Episode Summary
We brought Dr. Kathryn Konrad back on the show to talk about something we have been digging into all season, the relationships doulas have with the other people in the birth room. Kathryn moved from labor and delivery nurse to childbirth educator to nursing professor to PhD researcher, and that career path means she sees the doula and nurse relationship from every angle.
We get into what nursing students actually learn about doulas (often nothing), what is missing from the textbooks (often the doula role and even photos of vaginal birth), and what it would take for the next generation of L&D nurses to arrive ready to work with the rest of the birth team. Kathryn also expands the definition of maternity care deserts beyond hospitals and OBs to include doulas, lactation consultants, and the broader support workforce. We talk about the updated AWHONN position on continuous labor support, nitrous oxide rollouts that left nurses untrained, and why “everyone has a heartbeat” was never enough as a measure of a good birth.
This one is for experienced birth professionals who want practical ways to plug into nursing education, state perinatal collaboratives, and the systems that decide how the next generation of L&D nurses gets trained. If you have ever wondered how to get inside a sim lab or how to talk to a hospital quality team, Kathryn has specific, doable answers. Listen in.
Meet Our Guest
Dr. Kathryn Konrad started her career as a labor and delivery nurse, then moved into childbirth education, advocacy work, and academic nursing. She helped found a birth network in Oklahoma, advocated for VBAC access and C-section rate transparency, and now teaches future nurses at all levels while pursuing PhD research on community support, doula integration, and maternal mortality. She is a returning guest on The Birth Geeks Podcast.
Listen to This Episode
Episode Time Stamps
00:00 From Midwives to Birth Advocacy
05:02 Maternal Health Challenges Persist
06:44 Indigenous Data Sovereignty Challenges
12:28 Oklahoma Perinatal Nurses Collaboration
13:37 Labor Support Training Essentials
20:09 Doula and Birth Team Roles
21:10 Doula Support, A Critical Role
25:34 Doulas Provide Crucial Support
27:53 The Importance of Evidence-Based Practice
33:40 Doula Involvement in Maternity Care
35:08 Community Engagement Through Health Networks
39:02 AWHONN Updates on Continuous Labor Support
42:58 Nitrous Use Misunderstood in Hospitals
47:29 What Strong Labor Support Means for Families
48:45 Students Know Differently, Build On That
53:14 Enough Is Not Enough
56:09 Why Do We Starve People in Labor
Key Takeaways
1. Most nursing students arrive without knowing what a doula is. The textbooks often skip the doula role and sometimes do not even include images of vaginal birth. If experienced birth pros want change, the path is into nursing curriculum, sim labs, and student-facing teaching. Konrad does it from the inside; the rest of us can show up at the door.
2. Maternity care deserts are wider than the standard definition. The usual measure looks at OBs, midwives, and birthing hospitals. Konrad’s research makes the case for including doulas, lactation consultants, childbirth educators, and the broader community workforce. Whole-team coverage is what actually keeps families supported, not just access to a building.
3. Curiosity is the doula and nurse skill that gets you everywhere. The fastest way to defuse role tension in the room is to ask. Nurses who know their stuff usually want to share it. Doulas who do not pretend to know it all earn trust faster. Curiosity goes both ways and almost always lands.
4. Nurses do advocacy that doulas do not always see. Calling the doctor on a quiet phone, sitting on a chart instead of pushing for an exam, slowing down a checklist on a quiet night. A lot of nurse advocacy looks like neglect from the outside. Naming this for newer doulas changes how they read the room and how they treat the nurse on shift.
5. AWHONN updated its position on continuous labor support. The new statement gives doulas a formal opening to start conversations with hospitals, units, and quality teams. If you want a door into hospital policy, this is the document that opens it. Bring it, name it, and ask how the doula community can support continuous labor support locally.
6. Nitrous oxide rollouts are happening without the training to back them up. Hospitals add the equipment, the nurses get a quick demo, and clients get incomplete instructions. Doulas who know how to coach the breath pattern can fill that gap, both bedside and in nurse education sessions. The opening is real.
7. “Everyone has a heartbeat” sets the floor, not the ceiling. Survival metrics measure whether a birth was technically safe. Konrad argues we need to measure whether families leave a birth ready for the next chapter, not just intact. That shift is what experienced birth professionals can push for in their corner of the system.
Mentioned in This Episode
AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses)
ACOG (American College of Obstetricians and Gynecologists)
Oklahoma Perinatal Quality Improvement Collaborative
Read the Full Transcript
This transcript was auto-generated from the audio and lightly cleaned. Speaker names are not labeled. Read it as a rough record of the conversation, not a verbatim quote source.
[00:02]
Hey Hillary. Hey Robin. And welcome to Dr. Katherine Konrad. I love saying that. I do too. I'm still not used to it. It takes a while. It does. Uh, I, I just, um, I knew you when you were Katherine Konrad, and so I love the fact that you have worked so hard and, um, now you're Dr. Katherine Konrad and all to help parents and families and babies and do all that stuff. So just have a little sweet spot in my heart for you. Well, you were my dissertation doula. Everyone needs one. Oh, right. Yeah, absolutely. Well, I'm so glad you are actually a repeat for us here on the Birth Geeks. Glad to have you back. And I wanted to have you back because we have been talking to people about relationships that doulas have with others.
[00:58]
And you have a really interesting background. Can you tell us a little bit about all of the things that you do that are around this sphere? Oh gosh. Well, my, my first role in kind of all things moms and babies was as a labor and delivery nurse. And I always consider myself like first and foremost, a labor and delivery nurse. Um, I did that for several years and that led me to childbirth education. Um, and in my childbirth educator role, um, I learned more about doulas cause I had worked with doulas, but not a lot. This was in the early 2000s. There weren't a ton around yet. There really weren't very many doulas. We did have midwives in the hospital I worked at, but they were— I worked on the high-risk side and they were on the private side. So I didn't get to work with the midwives quite as often as I would have liked.
[01:48]
Um, I did work with them, but not as much. And so we didn't see doulas as much on the high-risk side. Um, but when I got into childbirth education and I was getting to see kind of all the things, not just, um, the 12-hour shift of labor that kind of gives you a narrow focus, like you only see that 12 hours, was actually getting to see people throughout the pregnancy and throughout the postpartum that really helped me understand how broad everything was and how, um, how much you really need community support and how important that doula role is So, and within that time, I've worked with several doulas and childbirth educators and midwives, and we started a birth network in Oklahoma, and we worked on that for several years. And that led us to, to do work on VBAC advocacy and advocating to get C-section rates published and a lot of work that way, which then, while that time I was working on my master's and transitioned to academic nursing where I teach nurses. Teach nurses how to be nurses on all levels. And then started working on my PhD. And now, oh, many, many moons later, I research community support to address maternal mortality, which includes doula support and labor support. And so I look at kind of all of those pieces and how everything works together.
[03:12]
And I also within that look at maternity care deserts. And staffing for— I'm starting to kind of look at staffing for doulas. If you look at the maternity care desert pieces, which has a lot of overlay with maternal mortality, and especially particularly in rural areas, maternity care deserts is a pretty narrow definition. It talks about, oh, we don't have enough OB-GYNs. Okay. We don't have enough certified midwives. Okay. We don't have enough hospitals. Okay. Oh, that's what we don't have enough of. How are you going to run a hospital without a nurse, and an expert nurse at that, and, um, a whole bunch of them? Yeah. And how is your community going to sustain, you know, pregnant people and postpartum without doulas?
[03:58]
How can you support them? How can you support them in their postpartum? How can you support them in their prenatal? How can you support people without doulas? How can you have a viable situation without Lactation consultants, like there's so many pieces that are missing in that definition of maternity care deserts that it's just, it's, it needs to be kind of broadened so that we really understand the true depth of what needs to be there to make things not just safe but successful. So, you know, and not just to reduce mortality, but to actually have broad definitions where we can actually have happy, healthy, successful families. And I really appreciate that because so often everyone defines like everyone has a heartbeat. Yay, it was a successful birth.
[04:47]
That's a pretty low bar. We don't talk about morbidity, right? Right. Oh yeah. I mean, we're barely talking about mortality and like while we are starting to talk about mortality, how long has it been going on? Right. Before. Yeah. Well, and where does Oklahoma stack up? In the middle of the road, surprisingly, because we do have huge maternity care deserts. So we have 77 counties but only 44 birthing facilities, and that will probably change in the next couple months given the funding changes. So we're actually kind of middle of the road, not as high as some states, but not as low as we should be. And it's a little hard where we have the challenge of doing— we have to look at our data every 2 years, because if you look at the rates of maternal mortality per 100,000 births, We only have around 50,000. We essentially look at it over a 2-year time period. And so if the country is at 18.6, and we're— our last look at things were in 2023, and we were at 23, which is higher than it should be significantly, as the country is significantly higher than it should be.
[05:56]
But sadly, that kind of puts us in the middle of the pack, which is kind of sad. So our C-section rate is about where the rest of the country is. We're at 32%. 2.6, where everybody else is. Where we're really struggling is preterm birth. We have a lot of preterm births. And we have a lot of women at risk. We have 39 federally recognized tribal nations in Oklahoma. We have a large section of indigenous women. And typically when you look at maternal mortality data, it will address white women, Asian women, African American women. And Hispanic women, but it will not address— it does not typically include Indigenous maternal mortality, which is in the 60s. Does that mean that they're lumped in with some— a different group? Okay. Either they're lumped in or not counted at all. It kind of depends. Most— because the hard part is for most people who are Indigenous, they'll say, I'm, you know, there's not necessarily a box to tick for tribal affiliation.
[06:59]
So they just kind of get lumped in wherever. And so it's A lot of that data is lost. So, and data sovereignty is a huge issue that is really important. It's something we need to be aware of for all people, really. But particularly when you're speaking about Indigenous women, you know, there's a lot of pieces there that is just lost. Their numbers were lost in the data. Like, how do you kind of pull that out? But when you are able to pull it out, it's 60-something per 100,000 births compared to 18 with the rest of the country, which is still too high. And then when you look at that, It's just, it's shockingly high. It just reminds me, I interviewed an OB who had just come off of her IHS rotation. And so we were talking about, yeah, some of that stuff. So thank you for educating me too. So when you're, when you're in the classroom, I want to go back to doulas because, you know, we navel gaze a little.
[07:57]
When you're in the classroom with nurses, what kind of, do you find that they are coming in with beliefs about doulas before you even get to them? Typically, no, they don't. They're like, what is this word? So, and it's even, we're actually in the process of reviewing textbooks. We're doing our curriculum revision and looking at our new textbooks for a new reproduction course. And that's the reps usually know if the textbook doesn't have doulas in it, doesn't have midwives in it, and doesn't even have a picture of a birth. Wait, what? For OB? You'd be surprised how many OB textbooks don't even have a picture of a vaginal birth. And I mean, think about it, if you're a student, you're like, I'm just curious. That's like one of the first things you're going to flip to because you've never seen a birth, right? You'd be surprised how many textbooks don't even have a picture of a birth. So, and one of the ones I looked at, I was like, y'all, like, where was your copy editor? Because that's upside down.
[08:52]
Like, no birth or like, are you saying absolutely none? None. No, not even cesarean, nothing. No, they might have like a drawing and you're like, I feel like this is— listen, I'm not saying it needs to be scratch and sniff, but come on. So it's hard to find. I'm gonna have to use that scratch and sniff. That's awesome. There's a lot of textbooks that don't even list the role of doula, and which is kind of surprising given that most of our textbooks have a lot of shoutouts now to interprofessional work and interprofessional communication, and will often have like whole chapters devoted to interprofessional care and the blah, blah, blah. And you're like, I feel like we're missing something here, folks. So what are they referring to? Like pelvic floor PT and that kind of stuff? Or, well, for interprofessional, you should be including things like, absolutely, you know, What's the physician role? What's the, um, what's the, um, midwife role? What's the doula role? What's the lactation role? What's the nurse's role?
[10:02]
When should you refer out and to whom? Yeah. What's the anesthesiologist role? You know, who are the people in your neighborhood kind of deal? Oh, I love that. Thank you for this for your efforts. So like, who are the people you're going to work with when you're taking care of pregnant people? So it doesn't even come up in a lot of books. So if you're lucky, you at least have a discussion of what the doula role is in your textbook, which some of the more progressive books are starting to do, but that's really just within the last like 5, 10 years. So, and then being a Lamaze person myself, I also want to make sure that they have the Lamaze healthy birth practices and not Lamaze teaches you about breathing. You're like, Right. Hee hee hoo hoo. That's it. And you're like, yeah. So do they have a discussion about midwives and all the nuances within that, all the very different levels and what the different types of midwives are? You know, that doesn't come up in a lot of books either. So you want to look at those kind of pieces.
[11:03]
And then, but a lot of students do come to us pretty green in that they've never heard of the word doula. But look at you, you get to help shape that. Yeah. So we get to talk to them about that. This is one of the, one of the roles that you'll see. This is where you should see them. Yes, the doula is your friend, you know, yes, they are part of your team. Yes, you should incorporate them into report. So that's a huge piece too. Um, we're pretty fortunate in Oklahoma. We do have team birth at all of our birthing hospitals, which is, um, very pro-doula. So It's a movement trying to incorporate more birth preferences and improve communication in birth. So they, all of the nurses, all the students do see that, and they do see that there is an opportunity to communicate better. And some of the boards in the room will even say when they list the roles, like who's the RN, who's the scrub tech, who's the doula, So some of them will even be listed on the board, but it kind of depends on what they had, where they had their stuff done. So you take them from a do what to they're part of the team, please. They're part of the team. Yeah.
[12:16]
They're even on the board. Look, they're part of the team. So that's helpful. So you talked about you do a perinatal boot camp. Can you talk a little bit about what this is? Because that's not just your students at your university, is it? No. So the Oklahoma Perinatal Quality Improvement Collaborative, which is our quality improvement group in Oklahoma, hosts what the Oklahoma Perinatal Nurses Forum, which is where all the birthing hospitals in Oklahoma as a rural state get together and collaborate on training new perinatal nurses, either new or new to, you know, all things women's and newborns. So twice a year we offer workshops where they come in and they do a day on fetal monitoring, they do a day on postpartum, they do a day on infant care, they do all these things. And we can have all the kind of state people come in, all the experts that you may not have at your agency, but somebody else does, so that we can all share information and share pieces. And this is actually the 20th year. So, and within that, we do have a labor support workshop that they all go through.
[13:15]
So they all go through a 4-hour labor support workshop where we go over what is labor support, why is it important, what are the definitions, what are the theories, blah, blah. But then more importantly, we do labor stations where we have doulas and midwives and childbirth educators and nurses from all over the state come and provide different stations that they all rotate through so they get a chance to practice some hands-on techniques. Things for back labor, how to use a peanut ball, um, sometimes we do, um, Rebozo. And it just depends on who's there and what their expertise is and what they want to teach the nurses. And they all get a chance to rotate through and practice some hands-on labor support techniques. But more importantly, I tell the students I have two goals. Like, my goal for you as a new nurse is to have some basic understanding of what labor support is. I would love to say that you'd be confident at the end of a 4-hour workshop, but that's not going to happen.
[14:08]
At least understand what it is and how important it is and how you can incorporate it into your care. Then kind of my secondary goal is for you to meet doulas and midwives and understand that, that they're part of the team, because they may not always get a chance to see them in their orientation and training. And we had one last week, and it was too funny. Apparently a lot of them went to the coordinator afterwards like, I met a doula in real life. And we were like, yeah, it's really fun. They're usually pretty friendly. I know, like, the wild, there's doulas. When I first started working as a doula, people would often say like, you look like what I imagined. I was just like, what does that mean? Yeah, what did you— what did— I've literally been told the opposite, Robin. Like, I expected you to be wearing like flowing skirts and Birkenstocks. Yeah, no, that's what they, they're like, where are your Birkenstock socks. I was like, I don't know, nanny, like, you know, closed-toed shoes. It's a thing.
[15:06]
You know, it's a thing. Although, yeah, I don't do the clogs. A lot of them, all the nurses I know wear those clogs. I think it depends on what kind you get as to whether they are good for your feet or whether they eat your feet alive. Yeah. No thanks. So when was your first experience with a doula? Do you remember your first experience with a doula? Actually, my first one was not super great. I will be honest because it was a transferred home birth, which, as you know, those are, are difficult. And I had not been a nurse very long and I didn't know what was going on. I had no idea what was going on. All I knew was that I was getting a transfer in, which was not unusual.
[15:52]
I worked at the high risk, at a high risk facility. We got transferred all the time. So they're like, oh, this person transferred from home. I'm like, so they're just coming in? No, they're coming in with a midwife. I'm like, but they're across the street at the other— what? So I didn't, I didn't really understand. And then the midwife had to go to another birth, but she left a doula with her. And I was trying to figure out who was what. I think they were all pretty exhausted because it was like 2, 3 o'clock in the morning. This poor mom had been laboring a long time. You know, everybody was kind of tired and I was still trying to figure out who is what. So the communication was not great because we didn't understand each other's roles. And that's so key to know what everybody's roles are and what people's scope of practice is and what people do and what they don't do and what, what you can ask somebody to do, what you can ask for somebody about information about when you, what they may not have. I just didn't know. So that one, I was like, that was a weird situation just because it was just weird all over the place. But then the next time I had a doula, I was like, okay, so it's, it's early in the labor. I get to learn about what you are. Tell me, what is a doula? Because I didn't, I still didn't know, you know.
[17:09]
So I, the second one was much better because we got a chance to talk about like, what does a doula do? So, and I've had a lot of doula friends that I've worked with now for 20+ years, so, which is really cool. So, well, I love the fact that you asked. I think there are many nurses who sometimes are afraid to ask, right? Because they don't, for, for a whole ton of reasons that people don't wanna ask. But I love the fact that you came at it from a place of curiosity, which is what I always tell doulas when you don't know, come from a place of curiosity. Right. That's always going to be a win-win for everybody. If you don't understand what's going on, you know, privately at a quiet moment when you can, you know, ask that nurse, hey, can you— like, I don't understand what's going on. How can I, you know, help me understand this so I can help my client? And then, you know, at the right time, right, that nurse will be happy to help you understand what's going on so that you can all give this person better care as a team. Not during a cervical exam. And not necessarily in front of the client, right? Like, like, like I always talk about catching the nurse at the door as early. Hey, can I ask you a quick question? Um, you know, and then stepping outside the door to just say, hey, like, can you tell me a little bit about what, you know, what this is or what you're thinking or, you know, what am I missing? What could I do to be helpful? Like, I think sometimes that, that question is also hard to ask on the doula's end. Well, it goes for nurses too. Like, we have to be curious. We have to ask more questions. And I'm probably the overcurious person because I'm like, I'm never satisfied. I have to keep digging.
[18:45]
But you have to ask questions to understand. Like, how are you supposed to understand what's happening if you're not willing to say, well, I don't know about that, so let me learn more. What can you tell me about this? What do I need to know? Is there something I need to read? Is there something I need to look up, you know, those kind of things. So, and that's huge for nurses too, to ask questions, because you guys, you know, doulas have a relationship with patients that we just don't have the opportunity to have when we're doing labor delivery. We don't have prenatal, you know, we don't have an opportunity to meet with somebody multiple times before they come in for their birth, unless it's in triage, which may or may not be a good situation depending on how that's gone. That may not set up a positive relationship. So the onus is on us to be You know, if we're the most trusted profession, we have to make sure that we're building trust very, very quickly. So we have to be curious and we have to say, oh, tell me who's with you today. You know, cause that, and starting to understand some of that and understanding it's okay to say, oh, I've not worked with a doula before. I'm happy to work with you.
[19:53]
Tell me more, you know, those kinds of things. So it's It's hard. A little bit about the nursing textbooks and the curriculum. Like, ideally, what would you love to see included in nursing textbooks about doulas? And at least a definition, at the bare minimum, a definition. But there's so much kind of emphasis on the interprofessional team, and the doula is an incredibly important part of the birth team and the labor support team. I actually have a figure I show the students where the labor support team is the you know, parent at the center, and the doula, and the labor nurse, and the, um, provider, and the family. All of those folks are components of the labor team. And typically, we as nurses are the unknown, so we have to know who all these other people are. So the book should include a definition of what a doula is, but also what all the varying roles— because that has grown so much. You know, it used to be you know, 20 years ago you had a doula and you started to have kind of a postpartum doula role. But like, what does, what do all these different roles mean? Where would you potentially interact with doulas?
[21:06]
How important is the role? What does the literature say? That's incredibly important. There, there, I've yet to find scientific literature that doesn't support the role of the doula. And the thing that I find so cool about that is it's in so many different places. It's actually a little overwhelming. That you see, you know, doulas— their support for doulas in medical literature, in nursing literature, in social work literature, in sociology, in anthropology, in all the things that touch healthcare and how important that role is. So to not have it in a nursing textbook is such a huge miss, you know, not to have what this role is and how important it is and where you would interact with doulas and what and how you can work with the doula, how you can incorporate the doula into a report, how can you, how can you work side by side with the doula so that everybody has a better experience. It's better for the nurse, it's better for the patient, it's better for the doula if we all work together. You know, if our job is to help make sure communication happens, well then we have to make sure it happens with everybody.
[22:07]
So what are those pieces? Those are huge. And how to incorporate them into care would be awesome. So in my spare time, maybe I'll write a chapter on that someday. But that's, I think the nurse role has shifted from my perspective, right? As a doula, the nurse role, I've watched it change and not just as a doula, right? I'm also a university professor. I also do research, read all the literature. And one of the big things that I've seen and is, and this is one of the things I try to convey to doulas is this like intensity of what we're asking labor and delivery nurses to do. And, you know, and that has ratcheted up like all the tasks and work-related things we want this nurse to do. And yet when I first started working as a doula, you had to have a good 5 years of med surg experience before you could get on L&D floor. And now they're like, are you an RN? Like, like that. And, and it's a very intense— like, I've seen some things comparing like L&D to ICU, you know, monitored bed. And that is a really intense form of nursing. I like to bring up, like, I talk to people about like AWHONN's advocacy, like how they talk about like, here's the nurse's role as advocate, because a lot of times doulas think I am the advocate, right?
[23:36]
It's a dual— all are. We are all the advocate for this person. We all advocate differently. And I try and point out, like, that nurse makes a decision when, who, and how they call the provider and what they say, how they frame it. That's advocacy that you don't get a chance to watch, right? They may not be coming in to check you because they're pretty sure your client is 10 and that doctor is going to want them to start purple pushing, and that they know that's not what your client wants. That's advocacy, even though it feels like neglect. Like, it is, right? Like, it may feel like that nurse is like avoiding you, but like, you know, and I literally have had nurses be like, you don't want me to come in right now, you know, because like I'm gonna be forced to check them if I come in. I'm like, oh, okay, yeah, all right, watching on the central monitor. Yeah, we're fine, you're good, we'll come in if we need to. I've had nurses come in— oh, sorry, I was just— nurses come in literally like with phone in hand and the doctor on the phone like to talk in the room so everyone knows what's being said too. And I like, I think that's the beautiful, like subtle and appropriate advocacy in that moment. So as things have become more medicalized, because our answer as Americans is always let's make things more, more medicalized, right? Very, very going for us. But yeah, you're exactly right, Robin. I worked with a colleague for years who was like, OB is critical care woman style. I mean, that's all it is. Like the way we treat most pregnant people is that they're, you know, we're inducing them, so they're on a high alert med from the moment they walk in the door. Pitocin is a high alert medication, you know, which requires higher level of care and higher level of monitoring. Oh, and then because we're forcing their body to do something it's not ready to, it hurts more, so they're going to want an epidural. So now on top of being like doing critical drips, you are now monitoring anesthesia. Any other, any other place where anesthesia occurs, the anesthesia provider, be that the anesthesiologist or the certified registered nurse anesthetist, it's at the bedside the whole time because we're doing all the other things, right? But no, in labor and birth, they're like, so I started it, bye. And you're like, what? You're monitoring anesthesia, you're monitoring mom and baby. You always have two patients. You, you have all these other drips, you have all these other things that you're doing, you have obligations to the other staff on the floor. Like, you may have to go help with a birth or help with an emergency C-section or do some triage, or you might be in charge, or, or, or, or, or we're pulled so many different places. So for me to have a doula in the room, at least I know there's somebody there who, if I, if I, I can't be there to do continuous labor support like I know this mom needs I just can't because I'm pulled so many different directions.
[26:30]
So to have somebody there, I'm like, oh my God, I have a doula. That makes such a huge difference. And that's what I tell nurses, that if, if nothing else, you have somebody who's there to watch her and, and comfort her and make sure that she is feeling supported, because we just unfortunately don't have the option, which is so sad because none of us become nurses because we want to take care of machines, but it feels like We're there taking care of monitors and IV pumps and epidural pumps. And I mean, in an ideal world, we wouldn't have all of that, but we also wouldn't induce most of our people at 39 weeks either. So that's a whole other thing. Are you allowed to say that? Just teasing. I know. I know.
[27:16]
I had a clinical rotation once where I was helping my students fill out their paperwork. And they have to list the reason for induction. And they're like, I said, well, you listed your reasons for induction is that they're 39 weeks. That's not a reason for induction. Why, why are they being induced? Well, that's what the nurse told me. Okay. What did the chart say? Well, I could, you know, couldn't understand it, whatever. Okay. Let's go talk to the nurse. So you'd go and talk to the nurse and be like, okay, so the reason for induction that you listed was that they're 39 weeks. And they said, yeah. And I'm like, that's not a reason for induction. What's the reason for induction? And they'd be like, they're 39 weeks. You're like, I feel like I'm playing who's on first. So it's elective. You're telling me it's elective? So they're like, no. And I'm like, yes. So because a lot of times we don't always understand either, and the impetus and the, the importance of evidence-based practice, while it has been there the past 20 years, that's a huge curve that not everybody gets a lot of training on.
[28:14]
So not everybody learns how to read an article and determine Yes, this is good science and I want to base my practice on it, or no, it's not. So, and that's a huge piece. Like, that's something that is emphasized in the program I teach in. That's huge that like you have to be able to be a good consumer of science in order to incorporate into your practice. Yeah. Well, and I think one of the, one of the themes I think is understanding this tension between the ideal and then the real, like practical. Right. So I am very curious, as someone who does not have a nursing background at all, what does labor support learning look like? Or what are, what are you teaching nursing students about labor support? We don't get a ton of time to teach them.
[29:03]
So when I, you know, we have a lot of, it's, it's, we're in an interesting place in nursing education right now. Some programs are not doing an OB clinical at all. Um, because the spaces are so hard to get. It's so hard to get time in an OB unit. Some places are just doing simulation, which is an awesome opportunity for you guys, but something we'll get to shortly. But the downside of that is they only get a chance to basically like pretend deliver a mannequin, which, I mean, don't get me wrong, we have high-fidelity simulators that are really intense. I mean, they do all the things. Also not scratch and sniff. No, they're not, but it kind of depends on how you set it up to how real you make it look. You can't make it smell right, but you can sure make it look real real.
[29:50]
I'm just imagining a dry mannequin. Like, I'm like, there's no— Oh no, they're not dry. Oh no, they're not. Like, they bleed, they have— that you can give them mucus plugs, like all sorts of things. So it's kind of messy setting them up. Who do you get? Honestly, my sim class in my master's for teaching health professions, like, I thought it was going to be like a It was one of my favorite classes, learning all of the research behind using simulators and all that. And like, and I actually developed a simulation. It was really fascinating. Is there like a slime lab attached to it? You know what I'm saying? It depends on the type of mannequin you're using. Okay. All right. I know. Sorry. And some of the things that they do, like, yeah, exactly. A lot of, there's, there's typically staff at the bedside, staff on the sets helping them set all that up. Cream cheese and cherry and preserved cherries do a lot for you to make vernix and— get the right consistency, slather it on there.
[30:53]
So I don't do as much simulation as I did several years ago, but it can be really powerful. But that being said, a lot of students don't get the opportunity to be in an OB environment. So, and we get very little time often. So most of our time is spent on safety and advocacy. So we maybe get like a sliver, like sometimes I get a little sliver of like, hey, let's talk about labor support for like a half an hour. Like, and that's pushing it to get half an hour. Oh, does that hurt your childbirth educator heart? Oh my God, it does. And I try to like wiggle it in a lot of different ways. I have done labor support workshops for my students as Hey, if you want extra practice, I will do this for you and you guys can come in and do this. Um, I have done them in the past for clinical hours, but our clinical definitions have changed. So like, I can't always do that for clinical hours. Um, but if I can sneak it in, I do. And I do have, um, doulas and midwives come in and help with that because I'm— we need everybody to meet and we need everybody to meet on neutral turf.
[31:59]
Like, as a, hey, we're all learning here together. But the cool thing about simulation is, again, they're trying really hard to make their simulations interprofessional. So I think it would behoove doulas to reach out to their local nursing programs and say, hey, do you need some volunteers to help you with your OB Sims? I will be there. Like, that's just a good pro tip. Yeah. Like incorporate your, you know, ask if you can be part of that. So ask if you can be in part of their OB Sims. Most places are at least are doing at least one OB simulation. Now don't be alarmed because it's most commonly a postpartum hemorrhage simulation and those are intense. I've seen real ones too. So it's okay, right? But it might be helpful to like, go in there and be like, tell me more. Side effect methergine. Yeah, sure. Right. Like to actually go and practice those pieces. But that's typically, that's where a lot of programs have moved towards is the simulation piece because it's just so hard to get OB spaces. You know, as we close more and more birthing, birthing agencies, there's just not, there's just not a place to go. And if you think about it this way, if you're a nursing program in a rural area and you have to drive just like a parent would, 2 to 3 hours to get OB care, you also have to drive 2 to 3 hours to get an OB clinical. So that may not always be possible for them to do, or they might only get one shift and you know how it is.
[33:24]
There may be a birth, there may not be. You know, it just depends on what they don't know much of the sea and you want to make sure that they have seen some of that before they encounter it. Yeah, no, I, yeah, 1 million percent get it. And I'm sure, I'm sure you have like regional hubs there in Oklahoma as well. Yeah. Where people come to do the learning. I would also reach out to medical schools. They also have intense sim programs and patients. And so there might be a lot of a lot of different places that you can reach out to if that's something that you're thinking about doing locally. That brings me back to something you said earlier. I would love to talk about it, about how you think doulas could be more involved or, or get involved. Is that in your work talking about maternity care deserts, and you were talking about expanding that definition of who the team looks like, you know, and looking at like doula workforce as an example.
[34:19]
How would you tell a doula who's interested in doing some of that work, like, what are some organizations or types of organizations that they might reach out to say, hey, let me help you? Every state has a quality improvement body, so a perinatal quality improvement body. It varies state to state what that looks like. Sometimes they're separate organizations, like ours is separate, they're not part of the state health department, for instance. Whereas in some states it's part of the state health Health Department. Some states it's based in their local med school, for instance. Some states it's embedded, it's embedded with March of Dimes. It just varies all over the place, but you can look up your state and quality improvement, you know, perinatal quality improvement. It will come up when you Google it, and that's a great place to reach out to them. They always are looking for people to engage with in the community. Look and see, hey, how can I get involved? Can I go to some of their meetings? Can I, you know, work with some of the people there?
[35:20]
How can I help there? And some of them may even have jobs that you might be interested in as well as patient advocates. So, because sometimes they have patient advocacy roles that they're looking for. So that's a huge piece to look in on those pieces. Birth networks, we don't have as many as we did probably 15 years ago, but that's another place to grow. Connect with your local AWHONN chapter. AWHONN is the Association of Women's Health Obstetric and Neonatal Nursing. Every state has their own chapter, and sometimes they have subchapters within that, depending on how large the state is. And so they have meetings that they have at least quarterly, and they usually have at least have a state conference that you would be more than welcome to go to. You might want to consider a table, or at least going and meeting the nurses there., and just, you know, hear what they're hearing. What are they learning about? What are they focusing on? What are the huge pieces that they're trying to improve? Because every agency has certain pieces that they're trying to improve.
[36:22]
Um, right now a big piece is what's coming up next is going to be the lower extremity nerve injury prevention, LENI. So lower extremity nerve injury is L-E-N-I. So the— they're saying it's LENI. Um, so that's something you'll start hearing more and more about. How can we prevent lower extremity nerve injury. Well, the first thing is, for the love of God, not everybody needs McRoberts while they're pushing. Why do you need purple pushing? Yeah, shocking. So, you know, go find a way to kind of work with that. Um, so those pieces are coming up more and more, and those are great ways to meet people. Also, the ACOG groups, the American College of Obstetricians and Gynecologists, they may have local conferences that you can go to as well. So your breastfeeding coalitions often have big conferences that are places to meet people where kind of all of these folks come together. That's a good opportunity to come up. It's, um, March of Dimes is going to start doing their, um, walks for babies soon. That's a good place to meet people. Um, those kind of things are coming up now that it's springtime-ish. I don't know what the weather is confused about, but, um, today, yeah. But those are great places to meet people because no matter what our role, be it nursing, doula, physician, we tend to be very siloed and only knowing other people in our role, which is not good for anybody. So we want to make sure that we're learning and we're working with and learning from all the roles. So do you know your friendly neighborhood lactation consultant, for instance, you know, that's a great place to learn and grow. Your chiropractors, your, um, you know, dentists working on tongue ties. There's so many people that you can kind of incorporate into your larger network to help learn more. I mean, just, just keep looking around and be curious and say, hey, I'm curious about what the services that you offer, how can I learn more about it? And most people are happy to talk. Yeah, one of my favorite things I did was I actually got invited by our state AWHONN to come and talk about nurses and dual relationships and how we could work together. Like that's the perfect, like, that's a great opportunity. Right. So look for things like that. And I love that you're talking about like big picture networking, because I think that's something that doulas are often afraid to do. And while doulas often are, you know, hey, we're siloed. Sometimes we're not doing the, you know, we're not doing our part to get out and, you know, we're like, okay, we're siloed. Yeah. We're not building our side of the bridge. Right. So you gotta, yeah, we've gotta build our side of the bridge. I like how you put that. Yeah, well, and this is now a really good time because AWHONN just updated their position statement on continuous labor improvement, and it just came out in the 2026 Joggan and the first Joggan of the year and the first Nursing for Women's Health, which are the research and evidence-based practice journals for AWHONN. So that's how they disseminate their practice statements. And a huge piece of the continuous labor support position statement is what is a doula, how you can incorporate them into your care, and how do you make your environment more welcoming for doulas. So that's a great piece to capitalize, you know. I'm happy to— then you're— most people are happy to send you guys a copy of that position statement and say, hey, next time you go to a hospital, hey, I would like to help you guys. What are you guys doing on this? How can I help? You know, what can I do to open the door and have some discussions on this? So because we're just now starting to kind of come out from the COVID bubble where everything was like, nobody can be here, right? Um, but unfortunately, as we're coming out of that, the, the downside that we aren't talking about much in about COVID is we lost so much wisdom during that time because so many people were like, I'm out. Like, this was really, really hard and I just can't anymore. So we've had a lot of people who worked in the— who worked in labor and delivery and a whole bunch of other places in healthcare for a long time.
[40:30]
And so a lot of our wisdom is being slowly drained away. So now is a good time to try to connect and say, okay, what can I do to help? How can I help you guys rebuild in a purposeful way? So we're getting there. Um, Nitrous is also a great place to, to grow on that. Um, that's it. Nitrous. Yeah, so nitrous is— I, I'm, I'm saying it's the new arms race in OB. So if you think back in the '80s and '90s when they started doing, um, birthing suites, you know, that everybody was wanting the birthing suite and the cool, the best and the most beautiful birthing suite. And we still have some of that, but now people are like, oh, do you have nitrous? It's cheap and easy to enter, to put into your care, and it provides it changes your kind of lens of care a little bit, but like helping people understand what it is and saying, hey, I can help teach childbirth classes that incorporate nitrous, or I can help you guys, you know, do some more labor support because when you have nitrous, guess what? Your epidural rates go down. So, hey, what do you guys need to know about labor support? How could I help with that?
[41:41]
Yeah. So, well, those pieces start coming more and more. I'm just so skeptical. Sorry. They like our local hospital who catches the most babies. They, they just took it away. Like we've had it for years. They took it away during COVID Um, and they, and they brought it back and then they just took it away. It's, there's some like policy stuff going on at the hospital, which I've talked to the people, but I'm just like, you guys, come on. Well, and I think so many get it wrong about what it's actually, what nitrous is actually good at doing and what it's not. Oh yeah. Yeah, yeah. Some people are like, oh, it's like an epidural. No, no, it's gonna be— it's, you know, yeah, you have to understand. And some of that is that brings you into a really good discussion about what is pain and what is, what is discomfort, and how there's maybe— there's a Venn diagram, there's a little bit of overlap, but these are separate. Let's have that conversation. Exactly. That's a whole other thing too. So, you know, what is pain versus discomfort? That you have to understand how those are different, but yet overlapping. And how nitrous can really help with that and how anxiety plays into pain and how nitrous can help with anxiety. Nitrous can help with some of these other pieces. Yes. I mean, it's so much about this a second because this really involves nurses and doulas particularly is that our nurses were done a disservice in that the hospitals got nitrous and then didn't tell them how to use it. Right. They told them how to turn the machine on, and that's about it. And so then they're giving clients the wrong information on how to get the most care out of it, and then it doesn't work. And so the nurse stops recommending it because they're not seeing it work. And so, you know, I will say, hey, like, are you— my client's wanting some nitrous. And they'll be like, oh, fine, we'll go get it. Like, you can tell they're like, oh, this is never going to work. And you know, they get it. And then I'm like, you know, I try and always say like, oh, hey, I use it a little bit differently. Let's just try it. And they're like, oh, wow. Like afterwards they're like, oh yeah, that was really different. What were you doing? And I was like, well, you tell them to start breathing before the contraction, not during the contraction, right? Like it takes 60 seconds to start being effective. And they're like, oh, like, right. It's magical healing gas that poof, like, it's not like a spell for all my Dungeon Crawl fans. Right. It doesn't work that way. Unfortunately, I feel like with COVID we've gotten to this really bad place of all education is just-in-time learning, and you're like, that's really not a great long-term plan. Not a good plan because you don't get a rationale. You don't get the how does this work kind of pieces. And more importantly, what people often don't understand about nitrous is it changes your care. Like, your patient isn't numb from xiphoid process down. Yay, thank God, themselves. But at the same time, how does this change? What does this mean for how you help somebody through? You do need different types of labor support. You do need to help the mom understand, okay, you're feeling this, this, you know, something changed. Maybe that's a good time to pick up the nitrous. Maybe that's a good time to start having some slower breaths and getting comfortable and preparing for the contraction. Let's work through the contraction. Okay, now let's take a break and let's, you know, those kind of things. They haven't really learned that. So that's the piece where you guys could be really helpful and say, let us work together. If you got, if you're, I heard your hospital is going to incorporate nitrous. Can I come and help you guys with some training? Can I Can I come to those pieces? Can I offer some expertise there? You know, it's kind of a fine line because it's medication. You're not giving the medication, but helping somebody understand how that changes care around it is huge. Well, and it's also taking something off their plate, right, that they have to deal with. And if I know nothing about nurse managers, that is one thing that they really love is when they are able to take something off There's so much, and for that nurse manager having to say, okay, I'm having to do a new policy, I'm having to write a new policy, I'm having to teach a new policy, I'm having to teach all this, to have to teach that other piece that they may not be as familiar with and just don't have the time to do, um, would be huge. So to offer some expertise there would be really, really helpful and beneficial. And then for people to be able to see that you offer so much more than that would be part of that, and that would be so helpful. So what do you think that nursing schools could do differently in the next 5 years, particularly to change that culture around labor support? What would you— in your ideal world, what would you love to see happen? Well, we kind of— we get an— we have a cool opportunity now in that our students are really different. Our, you know, our students, as you know, look at things so much differently than I know I did when I was in nursing school.
[46:45]
Um, they're about the experience. And like, I was basically taught labor was just something to get through, whereas they're really about how can we make experiences better for people, because experiences are important, to kind of leaning in on that. And labor is what I tell my students and what I tell people, nurses that I teach all the time, is for us it's 12 hours. It's a 12-hour shift. But for our family, it's a once in a lifetime, even if they have more than one birth, this birth will never happen again. And so this is the once in a lifetime, and we have an opportunity to shape that once in a lifetime to be really meaningful and empowering through labor support. Like labor support is how we set up families to have an empowered birth and to set them up to be successful parents. So it's the opportunity to engage and to help somebody not just now, but generations from now.
[47:45]
Like this 12 hours that you have with them with labor support can make such a huge, such a huge impact. So in helping them understand that labor support is the key to decreasing perinatal mood disorders, to decreasing morbidity and mortality, like this is such an easy thing that hits all the marks that we know they want to hit. And, and students are very in tune to how can we make things better for people and how can we recognize people where they are, so much more than I was when I was a new— when I was a new nurse. So let's lean into that. This is how they can— how we can take some of the positives that they bring to us and build upon it. So that's a great place to start, is where our students kind of already are, which is different for us because that's not where we were when we were students. You weren't talking about epigenetics when you were a student. I mean, there's— they know so much more and they just know different things. And I think that's the piece that we have to acknowledge is really the cool thing about where our students are, that they know things differently than we do. And it's a great place to lean in, in that If nothing else, not all of my students— I mean, I tell the students every year, I'm like, I'm gonna be happy if I get to keep 10% of y'all, but I know that most of y'all will be parents, you know? So let's talk about this from that viewpoint. Like, how can you advocate for yourself as a consumer? How can you advocate for yourself, for your— for people you know and love who are childbearing? So how can you advocate for that? So there's so many pieces that they already kind of lean into on that, that let's just build on that, folks. So they're a lot more in tune in things than we were. Is that right?
[49:41]
10% retention? For labor delivery. Oh, no, they stay. No, the hard part is most nurses don't stick around after 2 years, and that's a whole different discussion. But no, of a graduating class, I'm lucky to keep, you know, all of them are like, I want to be critical care nurse because then I can be a CRNA, or, you know, I'm going to go straight to grad school, which is great. I mean, they have, there's so many options. And like Robin said, it used to be they had to spend so much time in med-surg before you got to go to specialty. I was really fortunate. I got straight into labor and delivery 25 years ago, and that was unusual. Um, but mostly because I don't take no for an answer. This is why we love you. I will keep, oh, you're not going to hire me at the place that I'm already working. Okay, I'll go somewhere else then. Thank you. Have you heard of the word persistent? You want me to work nights? Done. So if I ever have the entire time— so if Catherine doesn't have a smile, be very afraid. I don't know what it is, but I don't want to find out either. Dude, if I ever went back to the hospitals full-time, I'd be like, you're putting me on nights. That's where I belong. I do not want to be awake learning oriented before 10:00 AM if I have to be. So, but you know, that's such a different thing that they get to start straight in. And so because there's so many opportunities for them straight outta school, um, that not everybody chooses this path. The other piece that they look at is they do recognize that babies come anytime, day or night. And for some people that's a little overwhelming. So that's— I think for some OBs that's overwhelming sometimes. I'm like, it's overwhelming for me too, right? Right.
[51:32]
So, and some people more and more, we have more and more students who are looking, as they should, at their career in a different way. Like, I need to spend 2 years here to get me to train for this piece that I'm hoping for, for that piece that I'm hoping for. Hoping for. Um, so, and unfortunately they don't always see a positive way forward in labor and delivery, which, I mean, you can spend your entire career in labor and delivery in so many different ways. Like I tell my students, I'm once a labor nurse, always a labor nurse. Here's all the things that I've done over the course of my career that have always been labor, you know, and I've done lots of different things. Like you don't have to just work bedside. It could be so much more than that. And they don't always see that. Whereas they see, well, if I do this, I can go be a nurse practitioner. Well, why not be a women's health nurse practitioner? Why not be a certified nurse midwife? You know? So, you know, it's, and they all think they're gonna go to NICU and hold babies. And I'm like, oh, sadly you do not hold babies in NICU.
[52:38]
Yeah, yeah, you don't hold babies anywhere. Like, we're not— we should not be the ones holding the babies. The mamas and the daddies should be the ones. The parents should be holding the babies. Families hold babies. We have to do the interventions and the mean stuff. And for some people, they're not comfortable with the idea that, oh my God, I'm gonna have to stick a baby. Yeah, well, you might not belong in nursing. Well, I mean, if you don't mind sticking adults, then go where you can stick an adult, you know. Sure. So, Katherine, is there a question that nobody asks you about the work that you're doing that you wish they would ask you? Oh, gosh. I get asked why it matters a lot. And I tell people all the time, if we don't have this, these support pieces, we, we are not gonna be enough. But I think nobody ever says, well, what is enough? Enough is not just that we're not— our C-section rates are where the WHO recommends, that our maternal mortality rates are what they recommend, but our perinatal mood disorders are what they should be, that our families feel empowered. Do we have a tool that measures empowerment?
[53:54]
No, we don't. Because we haven't ever really leaned into that. So that's why it matters. It matters because enough is not enough. It's not enough to be safe. It's more than that. We have to be more than safe. We have to provide a true experience that helps people start the journey of parenting, of taking— it's not enough to have the baby human exit the first human. Care of the humans. They do. All of them. All of the humans. All of the humans. You know, it's not enough to just have human, you know, human A exit human B. And they both have heartbeats.
[54:41]
Yay! Yeah, that's not enough. Enough. It's not going to be enough until it's a good experience that sets them on the way to care for one another. In the way that helps them grow and develop as human beings, as parents, as infants, as, you know, families. How are we gonna help them grow? So, cuz that's the piece that I think we're just so focused on safety that we forget. That's the black and white. That's the easy part. It's all the other stuff. Well, I mean, it's not entirely easy, right? Sitting in the state that's consistently in the top 10 for maternal mortality, like It's not always easy. Um, we're not always getting that part right either. So I think that— I think for me, what gets lost in that discussion sometimes is like, okay, well, if we can't get that right, then we shouldn't worry about this yet. And like, no. And what I don't think we realize is that when you really sit down and look at things, helping somebody feel supported actually is a safety piece.
[55:45]
Because if you keep everybody calm, you help everything stay chill, you follow the physiology, our blood pressure is going to remain normal, our heart rate is going to remain normal, everybody's going to be fully oxygenated, which helps people progress. And hey, maybe while we're at it, maybe we should feed some people, but that's a whole other— you're preaching to the choir there, Katherine. Oh my God, like, why, why do we starve people? Why, why do we do that? You know, why do we starve people? They might, you know, I tell my students all the time, I'm like, why do we starve people in the ICU? Why do we starve people in the, in labor and delivery? If you were to get in a car accident on your way home today and they said, oh, I saw that, you know, you know, Big Mac wrapper in your front seat, they wouldn't do this. They would still do the surgery to save your arm. Yeah. Yep. Well, Katherine, thank you so much for joining us again today. Uh, it was a great conversation. We so appreciate you and thank you for all that you were doing out there building nurse doula relationships and all the things you're doing for everyone in your state and everywhere else. Thank you for having me.
[57:00]
I always love talking to you guys. We need to get together like in real life. I, I think, Phillip, we haven't seen each other in real life in like far too long. So we need to have— I've never met you in real life. Oh, that's right. Oh my gosh. Like, I— Robin knows I have an obsession with figuring out how tall people are, and like, I have no idea how tall you are. So you don't know in Zoom, you know? I'm actually— I'm 5'4", which makes me a foot shorter than everybody else in my house. I'm the shortest in my house too. It's okay. They think it's hilarious to put things where I can't reach them. I'm like, stop it. Thank you, Katherine, for being here. Thank you, guys. It's so good to see y'all.