EBB 242 – Empowering Nurses and Parents with the Founder of Bundle Birth, Sarah Lavonne

 Learn more about Sarah Lavonne and the resources she provides at Bundle Birth

Check out the education and support Bundle Birth provides on their social media channels:

• YouTube channel
• Instagram
• TikTok 

We talked about Ana Paula Markel’s doula training program, check it out here.

Rebecca Dekker:

Hi everyone. On today’s podcast, we’re going to talk with labor and delivery nurse and the founder of Bundle Birth, Sarah Lavonne, about supporting families so that they can have a confident and empowered birth experience. Welcome to the Evidence Based Birth® podcast.

My name is Rebecca Decker. I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hey, everyone. My name is Rebecca Dekker, pronouns she/her, and I will be your host for today’s episode. Before we get started, I have some exciting news, tonight, Wednesday, October 19th at 8pm as well as this coming Sunday, October 23rd at 2pm Eastern Time, we will be presenting our free public webinar all about the evidence on Pitocin. The research team at EBB and I will cover oxytocin and Pitocin, what are the differences between these two things. I’ll give you some history and research updates and we’ll also talk about the evidence on induction and the evidence on using Pitocin to augment labor. If you want to attend, you can register for free at ebbirth.com/webinar. Even if you can’t attend live, make sure you register, because everyone who registers will receive a link with the replay. We also have our Evidence Based Birth®  Pro Membership on sale for a limited time only. The Pro Membership sale gives you $20 off the monthly price so you’d be locked into the lower price and $120 off the annual price. So you really can’t beat this deal! The sale starts today and ends at midnight on Tuesday, October 25th. To join, just go to evidencebasedbirth.com/membership

And now I just wanted to let you know that in today’s episode there will be a mention of infant and child loss. If there are any other detailed content or trigger warnings, we’ll always post those in the show notes that go along with this episode. 

Now I’d like to introduce our honored guest. Sarah Lavonne, pronouns she/her, is a pioneer in nursing and birth education and the founder and CEO at Bundle Birth, a nursing corporation. Sarah is a registered nurse, certified in inpatient obstetric nursing, a certified childbirth educator, and a certified lactation education counselor. With a vision to unite patients, support persons, and medical personnel together through education and support, Sarah and her team at Bundle Birth have fearlessly developed a community of learning and inspiration across labor and birth. Sarah dreams of all birthing people having not only a healthy birth with safe outcomes, but healthy birth memories. She offers a spectrum of services from support to on demand classes, to a robust online YouTube presence. Sarah loves seeing families and nurses transform from nervous and overwhelmed to confident and transformed. We are so thrilled that Sarah is here. Welcome to the Evidence Based Birth® Podcast. 

Sarah Lavonne: 

Thank you so much for having me. This is truly an honor to be here. 

Rebecca Dekker: 

Sarah, we’ve been following your work for a while. I know you’ve followed EBB, but this is the first time we’ve collaborated on an interview together. 

Sarah Lavonne: 

I know. 

Rebecca Dekker: 

We’re so thrilled. Can you go back towards the beginning of your story, and tell us about your journey to becoming a labor and delivery nurse? 

Sarah Lavonne: 

Yeah. For sure. 

Rebecca Dekker: 

I know you went straight from nursing school into labor and delivery, so tell us all about that journey. 

Sarah Lavonne: 

Yeah. Actually, I’ve been in Los Angeles since nursing school. I grew up in South America, in Ecuador, and then moved to the States by myself. Remember, this is dating myself, but this was right when wifi was coming out. I look back at that experience and just how much I didn’t know and how little I could Google everything. I learned a lot about living in the States in that amount of time. Then that experience led me. I knew I wanted to do nursing, but as far as labor and delivery, I started working at Children’s Hospital Los Angeles. Learned quickly that pediatric nurses are the most amazing, one-of-a-kind, unique types that I am not. So I was dabbling between pediatrics and labor and delivery. It’s a crazy story, but I ended up getting hired. Of 900 applicants, there were two positions. I got hired as a new grad into labor and delivery right away. Really, the dream was I had been a part of sad nursing. All nursing is sad in some ways. But there’s certain specialties that are more sad than others. 

Rebecca Dekker: 

Can you pause a minute? What do you mean by sad nursing? That’s not something- 

Sarah Lavonne: 

Just where you’re dealing with the spectrum of life, where you’re dealing with the end of life. Nursing in general is dealing with health and wellness and helping people be well, but that doesn’t always happen. Particularly in pediatrics and then through my clinical rotations, I had so many experiences where I walked away just miserable and so affected by being around death regularly. I knew that while I actually really liked certain elements of that, I thought about labor and delivery. Also, we’ll get to the patient population side of things. There was a combination. But it was like, “I don’t know that I have it in me. This will wear out my soul to be around this day in and day out.” I was so deeply affected by especially pediatric loss. Mind you, I will say, labor and delivery, when it’s sad, it’s really, really sad. But for the most part you’re on the other spectrum of life. So I liked that more positive side of nursing for that. 

The other side was I knew I loved working with young women and birthing people. I liked that younger population. Then I also loved babies. So I will say that going into labor and delivery nursing, I don’t know that I knew exactly what I was getting myself into. Do we ever as nurses? But I knew that I didn’t want to do pediatrics. When I did my clinical rotation as a nurse, I loved it. My soul came alive. Everything about birth and the process was just fascinating to me. My clinical instructor knew that. She’d pulled me from the postpartum side and put me in more births. I saw … I think it was 13 births as a nursing student, which is insane. You’re lucky to see one or two, normally. 

It was a combination of things. I think my pediatric experience and loving that learning so much, but also just being so sad all the time because of it and so deeply emotionally affected, and then the fact that I just loved birth, I think led me. And then I got hired. Ultimately, especially, that was back in the nursing shortage, where there were nursing students from my class that didn’t get hired for two years on the floor. So I got hired- 

Rebecca Dekker: 

There was a nursing surplus at the time? 

Sarah Lavonne: 

Yes, thank you. A nursing surplus where there were- 

Rebecca Dekker: 

A very brief one. 

Sarah Lavonne: 

Yeah. The opposite of what’s happening right now, where you couldn’t get a job as a nurse. So, of the 900 applicants, it was a very clear movement into labor and delivery. What I found when I got there was I remember my very first shift, I called my parents in Ecuador. I was like, “This is so hard, but this is amazing. I will do this the rest of my life.” Thinking how many people have multiple careers, and now I’ve had multiple careers, just all within birth, and shifted things along the way. But I just was like, “Literally, my soul is going to just thrive here. I love it. It’s so hard, and I’m completely overwhelmed, but I love this so much.” 

Rebecca Dekker: 

Well, tell us about being what I like to call a baby nurse. When you are just starting out after school, that first year can be really rough. 

Sarah Lavonne: 

Oh, yeah. 

Rebecca Dekker: 

You said it was hard, but it was good. What are some of the memories that stand out or some of the experiences you had that first couple of years? 

Sarah Lavonne: 

Yeah. I started at a hospital in East LA. Because of my experience in Ecuador and being fluent in Spanish, not only was it amazing for bringing my worlds together and nursing school, Ecuador, all of that, but also, the patient population was my favorite. Still to this day, when I joke about going back to the bedside, which I don’t think I will, but I always say, “I would go back there,” because it was the most incredible, diverse experience, which, with labor and delivery, what that means is I got to see a whole lot of births and a whole lot of unique, different birth experiences, and a diverse experience, not only in the way people labored and their family histories. I got to use my Spanish, so I got to connect on a really deep level with my patients, which I loved. But then, also, I got to see the actual nursing side of things, which I think a lot of people think labor and delivery, you’re just catching babies all day. I say it’s happy nursing. For the most part, it’s happy nursing, but there are complications that can happen. 

The population I was working with was a high-risk population. So I got to see and experience all of these complications and carry these families to the finish line, hopefully as intact as possible. I realized that I really liked that, too, that there was an element of … I’m kind of the adrenaline junkie. I liked the high-risk cases. I liked figuring out how to get them there and how to keep them safe. Early on, I think back to that experience of being at that hospital. I remember being told in orientation that working here for a year is like working four elsewhere. I was like, “You get to see everything.” I really did, whether that be the perfectly normal, expected birth, that’s their first to 15th child, no joke, to the really high-risk, keeping them safe, where it’s really a medical birth, and I loved all of everything in between. 

Rebecca Dekker: 

What happened next? You got your feet wet as a labor and delivery nurse. You were learning so much. What was the rest of your experience like in the hospital? 

Sarah Lavonne: 

Yeah. I was a floor nurse, staff nurse, and I ate that up. I realized very quickly, and again this is my first career. I was 22 when I started as a labor and delivery nurse. I learned about myself, that I like to be challenged. I learn pretty quickly, and I’m pretty self-motivated. So I got to a place, probably a year and a half in, where I was like, “I don’t know that this is all of how we do birth.” So I wanted a second job. Really, I also looked at my student loans and was like, “I’m going to be in debt for the rest of my life if I don’t do something about this.” So I got a second job specifically in a completely different world, to give me a diverse experience. That was in the heart of Beverly Hills, at a very prestigious hospital in Beverly Hills, with a completely different patient population. All private doctors. That just really, all of a sudden, woke me up. 

I remember I was at the bedside, and this nurse was like, “Yeah, we could use a stirrup to put their leg, when you turn them to the side, to hold their legs open, to put them in a different position.” This was the beginning of my physiologic birth days. I was like, “What? We can use the beds? We can change them in this position? It just all of a sudden started opening my eyes to a different way of birth and labor, and how other providers may assist families to the finish line. So started in Beverly Hills, and then very quickly there was selected as a group of … There were eight of us nurses to revamp their childbirth education program. 

I’d always loved education, always spent a ton of time at the bedside educating my patients, and had my way of explaining things. They pulled us from the floor for four months, and we, alongside of Ana Paula Markel, who is a doula here in LA, she’s very involved with DONA and incredible, they brought her in to help develop a hospital-based childbirth class with more of a … I’m going to say natural approach. Less hospital based, more well-rounded in its approach for childbirth ed. 

I learned to teach childbirth classes, developed some specialty classes and taught those, and then really found that that experience, seeing families prior to coming to the bedside, because as a labor and delivery nurse, we see them, they come in, in labor likely, or maybe to be induced or whatever their circumstance, and then they have their baby. That’s the only interaction we have with them. Whereas now, seeing their concerns, seeing their fears, their anxieties prior, and then watching them show up to the unit after having taken a class completely transformed, and comparing that to the experience of people that don’t do education, I can see a visible difference in how they carry themselves, how calm they are, and their experience. 

I loved that side. I feel like it created this diverse, newfound passion in me. It’s still birth, but it’s just another branch or another way that you can go about being involved in that world. So I started teaching those childbirth classes. Eventually, they actually brought me into a peer-mentor role, where I was training labor and delivery nurses once they got off orientation and doing other nursing education on the floor, being a resource. They pulled me from count, meaning I didn’t have my own patients. I basically roamed the floor helping people and seeing how nurses practiced, and filling in the gaps, and coming up with … Clearly, we need some work on learning about fill in the blank, XYZ-type procedure. Then I would train the nurses on that, which led me into an administrative role, managing the childbirth and parenting education program at that hospital. 

At this point, I quit my job at the other site. I’ve paid off my loans. Hallelujah. And went into an administrative role, which, again, just showed me the management side, the business of the hospital and being a part of meetings with higher ups in the hospital, seeing the way it runs, having my own team and developing them. Improving the childbirth and parenting education program was also just thrilling. I’ve done a lot, and it led me to where I’m at now. I think each piece, looking back, I’m like, “I couldn’t see it then, but now I can see how those diverse experiences in birth and in education, in the community and then also in the hospital, have led me here. 

Rebecca Dekker: 

Do you feel like you saw amazing, incredible care in births? Did you also see the opposite side, where there was a lot of shortcomings or things that you didn’t agree with? Tell me a little bit about that. 

Sarah Lavonne: 

I have a lot to say about this one. I think partially yes. Starting with what I saw in the way that people practice, I think that medical people, nurses, doctors, the people that I was working with, have the best hearts. They’re some of the best people I’ve met. They mean well, most of them. Obviously, you have the one off, but in general, they mean well. But what I was finding was there was a disconnect between especially what they were being taught and then they’d show up. I mean, this is evidence-based birth. They’d show up, and the patient will have done the education. This, even currently, I had struggled with early on in Bundle Birth days, where they’ve done the education. They’d show up to the hospital, and the nurse is like, “Nope, I don’t like that. Nope, I don’t feel comfortable with that. Nope, that’s not how we do it here.” 

That’s really disempowering as a family member or a birthing person who’s like, “I did my homework. I’m ready. We’re on the same page. You’re the expert here, so I would assume that you would know this stuff.” But that wasn’t always the case. That disconnect, absolutely, I saw, I think, what we’re teaching versus what we’re practicing. They say in the medical world that any change, any practice change, any evidence change takes what, five to 10 years or something? We’re the slowest to move. Now, I would say probably a little faster thanks to technology and the internet and stuff. But still, to change your practice, especially as nurses, when we have less control over the room, when the provider, the doctor, the midwife is going to be the one running the show, I think, yeah, there was a good amount of disconnect. 

The other thing was just this centering around the patient that I just was like, “The shared decision making has always been something that’s been a passion of mine.” I actually found recently, I won a shared decision-making award at some point along the way. I have no idea where. But it goes to show that the idea that you have control over your body, that you have control over your choices, that the provider’s job is to help you understand the risks, benefits, other options. Then the shared decision-making model is how do you feel about it? But there’s actually a discussion, given that it’s appropriate and not an emergency or something, but there’s a discussion. How do you feel about it? What concerns you? What sounds good about that? Then the patient or the family comes to a decision for themself. That’s always been a passion of mine and something that I wasn’t seeing happen all the time. 

Rebecca Dekker: 

Okay. So you weren’t seeing that all the time. 

Sarah Lavonne: 

No. 

Rebecca Dekker: 

Did you see it more with certain populations than others, or did even the privileged clients in Beverly Hills struggle? 

Sarah Lavonne: 

Oh, yeah. Oh, yeah. Especially if we’re going to compare locations and patient population, I think one of the things that was this stark shocker to me when I just had never been exposed to it before, that the hospital in Beverly Hills, the patients were very educated. They came in. They’d done their work. They had questions I had never been challenged with before, where I’m like, “Whoa, I don’t actually necessarily know the answer to that,” or “Let me get your provider in here for that.” Whereas, I just wasn’t used to being challenged in what we did. 

How I was taught was this is just the way we do it. We come in. I’m starting your IV. I’m checking your cervix. We’re doing a C-section. We’re da da da da da, fill in the blank, versus that shared decision-making model. Once I saw the other side, I was like, “Wait, hold on. This is not okay.” The patient population in East LA was mostly Hispanic, Spanish speaking, Medicaid or MediCal. There was no autonomy over their decision. It was very culturally, yes, doctor, yes, nurse. I was called doctor all the time, where I’m like, “No, no, no. I’m your nurse.” Luckily, I was there translating, and I was able to help have some of those conversations with my patients. But absolutely, it was- 

Rebecca Dekker: 

It reminds me of one of my kid’s kindergarten classes, where they say, “You get what you get, and you don’t throw a fit.” 

Sarah Lavonne: 

Yes. 

Rebecca Dekker: 

Yes. 

Sarah Lavonne: 

Yes. 

Rebecca Dekker: 

You get what you get. You don’t throw a fit. This is what we do. This is how we do it. You don’t really get to question us. 

Sarah Lavonne: 

Yeah, absolutely. Absolutely. That’s how I was trained. That’s all I’d seen for a year and a half. It was just like, “Oh, okay.” I think about myself now, and I’m like, “How did I not question that?” But also, you’re a new nurse. You don’t know any better. You’re terrified every single step. 

Rebecca Dekker: 

And you’re socialized into that. 

Sarah Lavonne: 

Totally. 

Rebecca Dekker: 

It’s drilled into you. This is how we do things. We follow procedures. We follow protocol. 

Sarah Lavonne: 

Yep. Yeah. I knew that policy and procedure manual like the back of my hand. When I found that thing, I was like, “I’m going to memorize this because this is going to help me know how to do my job.” I was very regimented. That’s just not how we do it. No, that’s not an option. Oh, no. We don’t get you out of bed once your water’s broken. That was absolutely how I was trained. Then, all of a sudden, I got this diverse experience where it was like, “Oh, no. We can get it. Let’s get them in the shower. Let’s get them in the bathtub. Let’s walk them down the hallway.” I was like, “Huh?” It was very stark difference in practice. 

It was very population based. Mostly upper class in the Beverly Hills Hospital and private doctors whom are being demanded a certain thing, who are on social media and on the news and taking care of celebrities, where there’s competition. It was a whole different world. Absolutely, there was a different way of practicing. Now, mind you, what I see now is different than what I saw back then, even, as far as practice changes and how we’re approaching families. I’ve been a nurse for … I think it’s 11 years. I was trying to figure that out the other day, but 11 years, and in an age where, again, I started nursing school where wifi wasn’t a thing. What we’ve seen since is just … There’s been a lot that’s changed. 

Rebecca Dekker: 

Yeah. Tell us what inspired you to create Bundle Birth and what all you’re doing there. 

Sarah Lavonne: 

Yeah. I’d done a lot in the hospital. I got into management and was like, “Eh.” I loved the team aspect. I loved the leadership. I loved the strategy and knowing the ins and outs. But I was like, “Man, I really miss birth. This is not it.” But then, when I was in birth, I was like, “I feel like I have all these gifts and skills that are just not being utilized.” I had seen what was happening in the community, in the hospital. I was like, “I have this dream. We should create a center for all things birth. It could have education classes and group prenatals and all these things.” They didn’t want anything to do with me. I just was like, “Okay.” 

I was trying to be creative with how do I continue to innovate and help? I am a fixer. I love helping. I love education. I love people. I was just like, “Oh, I don’t know.” Everywhere I went was a roadblock. It was just no. The answer is no. If you’ve worked in a hospital system, you know that the hospital has a lot of red tape. You want to put a flyer out on a unit, and it takes a year. So I got to a place where I was like, “I think my soul will die here.” I remember saying that and being like, “Whoa.” I had a hair appointment later that day, and I was asking my hairdresser, “What does it take to become a hairdresser?” I was in this in between, like this isn’t it for me. I have so much more that I feel like I can offer the world of birth. I’m not done in birth, but I’m not totally satisfied, and I see so much area for improvement. 

I determined that I felt like I had maximized my reach from the inside out. It was like, well, you can go from the outside in. That’s the other option. So not knowing at all what it’s like to be an entrepreneur, not knowing anything about business, never a business class in my life, I quit my job and said, “I’m going to do it on my own. I’m going to start with labor support.” I always said that, knock on wood, I don’t even want to say this out loud because I’m so superstitious, but if I ever lost my nursing license, I’d be a doula. Again, knock on wood. That freaks me out. But I was like, “I still want to be involved in birth. Let me have my own client base. Let me create my own childbirth classes, do it the way that I would dream of doing it, being fully independent, and then see where this goes,” really with the idea of everything that you introduced in the beginning, of building confidence through education and support. 

What I’d learned in the hospital was, and I’d seen it, the families that had the support and had the education had a completely transformed experience than the ones that didn’t. So landing on those key things, education and support being my goals, I started Bundle Birth. I quit my job October of 2017, and Bundle Birth was official in January of 2018. We are coming up on our five-year anniversary, which is insane. I just was like, “I just want to help. I just want to be a part of it. I want to try to impact from the outside in and see what we can do for the masses.” That led me to, on a whim, this was so not the intention, start a YouTube channel. 

I remember starting the business and being like, “If I were a pregnant person, what would I do? I’d Google.” So I Googled, and it was a bunch of YouTube videos. There was one, and I was like, “Oh, I can do that.” Fast forward four years and over 200,000 subscribers later and hundreds of videos, I’m like, “I’m fully a YouTuber now,” which, again, was never the intention. But what I love about this life is that flex and flow. I say flex and flow, really with my goal just being I just want to help the world. There’s so many amazing people doing such amazing work, you being one of them. For me to get to offer my giftings in my own unique way, given that I’m my own unique person, was just so fun and the hardest thing I’ve ever done, but amazing. 

I started Bundle Birth, really with online childbirth classes, in-person labor support, turning virtual, YouTube, social media. That led me to a crossroads, where I always knew I love nurses. I always knew that we’re not all on the same page. What’s being said in the hospital is one thing. What’s being said in the community birth stuff is another. I was training doulas. I worked for Ana Paula in LA, was teaching childbirth classes. That was different, too, because it was hospital, home, and birth center births, so learning that side of things. I had clients in various other places and was seeing birth now from a more macro perspective in LA, and then learning about it worldwide through my YouTube and social media presence. 

Just the most frustrating thing is they do all the things, they fill in their birth preferences, and they’re like, “I did my homework. I’m ready.” They hand it to their nurse, and their nurse is like, “Ugh.” It’s the most distant. That one ugh is just that one diss. I remember that because I saw that with one of my clients. She was the most, quote-unquote, “normal birth plan.” Everything expected, what they normally do. But she was so proud. I was just like, “Oh, boy.” What I realized very quickly was I can teach patients until I’m blue in the face, and they show up to the hospital, and they’re totally whacked across the head by the nurses not being on the same page. When you think about that impact and that reach, it’s like I can touch one family, or I can touch a nurse who touches two families a shift, three times a week, four weeks a month, into the year. That is more impact. And knowing now nurses, knowing the community, and having this picture of what’s going on, I was like, “We got to do something for nurses.” 

Rebecca Dekker: 

Yeah. How are you serving nurses? 

Sarah Lavonne: 

Yeah. Well, it led me to how we’re serving nurses, which was the first step in, because I’m a nurse, I’m offering my nursing self to my patients, but my hands are tied at the bedside. Instead of the medical way that I was taught of, well, their labor slowed, so start the pit, or let’s AROM. Let’s break their water. Let’s move things forward. Let’s rush the process. I couldn’t do any of that. I couldn’t call the doctor to be like, “Hey yo, let’s do this.” That led me into a practice of using my hands and reading every book on the planet of how do I really serve my patients? How do I know the body so well? And then getting to practice that and strategize birth along the way, in a physiologic way, which led me to this physiologic birth class, which was our ushering into labor and delivery nurses. 

I put together an eight-hour class for nurses, very hands-on, specific to labor and delivery nurses, on the physiology of birth, and the training that we all should have, given that we’re birth people. But stepping back from a nursing perspective, let’s walk through every body system and how they all interplay to birth the babies vaginally and safely. I put together that class, and we launched. We sold out, which was 46 people in LA, in person, in January of 2020. I was like, “Oh, this is great.” We sold out. We added a second date. I thought, “46 people. That’s amazing.” So we did this class. The pandemic hits. We have to pivot. We have to figure things out. My partner, Justine, who’s Director of Nursing at Bundle Birth Nurses, she was like, “You got to put this thing online.” I was like, “No, no, no.” Put it online. Now to date, we’ve trained a thousand. I think it’s 1,800 at this point. 

Rebecca Dekker: 

Wow. 

Sarah Lavonne: 

Providers, doctors, nurses, midwives, worldwide in physiologic birth. I will say, I think it’s starting to shift the culture. When I go to births, I had a virtual birth three days ago, and they were like, “Let’s do closed knee pushing. Let’s turn to the side. Let’s try this. What do you suggest?” The whole perspective, how they included the patient, the shared decision-making model, all the things I talked about, I’m seeing happen more now, as I would say, partially as a result of the work that we’ve been doing. 

It started with physiologic birth. Then we put together a 12-month mentorship program, which is really all the heavy hitter nursing topics. That’s the nursing orientation that I dreamed of having. It’s all on demand. It’s virtual. We have nurses all over the country and in Canada in that program. We have a social media presence. Really, I think that’s been the biggest surprise of this whole thing. Really, my soul just is so alive. Like I said, my soul will die here. I’m so the opposite, living that reality of seeing families transformed, of, I feel like, putting our mark into the birth world and helping impact nurses so that they can give more evidence-based, more confidence-building, trauma-informed care for these families so they come out whole. 

Rebecca Dekker: 

I was wondering if you could share. I know you said you’ve seen the difference in the nurses. When they come fresh to a workshop or one of your online training programs, they haven’t received this education yet. What are some of their questions? What are the nurses like, and how are they at the end of their transformation? 

Sarah Lavonne: 

I think just a knowledge base. We think we know the body, and I think they walk out of particularly physiologic birth going, “Whoa, there’s a lot going on.” There’s a lot that I, nursing intervention-wise, can do to help support the body to do what it knows how to do. That, to me, equates to an added layer of confidence. The other thing that I’m seeing that is a byproduct that I expected, but I think has also surprised me in some ways, is an added love for their job. I think one of my skills is I’m pretty motivational. I’m pretty inspirational. I bring a lot of challenge, but I also bring some grace. I think by the end, they’re like, “I am going to be able to do this. I do have control.” There’s nothing worse as a nurse of wanting to give your best to your patients and not knowing how. 

I actually have to make a disclaimer that at this point in the class, you’re probably thinking about a patient where you’re saying, “What if I would’ve done this? What if I would’ve tried that? Oh, my goodness. That’s probably what was happening then.” It’s easy to beat yourself up. That’s moral injury. We talk about that in our mentorship program, where these nurses are caring a lot. They work really hard, but also, I think they’ve been ill-equipped to handle what’s been handed to them. So to walk out of particularly a physiologic birth class, they’re like, “Huh, I can do this. I have tools. I’m not at the disposal of the doctor’s order or the Pitocin or the C-section, even. I know how to advocate for that with my providers to say, ‘Hey, I got something else. I have an idea. Can you give me an hour?'” And they’re doing it. How good that feels as a professional who’s given three days of 12 hours a day of their life to these families, that they’re feeling more empowered, more confident in their jobs and less burnout, to be honest. 

I see that through mentorship. One of our mentors that I just hired, she did our mentorship program. She came in into mentorship feeling like, “I’m done. This is my last-ditch effort to find passion in this because it’s a challenging job. It’s emotional.” She walked out being like, “I love this again.” To have nurses who love their jobs … The challenge that we say all the time is do you on the outside so that when you come and you go to enter that room, you clear it away, and you offer your best self to that patient. How good that feels for them and how much better care the family’s getting when they are, and not only their best self, because that is therapeutic communication. That is your approach in a more trauma-informed way. That is removing bias as much as you can. Then it’s also this added expertise of I know what’s up. I can assess, know what’s up, and help them achieve their goals for their birth. How good does that feel? 

Rebecca Dekker: 

It sounds like what they’re gaining is new knowledge about how the body works, and then hands-on labor support skills, similar to what doulas and midwives are trained in. So they don’t feel so helpless when labor isn’t progressing, or the doctor’s saying, “Maybe we should do a C-section.” They actually know how to facilitate normal birth. 

Sarah Lavonne: 

Yes. Back to the basics. I mean, some of the books that I read for the physiologic birth class were from the 1800s. I’m pulling history to play into everything that we do here. Some of that, I think culturally, we need to go back to what birth was, to start there instead of starting with the medical side. The other added layer is the whole shared decision-making model, where we’re offering. The practice change that we have challenged for, it’s been as long as Bundle Birth Nurses has existed, is consent for everything. That added like, “Oh, hello. Let’s just alert to the fact that it’s not okay that you’re doing a vaginal exam without asking them and getting permission from the patient.” You don’t know. I’ve done it because I’m going to check you now. Okay. Open your legs. Here you go. Now I think about that, and I’m like, “Cringe.” But you just don’t know. 

I’ve seen that, too. It’s so fun to … whether it’s virtual or in person or hearing the stories of … I had a patient text me the other day. She’s like, “I went into L&D for an NST, and the nurse just kept asking me for permission.” I was like, “That’s amazing.” She’s like, “I know. It got old, but I really liked it.” That’s new. That’s not the way that we have practiced in the past. That, for me, is just a way that I can serve the world at large to help them have better experiences. 

Rebecca Dekker: 

That’s awesome. It’s fun when you can see the culture shifting as you’re working on things. I think it is part of a wider movement of people becoming more aware of the gaps in our healthcare system and what needs to be changed. That’s exciting to hear that nurses are actively participating in changing how we do birth in the US. 

Sarah Lavonne: 

Yeah. Well, we’re not stuck. I saw that on the patient side. One of the things I talk about a lot, whether it be YouTube or classes or whatever it may be, I think there is a stigma, and it comes from somewhere 100%. I’m not saying that this is wrong at all, but there is a stigma that the hospital’s out to get you, that the hospital’s a scary place, that it’s very sterile. It’s not therapeutic. It’s not healing, necessarily, in birth. To me, I think about how I practice as a nurse, and I think, especially the more experienced I got and the more I learned, that hurts my soul that anyone would feel that way about my care. The other dream is the majority of people in the United States give birth in the hospital. Not the safest first world country to give birth in. As we start alerting the medical team to this, it’s like let’s shift it ourselves. I think it can feel overwhelming as a nurse, of this is a bigger problem. I’m only one little fish in the sea. 

What we challenge in the physiologic birth class is that one patient matters. When I tell this story of a starfish, this dad walks around the bend with his son, and the beach is covered in starfish. It’s like, whoa, there’s so many starfish here. The kid starts picking up a starfish, throwing it in the water. The dad’s like, “There’s a lot of starfish here. What’s the point?” He throws it back in the water and says, “It mattered for that one.” So when I think about you have 300 people coming to our physiologic birth classes, 300 people show up to that beach, and every single one of them throws a starfish back in the water, that beach is cleared off real quick. That’s the idea of changing a culture, changing a dynamic. I’m the dreamer of the world that’s like, “Let’s do better. Let’s fix it. We can do it together.” I think that was naive of me early on, but now that we’ve been at it for a little bit, I’m like, “Oh, my gosh. It really does happen. We actually can change things.” That’s just so inspiring and keeps me going. 

Rebecca Dekker: 

Yeah. Not only do nurses affect the families they care for, but nurses create the culture on their own units. What they tolerate and don’t tolerate can really change a lot. If they’re tolerating physicians cutting episiotomies without consent, then that’s the culture of that unit. But if the nurses are like, “Not on my shift,” they have more power than they realize. They influence each other, and then they create a culture that doesn’t tolerate abuse and instead is standing up for informed consent and bodily autonomy in those things. Yeah. 

Sarah Lavonne: 

Well, there’s power in numbers, too, even for your own confidence. If you are that nurse that’s maybe on the shy side and could never imagine pulling a provider aside and being like, “I’m uncomfortable because I have a concern. Help me understand this. I have a safety issue.” If you are that nurse that’s nervous, but everyone around you does it regularly and it’s a part of the culture, you’re going to have a lot more confidence to speak up for what’s right than you being the only pioneer in that way. We’re seeing it. There is power in numbers. That, to me, is I think probably what’s driving the change. 

Rebecca Dekker: 

Oh, yeah. There’s nothing worse than being the only one. I think that’s where I usually see the most burnout in nurses and midwives and even doctors. When they’re the only one advocating for evidence-based care, they often leave where they are. But if you can get a group a three or four, it spreads from there. Then the new graduates who come in, they have mentoring and role modeling, and then gradually the culture shifts. Yeah. 

Sarah Lavonne: 

Well, those new grads, those new nurses are really, to me, the opportunity. There are so many of them. We see this in mentorship. They come in inspired, thrilled, excited, and with this picture of birth. Then they get hit by the reality of, oh, wait, hold on, this isn’t what it is. Yet when you have those role models that can say, “No, no, you get to create that in your room,” it’s the room. It’s the starfish. It’s not the whole unit. Yes, there are frustrations, but what happens is then you train up, and all the new ones coming up have a foundation of physiologic birth. They have a foundation of body autonomy and all of those principles that are, to me, expected. But we haven’t done well as a medical community in training it. 

Rebecca Dekker: 

Yeah. The nursing community in general, we don’t teach that necessarily in most nursing schools. 

Sarah Lavonne: 

Totally. 

Rebecca Dekker: 

Yeah. Sarah, how can our listeners follow you and your work with Bundle Birth? Do you have any exciting projects you want people to know about? Anything like that? 

Sarah Lavonne: 

Yeah. The easiest way is just bundlebirth.com. Everything’s there. I’m Bundle Birth on Instagram. There’s Bundle Birth Nurses. We actually just launched a podcast for nurses. It’s called Happy Hour with Bundle Birth Nurses. We are getting going. We’re like three weeks in. Literally, it was launched a couple weeks ago. So podcast for nurses and then YouTube. I’m Sarah Lavonne. I have classes and support and all the things. But if there’s anything happening, you can find it on bundlebirth.com. 

Rebecca Dekker: 

Thank you so much, Sarah, for coming on. I think my listeners would probably join me in saying that it was inspiring and empowering to hear you talk about changing the culture of nursing. We are thankful for the work that you do. 

Sarah Lavonne: 

Aw, thank you. Honestly, I said in the beginning, it’s an honor to be here, but I mean, you especially, a new nurse, as I was beginning to grow in my practice and start questioning things in a way that like, wait a second, hold on. What is the evidence? I can’t tell you how often I’d go to Evidence Based Birth® and be like, “Oh, thank God for this resource,” because otherwise you’re weeding through the weeds. 

Rebecca Dekker: 

Somebody already did it. Yeah. 

Sarah Lavonne: 

Yeah, yeah. The work that you’ve done, I think about all the giants in the birth world. I see us as a little fish in the sea, but also, we all have our own beautiful role to play. You’ve played such an important role in my development as a nurse, especially while I was in leadership and at the bedside, but continue to be one of those giants for us that, together, I really see that the work you’re doing, the work we’re doing, the work other people are doing, it all plays together for the greater good. So to be a part of that with you, really, truly is an honor. 

Rebecca Dekker: 

All right. Thank you so much, Sarah, for everything. 

Sarah Lavonne: 

Thank you so much for having me. 

Rebecca Dekker: 

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