EBB 349 – An L & D Nurse’s Advice for Advocating in the Birth Room with Trish Ware the Labor Nurse Mama

• Join the virtual EBB Conference here.
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• Listen to The Birth Experience with Labor Nurse Mama podcast here.
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• Learn about induction and informed consent with the Induction Pocket Guide here.

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Dr. Rebecca Dekker – 00:00:00:

Hi, everyone. On today’s podcast, we’re going to talk with Trish Ware, a registered nurse and host of the Labor Nurse Mama podcast about tips for advocating for yourself during labor. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Decker, and 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.

Before we get started, I wanted to remind you that the virtual EBB Conference is happening March 18 through 20, 2025, and the last chance to buy your ticket is March 14. So, if you want to join me, the rest of Team EBB, and our amazing speakers and attendees– all from the comfort of your own home– then go to ebbirth.com/conference and get your ticket before the doors close on Friday, March 14. I can’t wait to see so many of you there!

And now I’d like to introduce our featured expert for today’s podcast, Trish Ware.

Trish founded Labor Nurse Mama using her 16 years of labor and delivery experience because she wanted to change the birth culture, one birth at a time. Trish believes that if you don’t know your options, you don’t have any. Now, she’s using that same passion and expertise to coach other perinatal experts on how to bring their knowledge online and create unhinged impact. Trish is passionate about her students and members but she’s also dedicated to helping experts build movements that not only educate but also transform lives, empowering them to make a difference on a larger scale. And today, Trish is here to talk with us about how to use your voice during labor, and insider tips on how to speak up and advocate for yourself.

Trish, welcome to the Evidence Based Birth® Podcast!

Trish Ware – 00:01:31:

Thank you so much for having me. I’m so excited to be here today.

Dr. Rebecca Dekker – 00:01:35:

Yes, it’s like amazing having such a powerhouse on the podcast. And I was wondering if you could share your story about becoming a labor and delivery nurse and then maybe a little bit about how, you know, when you first realized the importance of advocacy.

Trish Ware – 00:01:51:

Yes, I love this. This is such a good topic for me because it’s really the reason why Labor Nurse Mama was born. Honestly, it comes to the root of it. So I had my first child when I was very young, had my last one when I was old. But when I had my first child, I come from a very like birthy family, you know, everyone breastfeeds, you have your baby. And I went into that birth really thinking that my doctor wanted the best things for me and that they would be in alignment with what I wanted. And I obeyed everything he said. He said, take a Lamaze class. I took a Lamaze class. He told me, you know, if your water breaks, come right in. If you go into labor, come right in. More than likely, you’ll have to have an episiotomy. Now my son is older. So, you know, back then we didn’t question that at all. I had one, even though looking back, I had a very short first birth and I had every intervention known to man. But I also loved birth. And I left that birth feeling like it had happened to me. And inside of me, I was like, this isn’t how it should be. Like, that was my birth, but it wasn’t my birth. And so I started really researching and looking into like different options. So I go on to have more children. I have seven now, one who’s adopted. And the rest of my births, I’m definitely strong-willed. I’ll say that. And I’ve never really been one who is like wishy-washy or what have you. So I educated myself a lot. But I also had hospital births because I also appreciated the medical side of it and just having those options. So fast forward, I’m pregnant with baby number five. I had decided I wanted to be a midwife, but I wanted to start as a labor and delivery nurse. So I went through school. I waddled across the stage. Huge. Like she’s 19 now. She’s my visual sign of my nursing career. So I walked across the stage. I ended up sitting for the boards on a Friday, had Laney on Monday. And when I did med surg for a short period and then went right into labor and delivery, that was my dream. And I loved it, but I also was heartbroken over the things that I saw. And I loved your book. I told you when you came on my podcast, I was like fan-girling. I’m like, oh my gosh, because the things that happen to you happen all the time. And as a labor and delivery nurse, and my students like to say, like, I’m crunchy with a side of medical. I appreciate an intervention when it’s needed. Like, thank goodness we have them. But I found myself constantly sitting in my car crying and watching women being coerced and bullied and threatened. And I just finally said enough. And I’m like, and that’s why I say like, I’m changing the birth culture one birth at a time, because I can only do so much. But there’s a lot of us out there that feel the same way that you and I do. And so that’s my story of how I became a labor nurse and then how Labor Nurse Mama was born.

Dr. Rebecca Dekker – 00:05:12:

That’s an incredible journey. Did your other births like turn out better? Did you feel like as you had more children, you were able to make choices that were more aligned with your beliefs and values?

Trish Ware – 00:05:25:

I did for sure. And I definitely picked my providers better after that. Now my second birth. Was just super fast. So everything I planned, but it was, it was perfect because I got there, had him 50 minutes later. So, but I will say that my fourth, he was breech and I agreed to do a version. It was a little bit, not as perfect as I wanted because of having to have the version. And then back then they would do the version and then immediately induce you. If I knew what I knew now, I wouldn’t have made those choices, but I still had a really empowered birth. And I went into that version. My midwife was willing to deliver him breech. So I felt very much like I was a part of the decisions. Yeah. And looking back, I might not have made the same options I made. Knowing what I know now, because the last one I had, he’s almost 10. And his birth, I was older. So I had a lot of different things going on. And I ended up being on blood thinners. So the ranges of options varied with each of those kids. But I feel like I made the decisions. I researched and I made the decisions.

Dr. Rebecca Dekker – 00:06:40:

You weren’t just obediently following direction.

Trish Ware – 00:06:44:

Yeah. Some of my decisions with Grayson were fear-based. Looking back, but at the time, it was like, you know.

Dr. Rebecca Dekker – 00:06:52:

It was still your choice.

Trish Ware – 00:06:54:

Yes. And I knew my midwife would listen to me.

Dr. Rebecca Dekker – 00:06:59:

And then you’re, you know, painting that picture of the nurse crying, you know, on her way home from a long shift. And I feel like a lot of nurses can relate to that. I know I can. What were some of the things that you saw? That you know, horrified you and made you fall apart afterwards.

Trish Ware – 00:07:22:

So the first one was a C-section. When you say horrified me, this was the first one. It was a C-section. First of all, I was very new as a labor and delivery nurse. And this mom really didn’t need a C-section. I was still shadowing someone. So I was, you know, I didn’t have as much of a voice. And, the C-section, like I just felt like she wasn’t prepared. This is part of why I have a module, like a lesson in my birth classes about C-sections. Because what I see a lot of times with C-section is these moms are just taken back without any information. And here’s this mom. She’s butt naked, sitting up. We’re cleaning her. We’re doing all these things. Then we’re laying her down. The room is bustling. There’s different team members coming in. And she’s laying there just naked. And no one’s talking to her. And I remember I’m shadowing. I’m learning. So I went up to her. Which, you know, it’s a sterile field. And it’s something we have to do. But I was like, why did no one prepare her for that? I was new. So I didn’t have C-sections myself. But I made that a mission from then on that I made sure that at the very least, moms know that that portion’s going to happen. But I really realized, like, they’re not looking at her as a person, as a woman who is now sitting butt naked in a room full of people, which is never comfortable. You know, and I know it’s not like some of the huge problems we have in the hospital, but it was a changing moment.

Dr. Rebecca Dekker – 00:08:59:

It was like about human dignity. Right. Right. Like being literally stripped.

Trish Ware – 00:09:04:

I’m starting to tear up. Yeah.

Dr. Rebecca Dekker – 00:09:06:

So is that something that your hospital did? They removed all the patient’s clothes right before the C-section?

Trish Ware – 00:09:12:

So when you get into the room, we have to scrub them. So they have to be naked. Yeah. So they go in, they sit up for their spinal, unless they already have an epidural, we bolus it in the room and then they get to the operating table and they get stripped down. I mean, you can’t, so we have to sterilize them. We have to scrub them. So they’re naked while the nurse is scrubbing them. And then we drape them and stuff, but for that period of time, and then we have to put in the Foley and everybody else is doing their job, which it’s their job. And no one’s like, Oh, she’s naked. No one’s thinking that. But from the very first, I saw her face. And even thought like how I would feel to be in that. So that was one of the first, real, and I could still see this patient like in my brain. That was one of the first moments where I was like, something is not right here.

Dr. Rebecca Dekker – 00:10:09:

Yeah. It’s making me feel flushed. Like just thinking about it, you know, like I feel warm. And it’s, it’s interesting kind of trauma because it’s not what we typically think about of trauma, but like we were saying, it’s about a lack of like respecting someone as a human being, treating them more like a piece of meat or something like a task.

Trish Ware – 00:10:29:

And in all fairness, that part does have to happen. But imagine if she knew that it was going to happen.

Dr. Rebecca Dekker – 00:10:36:

Or that somebody was talking her through it or helping, you know, if she needed privacy of some kind, helping with that or, yeah.

Trish Ware – 00:10:46:

Yeah. It’s a moment during C-sections that I don’t think a lot of people are educated on. And that is something the same thing is I teach my students if they don’t have an epidural, if they’re a scheduled C-section or they’re converted to a C-section to ask to walk into the OR. Because that in itself makes them feel more human and more powerful.

Dr. Rebecca Dekker – 00:11:07:

More empowered, more strong.

Trish Ware – 00:11:09:

Yeah.

Dr. Rebecca Dekker – 00:11:10:

Like it’s their choice and they’re going to their birth instead of.

Trish Ware – 00:11:15:

And most of them have never been a patient before. And, you know, you’re not there because you’re sick or something bad. So came from one of my VBAC students. Which well with her VBAC birth, which didn’t happen, she ended up a repeat C-section. She walked to the OR and she told me how empowered that made instead of being rushed on a stretcher or wheeled in a wheelchair. She walked there like a person talking to the nurse, her partners at one side. And it was like, she said it just made a huge difference for her.

Dr. Rebecca Dekker – 00:11:47:

Yeah. Even the, like you mentioned having family in the room, it sounds like in the first one, when she didn’t have a partner or anybody that was allowed back.

Trish Ware – 00:11:56:

Well, and they don’t, they don’t let them back until they know they’re numb. Then they do.

Dr. Rebecca Dekker – 00:12:02:

So they don’t want them in if they’re doing a spinal or anything like that.

Trish Ware – 00:12:05:

They don’t let them in until they’re laid back, draped, and all the sterile drapes are up and the surgeon tests.

Dr. Rebecca Dekker – 00:12:13:

Yeah. And I know that’s not every hospital, but most hospitals, okay.

Trish Ware – 00:12:16:

The majority of the ones, I mean, all of the ones that I worked at throughout. I did travel nursing.

Dr. Rebecca Dekker – 00:12:23:

I think that was one of the things that really motivated me as well at EBB was the family and friends that were having Cesareans were not having empowered, respectful care. Even if that type of birth was necessary or life-saving, it seems like often they’re prioritized last in terms of being given information and support and all those little things that make a difference and make it feel empowering and not traumatizing. It’s interesting that that’s the big formative memory you have as a baby nurse. That was my first. Yeah. Right? What are some reasons that you’ve seen that parents might feel hesitant to advocate for themselves when they’re there for labor or birth?

Trish Ware – 00:13:08:

So I, from talking to my students and teaching so many women and talking to them, this is one I did not struggle with, but a lot of them, they want everyone to like them and they want to be, they don’t want to be that patient. They don’t want to be the patient that people are talking about or thinking that they’re trouble. And the sad thing is, is that they really have like this internal feeling that by questioning or wanting something different or having a birth plan, there’s some sort of trouble for us. And that has been the thing that has been really eye opening for me from this side of the labor room, from spending so much time with my moms, because I do like a weekly hangout with my students. So I’ve gotten to know them very, very, very well. So I think a lot of them are so scared that they’re going to be that patient. And a lot of them love their providers. Like they almost idolize them. And they think like I did with my first, that their provider would never do something that’s not absolutely best for them. And I do want to say some of my best friends are OBs. And, some of the things they do are not like inherently evil, but this is their job. And for all of us, our job becomes sort of routine. So I think a lot of things that are done just because that’s how they’ve always done it. But I think this, the patients. Feel like, who am I to question what this doctor who has all this experience, this is what they do every single day. Who am I to question? So I think a huge root of why they don’t speak up is even when they know that this is not the right choice. They get scared to speak up. And I think it’s because they don’t want to be disrespectful maybe, and they really want their nurses to like them, you know?

Dr. Rebecca Dekker – 00:15:05:

It’s a defensive response. I think a reaction we used to cope in terms of something, some people call it fawning as well, like where you just defer to authority and then there’s quite a power imbalance. And then as you were saying, like, even in how you’re positioned, there’s a power imbalance. You’re naked except for a gown or you’re like lying in bed and they’re standing over you. And so there’s all these like signals in the room to tell you that you’re the subject and they’re the, like the director. You’re helpless. You’re weak and helpless.

Trish Ware – 00:15:36:

I just filmed a reel because I teach my students this, but most everyone doesn’t realize this. But when you get to the hospital, whether you’re being induced or you’re in labor or not, you do not have to lay down in that bed. You can stand up and go through your admission questions, do your interview. We can hook you to the monitor. We can listen to the baby while you’re standing up. I feel like just that starts the experience off like eye to eye. You know, they’re meeting the team. They’re standing up. They’re not laying down and everyone’s coming in over them looking. That’s really nerve wracking, especially if you’ve never been a patient before. So that, I think, is a little thing you can do. I’ve had several of my students have never even gotten into the bed at all. They’ve delivered out of the bed. So I just think we don’t think we can do even something like they can’t even say no thank you, I don’t want to lay down. You know?

Dr. Rebecca Dekker – 00:16:37:

Yeah, some people think they have to put on the hospital gown. You know, they have to get in the bed. That’s a really good point. And I know anthropologists have written a lot about the hospital bed and how it’s kind of this symbol. And it takes up this almost like throne-like location in the room, like everything revolves around the bed. Like you’re sick, you get in the bed, you know, so it’s a… There’s been research on removing beds from the rooms and only instead having cushions and couches and swings and chairs and balls and tubs and stuff. And it’s been interesting to like,

Trish Ware – 00:17:09:

I hope I live long enough to see that.

Dr. Rebecca Dekker – 00:17:10:

I know. Yeah. I think there’s some research on some Scandinavian countries about it. I know they were carrying out those studies. I haven’t seen the final results, but I thought that was a really interesting way to like, let’s just remove the bed. I think they were like, yeah, like mattress pads on the floor kind of thing, but no, no actual hospital bed, which is also incredible to think about how much money hospitals spend on each of those beds. Like, so it makes sense that if you refuse to use it, everybody would be like, why? I mean, how much those beds cost? Like, like 10, $20,000. I know they’re really expensive.

Trish Ware – 00:17:44:

They’re like transformers, but you know, I always tell one of the things I say over and over, I have a couple of mantras. I say, like you said at the beginning, if you don’t know your options, you don’t have them. You don’t have options if you don’t know them. That’s simple. But also is nothing out of convenience or curiosity. And some of my students have said that they’ve like yelled that out in, in labor. I’m like, unless it’s convenient for you, nothing out of convenience or curiosity, because the bed nine times out of 10 is convenient for me and the doctors, not for her. It makes it really easy. And I’ve even confessed to my students for the first few years as a labor nurse, I could only check your cervix if I were on this side like this, you were laying like this. And I don’t know why, but in my brain, that’s how I was taught to do it. OK, mama, let’s get in the bed. I’m going to check your cervix. There was no I mean, I’ve been a nurse for a long time. There was no like, would you allow me to check your cervix? You know, like none of that. There was OK, mama, let’s get in bed. I’m going to check. Let’s see what’s going on. And I could not do it unless she was in that position. And then when I started as a travel nurse and I went all over the country, which was really eye opening and why I ended up doing what I’m doing now, too, because I realized, wow, a mom in Seattle can eat during labor, but in Georgia, she cannot. It’s dangerous. Like something’s not right. But I had a midwife who delivered anywhere. And I’ll be real. The first time I delivered with her, she came in. My patient was like complete, ready to push. She comes in. She gets her out of the bed and takes her to the toilet. And sits her on the toilet. And my internal labor nurse system was like, like what, you know, but it was beautiful. And then the rest of the delivery is one of them. I was just crawling around on the floor behind her, putting the pads down when she was ready to push. And that experience taught me that I could check a cervix and a million different, the cervix is still the cervix and it’s still the same dilation. But I think a lot of nurses. Especially labor and delivery nurses, we’re diehard. So a lot of them will work at one hospital for 30 years, like their whole career. So they’re not exposed to anything but what they were taught. Then they train the next nurse and then the next nurse, and then they all stay there. They never think outside of the bed, you know? So, and that, that can change everything.

Dr. Rebecca Dekker – 00:20:13:

Wow. Okay. So many quotes from there. They never think outside of the bed instead of outside of the box. It’s a good one. And the point about how a lot of nurses and a lot of physicians, they only ever practice in one hospital. And I think that’s one benefit of a doula is because they are at so many different hospitals and birth centers and homes that they’ve seen things happen so many different ways. And again, like you as a travel nurse, you realize all of the options out there and you don’t get stuck in one way of thinking about things. They don’t question policies. And a lot of them don’t even know the policies. They just are just going on what was told to them when they were trained. Well, a lot of times is.

Trish Ware – 00:20:57:

Yes. So a lot of times when I was at it, I’m a I’m a question girl. Like I homeschool my kids. I teach them. You ask questions. So I was just having this conversation with my husband. I remember the first hospital I worked at. They check the blood sugars on every baby, every baby. And I was like, why? But I didn’t question it because that’s what I was taught. So we did it. Well, when I went to my first travel assignment and they checked them on only the babies that needed it, when I came back to my home hospital, I kept asking everyone why. No one really knew why. So I went to the policy and nobody was following the policy. It wasn’t the policy. So all these babies were getting their heels pricked. Because someone probably missed a blood sugar drop and then everyone was doing this because they were fear based, you know. So, yeah. It’s a, that’s an interesting part. I saw a lot too.

Dr. Rebecca Dekker – 00:21:49:

And another advocacy tip is if somebody says it’s hospital policy, you can always say, Oh, I’d love to see that hospital policy. Like, yeah. Can I have a copy so that I know exactly what the rules are and then they, you know, can’t find it or it doesn’t.

Trish Ware – 00:22:03:

That’s what I tell my students. Yeah. If they quote a study or a policy ask them to print them, don’t make a decision right then and there, unless it’s emergency. And then ask, take it home and actually read through it. Because a lot of times the physician is quoting like a little part of the study that benefits them.

Dr. Rebecca Dekker – 00:22:23:

Yeah. And it’s also a way that doulas and other advocates can get involved. I know in our town, there was a hospital where they kept calling child protective services on parents who refused the eye ointment. So we figured out like, is there an actual policy? And it turns out there was not, you know, the nurses just believed that they had to do it. They thought it was policy. And then a childbirth educator who’s a nurse there advocated to get an actual policy written that explicitly said like, don’t call child protective services just for the eye ointment. And that impacted a lot of people’s births because that’s a very traumatic and scary. Yeah.

Trish Ware – 00:23:04:

I remember when I first became a labor nurse. They would call child protective services if the mom refuses a bath.

Dr. Rebecca Dekker – 00:23:15:

For the baby?

Trish Ware – 00:23:16:

For the baby.

Dr. Rebecca Dekker – 00:23:17:

Wow. Have not heard that one, but it does not surprise me. Yeah.

Trish Ware – 00:23:21:

And I remember at the time we were not educated about the benefits of delayed bathing. That was a long time ago, you know, but I remember being like, what? Yeah. And then we’d have the parents that really needed child protective services, but were following all the rules so they didn’t get called.

Dr. Rebecca Dekker – 00:23:41:

Yeah, I’m sure as a labor nurse, you’ve seen it all. Yes. What would you say are some other ways people can get over those mental blocks of like, you know, just being afraid to speak up?

Trish Ware – 00:23:55:

So what we work on with our students, and really that’s a lot of our hangouts, is we’re diving deeper into how to communicate that to your provider. Because I think when I know when they’re taught how to communicate it in a way where they don’t feel that they’re being rude and because I think they think it’s either, no, I’m not doing that or OK, and it’s not. And so what I teach them is. First of all, you have to know why. I tell them all the time, we don’t refuse things just because we can. We need to know why would that not be appropriate now for me? And if you don’t know, be okay with asking a lot of questions and digging deeper and keep going. But I think that for most of them, they have in their head that it’s going to be terrible. And what I find is a lot of times it’s not as bad as they think it will be the outcome. A lot of doctors are like, okay, you know, that’s fine. Or what have you, or they’ll state theirs. What I teach them to do is not overcomplicate it for themselves. Don’t get all worked up and thinking, I have to explain it all. And I have to say all these things. And what if I can’t remember it all? You can simply just say no. And you don’t have to explain yourself.

Dr. Rebecca Dekker – 00:25:13:

Yeah, that’s something I’ve been learning recently is the more you explain yourself, actually, the weaker and less confident you come across.

Trish Ware – 00:25:21:

Yes, that’s what I tell them. And I actually tell them speak up and shut up is what I say, because that’s how I am. But I tell them like zip it, like say, no, we’ve educated ourselves. And that is not the choice we want to do. But thank you. And then let them fill the silence. Don’t you? And it really does empower them. Even if they’re really shaky inside, they can stop and take a breath. They don’t have to come up with all the reasons why they don’t have to explain themselves. They can say no.

Dr. Rebecca Dekker – 00:25:50:

Yeah. No, thank you. And yeah, you don’t have to explain why you don’t want something.

Trish Ware – 00:25:58:

The thing about it is, and I’ve seen this in practice, the more they try to explain themselves, they give more ammunition for the doctor to break down their defenses. And then the doctor will start breaking down all the things they say. Breaking down a simple no is a lot harder.

Dr. Rebecca Dekker – 00:26:13:

Right. Unless there’s a really good reason. They don’t necessarily need to know all the private thoughts in your head or your partner’s private conversations. Unless there’s an important reason for that. I think sometimes we think we have to explain our no’s. And you’re right. You don’t have to. Like, what about for partners or family members who support people in the room?

Trish Ware – 00:26:38:

So interestingly enough, I just played doula for one of my doulas who had a baby because I have two doulas on my team and I did not like it at all. I’ll tell you that. Number one, I’m used to being kind of like in charge and it was a really interesting position for me to be in. But your doula really can’t refuse things for you. Your partner can and you can. And I always tell my moms, like their job is during labor is to labor. They don’t need to have to worry about everyone listening to them. That’s when your partner steps up. But your partner has a lot of power, but they have to know everything you know. So we tell our partners, access the courses, do them all, not just our birth coach class. You need to be as educated because that is one way I’ve seen a lot of moms. Broken down, like they end up doing what they don’t want to do is because the partner has no idea all that she’s learned as to why that’s not right for her situation. So when a doctor says things like, well, you don’t want a dead baby, do you? Well, no, sir, we don’t want a dead baby, of course. But when a partner hears that and they don’t have all the education she has, that’s really scary. And you don’t think that people will say things like that when it’s not 100% what’s going to happen, but they do. So if they both go in there knowing like this is what happens a lot. These are things that are because I’ve heard some really terrible things said at bedside that are really absolutely like unbelievable.

Dr. Rebecca Dekker – 00:28:14:

Like false, but they’re presenting it as truth or.

Trish Ware – 00:28:18:

Well, just things like that. Like, we’ve been doing this for a while. You’ve given it your good gung-ho. I really think we need to go back for a C-section because we don’t want a dead baby, do we? And there’s like no indication that.

Dr. Rebecca Dekker – 00:28:34:

That that’s going to happen. Yeah.

Trish Ware – 00:28:37:

You know, instead of saying like giving her all the options. So when things are said, like, I mean, I’ve heard some really horrible things that are said, you know. When things are said like that. And the partner hears that they need to be prepared and they need to be educated because if she’s knows that’s not the best situation. And then you’ve got a partner who’s crying like, babe, like, please go back. Let’s do this. We don’t want her like. That’s going to be 100 times more. More when you have partners educated, like even my very first VBAC lab student who had a successful VBAC. So I had 10 founding members, the first one to give birth. She’s laboring. It’s taking longer, which I always prepare them. VBACs are slow. Be patient with your body because, you know, they don’t want to do all the things they do to everyone else, which you don’t want anyway. But she was laboring perfectly, but she was not following the rules. And her doctor comes in and says to her, you know, I really think we need to think about going back. Like, I just don’t know your body’s going to do this and blah, blah, blah. And of course, she’s wide eyed now because she’s in labor. She’s unmedicated. And her partner leaned in and said, we’re doing this your way. And so he said to the doctor, can you go out? We want to talk. And so the doctor went out. She ended up delivering vaginally like 45 minutes later. But if they hadn’t been prepared and if her partner, I mean, you know, maybe she could have refused on her own, but her partner reinforced, like, we know what we’re doing. This is the plan and it’s safe. Baby’s fine. We don’t need to rush it. Otherwise, more than likely, they would have been in the OR. She would have been delivered C-section. At the same time, she would have been delivering vaginally if they wait, you know, so.

Dr. Rebecca Dekker – 00:30:29:

Right. So the partner, and this is something a doula could do as well, is to help create time and space and privacy so that you can think about it, figure out what questions you’re going to ask or what you’re going to say. Trish, can I give you a couple scenarios? And you’re great at coming up with these, like what would you say? Let’s do it.

Trish Ware – 00:30:46:

Yeah.

Dr. Rebecca Dekker – 00:30:46:

Okay, let’s do it. So let’s say that one of your students, one of your childbirth education students, has a history of trauma and wants to avoid cervical exams except when she’s requesting them. And she’s in active labor, comes to the hospital, contractions are like every two minutes, clearly, even though it’s her first baby, like this baby is coming. And they say to her. We can’t admit you without a cervical exam. What’s something she could say?

Trish Ware – 00:31:20:

She can refuse it. Like she can simply say no. So she needs to know that if she’s in active labor, they cannot legally not treat her. So that one’s pretty easy if she’s educated. And I would say that anyone’s going to refuse a cervical exam, they’re usually educated. So that is not true.

Dr. Rebecca Dekker – 00:31:41:

But how would you say no? Like, what if they say, but we really need this? You know?

Trish Ware – 00:31:45:

I mean, I would tell my girls to just say, I’m sorry, I I’m refusing a cervical exam. You can chart that.

Dr. Rebecca Dekker – 00:31:52:

Okay. That seems simple, but it seems so hard.

Trish Ware – 00:31:56:

No, it doesn’t have to be. It does not have to be. And I tell my students all this time, I have never once in my career manhandled someone to force them into doing what I want.

Dr. Rebecca Dekker – 00:32:07:

That would be extremely rare.

Trish Ware – 00:32:08:

Yes. And this can go to the point of danger for a patient because we had a patient one time. She wasn’t my patient. She was refusing to push. The baby was right there and having a really deep deceleration. That baby needed to come out. It was a midwife delivery. You could not put a suction on, couldn’t do a vacuum. So we were waiting for the OB to get in-house to pull the baby out because the mom was refusing to push. And that baby did not have a good outcome. We couldn’t make her. We couldn’t physically do anything. Now, the doctor could have. Which he did put a vacuum on and pull the baby out. That was… an extreme situation, but we can’t physically force you to do anything. So a lot of times moms think that we have the power to force them to do everything. In a lot of circumstances, we don’t. So you don’t have to fight it. Like, that’s just how I roll. I tell them just say no and simple. I also teach my students how to read the room. There’s a much different scenario. If the entire team runs in. And you can tell something emergent is happening. And they’re like, we need you to roll on your back so we can check on baby. Totally different scenario than if your nurse comes in and says, OK, we’re going to have this baby. It’s time to get on your back and put your legs in the stirrups. And no, you just say, no, thank you. And that’s that. So I don’t overcomplicate it. They don’t have to overcomplicate it. They have a human right to say no to someone putting their fingers inside of you or touching you or forcing you into a position. You have a right. And I think that we think that we don’t have that right.

Dr. Rebecca Dekker – 00:34:01:

Right. So it’s remembering and knowing that you have the right and then being able to say no, and it can be a really simple no. It doesn’t have to be an in-depth explanation. I think that’s really good advice. I have one more scenario, Trish. This has to do with amniotomy or breaking of the waters. So have you seen this as a labor and delivery nurse when a provider is doing a vaginal exam and they go to break the waters without asking?

Trish Ware – 00:34:27:

Yes. And it’s frustrating. So this is one thing why my birth classes are a little bit weird compared to other ones is because I actually teach them all of these things, all of these scenarios. So that they’re not surprised. Like when they get GBS testing and they do a vaginal exam and they’re prenatal without talking to them, that happens a lot too. But yes, I have. I even had a doctor that would break their water during an early induction, like come in in the morning, do his rounds, break their water and put an FSC on, fatal scalp electrode. That’s what he would break their water with. Like one centimeter dilated and not say a word. Break the water and put an internal monitor on the baby’s head.

Dr. Rebecca Dekker – 00:35:17:

Yeah. Yeah. So what advice would you give to families who maybe they just want to have a say, you know, or maybe they know they don’t want their waters broken? How can they protect themselves or how can they speak up? How do you know that that might happen?

Trish Ware – 00:35:32:

So there’s a huge chance, whether you go in in labor or induction, that your provider is going to want to come around and break your water. They make rounds in the morning and they break everyone’s water if they deem it’s appropriate, which means they’re one to two centimeters or, you know, the baby’s floating and high. They’re not going to. But best way to prepare that is I tell my girls, start having conversations early and often throughout your pregnancy. Talk through these things so that by the time you deliver, your doctors know, I don’t want my water broken. I tell my moms, like if they want to, once they’re in active labor. That’s fine. It’s not really going to shorten their labor that much. Sometimes it does. Sometimes that’s the key.

Dr. Rebecca Dekker – 00:36:17:

And there’s evidence it can be helpful with an induction.

Trish Ware – 00:36:20:

Right.

Dr. Rebecca Dekker – 00:36:21:

Right.

Trish Ware – 00:36:21:

That can. But I do teach them to have those conversations. And then for the most part. Only agree to it if you want to once you are actively contracting and your cervix is making change and you’re in that. Because for an induction, if we don’t break your water and we have a failed induction, they then have the option of going home unless it’s like a major medical reason. So for an elective on the West Coast, they do this more. The East Coast, no. But on the West Coast, if they come in for an induction, especially an elective or a non-emergent type medical one, if it’s a failed induction and their water is not broken, they can go home and come back. So that makes a huge difference. Right. You can stop the induction and you have choices.

Dr. Rebecca Dekker – 00:37:12:

But what you’re saying is once your water is broken, they’re not going to say, all right, we can stop inducing you. It’s kind of like you have to keep going.

Trish Ware – 00:37:19:

And a clock starts.

Dr. Rebecca Dekker – 00:37:20:

Yeah.

Trish Ware – 00:37:21:

Yeah.

Dr. Rebecca Dekker – 00:37:21:

Okay.

Trish Ware – 00:37:22:

They’re excited too. I think a lot of women fall into that because they’re going to break my water. Like this. This is really happening. But if you can delay it, it is best.

Dr. Rebecca Dekker – 00:37:32:

Okay. And families can kind of know what the amnio hook looks like, the long kind of like crochet needle kind of thing. But also there’s a little finger cot that a lot of people don’t realize that a doctor can just put on their glove and you don’t.

Trish Ware – 00:37:45:

Well, they can break it with their fingers if they really want to. If the bag is thin enough and we’ve got, let’s say we have what we call a bulging bag or a tight bag, you can accidentally break that when you’re doing a vaginal exam. That has happened to me as a nurse, which we’re not allowed, but used to be able to do it in some states, but most states we’re not allowed to break your water.

Dr. Rebecca Dekker – 00:38:05:

It can happen accidentally.

Trish Ware – 00:38:08:

Yeah, it can. But it can also happen intentionally without an amniocot or an amnihook. So I really just say you have to have those conversations. But I’ll be honest. I’ve had students that have told them absolutely they don’t want them to break their water. And then they do. In that case, you need to write a letter to the hospital. You need to write a letter to the board. Like that’s the other thing.

Dr. Rebecca Dekker – 00:38:30:

I would like you to chart that you just broke my waters against — without, without my consent.

Trish Ware – 00:38:35:

Yeah. And then you can ask your nurse to chart that. And then like another thing that I feel is really important that a lot of people don’t know is that you can fire your doctor and your nurse. And the hospital will have to provide you with a provider and a new nurse. And I know that’s really scary to women. And a lot of my students are like, well, then they’re going to all really hate me and be mean to me. But honestly, what happens in that scenario is then they get a nurse like me that can deal with the problem child. And I love them. You know, so what will really happen if you fire your nurse is you will get the most patient, like best crunchy, like labor nurse on the floor.

Dr. Rebecca Dekker – 00:39:15:

Who won’t bat an eye at your requests.

Trish Ware – 00:39:17:

Right, exactly. And you know the nurses that need to get fired. So we’re not going to be judging you on that.

Dr. Rebecca Dekker – 00:39:22:

Right. And often when you fire a nurse, they’re probably ready to be done with you as well if you’re butting heads.

Trish Ware – 00:39:29:

Well, the flip side, and this is what I tell my students too, is obviously be polite because we are people. And, you know, there have been times I’ve had to go to work after some really horrible events in my life. So maybe she’s just brought that in and it’s a, she’s doesn’t have her head in the game thing. And so what I teach them how to do it in a way that’s polite, but, you know, like, hey, I really appreciate you, but we’re just not jiving. Like you’re not now, if she’s really being awful, this is different. But what might happen is this nurse might start crying and you end up giving her another chance and having an amazing experience in bonding for life. Or. She’s ready to be done too. And she goes and it’s confirmed. Like either way, you need to have the conversation.

Dr. Rebecca Dekker – 00:40:17:

And you don’t have to fire the nurse directly. You could ask for the charge nurse.

Trish Ware – 00:40:22:

Yes.

Dr. Rebecca Dekker – 00:40:22:

And then tell them and they could arrange it all.

Trish Ware – 00:40:25:

The thing is, is it’s her experience. It’s life changing for that mom. But for that nurse, she’s going to clock out and go home. Now, obviously, there are events that affect us during our work hours. But for the most part, it’s another day at work for her. But that is your birth with your baby that only happens that you’ll never forget.

Dr. Rebecca Dekker – 00:40:44:

Right.

Trish Ware – 00:40:44:

So it is worth having the courage that it’ll take a few seconds to speak up and advocate for yourself.

Dr. Rebecca Dekker – 00:40:51:

Yeah. And one more thing I think we didn’t really say, but with the waters being broken, you know, without your consent, another way in addition to prenatal visits is if you’re consenting to a cervical exam to know that that might happen and to affirm that you don’t want your waters broken if that’s what you want.

Trish Ware – 00:41:11:

Yeah. Just having that conversation, speaking up. I know a lot of people think there’s like bad juju or something if you have a birth plan, but a birth plan is just a really easy way to see the things that you desire and for them to have it in because we put them in your chart. So it’s charted that you do not want your water broken. So, but you still want to speak up and say it.

Dr. Rebecca Dekker – 00:41:32:

Right.

Trish Ware – 00:41:33:

And I will speak up and say it. Okay. So if you let your nurse know, she knows the doctors that will push that limit. And so what I will do is say, Hey, Dr. So-and-so, by the way, she does not want you to break her water. I will advocate for you as well.

Dr. Rebecca Dekker – 00:41:49:

Okay. So it’s good to know. Yeah. It’s important to build a trusting relationship with your nurse so that you have a whole team of people there to support you. And obviously like this does not happen at every labor or birth, but it’s helpful to know that, especially if you don’t know the provider taking care of you, like if they rotate call or you’re getting, you know, somebody that you’ve never met before to just know all of these things can happen so that you speak up and prevent them if possible.

Trish Ware – 00:42:18:

Yeah. And just a side note on the cervical exams, if you do agree to an induction, you are going to have to have cervical exams because we have the titrate medicines. We have to choose which medications to use. So I think a lot of moms miss that. They think I’m not going to have cervical exams, but you will have to have some if you’re being induced.

Dr. Rebecca Dekker – 00:42:37:

It should be part of the induction informed consent conversation, but often it isn’t, right? So when you’re choosing an induction, you’re choosing kind of like a package of interventions and you can, you know, some of those you can tweak and decide, you know, or speak up. I want the low dose instead of the high dose or, you know, and we go into that in our induction Pocket Guide and other podcasts we’ve done on induction. But you’re right. There’s some things that kind of go together and it’s all part of getting true informed consent in advance.

Trish Ware – 00:43:08:

Yeah. But I will say that 90% of my inductions don’t even have any idea what medications are going to happen.

Dr. Rebecca Dekker – 00:43:15:

Right.

Trish Ware – 00:43:15:

A lot of them come in and they don’t. And like, even for my students, we teach them the same, how to navigate the induction. They have choices.

Dr. Rebecca Dekker – 00:43:24:

Right.

Trish Ware – 00:43:24:

On the medications, as long as the hospital provides that. Yeah. But they have a choice. Like she’s now one of my doulas, but she started as a student. Her doctor had never done a foley bulb induction. And Ashley was like, if I’m being induced, she had GDM, she had hypertension, she needed to be induced. She said, if I’m being induced, I want to start with a Foley bulb. And her doctor’s like, okay, I haven’t done one, but let’s do it. Yeah. And that’s how it can go sometimes when, when you speak up to your doctors, they’re not all going to fight you about everything. Sometimes that’s just what all their patients agreed to and they’ve just gotten into the habit.

Dr. Rebecca Dekker – 00:44:01:

So like you said, it’s not necessarily something devious or manipulative. It’s just their work schedule and what they’re used to doing. Yeah, exactly. Well, Trish, thank you so much for coming on the podcast and sharing your wisdom and tips with us. Can you tell our listeners a little bit about the resources you have at Labor Nurse Mama and a little bit more about your podcast?

Trish Ware – 00:44:25:

Yes. So I have a podcast. It’s the The Birth Experience with Labor Nurse Mama, and you can find me on all of the socials as Labor Nurse Mama. We have birth classes. We have a Mama Membership. That is amazing. It’s amazing. And we just have all the things over there, but mostly you find me hanging out on Instagram.

Dr. Rebecca Dekker – 00:44:43:

Yeah. And lots of great reels and educational videos on your Instagram. I saw one that you did today about like what it looks like to break the water with an actual plastic bag with the baby inside of it in the water.

Trish Ware – 00:44:55:

It’s so funny to have like an old fart, like me doing these videos, because like when I started on Instagram, there was no reels. There was IGTV, right. Which was awkward enough, but that reel is so funny to me because I did not expect it. It was so unexpected. I did not expect the gush. And then my dog came running in and was licking the floor. That was funny. But that was a fun reel. Yes, there is an amnihook. If you want to know what it looks like, there’s the culprit.

Dr. Rebecca Dekker – 00:45:25:

Right, exactly. So, all right, Trish, thank you so much for joining us and sharing your tips about advocacy. We really appreciate you.

Trish Ware – 00:45:32:

Thank you for having me.

Dr. Rebecca Dekker – 00:45:34:

This podcast episode was brought to you by the book, Babies Are Not Pizzas. They’re Born Not Delivered. Babies Are Not Pizzas is a memoir that tells the story of how I navigated a broken healthcare system and uncovered how I could still receive evidence-based care. In this book, you’ll learn about the history of childbirth and midwifery, the evidence on a variety of birth topics, and how we can prevent preventable trauma in childbirth. Babies Are Not Pizzas is available on Amazon as a Kindle, paperback, hardcover, and Audible book. Get your copy today and make sure to email me after you read it to let me know your thoughts.