EBB 156- Nicole Deggins of Sista Midwife Productions on Navigating Systemic Racism in Birth Work

Learn more about Nicole Deggins and Sista Midwife Productions Birth Sister/Doula training here (https://www.sistamidwife.com/ and https://www.sistamidwife.com/doulatraining). Follow Sista Midwife Productions on Facebook here (https://www.facebook.com/SistaMidwife) and on Instagram here (https://www.instagram.com/sistamidwife). 

Learn more about Louisiana Perinatal Quality Collaborative here (https://partnersforfamilyhealth.org/lapqc/). 

Learn more about Louisiana Healthy Moms here (https://ldh.la.gov/index.cfm/page/231). 

Learn more about Global Infant Safe Sleep Center (GISSC) here (https://gisscenter.org/). Follow GISSC on Facebook here (https://www.facebook.com/gisscenter/). 

Learn more about New Orleans Maternal Child Health Coalition (NOMCHC) here (https://wavestarter.tulane.edu/campaigns/new-orleans-maternal-and-child-health-coalition-student-assistant-stipends) and follow NOMCHC on Instagram here (https://www.instagram.com/nolamchcoalition). 

Learn more about Birthing Project USA here (https://www.healthystartepic.org/resources/evidence-based-practices/birthing-project-usa/). 

Learn more about the Birthmark Doula Collective here (https://www.birthmarkdoulas.com/). Follow the Birthmark Doula Collective on Instagram here (https://www.instagram.com/birthmarkdoulas/), on Facebook here (https://www.facebook.com/birthmarkdoulas), and on Twitter here (https://twitter.com/BirthmarkDoulas). 

Learn about Healthy Start New Orleans here (https://www.nola.gov/health-department/healthy-start/). 

Learn more about New Orleans WIC here (https://www.nola.gov/health/wic/). 

Learn more about the “Bringin’ in Da Spirit” documentary here (https://www.twn.org/catalog/pages/responsive/cpage.aspx?rec=1119&card=price). 

Learn more about Shafia Monroe and SMC Full Circle Doula Birth Companion Training here (https://shafiamonroe.com/). Follow Shafia on Instagram and Black Midwife Cooking here (https://www.instagram.com/shafiamonroe/).  Follow Shafia on Twitter here (https://twitter.com/Shafia_SMC). Follow Shafia on Facebook here (https://www.facebook.com/shafiamonroeconsulting/). 

Learn more about the International Center for Traditional Childbearing (ICTC) here (https://thenaabb.org/).

Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with Nicole Deggins about Black midwifery and doula care and the founding of Sista Midwife Productions. 

Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker 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. 

Hi, everyone. Welcome to today’s episode of the Evidence Based Birth® Podcast. I’m so excited to introduce our honored guest, Nicole Deggins. Nicole is a certified nurse midwife, and one of the country’s leading birth advocacy experts. Nicole is also the creator of the Sista Midwife Productions Birth Sister/Doula training. She served as faculty for the Louisiana Perinatal Quality Collaborative and sits on the Louisiana Pregnancy-Associated Mortality Review committee, the Louisiana Healthy Moms, Healthy Babies council, and is a consultant for the Global Infant Safe Sleep Center. Nicole has provided guest lectures to public health students at universities and has provided training and consultation to many local and national agencies, including the New Orleans Maternal Child Health Coalition, Birthing Project USA, Birthmark Doula Collective, Healthy Start New Orleans, New Orleans WIC and others. 

Prior to Sista Midwife Productions, Nicole received her BS in nursing from Georgetown University and completed a dual degree program at Emory University where she fulfilled the requirements for the MS in Nursing with a concentration in midwifery and a master’s in public health with a concentration in health policy and management. During her clinical career, Nicole practiced as a midwife in Washington D.C., Mississippi and Louisiana, and has worked as a labor and delivery nurse in many public and private settings throughout the U.S. Welcome Nicole to the Evidence Based Birth® Podcast.

Nicole Deggins:

Thank you so much, Rebecca. I’m happy to be here.

Rebecca Dekker:

Thank you for coming on the podcast. I’ve been wanting to have you on the podcast ever since we met in person in Louisiana a few years ago. And I was wondering if you could tell me what inspired you to become a labor and delivery nurse.

Nicole Deggins:

Yeah, absolutely. Because that kick-started so much for me. You mentioned this in my bio, that I went to Georgetown University undergrad, where I went to nursing school. And really, I would say that when I entered nursing school, I had visions to go into medical school and I went to the labor and delivery rotation my first day at the labor and delivery rotation. And people who know me and know who I was and even who I am, I talk a lot, I’ve always been a talker, I’ve always used my voice a lot. And so we show up on the unit, it’s a pretty slow day. And the charge nurse spoke with the nursing instructor and the nursing instructor comes back to the group and she’s like, “Well, there’s this one mom who’s by herself. She’s probably not going to have her baby today, but she really needs some company.” And the charge nurse said that she really needs someone who can talk to her. And immediately, everybody looked at me like, “Nicole is the one, let her because she always talking.”

So the way it turned out, I was actually the only nursing student who saw a birth that day, because not only did I talk with this mom, I helped her with her labor. She was my first kind of official doula client. After that experience, I think what I really enjoyed was the autonomy that the nurse had, the relationship and the professionalism that I saw between the nurse and the physician, the way that the nurse was able to really bond and connect with the patient, just that entire experience, which is very different from Med Surg or ICU. It’s just, it was a different dynamic. And I had been in those other areas, we had done psych and we had done Med Surg and we had done ICU. And this was so different in the energy of it, the entire dynamic, nurse to mom, nurse to physician, physician to mom and nurse, all of it just warmed me. And I was hooked immediately, “I’m definitely doing OB when I get out of school,” there was no turning back after that.

Rebecca Dekker:

And were you able to do obstetric nursing right out of school or did you have to do something else first?

Nicole Deggins:

I did get into easy feat to get into OB. There are so many different dynamics that are a part of specialty areas, postpartum was not as difficult. And in fact, I could have gotten a job on labor and delivery, but I was actually, I tell people secretly I was afraid because it seemed like it was such a high paced thing. And my job was at a university hospital, which is the Inner-City Large Medicaid Hospital of New Orleans, where they were having so many babies. And I didn’t think I could handle it. So I did postpartum first for just about a year and then transferred to labor and delivery.

Rebecca Dekker:

And what did you think about your role as a labor and delivery nurse now that you were out of school?

Nicole Deggins:

You mean when I became a labor and delivery nurse from nursing school?

Rebecca Dekker:

Mm-hmm (affirmative).

Nicole Deggins:

Yeah. Oh, it was great. It was definitely a change from postpartum. I really was ready to shift. I went to postpartum first because like I said, I was a little bit nervous about the high pace and the high energy of labor and delivery. But after six months, I knew I needed a bigger challenge and I needed to be involved in something different. And so moving to labor and delivery was definitely a challenge, it was sink or swim learning. We had a really intensive orientation, but even at the end of the orientation, you still don’t feel 100% up to par ready to take on the challenge. And I remember at the end of the orientation, you get assigned a nurse who’s orienting you, but she’s just shadowing you at this point.

And so my first day of being shadowed, my preceptor person did not help me at all. And when shift change came, there was so many things I hadn’t done. It was so crazy. And the nurse getting reports, she was like, “Nikki, what did you do all day?” And I was like, “I’ve been trying to catch up,” because this was a really high-risk, high paced hospital where we had lots of patients, antibiotics, medications, people in and out, admissions and discharges, all in one shift. And so the nurse who was precepting me that day, she was like, “You got to figure it out. You got to figure it out.” And it was sink or swim, this is how you’re going to learn how to juggle, how to balance all of the various pieces that are connected to working as a labor and delivery nurse in a high-risk, high volume teaching hospital.

Rebecca Dekker:

And that was your first day of orientation or towards the end of your orientation?

Nicole Deggins:

No. This was toward the end. But up until that point, it was very systematic and very organized. And then it was like my last week, maybe it was the first day of my-

Rebecca Dekker:

When they gave you the full load by yourself.

Nicole Deggins:

Yes. And it was my first day of that. And she just let me, she’s like, “This is how you’re going to figure it out. You don’t need to be coddled. You can do this, just do it,” that was something. But once I got through that, I learned a lot that week and the next couple of weeks, and I really loved my first labor and delivery job. We were high-risk, it was cocaine epidemic, crack cocaine epidemic. It was high-risk moms, teenage moms, moms with no prenatal care, teaching facility, residents everywhere. We had two residency programs. We had two Lane University residents, as well as LSU residents, which anyone who’s ever worked in a teaching facility with a residency program, they understand what that looks like. 

And so it was lots of chaos often. It was often high energy, but the nurses, we worked together, I look back on that time and I can say for sure that we were a team and we cared about our patients and we worked hard to make sure that we gave the best care that we could under the circumstances. This was the mid ’90s, ’95, ’96 and so, we did the best that we could with what we had, with what we knew for the culture and the time of that day in labor and delivery.

Rebecca Dekker:

And what other types of hospitals did you go on to work at? Because I think you’ve had experience as a labor and delivery nurse at many different hospitals.

Nicole Deggins:

I have. So that was my big, big start into labor and delivery. And then after midwifery school is when I really started working all over the country. I did travel nursing, I went to midwifery school and I had a couple of jobs and long story short, I ended up going back into being a labor and delivery nurse. And so when I went back into labor and delivery nursing, I was everywhere, New Hampshire, Minnesota, California, New York, everywhere, I worked. And of course, Louisiana, Mississippi, I can’t even remember I was in, what do you call it? St. Louis, Missouri. I can’t even remember all of the places that I worked. 

And so, I saw a lot, I was in a hospital that had maybe three babies a month. And then I was in hospitals that had the most babies in the country, the number one hospital with the highest number of labor and delivery births in a year. So I’ve seen it all, small hospitals that don’t have epidural, it’s one-on-one Doppler for every mom and one nurse to one mom for every delivery. That was a great hospital, I loved working there. I worked in hospitals that were a real good mix of everything, midwives and home birth transfers and physicians who were really medical as well as physicians who were open and more natural. So I’ve seen such a variety across the country in how obstetrical care can look even in the hospital.

Rebecca Dekker:

So it’s probably safe to say you’ve seen really high quality care delivered as well as poor quality care in your travels?

Nicole Deggins:

Absolutely. I won’t name any hospitals on your podcast, Rebecca, but I have seen it all. I’ve seen some really like, “This is really great. I like how the whole unit is set up, I like how the shift change happens, I like how the communication is. I like how the doctors and the nurses work together.” And then I’ve been places where it’s like, “Get me out of here, get me out of here today.” I’ve been in everything in between.

Rebecca Dekker:

So I wanted to thank you upfront for being open to talking about this. Because I sent you the questions ahead of time, but I wanted to talk a little bit about systemic racism and nursing. I know that nursing education itself has a huge problem with racism having worked in a nursing school myself. And the end result is that most nurses in the U.S. are white with very few Black, Indigenous , Asian and Latina nurses. And I know this means that people of color cannot routinely receive culturally congruent care. And this feeds into our maternal mortality crisis, especially when Black women are not listened to or cared for in a timely manner. Can you tell us a little bit about what you noticed with discrimination and racism in nursing school or on the hospital floor?

Nicole Deggins:

In nursing school, it’s interesting because I can look back on it and think about… I went to Georgetown. So this is a white institution. It is not an Ivy league, but it is in the upper echelon of educational systems. And there were lots of wealthy, privileged White girls who were in my nursing program. And so there were always things happening and statements being made, but I didn’t even internalize them because at the time I was 19, 18, 19 years old and just really green and from New Orleans and just happy to be in college. And I look back on it as an adult. And I’m like, “That was some really racist f’ed up [bleep] that she said that day.” 

In terms of professors, I felt like most of the professors were as neutral as they could be under the circumstances. The biggest issues always came though, in diagnosing and having conversations about how people’s skin look and not having any cultural competency to understand that that’s not how a Black baby will look at birth. And even when we’re talking about geriatrics, so the way an old Black person’s skin looks versus an old White person. Just all sorts of things that would happen, that they would say, and being in nursing school, as we would talk about. And again, this is in the ’90s. So in the ’90s, we’re not even talking about racism as a factor for health.

Rebecca Dekker:

Race was the risk factor, not racism.

Nicole Deggins:

Exactly. So you’re Black, you’re high-risk, you’re a Black, you’re high risk, we’re high risk for everything. And so I’m in a program with 60 some odd students. It is me and one other Black person in that class. And so every time that comes up, “And if you’re Black, you’re high-risk.” It’s like, “Oh, there’s the high-risk girl.” This was in graduate school too. It repeated itself in the late ’90s in grad school where it’s like, “So what do you think?” It’s so interesting because you watch a movie that is attempting to be maybe political satire or racial satire. It’s given you these experiences like a Dear White People type of show. And you think to yourself, certainly this is not how it is, but in the reality, it really was like that. So it’s like, “So Nicole, what do you think? Nicole, what do you think?” As if I had the authority to speak on behalf of every Black person in the United States of America simply because I was Black. 

And that was a constant reminder that you see me as different and that you see me as less than, and that you see my race as different and less, not just different, but less than, in the way that conversations would be had around particular issues, it was all our faults. We didn’t eat good, we didn’t exercise. Everything was blame, blame, blame on the population, as opposed to looking at the entire social construct of racism and systematic racism across the country. So I would say that. And then in nursing as a practice, when you ask me the question, if I got an OB job straight out of school, and I can say yes, but I got it at an inner city hospital. I got it at the teaching facility where all of the indigent, all of the Medicaid, all of the poor people go. Trust and believe, I would not have gotten into labor…. And I actually applied for labor and delivery positions at other hospitals and I was denied. And across the country, routinely, there are very few Black labor and delivery nurses because labor and delivery is seen as a specialty area.

And so I always jokingly say, “Right, because Black nurses are not smart enough or wise enough, or quick enough to be able to handle the demands of labor and delivery.” I’ve actually been told by patients, “It’s so good to see you. I’ve been here before.” Or I’ve had a family member, she was like, “It’s so good to see you. I’ve been here with three different family members and you’re the first Black labor and delivery nurse I’ve ever seen.” And I’ve heard this in California, I’ve heard this in Louisiana, I’ve heard this on the East Coast. People are like, “Oh my God, I never met a Black labor and delivery nurse,” very common. And this just goes, ICU, emergency room, post anesthesia recovery, recovery after surgery, those are considered specialty areas. And there is a lot of discrimination where Black nurses are discriminated against and really not given the opportunity to work in those areas.

Rebecca Dekker:

What about on the hospital floor with your patients who were Black or Brown? What kinds of things did you notice with that?

Nicole Deggins:

A lot of assumptions about why a person is a certain way, not as much empathy or compassion because, “Oh, that’s just the way they are.” I’ve been at the nurses station and overheard conversations. And the only thing that was missing from the conversation was the N word, everything else that they’re saying, it’s like, “Is it 1940? I’m a little confused about where I am because those people and they, and that type of conversation about a patient,” when you’re receiving report the way that they would talk about the father, if it was a Black father, it was always like, “baby daddy” kind of conversation versus “husband” or “partner”. Very different if it was a White woman, single or married, it didn’t matter.

The conversation, the way that the family was talked about would be different. How much pain medicine she called for, the reaction to the request for pain medicine would be different. And the use of discretionary testing. So inside of labor and delivery, there are a lot of standing orders and inside of the nursery and the whole obstetrical space, there’s a lot of standing orders. And so there would be an order, you didn’t have to call the physician to request a urine toxicology, a urine drug screen. And statistically, for sure, if there was a young Black girl who came in, a young Black woman who came in for labor and delivery, for anything, she’s suspicious for being high and, “Let’s drug test her.” But White patients were certainly not drug tested with the same amount of regularity. 

And then they would test people’s babies for no reason. They just went, “Oh, this baby seems jittery.” But then you have a Caucasian baby who is jittery and you’re like, “Ah, you want to catch a meconium test?” “Oh, no, it’s fine.” Like, “Oh, okay. I’m telling you this baby looks jittery.” So there would just be discrimination particularly around that, the way that people were talked about, the way that they were medicated, the amount of compassion or the lack of compassion. And even in situations where there was drug seeking behavior all around. So if there was a Caucasian woman who was methamphetamines addicted, right? She got a different type of compassion. Then the Black woman who came in who might’ve been addicted to crack, cocaine, totally different amount of compassion.

Rebecca Dekker:

This all is so important to talk about because this speeds into the maternal mortality crisis. It’s those subtle and sometimes not so subtle differences in how you treat somebody that can make the difference between surviving or not.

Nicole Deggins:

Yeah. So often, if it were a Black mom calling out, asking for whatever it was, that if this mom had been labeled, so more often than not, a Black mom would be labeled in a negative fashion compared to White women being labeled. But if the mom has been labeled as “a problem”, as “drug seeking”, as “project”, as “ghetto” as whatever label you want to put on that, she was treated completely differently. Her call light was not answered as swiftly, her requests were not tended to as swiftly, her family was treated differently. And just going across the country and really seeing the differences in the way poverty looks because poverty is poverty. There’s poverty across all racial lines. And so White women in poverty who were just looked at with a different level of compassion compared to the Black women in poverty, who also had poverty, as well as racism on top of that. And they were not seen the same way.

Rebecca Dekker:

Mm-hmm (affirmative). So what made you go on to midwifery school?

Nicole Deggins:

I went to midwifery school because I wanted to be able to do more. I worked, like I mentioned, in this high-risk hospital, it was 12 hour shifts. You come in in the morning, you leave at night and that’s a wrap. And that 12 hours, on a really busy day, I literally might turn over my rooms three times and see six deliveries, literally six deliveries in the 12 hour shifts. Yeah, it would be crazy some days. That’s a crazy day, regardless whether it was a slow day or a busy day, at the end of the day, I go home. And so in my six hours with this one mom, four hours with this one mama, even 12 hours with this one mom, I can create a bond. I can talk to her, I can encourage her to breastfeed and consider breastfeeding. If you are in labor and you have not had anyone to talk to you about the benefits of breastfeeding over the course of your pregnancy, for me, you’re a nurse that you’re just admitting, might impact on your desire to breastfeed is so minuscule.

Rebecca Dekker:

Probably feel like you’re a band-aid, you’re not able to prevent-

Nicole Deggins:

Not even a band-aid. And so basically it was like, “I want to do more.” So there would be some people that I would see repeatedly. There was some women who came to the emergency room, but when you’re pregnant, you go into the OB emergency at a busy hospital. So there were some women that would come in all the time. Their entire prenatal care was pretty much an OB ER. So you’re meeting them and it’s like, “Oh, hey, Tasha you’re back. What’s going on?” And so we’re taking care of her while seeing her. So, “Oh, Nicole, I want you to be my nurse again,” kind of thing, because now we have a relationship.

But still, in my mind, I thought if I could talk and bond and communicate and teach and create relationship over the course of six, seven, eight, nine months, over the course of a year, because then they would come back to me postpartum. I thought, “Wow, that’s how I could really make a change. That’s how I could do something bigger and really impact lives.” Because this 12 hour shift is not enough. It just didn’t feel like enough. So I wanted to do more and have a bigger impact in the lives of the women that I was working with. 

Rebecca Dekker:

So I know you went to midwifery school in a university in Georgia, and I was just curious. There’s a strong history of Black grand midwives in Georgia, as well as the attempt to eliminate the Black grand midwives from Georgia. When you went to midwifery school, did you or your classmates receive any education about the history of midwifery or anything like that?

Nicole Deggins:

We got history of midwifery out of a textbook that started with frontier nursing service.

Rebecca Dekker:

Okay.

Nicole Deggins:

We did not get any history of Black midwives. We did not learn about Black midwives, the history of the legacy of the grand midwives or anything of that nature. So no, generally speaking, no is the answer. Which is really appalling to me now that I am connected to that information. A lot of people go to midwifery school, Black women today that I talk to, a lot of them are going to midwifery school with some knowledge of that history and that legacy and an excitement to be able to carry on that legacy. I went to midwifery school because I wanted to go to graduate school to make a different kind of difference.

I had no idea, I was very ignorant about the history and legacy of Black midwives. And what brought me to that information was an opportunity to be connected to a phenomenal documentary called, Bringin’ in Da Spirit that was done in 2001, I think it was completed. Don’t quote me. But anyway, when I was in Mississippi, Rhonda Haynes, who was the director and producer of that documentary and she came to Mississippi and I was her local host, to help her meet other people in the area around midwifery history and that sort of thing. And she interviewed me, and as a result of being a part of that documentary experience, that was my introduction, that there is this huge legacy of Black midwifery in our country. And I’m not sure why I didn’t know it. Well, I do know why I didn’t know it, of course, why would I know it?

Rebecca Dekker:

It wasn’t taught.

Nicole Deggins:

Right. So yeah, I didn’t know anything about it, but I’m so grateful that I had an opportunity to meet Rhonda, to be introduced to the legacy and the history and to now be connected to it.

Rebecca Dekker:

Yeah. And you eventually went on to get training from Shafia Monroe. Correct?

Nicole Deggins:

Well, I didn’t train with her per se, but I worked closely with her as a state rep and a regional representative for the International Center for Traditional Childbearing, which at the time was the only organization that was really pushing and was dedicated to increasing the numbers of Black midwives and doulas across the country. And so I began working with her and I became a part of the leadership team in a certain timeframe with ICTC. And I worked closely with her in that realm. I did study with her in terms of doula training. For years, Shafia was the only person really out there actively training Black doulas.

And so she made a decision that she wanted to expand the training. And she was looking at a few individuals to come on board to become trainers under ICTC and to become a part of the ICTC team to do additional training. And when the conversation started, it was more of a conversation, a pilot. So I did do some studying with her around training doulas, but the pilot didn’t work out. That’s what we, it was like, “Let’s try this out, let’s see if it’s going to work.” And it just wasn’t, just the timing just wasn’t there. But in spite of that, I moved on to continue the work, to begin training doulas, even though I wasn’t able to do it through ICTC or through her brand, it opened up an avenue for me to begin doing it in another capacity.

Rebecca Dekker:

Yeah. And we can talk about Sista Midwife Productions in a minute, but first I want to hear your birth story. Because after you became a nurse midwife, you then had your child. So can you tell us a little bit about that experience?

Nicole Deggins:

Yeah, not only after I became a nurse midwife, I had been a midwife for 20 years.

Rebecca Dekker:

I forgot about that.

Nicole Deggins:

And I had my baby, yeah. And there were a lot of things leading up to me having my baby that I was… When I say that, meaning there are a lot of different things going through my head, “I’m Black, I’m over 40. I am a nurse, a labor and delivery nurse and a midwife.” And there is an underlying bad joke, all the way a bad joke, but there’s this underlying bad joke that’s talked about that like, “Oh, if you’re a labor and delivery nurse. Oh, if you’re a midwife, that’s your ticket to the OR.” So there’s all these things playing in my head, quotes unquote, “I’m old, I’m Black, I’m a midwife. But I have so much information, I need to get ahead, how am I…?” But I really was excited about being pregnant and I had the most uneventful, beautiful, easy pregnancy, was absolutely wonderful. 

I did seek out care from a midwife at a hospital, even though I was planning a home birth with just friends and my partner at the time, that was my plan. But then my baby decided that she wanted to come a little early. So it’s so funny because she’s almost six and she will say to me sometimes, “Mama, I bet you when I was inside of you, I think I was just ready to bust up out of there.” She told me that one day and I said, “Yes, you were ready to bust up out of the there. That’s why you broke your water bag early.” But because I had all of these things floating around in my head, I also, or not because, but in addition to that, I also made a very firm decision that I did not want, not only intervention in labor, I wanted a home birth, but I also didn’t want prenatal interventions. I didn’t want an ultrasound, I didn’t want unnecessary labs, I didn’t want genetic testing. I didn’t want an MFM, Maternal-Fetal Medicine appointment or any of those, no genetic counseling. I didn’t need it, I didn’t want it.

And so I intentionally stayed away from prenatal care until I was pretty much too late for any of those tests to even be offered. Because I didn’t want to even have to have the conversation. So I did self prenatal care for the first couple of months. And then I went to the midwife and I was like, ‘Here are my blood pressures. Here’s some blood sugars I did. Here’s my weight.” And she’s like, “Okay,” so we have a whole conversation. And then it was, I was 34 weeks, six days and 23 hours, literally, and my water bag grossly ruptured, clear fluid everywhere. I had just gotten up to go to the bathroom and I just started sobbing and sobbing and sobbing. And I was like, “I don’t want to go to the hospital.” And it was almost midnight. And I just was like, “You don’t have a choice. You’re not full-term. And while you’re pretty sure that a 35 weeker is going to be fine, you never know. Because some 35 weekers are not fine at birth. And so don’t be selfish, go to the hospital.” And at the time I was having contractions, so I waited a few hours to see if they were going to slow down or whatever, but I was actually contracting regularly. They were very uncomfortable. 

So after the maybe four or five hours, we go to the hospital and, I do admit, I say I had midwife privilege. I walk in and like, “My name is Nicole Deggins, call the midwife, let her know that it’s me. She will let you know who I am and that I don’t want any cervical checks and I don’t want the…” I’m just giving them my orders, “I don’t want those, I don’t want that. I don’t want this, I don’t want that.” And they’re like, “Okay.” And like, “I’m grossly ruptured. I promise you, I’m ruptured. My water bag is gone.” So I get admitted. And this is Friday. Saturday, Sunday, Monday, Tuesday. I think it’s all day Saturday, all day Sunday, all day Monday. So this is Friday midnight going into Saturday. 

So I get admitted to the hospital. With this midwifery practice, any midwife patient who intentionally came in to see the midwives, you had to get a physician assigned to you specifically, rather than just whoever’s on call. So the midwife knew who I was and about me. So she picked a physician very specifically, who she knew was not going to be really pushy about interventions and inductions or any of those things. Well, it just so happens that he was a very experienced OB GYN, but he was from out the country. And the weekend that my water broke, he was in Texas taking his boards to recertify in the United States. So I get the on-call physician and I don’t want any cervical checks. And I also don’t want to be induced. And so I’m 35 weeks. And so, I know what the evidence says, 35 weeks ruptured, it’s equivocal. Some things they induce, some things they don’t induce. “I don’t want to be induced. Thank you, kindly. I’m good, my baby’s good.” I let them put me on the monitor.

Rebecca Dekker:

You were already contracting on your own too, right?

Nicole Deggins:

Well, but then it stopped.

Rebecca Dekker:

Oh, it stopped?

Nicole Deggins:

By the time I got to the hospital, yes. I didn’t say that. So I was contracting, so I go to the hospital, by the time I get there and get settled, everything went away. So now they want Pitocin. So it’s Saturday morning and the nurses, I think secretly were loving it, that I was really just commanding what it was I wanted in my care. The first physician is very irritated, after I just declined Pitocin three different times, the doctor comes in and she’s very forceful and she is young, very young. And I’m laughing because I’m thinking to myself, she’s probably younger than me. So she’s like, “Why don’t you want Pitocin?” And I was like, “Well, for a number of reasons. First, really there’s no evidence to support that I should be induced with Pitocin at 35 weeks, number one. Number two, I want an unmedicated birth. I don’t want an epidural, I don’t want any IV meds. And we both know that if I take Pitocin, the likelihood of that really goes down. Three, in my opinion, there are a lot of spiritual and metaphysical reasons why I shouldn’t take Pitocin.” And she just throws her hands in the air and she walks out and she storms out the room and I’m like, “Oh, okay. I guess she understood.”

So then she fires me. She tells the midwife if I won’t take Pitocin she can’t be my doctor anymore. But she was only really able to do that because they were super, super busy. And so they had two physicians from their practice on the unit that day. So the other physician comes in with this long consent and he makes me sign it. That’s just basically like you’re at risk for uterine infection and scratch C-Section and prolapse cord and all of these things. And I’m like, “Okay.” So I sign all the papers and they leave me alone. A couple of hours on Saturday and a couple of hours on Sunday, I did try nipple stimulation with a breast pump to no avail. So I would nipple stimulate, I would have contractions, no nipple simulate, no contractions. So that was a wrap. That was Saturday, that was Sunday. Monday they’re like, “Okay, you’re taking up a bed. You’re in the way, we will move you to the postpartum.” So they moved me to postpartum. 

And by this time my physician was off taking his boards, he was back in town. So he comes to see me and we just have an agreement. And he’s like, “I’m not worried about inducing you. When the baby comes, the baby will come and we’re here. We’ll be here to catch the baby. It’s not a big deal.” “Thank you so much.” So here’s the good part, the actual birth part. So midnight on Monday, literally, it’s 10:00 PM. And I eat this huge plate of beans and rice and fish and broccoli. I’m starving and I go to sleep. At midnight on the dot, this contraction wakes me up out of my sleep. It was a pain, a discomfort, a crushing thing like I’ve never felt before. And I jerk myself up in the bed and I’m like, “What the hell was that?” And I know it was midnight because then I looked at the clock and I was like, “It’s midnight.” It was right at midnight. And man, they just started coming immediately. There was little lead in time. I started having loose bowels, I’m going to the bathroom, I’m pooping.

And I had been on antibiotics at this point for 48 hours. And they had switched me to an oral antibiotic. So I was like, “Well, maybe I’m having some loose bowels.” At first I was denying what was really going on. Like, “Maybe I’m having some loose bowels because of this new antibiotic,” and it doesn’t stop. The nurse comes in to check on me because at one point, I’m in the bathroom for maybe, I don’t know, 15 minutes or whatever. And I was off the monitor. So off the monitor, “Oh my God, what’s going on?” So she comes in there and I’m like, “Oh, I’m just having some diarrhea. I’m okay.” And she puts me back on the monitor. I didn’t want her to know that I was in labor because by this time I had realized it. I was like, “I think something’s happening. I don’t know. But I think something might… It’s so crazy, I think something’s happening. I’m having pains every five minutes, maybe?” 

So I get her out the room and then my partner is there. He’s there, I wake him up. I try to get him to do a little back rub for me. It was ineffective. And I was like, “Forget it. You’re not being effective. I got this by myself.” And I just had this really interesting experience where I would have a mild contraction where I could just wiggle my hips on my own a little bit, and it would be fine. I would have three or four of those and then, it would be like a wrecking ball, just poof in my head. I couldn’t see, I couldn’t think, I couldn’t breathe. And that would come and then that would go. And then it would be again like three or four. Like, “Oh, this is fine. This is fine.” And then a wrecking ball. Every three to fifth contraction would be a wrecking ball. So if we think about that, that’s two to three wrecking balls an hour. 

Rebecca Dekker:

Mm-hmm (affirmative).

Nicole Deggins:

And every time I had a wrecking ball, it was insane. So maybe around three in the morning, the midwife came to the hospital for another mom and she was like, “Oh, do you want me to check you?” And I’m like, “No, I’m good.” Because at this point we all agree, I’m in labor. It’s still really early, this just started at midnight. On admission to the hospital, I was two centimeters. No one had checked me since then. So this is three days later and I hadn’t been contracting, “So there’s no need to check me now. It’s only been three hours. So we’re good.” So about an hour after that, maybe four something I tell my partner, I’m like, “Please call my doula.”

So my doula comes and then a little while after that, the midwife comes back in, she’s finished with the other birth. And she’s like, “Well, it looks like this is really, it. Things are just moving right along. It looks like you’re really active. Let’s move you back to labor and delivery.” And I’m like, “Okay.” And at this point I’m in the zone, I’m not really present in my physical body. I’m in the zone. And so I’m like, “Okay.” So she says, “Well, do you want to walk or do you want us to put you on the stretcher?” And so my doula says, “She’ll walk.” And I was like, “Okay, I’ll walk. Okay, whatever she’s saying.” And so right before that time, I’m in the bathroom and I’m sitting on the toilet. I have my head on my partner’s belly. I’m leaning over and I’m sitting there and I’m asking him for help. And he’s like, “I said I need help. I need help.” And he’s like, “What do you want me to do?” And I’m like, “Oh my God. You’re so… Well, I don’t know. But help me.” 

And I have this fleeting thoughts this moment, this fleeting moment where I say to myself, “This is insane. Why on earth am I doing this? Why would anybody do this? This is so stupid. This is just stupid. Just stop this already,” this is in my head. I never spoke any words. I just was in my head talking to myself about how ridiculous this was and, “Get some pain medicine. This is so crazy.” What I learned later was that I was in transition. Which is what we know, in transition, you go into another space and you’re like, “I changed my mind. I want pain medicine, all this stuff.” I never spoke a word about it. I just felt that while I was in the bathroom, I had a contraction. I felt my baby move. I felt her move down into my vagina. And so then I go back out and the midwife’s like, “Let’s move you.” And the doula’s like, “We’re going to walk.” 

And so I began to walk to the door to leave the antepartum room and I get a wrecking ball. The wrecking ball gets to me and I just drop to the floor. And I’m like, “Oh!” And so my midwife is like, “Wait a minute, let me check you.” And she checks me and she’s like, “The baby’s right here.” I’m like, “Okay.” So they’re like, “Let’s put in…” So she told me later that we would have given birth in that antepartum room, except she also was like, ‘Well, she is 35 weeks. What if we need the warmer? What if we need this?” 

So we went to labor and they put me on just on the bed. They wheeled the bed to the labor and delivery room. And at this point, I swear to you, Rebecca, I am out of my body, literally I’m above myself, watching myself. And the way that I describe it, that makes people get it. Have you ever been in a dream watching yourself in the dream and then being in three levels of a dream? You’re in the dream, watching the dream, watching the dream. Have you ever had an experience like that?

Rebecca Dekker:

Close. Not maybe that intense.

Nicole Deggins:

But you can see that you’re in the dream and you’re watching it from the outside rather than experiencing it directly.

Rebecca Dekker:

Mm-hmm (affirmative).

Nicole Deggins:

So I’m like floating above myself as we wheel down the hall into the labor and delivery room. We go into the layman’s labor room and I see these guys, this one tall, White guy. And I’m like, “Who is that?” And I realized he’s the resident I had given the midwife permission earlier to let him observe my birth so he can see a normal birth. So I’m like, “Oh, that’s that guy.” So then I see this tall Black guy I’m like, ‘Who is that?” And then I realize he is the OB tech setting up the instruments. So these two men are in there who are so random. And then the nurse is in there and my partner he’s there and my doula and the midwife.

Well, then you get to complete and all this movement and my body just stopped. And so I’m still floating outside of my body, but there’s no contractions, there’s no baby. And so everybody leaves, there’s other stuff going on. So the OB tech leaves, the resident leaves, the nurse leaves. And so at this point, it’s just myself and my partner and my doula and the midwife. And my doula says to me, “I remember when we had our meeting, you gave me a vision of how you want to birth. Do you want to do that now?” And I said, yes. And so that really meant her helping my husband at the time to get behind me as my chair, to cradle behind me. So we got in the bed, she helps him get behind me, get situated. And it was like, “Okay, have your baby.”

And my midwife and my doula, they stood across the room. And I had a mirror where it was just set up for me to see, because I wanted a mirror. And I remember just watch… It almost was effortless at that point because I really was not in my body. I remember her head being born. I remember every time I would have a contraction before she was born, I would put my hands right over my vagina. My ex, he asked me one day, he was like, “Why did you keep doing that?” And I was like, “Because I needed everybody in the room to know that I was going to be the first person to touch my baby’s head. I don’t want anybody else to come over here. I’m good.” So as she started crowning, I just held my hand there and I let her head come out. And then I remember looking in the mirror and seeing her hanging out of me. And I remember just being like, “Just get out!” And then she was out, but there is literally a space in time that I don’t know what happened. She came out, I’m completely absent from that space.

So I close my eyes or something because I was looking at her. I was looking at her head and then she was out. But in that one second, two second, three second moment, whatever that, I was absent, I don’t know where… I was in a Black hole somewhere. So she comes out, she’s on the bed, she has a really short cord. So I just hold her on my belly for a while until the cord stops pulsating, then we cut the cord. She immediately… She was so tiny. She was under five pounds and she nursed like a champion. She went to my breasts so easy and she nursed and nursed and nursed. And it was just beautiful and wonderful. I was so fortunate that I gave birth right near shift change because otherwise all of the NICU nurses would have been in there, harassing me and harassing my daughter. But they weren’t in there because we were fine. And they were in reports changing shifts. 

So when they came to the room, probably about eight o’clock, they took her blood sugar and it was really, really, really low, super, super low. And they were like, “We got to bring her to the NICU to give her some IV fluids.” And so then she went to the NICU and I still stayed in my postpartum, unconscious, conscious metaphysical world bubble for a little while. But once she was gone, I came down pretty quickly. And I sent my mom and her dad. I sent them to go with the baby, “Go with the baby.” And they went to the NICU with her. 

And as soon as I was, I don’t know, not long after that, I’m like, “I got to pee. I’m going, I’m out of here. I’m going to check my baby. I’m going to the NICU.” So I always tell people that you can have a beautiful ecstatic orgasmic, if you want to call that, birth, even in the hospital, it can happen. I feel like I did. I had a very, very beautiful ethereal spiritual birth.

Rebecca Dekker:

Even with a preterm birth and the NICU stay, it sounds like it was blissful for you.

Nicole Deggins:

The NICU stay, not so much.

Rebecca Dekker:

Not so much. But even the fact that she had to go, it couldn’t take away from what you’d experienced.

Nicole Deggins:

No, not at all. So I was very grateful that I still was able to have that experience, even if she did have to go to the NICU, because I know that she also felt that. She felt this birth experience. She felt those first couple of hours of bonding with me before she was taken away.

Rebecca Dekker:

She wasn’t taken away immediately. I’m sure that makes a big difference.

Nicole Deggins:

Exactly. It was a couple of hours before she had to go.

Rebecca Dekker:

Wow, that’s incredible. I think it’s also really empowering to hear how you took command over your own birth experience, even though it was preterm and things didn’t go the way you wanted.

Nicole Deggins:

Yeah. Oh, because I cried for three days after my water broke. I cried all day Saturday, all day Sunday and half of Monday before I stopped crying. It was crazy.

Rebecca Dekker:

So is that before or after you started the Sista Midwife trainings?

Nicole Deggins:

That was after yeah, I had been training doulas. There’s actually a doula that I’m still connected to now. Our babies are a month apart. We were pregnant at doula training. And our babies are a month apart.

Rebecca Dekker:

So tell us a little bit about what inspired you to focus on the Siata Midwife Production, training doulas instead of CNM practice or labor and delivery nursing and what makes Sista Midwife different than other doula training organizations?

Nicole Deggins:

Yeah. Well, I started training doulas really out of a necessity. I was working like we talked earlier today about, I was working with Mama Shafia. And I was in Louisiana, I was trying to do some community work around birth options and elevating the voices of women. And how do we let women know that they have choices and that there’s this thing called a doula and how can we really bring this information forward? And I had a great meeting with a bunch of great people and we had a great plan in place. The one thing that was missing from the plan were the doulas. So when I say that at that time there were literally maybe 15 doulas in the whole area working as doulas. 

And so the vision that we had painted, where we were going to go to the WIC clinics and the Healthy Start and to job fairs and to health fairs and just churches and started spreading the good news about doulas that would not have worked in the current climate, where there were literally about 15 doulas, half of which were mostly for upper echelon, wealthy White women, like, “This not going to work. How are we going to do this?” So the timing was really lining up with working with Shafia to start training with her, but then that didn’t work out. But I had a group of women who they were like, “We don’t care who the training comes from other than you. We don’t care what name is on the training. We just want the trainings to come from Nicole.” 

And so at that time, I already had Sista Midwife Productions and I was doing… My original plan for my business, was that I was going to work with moms one-on-one and be a virtual midwife and really just provide them with coaching about how to have conversations with their providers, providing them evidence on, if the doctor wants to do an induction quote “For a big baby.” Like, “Here’s the evidence on that. And here’s some questions that you can ask and here’s your packet. Now go talk to your doctor and come back and tell me how it went.” So I had done that a little bit and had some clients with that, but I quickly began to realize that when I would do my calls, because I would do free calls about what I call the birth plan myth, and then I have this whole document, the birth plan myth, and I would do calls about the birth plan myth and how we should do what I like to say, cultivate communication, other than create a birth plan. 

So in the midst of those calls, I had a question on the registration that asked what you were. And I began to realize that pretty much everybody who got on my calls were doulas, or if they were a mother, they were not a first time mom, they were a mom with three or four children. They were midwife students. They were not just average, regular moms getting on my calls. And so I began to realize that my audience was moms, were doulas, were birth workers, the people who wanted could absorb and really digest what I was bringing and who really wanted what I was bringing, were other birth workers. And so between that experience and between having this group of women say to me, “We want you to train us on how to be a doula.” I had to sit down and make a curriculum and I did. And initially, it felt overwhelming, but I was called by my community and I was reassured by them like, “You have been doing this work for nearly 20 years. Of course you can teach us.”

And so I was like, “Thank you for trusting me. Thank you for believing in me. Thank you for wanting this experience and this information.” And I created my doula training from there and it has grown and blossomed from that time, that was in 2013. And we have just been on a roll, training every single year. It has really been rewarding. And I often say to people that it is probably the most rewarding part of my professional career to date. I really got into advocacy work as opposed to clinical work for a variety of reasons. And one of which quite honestly was that because of, I will say racism in midwifery here in New Orleans, I couldn’t get a license and I couldn’t get a job. And so after that happened, I realized I had to do something different for myself. And I began doing the pregnancy coaching, which then led into the doula training. 

And if I were to say, what makes my doula training different. One of the first things that I tell people is just me, I am a nurse, I’m a midwife and I have been a doula and I’ve done this all over the course of 25 years. I’ve worked with thousands of families across the country. I’ve seen birth literally… Because even aside from working as a labor and delivery nurse, my last job that I had that was a actual job, I worked for one of the companies that creates and manufacturers the fetal monitors. And when I did that job, I would be sometimes in three different hospitals in the same week, educating the nurses on how to use the monitor. And it was in that job that I saw so much because literally, I could be in three different hospitals in one week and I had that job for two years. 

And so it took me to almost every state and it was incredible, the number of hospitals in the states, in places that I was in. And so I bring all of that information. I bring all of that information to my doula training, which in my personal opinion, can’t be matched. What I say is, “I don’t care how long you’ve been a doula. I don’t know if you’ve ever been in a doctor’s lounge. I’ve been in a doctor’s lounge. I’ve been in a nurses station. It’s a whole different ball game to be in those places and to really be able to interpret the things that are unseen and unheard and unsaid. There so much that’s unseen, unheard and unsaid that happens in a doctor’s lounge, that happens in the phone call between the nurse and the doctor, that happens at the nurses station that doulas and patients just don’t know.

So I’m able to give those things, which I call insider secrets inside of my doula training. So that’s one piece that makes it very different. Another thing that makes it very different is that I do center the experiences and the lives of Black women. As a Black woman, that’s important to me, the majority of the people who train with me are Black women, or if they’re not Black, they are coming because they want to be given a new lens around caring for Black people in Black families and taking care of community. So that’s very different. I also come with a community model, a full spectrum model, so that we’re not just talking about birth doulas or labor doulas or postpartum doulas. 

But I believe that there is a continuum from preconception to postpartum, and we should not separate it. Even if you don’t do all of the work, the training should be all of it so that you can be more connected to how the preconception and the labor impacts the postpartum. Even if you’re just going to do postpartum work, I want you to have a very grounded in how all of the first nine months, the first 10 months, the first 12 months leading up to the postpartum, how it impacts it. So if you just get a postpartum training, some of that is missing. So that makes it different. And then I also bring some really important spiritual aspects to my training that for me, are very important as we’re talking about creating vibrational change to heal communities through births. If we want to just talk about having a baby, then that’s fine. You can just talk about that.

If we want to talk about the energetic vibration of when light meets sound, of when the smallest cell meets the largest cell, of when there’s a fusion between sperm and ovum, in a very deep spiritual, metaphysical kind of way. I also bring that. So between my experience that I have clinically, to me centering the experiences and the voices of Black women to the spiritual aspect that I bring to my training, all of those things make it what it is and make it very different from pretty much any other training out there.

Rebecca Dekker:

Yeah. I love the fact that you’re training so many doulas and I know you’ve had to shift online during COVID and I’m glad that you haven’t let that stop you. So I want to encourage everybody to check out Nicole’s website @sistamidwife.com, spelled S-I-S-T-A, midwife.com. And I want to point out that you have a really wonderful feature on your website, which is a find a Black doula/midwife directory. Can you tell our listeners a little bit about that?

Nicole Deggins:

Yeah. That’s probably the most exciting thing that I’ve done. Outside of my doula training, that’s the next, most exciting thing that I created. When I first started Sista Midwife Productions, there was no place to find in one location Black midwives and doulas. And there was always this constant frenzy on Facebook, on Twitter, “Hey, does anybody know a Black doula here, a Black midwife here, a Black doula here?” And I just looked like, “This is insane.” Whatever year it was at that time, it wasn’t 2020, whatever year it was. I was like, “How is there not a place on one website where we can find these people?”

And so I just decided that that was one of my big giveback projects. And I just created this directory. It has grown, it is so exciting. It continues to grow. It’s always been free. There was not in the past, but there is now an upgrade option because we’ve shifted it to a new platform, which allows it to be much more automated. So people can upload their pictures and attach their websites. And when they move or change names or whatever they want to do, they can have control over their profile. They can upgrade to be able to add their pictures, to be able to add reviews, to be able to add events. But most importantly, it is a free platform for moms and families nationwide and even worldwide. There are people who are not in the United States, which is super exciting to be able to go and find a Black midwife or a doula. Which to me, a critical piece and we talked about this a little bit earlier, to impacting Black maternal mortality. When we have a Black family connected to a Black provider, we know that there is the typically better care for that family and a better experience for that family. 

So in so many places, families have no idea how to find a doula or a midwife, and they can visit my website, click the links, search by state and find these people. And if you’re listening to this and you’re a Black midwife or a Black doula, please get listed. And even if you don’t need it for marketing, it’s for the family, they are looking for you. They are looking for you. They email me, sometimes they don’t click, they’ll just email me and I have to push them back to the website and say, “Hey, I’m pregnant. And I want a home birth. And I’m looking for somebody in Massachusetts or Rhode Island,” or wherever, Alabama, Mississippi, all over there. I get emails, at least a couple of emails every single day. And that directory is searched a thousand times every single year. And it’s beautiful and I’m excited about it. And I’m glad. I get people emailing me testimonies too like, “I get clients from you.” And, “I found my midwife through you.” They’ll email me their positive outcomes. So it’s really exciting to know that I helped create that.

Rebecca Dekker:

Yeah, it has been super useful and exciting and empowering. And thank you for hosting that directory. I also want to point out, people can follow you on Instagram at Sista Midwife and at The Art of Birthing where you host events, which people may be interested in following. So is there anything else you want to share before we go?

Nicole Deggins:

No. I just appreciate your platform. I love what you do. I’ve always appreciated Evidence Based Birth® from when you first started out. And so it’s been great to be able to follow the growth trajectory of your business and all the information that you bring in. It’s really an honor to be a part of your podcast.

Rebecca Dekker:

Yeah, likewise. And it’s a honor to have you, Nicole. We love your work.

Nicole Deggins:

Thank you so much.

Rebecca Dekker:

Today’s podcast episode was brought to you by the online workshops for birth professionals taught by Evidence Based Birth® instructors. We have an amazing group of EBB instructors from around the world who can provide you with live, interactive continuing education workshops that are fully online. We designed Savvy Birth Pro Workshops to help birth professionals who are feeling stressed by the limitations of the healthcare system. Our instructors also teach the popular comfort measures for birth professionals and labor and delivery nurses workshop. If you are a nurse or birth professional who wants instruction in massage, upright birthing positions, acupressure for pain relief and more, you will love the Comfort Measures Workshop, visit ebbirth.com/events to find a list of upcoming online workshops.