Pushing Back Against Fear

I am not very good about guarding what I say. I am awkward and often say the wrong thing. If an act, statement, or policy is harmful, unproductive, or meant to limit my ability to improve, I tend to speak before my passion can be tamped. I have gotten in trouble for making a “thing” out of a moment and bringing a concern to light. Unfortunately, there have been plenty of inopportune misunderstandings, and my actions negatively hurt myself or others, creating fear instead of change.

We encounter fear in many forms; fear of loss, fear of harm, fear of the unknown, fear of physical, psychological, and emotional pain, fear of inadequacy, fear of punishment and repercussions for ourselves and those we love, and more.

The use of fear to align others with a specific ideology, behavior, or action is written throughout history. Fear motivates positive and negative responses and can create those responses en masse if utilized correctly. Fear can motivate a kind of peer pressure so intense that those who do not conform encounter danger to themselves and their family simply by choosing not to follow and not to be afraid. Fear shut down the world and had neighbors calling authorities on neighbors for simply being outside their front door.

I understand that fear is an amazing change agent! Targeting one person on a team, when that person is leading a policy change or encouraging transparency and a better environment for the team can quash all momentum and stop any movement toward change. Using fear to set an example works.

This is especially true in the patient care setting, where the use of coercion, threats, gaslighting, narcissistic behavior, deflection, and fallacy is used to gain patient compliance. It can happen to anyone, even the most seasoned patient advocate I know.

I encountered the use of peer pressure and fear of failure in a recent conversation with an MD influencer. This MD used her platform and personal success with an elective 39-week induction to encourage her followers to comply with her preferences. I spoke up, but the replies were invalidating, and some were downright mean because I was not a doctor. It did not matter what ACOG statement I shared (the doctor’s governing body) supporting informed choice or the research indicating the benefits of spontaneous labor in low-risk pregnancies and the risks of elective induction…I was told my experience did not count because I didn’t have the ‘right’ credentials and did not know what I was talking about.

As a nurse, I have stood at a patient’s bedside listening to their provider use these tactics to gain consent or listened as the patient is told that they do not have the experience to make medical decisions regarding healthcare interventions.

Fear is used to create doubt and compliance en masse, because if the system can make you feel like an outsider, it is easier for it to control you.

So....what is the answer?

In my experience, finding those who think and believe like you. Want a homebirth? Find others who have birthed at home. Want to give birth in a birth center, extended breastfeeding (breastfeeding > 2 years old), not circumcise your son, or make other care decisions considered not mainstream? Find those who have made those choices, and the fear is melted away with support and knowledge.

This is a special note to those we turn to for support in our choices. To those who help us navigate informed choices and our options, please remember yours is not to convince but to guide, support, and ease the fear that comes when we venture away from the influencers and followers. It is easy to become the fearmonger when you have convinced yourself that your choices are right for everyone or that you know best because of your training and credentials. We need you to push that aside and support informed choice so that every voice can be heard.

Fear...it has had enough control!  It is time to be brave!

Everything Has Risks

I am a fierce supporter of informed choice and autonomy in healthcare. I have worked for 23 years to give my clients and patients the freedom to choose what they feel is best for them. That means carefully educating to avoid bias, coercion, intimidation, or the appearance of authority.

“Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment.“

Informed choice involves the review of the risks and benefits of options and is not solely a medical treatment issue. It often impacts the choices we make in our daily lives that have little to do with healthcare. Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.

This is the risk-benefit ratio. These are the options and choices where you have to consider the risks versus the benefits and is highly individualized. My risks and benefits pertain to my circumstances and center around previous choices and outcomes. This is the reason why routine care policies and standard practices can be harmful. Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment. It is our risk-benefit ratio, and no one has the right to tell us what risks are too much, and what benefits are too few or vice versa.

I have had clients/patients who want their nurse or provider to make their care decisions. In those cases I take that responsibility very seriously and try to consider the risks and benefits within their treatment. I then introduce options with the least risk first, ask their preference, and continue to involve them in their care as much as they desire. I never want to be responsible for making decisions for a human who can choose for themselves. Even as a parent, the “because I said so” was very rare, and there were almost always two choices and an explanation of why. I’m not going to let you run into the street and get hit by a car or grab a hot pan, but if you try to do those things, we will talk about the risks.

“We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity.“

The fact is, everything has risks, even those choices that do the most good or have the highest reward, we perceived the benefit so greatly outweighs the risks that we do not consider there to be negatives. We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity, and even when we only see the benefits or positives of our choice, there will be a negative aspect.

“My risks and benefits pertain to my circumstances and center around previous choices and outcomes. “

For those that do not want children, either temporarily or permanently, the risk of pregnancy is so high that they will do everything to prevent it. They accept the risk of their decisions, namely birth control or surgery, because the risk of a pregnancy is much higher. For those who want children, they view pregnancy as a positive without risk, or the benefits so greatly overshadow the risks they are minimized to the point of null. However, the risks still exist, and usually show up to be dealt with; such nausea and vomiting, fatigue, stretch marks, bone and joint aches, and ultimately birth.

“However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual.“

When we generalize healthcare and create an environment where everyone has the same interventions, we take away informed choice and force negative impacts creating a high risk, low benefit care environment. This is especially true with “you will” interventions – and often these are presented as you will have or we will be doing this intervention, and the options are often timed. For example: at 20 weeks you will have an ultrasound – at 37 weeks you will have a GBS (beta-strep) swab – we will break your water at 3 pm. These are suggested as interventions without risk, or where the benefit is assumed and the risk minimized, yet no one but us can assess the risks and benefits, and there lies the problem. For me, the option presented may carry acceptable risks, but for you the risks may outweigh the benefits and carry more harm.

“Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.“

I live the consequences of my choices. Yes, some of those choices impact others around me, and that should be considered in the assessment of risks and benefits. However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual. As patients we have the right and responsibility to question, investigate, research, and expect feedback regarding our options. As providers we have to acknowledge that we do not fully know the risks or benefits for our patients, and since we do not live their life, we have to defer to their personal assessment. This means taking the time to listen and educate without the bias or our belief system or personal experiences.

*Sometime the options available are outside of the providers skills or ethical beliefs. The solution is referring or deferring to a different provider that can meet your patient’s needs.*

The Story of the Long Labor

It’s amazing to me when women come to the birth unit and have a baby shortly after walking through the doors. They have usually spent the last few hours trying different positions and activities to get comfortable while they labor. Some take baths or showers, some sleep (or try to), some clean or cook, they eat and drink, spend time with their family and friends, and most of the time they move, move, move.

Compare that to a woman who is having an induction of labor, or comes to the birth unit very early in labor. These women often spend most of their time in a bed, in a very small room, connected to machines by very short cords. Because we limit how women in labor move, where they go, who is in the room, what they eat and drink, and what they do they are unable to follow their instincts that help ease labor and help it to progress.

Know your rights as a patient. You have the right to consent or decline any suggested interventions. This is called Informed Choice.

Position matters. Yours. Baby’s. During pregnancy. During labor.

During pregnancy being active keeps muscles strong, eating nutritious food with adequate levels of protein, calcium, vitamin D (etc) keep tissue and muscle pliable and able to change and accommodate the growing uterus. Body mechanics in pregnancy create posture, and as the baby grows posture guides the position baby settles in once baby is head down. Malnutrition, immobility, and spending much of your time reclining, and sitting with your pelvis tilted forward swing your baby’s back to your spine.

Want more information on Optimal Fetal Positioning and how posture effects your pregnancy and labor? Visit Spinning Babies

WHY? Why does this matter?

Let me tell you the most common scenario. Woman: 39 weeks pregnant getting induced for elective/social reasons. She is 1cm dilated and 80% effaced, with a Bishop’s Score of 6. Because her body is not ready for labor, we have to manipulate it with a Cook Catheter cervical dilation bulb, Cytotec, artificially removing the barrier between the baby and bacteria, and pitocin.

The body is amazing! That woman in the first paragraph, her body has been working for hours, maybe days, to prepare for active labor. However, the signal that started her body’s preparation…..was her baby. The baby starts labor. By communicating with chemicals sent to the mother’s system, the baby tells the mother’s body that it is ready to be born.

During induction we are forcing the woman’s body to labor, mechanically forcing the cervix open, making the uterine muscles contract, opening the membrane protecting the baby from outside bacteria, and creating a time limit for baby to be born. The process of labor is often slow, sometimes taking a day, two, or more. If at anytime in this process the baby or the woman’s body becomes stressed, or if the induction doesn’t produce active labor within a certain time frame surgery is performed to remove baby.

If you have had a surgical birth (cesarean) and would like support, information, or research visit ICAN

Back to posture.

If during pregnancy, labor or birth your baby assumes a position that prevents it from tucking its chin, flexing its neck, the head is sideways or baby is facing your front and not your back, labor could be long, extremely difficult, and regardless of time and effort your birth could end in a surgical birth.

There is still a chance that things can work out. Position to the rescue!

If you, your nurse, or provider know about optimal fetal positioning we might be able to, with hard work and patience, change your baby’s position. We may use the bed, chairs, the toilet, blankets, pillows, birth balls of all shapes and sizes, stretches and positions that feel foreign and uncomfortable to help change the shape of your pelvis and use gravity to help your baby change its position. As long as mom and baby are doing well with labor, we can try almost anything to help your birth go smoother, and help you achieve a vaginal birth.

Sometimes, no matter how hard we try, surgery is the best option for birth. However, the more you know, the more you can make choices that are best for you and baby through informed choice. No matter how you birth your baby, feeling empowered is a right, not a fantasy. You have the right to be as involved in your birth as you desire, and no one can take the right away from you!

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What’s in a Name?

About Me

Hi! My name is Chantel. I am a certified and licensed (literally) birth junkie. What is a birth junkie? Simply put it is a person who can insert the topics of pregnancy, birth, postpartum, breastfeeding, and babies in to the most obscure conversations without any hint of caution.

I started working in birth as a Doula, researcher and childbirth/breastfeeding educator in 2000 after the birth of our 4th child (6th pregnancy). I LOVED my work and would have been happy doing that for the rest of my life…….and then my life hit a transition.

In 2004 my family moved to extremely rural Minnesota, and while I was able to continue my work as educator, my work as a Doula stopped. Then in 2006 another transition occurred and I began my journey into college and nursing. I graduated in 2010 with my Associates Diploma of Nursing with Honors-something to be very proud of when getting your degree, especially with 4 young children. With the beginning of my nursing degree in hand we moved to Missouri and I started working as a Registered Nurse in Pediatrics while I continued in school. In 2013 I found my way back to birth, this time as an RN, while finishing up my Bachelor’s degree in nursing-graduating in 2014 and in 2018 I certified in Maternal Newborn Nursing. My history as a researcher has helped create many evidence based policies for my nursing unit.

Update:

I am now at the completion of my midwifery degree. Once graduated with my CNEP MSN degree I can license as a CNM APRN (certified nurse midwife advanced practice nurse practitioner).

Starting my journey as a Doula has given me a unique perspective as a nurse. I have found patient advocacy and informed choice an important foundation of childbirth education, and I work hard to support birthing families achieve their wants, desires and needs within their time of transition. My hope is to use this blog as a starting place full of information and ideas to help birthing parents achieve their transition in the way that is best for them and their family.

Education, Trainings, and Certifications

Certified Doula (CD) Childbirth and Postpartum Professionals Association
Associates of Nursing Minnesota West Technical College
Bachelors of Nursing Capella University
Certified Maternal Newborn Nurse
Spinning Babies
Vaginal Birth After Cesarean
Required to maintain as a hospital RN
- Basic Life Support
- Advanced Cardiac Life Support
- Neonatal Resuscitation Program
- S.T.A.B.L.E program for neonatal resuscitation
- Advanced Fetal Monitoring
- Baby Friendly Initiative training
Published author
Former Operation Special Delivery Doula
Attended births
- Homebirth
- Birthing Center
- Hospital Birth
4+ years of personal breastfeeding experience, including extended breastfeeding
23 years of breastfeeding education