a nice set of resources for women, Chandlers and also providers, because providers can experience trauma if there's a complication or something doesn't go well.

So it's available on our Ewing what website?

Anybody can access it and use it.

But we're really excited to be able to have those resources to offer to people.

Can you explain Trauma Informed Care?

Yeah.

So Trauma Informed Care is really trying to acknowledge and honor where people are coming from.

So many people have experienced trauma in their lives and wanting to be certain that we utilize consent.

And again, in every step of the way that we're educating people with the things that we're doing and that if we have the ability to screen for, like, childhood.

Childhood adverse events that we can.

Or also if there's been any history of intimate partner violence or any kind of traumatic event, sometimes people just come in with.

My first pelvic exam was terrifying to me and painful.

And because they had that experience, now every time they come into the space where they might need to have a pap smear or a pelvic exam, they feel frightened and really honestly terrified of what the next steps are.

So doing what we can to give the control back to the person.

And even if they haven't had this experience, and I think we want to treat everybody as though they may have had this experience and explain what we're doing, give the control to the person.

Like I always say to them, we don't have to do this today.

Like for pap smear, we don't have to do this today.

If there's a point where you feel like you want a break, you want to come back a different day, you're in control.

This is your body.

You're in control.

And then asking consent and telling what you're doing every step of the way.

I ask permission to lift the drape, I ask permission to touch their leg, and then to go on to touch the vulva before we go on to these other, the other procedures in that way.

And I think that just needs to be across the board.

Like when we take a blood pressure.

Ask permission before you touch someone and tell them what the rationale is.

That's.

Yes.

The anxiety, being at a loss for words.

It seems so simple.

Right.

I just think sometimes as providers and healthcare givers, we get in this.

These are the things we have to do.

Right.

These are the steps we have to do.

We have to go take vital signs and it does not take much longer to say, we're going to check your blood pressure now.

We're going to check your blood pressure every hour, and here's why.

And.

But even though you've said that, then is it okay if I put the blood pressure cup on again?

Okay.

Are you ready for that?

Would you like to get up and empty your bladder first?

Just really being.

Providing a space of safety, making people feel safe, being trustworthy and being transparent about the care that we're giving and why, and empowering people to have a voice and a choice.

I think these things are all really important.

Yes, they are.

And I think as women, for women, for all women.

Just kidding.

I think as women, we become used to being told, just deal with it, just deal with it.

Just deal with your pain, just deal with your whatever, don't complain.

And so we can forget that we deserve better.

My heart hurts for people who have those experiences.

And we need to be better in healthcare.

We really do.

Does it take something to say that?

Does it cost something to say that?

Or can you just say that?

Yeah, no, it's.

That's what I'm saying.

Like, it doesn't.

It does not take that much more time to explain why we're doing things and to give people that pause and that ability to consent to whatever work it is that we're asking them for.

And granted, they're coming and engaging with us for healthcare, so they're already trusting us with their lives and their bodies.

But we need to continue to provide a safe space and be transparent in what we're doing and why.

And again, shared decision making is just so important to be sure that we're informing people and giving them choice and autonomy and listening to their preferences.

And even in the cases of where we have a true emergency, let's say somebody's in labor and the baby's heart rate goes down and we have a set, set protocol and things that we try to do to get those, that heart rate to come up, we change positions, we increase IV fluids We check the cervix, see if there's been some big change.

And we have a few minutes before we are.

We feel like, oh gosh, we need to be moving down to the operating room.

The rule of thumb is we have three minutes.

If we're in a big deceleration and we can't get it to come up, but during that event we can still be talking to people like, okay, I really want to check your cervix now.

Your baby's heart rate is down.

Here's what we're going to do.

Just talking to people in real time as we're doing it, so that they're understanding.

And then because that when that event happens, it happens quickly and people are trying to process it.

And often if in many places there's a stat team called or a lot of people will come into the room, if we're worried about the baby's heart rate, saying a whole bunch of people are going to come into the room.

And then afterwards, hopefully we get the babies heartbeat up and then we continue with labor, then we sit down and say, okay, let's talk about what happened.

And do we, if we know why it happened, gosh, if your blood pressure dropped, it happened because your blood pressure dropped and when we changed your position, your blood pressure recovered.

Or if we don't know, then, gosh, we don't know why this happened.

But we're going to keep a good eye on the baby.

Things are looking good now.

Do you have any questions about what happened?

So even when we have truly emergent or urgent situations, we still need to be talking to people and not just doing things to them and explaining what happens.

Sometimes they're like, wait, just give me a couple seconds, right?

And then we need to be able to take a breath and say, okay, you know, give them those few seconds and then say, can I now please do this thing, whatever it is that we're wanting to proceed with next.

And I think sometimes providers feel uncomfortable with this, Right?

We're worried that litigation is very common in our country, malpractice suits and people worry if I'm not doing everything to improve the situation, will this come back in a legal fashion in the future?

And I think that it just documentation here is so important.

But we have to acknowledge that people have the right to make choices and the shared decision making part of that is giving them the information and allowing them to choose.

And then on our end, if we just have a good documentation of those conversations in the record, then we should also be protected there.

Feel like, yeah, I, that sort of post mortem.

I, I don't think that's the right word to use.

Maybe debriefing, oh, boy, there's no mortem happening.

Debriefing, that is.

I, I just feel like that never happens.

And I think it's so important.

And in fact, I tell people fun there for their birth.

And we have a practice where we're a group practice.

We have a commitment to bedside labor support, but they don't necessarily know which midwife is going to be with them in labor.

But I'm with somebody and something happens in birth and I'm like, please schedule your postpartum visit with me so we can go through this again, so we can pull up the tracing so we can talk about what happened, so we can answer any questions.

And also feel free to reach out at any other time so we can help you unpack what happened.

You're in the middle of labor and there's a lot happening to your body and it's sometimes overwhelming.

And then if an event like that happens to try to figure out how to put it all together when you're still just trying to cope with what's happening in your body, it's important to make space and invite people to continue to talk about the event and process it.

And again, like I said, give them resources if they are still feeling that they're holding some trauma about it.

Yes, you have to know the information.

You have to know what happened, even if it's upsetting, it's hard to hear, it's painful, you need that information and it's harder to understand it or know what to do with it.

If you're.

I guess I'm talking about with my babies.

Really, like, what exactly happened at birth?

And it.

No one ever explained it to me, so I have records, but this sentence doesn't necessarily make a whole lot of sense to me.

Medical jargon.

Yes.

Yeah.

So I know, like, the important things that I've had to take action on, but I still don't know, like, completely.

And I thought, like, maybe I don't want to know, but I need to know.

That's the information you need to know.

And it would have been.

It's nice to have that continuum there for you personally.

There may be an opportunity to reach out to your provider and say, I really still have some lingering questions and can we make an appointment to sit down and talk about these things that might be something that you could consider.

There are times that I will see somebody after the birth and they will tell me that they felt traumatized by a specific part of it.

And I'm surprised because in my mind, I was there and everything seemed like it went great, and they have a healthy baby and everything went well.

And I have to acknowledge that this is the person's experience.

Right?

It isn't how I thought it went.

It's how they perceived the event.

And if that event, even if it was medically perfect and everybody's healthy and happy and goes right home from the hospital, we have to acknowledge that's their experience, which can be hard to do as a provider because you can feel.

It can make you feel a little bit defensive.

Gosh, I did everything great.

What are we talking about here?

But that's not.

When it comes to perinatal trauma.

It's not my lens.

It's the woman's lens that's important.

We're spending a lot of time doing trainings on respectful maternity care, and as I said, getting these perinatal trauma resources out to people so that they know that it's there, and also just giving them the information of just how common it is for people to express that they felt traumatized by their birth.

It was much more common than I expected and was sobering, really, that this is the.

This is almost more.

It's more common than you would think.

So trying to really, in our state, trying to really communicate this to all interested parties, the women in family, the providers who give care, nursing staff.

We've been doing some training in the individual hospitals for nurses about respectful maternity care.

And we've just had incredible feedback from the nurses of how this really opened their eyes.

And they never thought about the things that they were doing as necessarily traumatizing.

And it really is that simple stuff I was referring to before coming in and just taking a blood pressure without saying why you're doing it or telling somebody or making somebody feel like they can't move because we're having a hard time picking up the fetal heart rate.

And then the woman feels like, oh, I can't move because I don't want.

She can't get the baby.

And then they are just spending this entire time in one frozen position.

That is uncomfortable.

So just.

We've received so much positive feedback from the nurses who have been part of this training.

And, wow, this really opened my eyes to how I could be perceived.

And I can make some small changes to be part of a team with this woman as opposed to being the person who comes in and does things to them.

Yes, that's been very gratifying.

Our.

I haven't been able to participate in that part of it personally, but I know that our Lewis who have.

Have just said that it's been.

People have been in tears all around at just how powerful and meaningful it's been.

That's such important work.

It's such important work.

Agreed.

Yes.

Wow.

I just can't thank you enough.

I'm just.

I'm given so much hope and encouragement.

The movie Barbie, of course.

And dressed in a Barbie costume when I went to see it.

You're like.

You're like this Women's rights, childbirth with Barbie.

God.

But yeah, that movie was amazing.

Right?

What a wonderful, empowering movie.

Yeah.

And the big monologue speech really talks about.

You were speaking to before about how there's so many expectations placed on women and.

Yes.

I appreciate you so much giving me this time to get on my soapbox and just talk about all the things that I feel so passionate about.

I really appreciate it.

Oh, I appreciate you so much.

Thank you so much.