Who Holds the Power in the Birth Room? with Nurse Mandy Irby

Hello, folks, and welcome to Transformed by Birth, a podcast about the rite of passage of pregnancy, birth, and new parenthood. I'm your host, Britta Bushnell, author, mythologist, and childbirth educator, with an all-around an all-around deep diver with a side of goofball, I'm so glad you're here. Today we're talking about nurses, so grab your comfy beverage of choice. I've got one of my current favorites, a cardamom chai latte, or take us along for a walk as we connect with the birth nurse, Mandy Irby. Before we begin, we start the way we always do by lighting a candle. If you want to join me, please do, or just take a breath as I light mine. Today's candle is in honor of nurses. I have a real soft spot for nurses. I see them working their asses off. I see them showing up with so much care and desire to help, and I also see them kind of cut off at the knees by the system they're working in. Ask most people who's providing their care during birth, and they'll say their doctor or midwife, but who's actually in the room hour after hour, offering physical support, reading the fear, continually watching vitals, fluent in the signs and signals of labor? The answer is almost always the nurse, and yet nurses sit near the bottom of the hospital hierarchy. They carry enormous relational responsibility, often more physical presence with a laboring person than anyone else on the care team, and rarely with the formal authority to match it. Nurses see things, they know things, and far too often they're caught between a desire to act and the authority to do so, which cannot be easy. My guest today has spent nearly two decades inside that gap. Mandy Irby is a leading authority in transforming birth care, birth care culture through the prevention of birth-related trauma. She co-created the embodied trauma-informed care framework, and since founding the Birth Nurse, she's worked with state quality collaboratives, departments of health, and hospital teams across the U.S. and Canada to strengthen physiological safety in childbirth and improve family outcomes across generations. Her workshops, keynote speeches, and consultations are shifting how nurses are trained and supported to show up fully in the birth room. Mandy believes nurses and everyone who supports people through birth carry a responsibility to understand the power they do have, even within a hierarchy that so often limits it, and to use that authority. She's watched that shift actually happening in real time over her career, hospital by hospital, nurse by nurse. So today we're talking about where nurses actually sit in the hospital power structure, what it costs them to witness harm without the authority to stop it, and what it might look like to genuinely change that dynamic from the inside out. Welcome, Mandy. I'm so glad you're here.

Mandy Irby

Thank you, Britta. That was so lovely. Thank you.

Where Nurses Sit in the Hospital Hierarchy

Britta Bushnell

So I mentioned that I have a soft spot for nurses and how challenging I imagine their role is, and not always for the reasons most people think. So can we start there? Can you talk a little bit about where do nurses actually sit in the hospital hierarchy during birth, and how does that impact how they work and what it's like for

Mandy Irby

them? That's a great question. I really loved what you said about we're in between the desire to act and the authority to do so, and it reminds me of the the injury that that causes, right? That that feeling of being in between, where we are told that we are with the patient all the time, right? We have the most most time with the patient. We are the advocate for the patient. We all of that is well within our scope and our ethical obligation for nurses, and yet we're often not at the table when it comes to big hospital business decisions, when it comes to budgeting for staffing. And even creating the hours that nurses work, and that are on the bedside, so that causes a lot of betrayal, institutional betrayal, when we're told we're very important, and then we're treated very differently, not very important. So I would say, I like, I totally understand that where where we are in the hospital hierarchy, like you said, we're we're very very low, and I think a lot of people outside of the hospital will look at nurses and be like, oh my gosh, you have so much, you have so much access to all these resources, and you have so much effect on change, and and I do believe that, but I do believe that inside of it, we we really don't. And where there's often a lot of quiet retaliation in there for bucking the system and disrupting the way things are within the business model. And so I would say we're sandwiched between what is portrayed and then what actually exists, which is very little ability to change unless we move together.

The Pressures in the Room

Britta Bushnell

So very little ability to to change. So there's in as I'm hearing you say that. What are some of the pressures that push down on nurses around their feeling of being able to really act in a space that is, in many ways, their domain. I mean, it's the space they work every day. It's they are with their peers. They're super familiar with birth. So, what are the the like energies? The hierarchical energies, and I mean, you mentioned not being in the rooms where decisions are made, so rooms of power. But what else, in addition to that, is making it so that it's in the moment, in the labor and delivery room that is, you know, in many ways, you walk into a labor and delivery room, and it and it can feel like the nurses have all the power.

Mandy Irby

So my work with understanding the nervous system makes my answer complicated.

Britta Bushnell

Oh, I love that. Oh, good. Oh, oh! Make a complicated answer, Mandy. Tell me.

Mandy Irby

I am the person to complicate things. If there were a simple answer, I'm gonna probably confuse it. I think my

Britta Bushnell

audience enjoys that. It's like we we we like to listen to things and understand them and tease them apart and unpack them in nuanced ways. So go for it. Let's hear it.

Mandy Irby

Okay, with the context that I do believe nurses have the most important job in the world. So I'm going to start with that context. Instead of apologize later, I'm going to start with deep to my core. I believe nurses have the power to change the world. Already do exhibit and express that power to change the world, and I am here to support them to do so. So I am not at all saying nurses are doing anything wrong in the way that they're already showing up. Like if anything, we owe nurses everything, and yes, to do that for them, we will complicate things because I think another thing that you said really like opens up the idea of the challenge that we have in making change. We'll say point of care change, right at at the bedside, inpatient labor and delivery. Is that you said we have an enormous relational responsibility, and I think it's right there. Any other, I think we can relate to this in any other parts of our lives if we've been socialized as women, if we've been made to prioritize others' feelings, then that is familiar. Is that is that what you meant, or part of what you meant in that statement?

Britta Bushnell

Definitely.

Mandy Irby

Okay.

Britta Bushnell

Yeah,

Relational Responsibility and Who's in the Room

Mandy Irby

I felt that like that is the that's the challenge because if we then so not all nurses are women, not all people who give birth who are in labor and delivery are women, right? Where, where we're talking about the the the spectrum.

Britta Bushnell

Yes, and I'm going to say a yes and on that because I've been in a lot of labor and delivery wards, and it's predominantly women. Yes, like it is an odd thing when there's a male nurse in a labor and delivery room, and it comes with a lot of like, is this okay?s And can I be here? And you know, unless it's

Mandy Irby

obstetrician, exactly. But but not when it's a nurse. I've heard I've heard a nurse actually be like, "Is it is." Is it okay with you that I'm here? And yeah, right. But a but an obstetrician doesn't always yeah doesn't often say that. So yes, in midwifery and in labor and delivery nursing in the U.S. it's usually done by nurses, and we're mostly working with female patients. But of course, yeah, we're exploring this or including the spectrum. So that falls a lot on the socialization, how women are socialized, to expect to manage the room and manage the emotional dynamics of the hierarchy, if you will, and the and that's

Britta Bushnell

part of what I meant by relational responsibility, both to the patient and also to the structure and system, including the often the OB and the rules of the of the hospital,

When Change Sets Off the Nervous System

Mandy Irby

exactly. So I think nurses are constantly balancing that, and that's what makes change challenging because we can, as nurses, we are trained to see all aspects. We're trained to see all aspects of a human experience, right, or as many as we can identify, right, and be curious about the rest. I think we're doing better about that and getting better about that, but that is within our training. Is like we're looking at a patient, a person coming from somewhere else into this space. This is not where they live. They have a whole story. They have a lot of other things going on in their body, in their dynamics. There's more to a person than their disease, right? And so that is nursing. It's very much looking at the entire network and web of the human. But then we we can see the web of the rules structure, right? The policies, and we understand why a business has to have rules, even though we're working with humans. And so it's almost like too much, too much information, because we can also identify, and a lot of the barriers that come up when I go teach rooms of nurses is their barriers will be so and so, meaning another person will have a problem with this, and it's not the patient and it's not the family because we can ask them. We're there. We're serving them, but it'll be my manager. It'll be the union rep. It'll be the obstetrician or the provider, it'll be the provider's boss, right? It'll be someone above will have a problem with the change, the timing, the request. This isn't what they're comfortable with, and so then when I think of the nervous system, another challenge is change. Even though we know what's right, and even if we are aligned to prioritizing the patient and their agency, that is not necessarily the default of the system, and that change is challenging. That it causes friction and causes our body to have a stress response, and so we're not. We don't always have all of the ideas coming to our minds, we don't always have like our higher self driving the bus. On no, this is aligned with the patient, and the the fallout is the problem, right? If there's a a problem with the institution identifying the patient's agency and following that as the guide post, and then then that's a problem with the system. That's not a problem with me or the patient or the way that we're doing things, but the nervous system will sound alarmed with alert, alert,

Britta Bushnell

yeah. Which really means that the a nurse is stuck in a middle point of of pushback between oh I'm hearing and I've I've been told agency for my my patient is incredibly important. I want to help be an advocate for them and their agency. Oh, but that's going against these things over here. I may have to deal with those later as the middle person. Ouch! Fear scared response. Did I get that right?

The Beautiful, Messy Goo

Mandy Irby

Yes. Can I complicate

Britta Bushnell

it, please? We've already established, Mandy. You can complicate it.

Mandy Irby

So it's messy, right? It's messy in like a beautiful way, right? You talk about that a lot. The the gooey,

Britta Bushnell

very messy, so

Mandy Irby

gooey.

Britta Bushnell

It's so messy.

Mandy Irby

So, in this beautiful goo of humans, what about the the individual? This is everybody, individual, but specifically nurses and all the clinicians. Our individual fear of something happening that's out of control, or that's harmful to our psyche and our emotional state, and that's valid too. Because, right,

Britta Bushnell

absolutely,

Mandy Irby

we see so much, right, in healthcare,

Britta Bushnell

so much, and who knows? Like a nurse may be walking into. A very beautiful physiologically flowing laborer coming out of a far more traumatic, out of the blue things went sideways kind of experience, and that's still in their body,

Mandy Irby

exactly. Yeah, they're bringing that in normally. That's totally normal. Yeah, yeah. Because we're present with our work. They're humans. We feel their feelings. We are connected with their system. Right. We feel the family. Like you can walk into a room and tell when something's off. Nurses are acutely attuned to the dynamics, the individual. We're trying to communicate with a fetus inside. There's so many layers, right? Like we're, and we're told with this technology and with we're in the U.S. We have the best. We can't predict much in childbirth, right? A lot of folks would much rather work on a disease process than this like very normal thing that occurs that we're trying to now figure out, let alone control and predict.

Britta Bushnell

And so it has so many different factors influencing it.

Mandy Irby

Yeah,

Britta Bushnell

I mean, it it we it would be so great if a crystal ball were really available.

Mandy Irby

But that's what it would take. It's not going to be any establishing because

Britta Bushnell

because exactly the a fetal monitor is not a crystal ball,

Mandy Irby

right? Yeah, it's it's a data

Britta Bushnell

collector, but that doesn't mean that that data is, you know, clear and transmutable in really definitive ways.

Treated Like a Machine

Mandy Irby

Right. We don't have very many diagnostic tools or predictive data points to tell us that we're all going to be okay. Yeah. Right. And it's not to say that the thing that happens is catastrophic. Like by definition, it might be that someone tells us something that touches us based on what's going on at home at that time, or what's going on with our own parents, or what happened in our own birth, or or or, right? We're carrying our whole human selves into this space with other whole humans, and it impacts us. And we are essentially treated as a machine by the workplace, right? To to move forward, like you said, like to leave a birth and to not be treated as that is going to impact our sleep, our mental health, our eating, our relationships, and our next patient. And we're not treated and supported as that will happen. And it's not that we don't have the science; we have the science. We know that it impacts nurses, and then we're asked to move on. And so we're like, okay, is the right thing to do to just shake that off. Okay, I'm going to dissociate. So we're practicing dissociating with our bodies, dissociating with ourselves, forgetting that patient's story, which is also a betrayal, right? Because that that was a whole thing that just happened, and now we're in this space to respect this other person and this other person's story, which is you know what they deserve too, and we are kind of slungshot in the middle of there. So, so then who's protecting us? And I'll say a lot of the ways that we, as nurses, and I'm not at the bedside, and so you know, just kind of include myself in that.

Britta Bushnell

And and you were so well, yes, and

How Our Brains Try to Keep Us Safe

Mandy Irby

it was. Yeah, both did this plenty of did this plenty of times, and am included in the we. We as humans, our systems are working to protect us, and they're working to protect perceived issues, right? Because we work with our beautiful brains are trying to conserve energy, and we're running on fumes, and so the brain is like, I have just enough fumes to protect you. You're going to be alive at the end of this, and that also includes connection to others. And so, in the messy middle that we are, connection is protective of our job and our ability to do our job, and our ability to be like socially safe, the way our brain has has decided on, and so it's taking patterns and predictions to be very very efficient at keeping us safe. And so sometimes, as nurses and as clinicians, we will do and say things that help kind of control the situation in ways that might protect us going forward, and so that can look like doing things that we wouldn't normally consider that we did in a time where we think maybe our system is saying there's no other option. Like this is the best way. This is the safest way. This is supportive of the patient, and so that can be really tricky when it's not in alignment with agency or autonomy with the patient. Can you give

Britta Bushnell

a just kind of a hypothetical example of what that means to kind of just ground it? Because I, I'm hearing that, and I'm imagining a listener going, "Well, what do you mean? How does how does that work? What might somebody say that? And and yeah, if you have a hypothetical,

Mandy Irby

I have lots.

Britta Bushnell

I bet yes.

A Hypothetical: The Hamburger in Labor

Mandy Irby

My brain goes to one that's probably a little hard. So an easy one would be: we don't allow anyone to eat and labor only clear liquids. And the patient says, you know the the family is like gross. I'm starving. I've been laboring all night. How about a hamburger? And the nurse says, inside all the things that that might entail. Who am I gonna? Am I gonna have to change the order set? Who am I gonna have to talk to about this? The order reflects what I just said. Like clear liquids only, no no food, no solids. The anesthesiologist is going to come and ask when you last ate, and it's going to be during my shift, and they're going to look at me. The obstetrician is going to be like, "Why are I found them eating this burger? This doesn't always happen. This is 100% of the time, but this does still happen and has happened all over the U.S. And the patient can eat whatever they want, but what the patient needs is information to make that choice. But what I'm, what the nurse might deal with later is vomiting, nausea, feeling sick, heartburn. They might have more emergency or urgency. They might have issues after their epidural. They might get the get the talk about maybe they have a risk for a C section, or they get talked to a about the consent for a C section. It includes aspiration and if you've eaten and now they're looking at me, but you let me eat, right? Which is kind of a weird thing, but those things all happen. And without solid grounding on my role as the nurse and my responsibility to the patient and to the system, that can be really challenging. Where I might just be like, "Look, you're going to probably be sick anyways. Do you want to be throwing up a burger or or have clear liquids. This is what everybody does. We have Jello. We have all these things. I can make them really nice, and you're not even going to want that burger later. And I'm sorry that you're hungry, but this is how it is, or this is the this is the order, or we literally don't have food, or I literally can't let you do that.

Speaker 2

So,

Information, Not Permission

Mandy Irby

I'm being hopeful. I'm anticipating their problems. I am laying them for like that's not agency though. That's overstepping and also my discomfort in the fallout of like all of these things that have literally happened to me. They've happened where someone looked at me and they're like, "Why'd you literally? And I'm like, "I've never let anyone eat in their life. They they eat. They just eat. I don't. I'm not in charge of that. I'm not feeding them. Right. We're not talking about folks who need help with their limbs, and we're not talking about we're talking about able bodied folks who are making their own decisions for their bodies, and where that discomfort of being in the middle can be challenging. Where that's that's mistreatment for nurses. Like we asking people why the nurse let someone eat is wild behavior, right? I'm not. I don't put a burger truck on the unit, and I'm like, everybody free burgers, and there's no questions asked. No, I am not like force feeding. Someone's eating. I've let people go smoke after I was finally like not let them, but like after I was finally really grounded in what is my responsibility and what do I have control over? Not much. Responsibility is information. Prioritizing safety. How can we do this safe? What are we worried about? And I share that with them. I'm worried you'll throw up, but also my brain is saying you might throw up anyway. So yeah, burger's not going to make you do that. I'm worried that you don't have enough calories, but also nausea is a thing, and and it might cause like it might look like a bigger risk, like turn out to be put you at a bigger risk for an injury later on if you were to need this urgent thing. They have to make that choice.

Britta Bushnell

They have to make that choice, and the way that you just mapped that out, it can also be really tricky for the nurse to be in that place of, it sounds like a simple, it it it presents kind of simply when especially you you know you hear in and we can go here and you know in social media it's like eat if you're hungry in labor it comes off as like a simple. Simple state statement to parents: Eat if you're hungry, like like the the evidence is saying, and you know they're unpacking kind of the evidence around eating and drinking in labor, and so folks are coming into labor and delivery with some of these bite size pieces of information about something that can seem as mundane as eating and drinking, and yet the way you just unpacked it about what is they're being met with is really actually kind of nuanced and complex.

Burnout and the Misunderstood Role of the Nurse

Mandy Irby

It is. It is complex, and it's it's part of the culture in healthcare that what does it do? It pits, it almost like it almost pits nurses against everybody. Yeah, which is

Britta Bushnell

part of why it feels like the the nurse burnout has got to be so effing high in labor and delivery.

Mandy Irby

It is high and it's it's growing, right? Especially post COVID, it is high, and I think it's it's a unique place to work, and it's magical, you know. Like

Britta Bushnell

it's it's totally magical, and traumatic and and it's it's a lot. So can we just leave it at you know it's a lot,

Mandy Irby

it's a lot. So nurses stay burned out often. Is the point is my point there is like we don't necessarily leave, but we're working burned out, which is a higher risk for patients. Right, we all benefit when nurses are supported. The entire community benefits when nurses are supported, and so identifying that this is a challenge isn't the patient's responsibility. This isn't the family's responsibility, but it is calling in that system, layered system issue. That it's not just it's also not just the hierarchy. It's that we've all kind of misunderstood the role of the nurse, nurses included. I think we've taken on a lot of that, and I see that as a change that hopefully the upcoming generation is really seeing it, and that may be impacting their burnout rates because they're seeing this is nonsense. This is let someone eat. No way! Let someone go out and smoke. No, I, I didn't let them. I gave them the information. We want them to be safe and come back. Like that's the goal, and to have the retaliation and the kind of the whiplash of we're trying to keep people safe, but we can't hold them there. But then the language sounds tricky. Definitely needs to be like talked about, discussed, and identified, so that everyone community coming in can identify. Oh, I see what's going on. This is really uncomfortable situation, but it's not necessarily a me problem.

A Me Problem or a System Problem

Britta Bushnell

Okay, that that sounds like the crux of your work. Am I right that there's a piece of helping them understand what part of this is a me and what part of it is a them, and where do I land in here? Is so how how do you do that? Because I'm I'm thinking about how how tricky it is for a nurse to feel safe speaking up And to use their voice and to have an expression of of you know they're they're working to support the autonomy and agency of their of their client their patient while simultaneously trying to do that for themselves.

Mandy Irby

Yeah,

Britta Bushnell

how do you do that? That sounds so challenging.

Mandy Irby

Thank you for seeing that. Yes, it is so challenging. And for many years, I didn't share the identities with my patients and with folks giving birth. I was like, "Oh, that's a separate type. That's not me. I'm over here. I'm a nurse. I'm just we're different, but our identities are very similar, right? They're very intersected, very aligned, and with the data showing that given it's given us a cookie data, right? Given nurse the resources, they'll change the community far beyond their patients, far beyond just who they see in the in the space, and so you know, as I evolved and understood that, I truly try to share and get across like, and it's very challenging how our identities intersect because I just want to shout out, we're the same. The things that hurt our patients hurt us, and I wanted. So I teach and talk about it in a lot of different ways because the last thing I want to do is hurt a nurse because they didn't have this information, or. Steamroll them with unpacking their own trauma before they're ready, and I know that's not my responsibility. But here we are.

Britta Bushnell

Well, but I mean, I think that is part of the the intersection of also what's happening for parents is they're the woulda coulda shouldas we know are a big part of what happens after birth for a lot of parents, and using what they know after going through an experience against themselves as if they could have known it first ahead of time,

Mandy Irby

right?

The Could Ought Would Shoulds

Britta Bushnell

And and those woulda coulda shouldas are really can can be really tough. You know, I had a teacher who called them the cows, could ought, would shoulds, and that the could ought, would shoulds tend. I mean, they're cows, and what do cows do? They they drop cow pies, which is a lot of bullshit, and when they get out of the pen and peruse around our lives, we end up stepping in

Speaker 3

it.

Britta Bushnell

And I, I always found that interesting to be like, okay, there's a time and a place to understand and unpack and get the cows out and tend to them, and there's a time to be like, hang out in in your pasture. I'm gonna acknowledge you are there, and I'm and I'm gonna also know that you aren't speaking truth because the would ought should coulds are often not true to what it is that's real in the moment.

Mandy Irby

Yeah. So your podcast is all about transformation, and when I took, so I did a dive quick, not quick for a few weeks. I've been listening to you in my ears a bunch.

Britta Bushnell

Aww, thank you, Andy.

Mandy Irby

Well, it's lovely. You have so many goodies in there. And I first listened to your year-end podcast, and it gave me a bunch of ideas for like, oh, I'm going to go listen to that one, and that one, and that one, and that one. And you ask about transition, transformation. You ask about, and you talk a lot about the themes of transformation and what changed for me was I had to unpack it backwards, and I had to experience it all one by one, and then look back without the coulda, shoulda, woulda's. Right?

Speaker 4

I

Birth Through the Lens of Gender-Based Violence

Mandy Irby

had to be a nurse, and then I had to have children to get that perspective, because like you can't just always know things. Even though I knew a lot, I knew more than everybody. Some people would say my younger sisters would be like, "You think you know everything. So that's what younger sisters are for. Yes, right. They remind me, and I remind them. I went in and had a baby and knew everything, and then turns out there were some lessons in that. I was like, "What? This is weird. Learning things when having a baby, and so that rocked me. And then I left, and haven't set down the concept that we are just so similar, right? Nurses and the folks that they serve and their communities are just so similar, and so that keeps coming back to me. And what changed the way I look at helping families through labor and birth was through the lens of sexual violence, gender-based violence That it's this private, quiet experience that in healthcare, like we get to know everything about somebody, and in perinatal care, we get to know more than everything about somebody. Right? You are in them in the deep, dark parts that come out, and you touch on that on your on your podcast and your your interviews touch on that that the stuff that we've experienced, the things that we bring in to our birth, sometimes come out, and we don't like open the door for them. They don't knock. They don't have a special key. They are just there, and we are kind of like facing it, forced to face it, or have the opportunity to face it. And I just kept coming back to you know, nurses have this opportunity. We have this opportunity. We're outside of healthcare. We're looked at as folks with opportunity, access for power and change, and I believe that where we have that power, where we can really make change, is the access that we have to that transformational process. And if we're looking at, and my specialty and special passion is gender-based violence, and if we look at the the opportunity, the numbers of folks that come in, women that come in who have they have experienced intimate partner violence, gender-based violence, child abuse, it's the vast majority of our patients. And what nurses aren't talking about often is gender-based violence among our patients, what other people are talking about is gender-based violence. What the like advocacy groups, community activists, millions and millions of people are talking about gender-based violence, and perinatal nurses. This isn't the most important thing that we talk about every single day, and it needs to be discussed, and that's the part that I believe needs to be studied is how our nurses so hurt. By this part of our identity, yes. That we can't yet tackle it in support of our patients, and I think, I think that the it's been a minute since I cried hard on a podcast, Britta.

Britta Bushnell

Yeah, that's really powerful what you're sharing. So thank you for bringing your not just your wisdom and your heart. Yeah, I

Coming Back to Self

Mandy Irby

think the quiet is significant, and I think that's a clue into how we can support nurses deeply, and yeah, help transform them, help them transform into understanding self. And so that's a lot of the work that I do when I'm with nurses is understanding how does yourself feel? How what what feelings are coming up when we're doing this work? How do you feel a stress response in your body, connecting back to their body, so they can separate their experience from the other experiences that are happening, and they can support from that place of self, that grounded place, that inner knowing. They can come back to their intuition, and they can support from a safe distance, but still support in a presence, families, and anyone else that they feel that their system feels like it needs to support where people please, whatever that looks like. But to identify what am I doing here? Why do I think my nervous system is doing this? How is this protective? And how can I come back to and recenter the patient and myself

Britta Bushnell

separately? There's there's so much importance in that and in the the the. the the the patient and myself, which is which I I find is is also true for doulas. Right. It's it's true for midwives. It's true for obies. It's it's the remembering and retaining the humanity In folks in a service position, I mean, I I notice my own caretaker response that shuts down my needs when I am acting in service for others, that that has a habituated or enculturated response in my body that I have had to pay very close attention to and work with so that I can be both me, the human, and the support person. Yeah,

Mandy Irby

yeah, and we're able to hold multiple ideas. Like it's possible.

Britta Bushnell

Yes, and and and I'm I'm thinking you saw the little smile on my face just now because I'm thinking back to what you said a few minutes ago about we are the same as the families that we are working with because this is also something that happens particularly for people who have been raised in a. Female raised, inculturated as girls and women,

Mandy Irby

right?

Britta Bushnell

When they become parents, when they become mothers, to then shut off their own needs in service of their children. So it's like there's all of the. It's all the same,

Mandy Irby

right? Yeah,

Britta Bushnell

it's all the same. But what we're talking about here,

Going to Pump

Mandy Irby

yeah. I I just remember one of my favorite patient experiences. This was her second birth with that I got to be with, and her first was very very sad, and it was just a few years prior, and she was having the second baby, and we were just together and holding her breath a little bit, but together, and I was pumping. Our kids are the same age. I had to pump, and she was having a baby. Like we knew, we knew her body and the way that it's given birth one time. So we were like, "Okay, this is serious. She said, "I'm starting to feel things. I said, "Great, I'm out. And she's like, "What are you doing? And I say, "Girl, I'm gonna pump. And she's like, "Right, okay, you have like a three or four month old. And I was like, "Yeah, I'm gonna pump so I can be here because I'm ready for this. But there's gonna be tears. I'm gonna be, milk is gonna be flowing like. And she's like, "Okay, go pump. But I'm gonna have a baby. I was like, "I know that's gonna be so fun in like two hours. I go pump. She calls me as soon as I get set up. Right top off, I get the call, and I'm like, "Oh, she's having her baby. And I came back, and she was like, "Where were you? And I was like, "I told you. What do you mean? What are you doing? And she's like, "I'm having a baby now. And she had her baby, and she remembers back. She was like, "I remember you telling me you had to go pump, and you were my nurse, and I was like, "Yeah, I mean, it's a very like human thing. It's like, oh, I'm gonna go eat. I'm gonna go to the bathroom. Like, I started doing that as I was seeing that not be done, and I was like, I'm a whole human. Like, you know where I am. I'm not gonna hide it, or you might think I'm doing something unrelated, but I'm doing something for you, even when I'm not in the room, and she says that she like remembered that for a really long time about how I was going to see her baby, but I was also going to prioritize my baby and my body. And she was like, "That stuck with me. It did, and I bet it stuck

Britta Bushnell

with her into her motherhood journey,

Mandy Irby

right?

Britta Bushnell

Of oh, I might my kid might need me, and have things, and I'm still gonna go take that shit I need to take. And if I need a little extra time to do it, that's okay,

Changing the Story of How Bodies Are Treated

Mandy Irby

right? My kid might cry when I drop him off with a babysitter, but I know they're safe, and I'm they're gonna be okay, and I'll be back, and it's good for both of us sometimes. Yeah, and so when we're people, people think that what we do is really important as nurses. They like take take it seriously. They look up to us oftentimes. We're modeling our behavior as modeling, but also the way that we maybe unrelated. That was just an idea I had. But as we understand ourselves, our needs, and how we're responding in the room, we're also understanding. We have the ability to understand how our patient experiences and our hospital experiences impact us. And so, when we look at the the way that we've treated women's bodies in birth. We are still a long ways into understanding how to respect body boundaries, how to respect consent and body autonomy in those ways. And I believe, even though this is challenging work to understand ourselves and separate it a little bit, and do the work of like, oh no, this feels uncomfortable, and I need to care for myself. And oh, it's ongoing. Like all of those things that are a little, they're change. They're not wrong, but they're they're changed from what we're used to. When we give care that's aligned with you know our ethics and nursing ethics, bodily autonomy, informed consent, body boundaries-we're healing a part of our generation, of our culture, and we're we're able to make changes not just for ourselves when we go pump, but we're able to make change when someone is going through their transition, their life transition, the biggest one of the biggest moments in their lives, one of their forever moments that will impact them forever. We're able to change that story of the way they were treated and level up how they're treated and how much they're believed and how much they're respected and how we pour into that relationship and grow that trust and grow that respect that we have for them throughout our care with them. That they've now leveled up to this is how I should be treated. This is how my body should be respected. Maybe it's not been like this before. Maybe it wasn't always like this in healthcare. It wasn't always like this with people. Power. Maybe it wasn't like this when I was scared before, or when I was vulnerable before, when I was a child, or when I was unclothed, or when I was, you know, experiencing these very similar to birth experiences that many women and children have. That we have the power to change it when they are in that open state, in that you know that forever state, and so it's

Britta Bushnell

yes, yes. I mean, oh my God, Mandy, I'm just, I'm like, I've got chills because yes, I mean this is it. It just the way you just voiced that. It's I want to wrap every nurse up in golden bubble wrap of gratitude because that is so the the opportunity there is so big, in part because it is such a transformative experience to give birth that that there is such huge wild opportunity for the people who interact with that population to make life-altering changes

Mandy Irby

to to everyone in the room, but to that dyad, right? That connection, that attachment, the way they talk about birth, the storytelling of what happened, and to themselves, so they can work and begin to understand. This is what happened this time. This is how I was treated when that happened. I just want to shout from the rooftops to nurses that and to families that how they're experiencing something and expressing something may be totally different because they feel safe to do so, and for nurses, that may look like, "Is this out of control? Are we okay? What's going on? And we can support though physiologically that that is a place to do that because they're reinforcing to their bodies that it's safe,

What's Changed in Twenty Years

Britta Bushnell

yeah. So I'm curious. You've you've been at this for a long time, and have seen things now for for a couple of decades in this field. Are have has it changed? How have you how have you seen it change? Where is it improving, and what's helping it improve? So that's a multi-tiered question, but pull from it what is juicy for you?

Mandy Irby

It's changing. There's so many people talking about autonomy and consent and rape culture and obstetric violence. Now, I said,

Britta Bushnell

and that was not happening 20 years ago, folks. No, not at all.

Mandy Irby

No, like we wouldn't even say those things on a podcast. I mean, podcast didn't exist, but

Britta Bushnell

we bet that too. We

Mandy Irby

would have had coffee, but that's what I say when when they were talking about what are those um what are those video cameras that you can they used to wear in their heads and now you can wear them right here like a

Britta Bushnell

oh yeah like body cams

Mandy Irby

yeah a body cam it it was like one brand that did it it came out in like 2009 dads wanted to wear them in and be like oh we're gonna like video camera the birth, and I'm like,

Britta Bushnell

oh, like like the the yes. What were the GoPros? GoPro, right? They were like what my kids like to wear when they go snowboarding. Yeah, yeah.

Making the Private Less Secret

Mandy Irby

Like I love a GoPro, but they were like, oh, we're gonna bring it in here, and I was like, that's not your place to do that, but also yes, more people need to be inside of this private space, not our private space, but the idea of what happens here. This needs to be made more public, right? Less private, less less harmful, less secretive, less scary. I think that yeah, the internet has been one of the best. Like social media has been one of the best things for nursing because we can share these ideas far and wide. We can understand that it's not just one person inside of our system. It's the system. It's not just this is the culture at this hospital because that's what we're told. This is how we've done things. No, it's this is how obstetrics has done things for this time. So I do love social media for that. I do love that nurses are on there talking, and we're able to like meet each other, and then go meet up at conferences and things like that, and share how it's been changing and how it happens. It's still happening, right? That's uncovering all the secrets is helpful to improving and changing that culture and families asking for more. Right, love a birth plan. Love the let's go find all the education that we can. Love coming in with a I want this, this, and this. And we like, ooh, I love that. Tell me more. Where's it coming from? Someone six page birth plan. Yes. Tell me more. Where's that coming from? There's so much here that you want done. What's happening? What did you think was going to happen? What are you afraid is going to happen? We get to the meat of it, right? Yeah. What's underneath

Britta Bushnell

this? Right. Not just what's on it. Not just what's on it.

The Next Generation of Nurses

Mandy Irby

No. What's underneath this? Yes. What made you want to write this? Love all of that. That's all changing, and I get to talk with nursing students sometimes. UVA has invited me some to do some guest speaking, and I get to talk with students, and they are ready, and they're they're already over it. When I talk about trauma informed care, and we talk about consent and the consent continuum, I didn't know what was going to happen. They're raising their hand, and they're like, in clinical, I already saw this happen. In clinical, I already saw this. That's in the red zone, WTF. And I'm like, right? They know the decision maker in the room. I say, who's the decision maker? And the first person was like, the patient. And then everyone else was like, and I was like, tell me more. Tell me everything. And they come up with insurance, the payer. I'm like, that's genius. That took us decades to figure out. Feel like they were that we we were in the pipeline, right? We were in the it's the it's the pipeline, just like every other system, right? Just like the legal pipeline, just like the public school pipeline. It's it's all the pipeline. And to think, like, wait, I'm part of the pipeline. What? I'm no, I'm I'm Mandy. I'm just a regular, yeah. So, to kind of turn inward and be like, ugh, it's the pipeline. Like, we're all part of it. We all got to adjust, and it's going to be an uncomfortable change. But the students, like, they're seeing it. They're seeing it

Britta Bushnell

earlier. Like, they're seeing it

Mandy Irby

so early.

Britta Bushnell

Youth is awesome.

Mandy Irby

Yeah, yeah. I had to talk about it right here in the room.

Who's the Grown-Up Here?

Britta Bushnell

I had somebody recently been talking with lots of people, and you know that we're we're in this era, or at least I am. I about you, where like our teachers are are either aging out and going into like serious retirement, or are passing, and it's kind of this element of oh wait, does that mean oh wait does that mean I'm an elder now like wait what what's going on and and who who do we look to for for guidance and and and I think it's the youth. I mean, they are they are. It's actually we need to invert that hierarchy too. I love because because there is an element of it's they're brilliant. They know things we don't know. They do.

Mandy Irby

Yeah, that's very nursing coded of you to be like, hmm, millennials. I'm a millennial. We're always asking like, where's the adult? I just bought a van, and I'm like, who's in charge of this? Someone make a decision for me. Like, who did this? Who put me in charge? I'll ask my kids regularly. They're like, God, you're the mom, and I'm like, that does not mean I know what I'm doing.

Speaker 5

So right,

Britta Bushnell

that's a great soundbite right there. That does not mean I know what I'm doing.

Mandy Irby

Nurse too. They might be like, I don't know. I've never been your nurse. That always is a good one, right? I've never seen this birth. Yeah. This never met this baby. But it's so nurse coded to be like, and millennial millennial nurse coded to be like, who's the boss? Who's in charge around here? Where's the grown up? And then be like, I'm gonna put it right back to the community. I'm gonna put it right back to the people I serve. Right? I'm gonna ask you what's needed. I'm gonna ask you what's missing. I'm gonna see what you think. That's so important and such a thing. You don't maybe you don't know, but there's like this generation war going on with nurses right now, where the leadership, the the the more advanced in age, not necessarily right, the elders, the elders we

Britta Bushnell

like to yes nurses talk about

Mandy Irby

are complaining and they're upset about the challenges and they're like new nurses, younger nurses, they don't you know, all these things. They gripe, grape, gripe, gripe, and I, you know, there's so many of us who are like, they know our patients, they know the folks that we serve. The reproductive continuum age is the new nurse generation. They are gold. We need to be, we need to be supporting them, and we'll have a better work experience. We support our patients. We'll have a better nursing experience, right?

Britta Bushnell

Yes, and vice versa. That those who have also seen and witnessed and been through generations of the work also have something. So it's that collaborative conversations that are really deeply needed. Yeah, yeah, all that

Mandy Irby

and change is happening, and we can do it, right? We have avenues, and it

The Nurse Disruptor Series

Britta Bushnell

is happening. There is change occurring. It's it's things like what the work is that you're doing. So can you share where where can people find you and what. Where can they learn more about you as the change maker and the work that you're doing to make change? Because I think it's important work.

Mandy Irby

Thank you so much. I talk less about myself in this era, but not with you. I guess I'm just gabbing on and on. I'm on LinkedIn at Mandy Irby. I'm at birthnurses.com is my site where we talk about ways that hospitals can bring in nurse education and trauma informed care. We have a nurse disruptor series going on over there.

Britta Bushnell

Ooh, a nurse disruptor series. What does that mean?

Mandy Irby

Isn't that so fun? That's I just love. I

Britta Bushnell

mean, it's just a tantalizing morsel of a line. So it's like I want to know what that means.

Mandy Irby

That's that's how it came about. We were like, "Ooh, that sounds so juicy. It's a presentation we did it at A One National, and a colleague, Maggie Runyon, and I are presenting the publication that we recently did in collaboration, reframing obstetric violence culture: A concept analysis that was published in the Journal of Advanced Nursing last October. That's it's so long. I just printed it because it's so cute. It's like I don't know, 20 pages. So instead of like you should read this, we're presenting it as we looked into hey we looked into obstetric violence culture. Turns out it's a thing. However, nurses are already countering it, and here's how. And so it's like a Teen Beat magazine quiz, like which Backstreet Boy are you going to marry at the end of the summer? It's like that. So you can take a quiz during the presentation or during the workshop, whichever one, and find out like which avatar, which disruptor are you based on where you are in life, your capacity. What do you want to focus on? Where do you want to go? Do you want to change that? Do you want to look to a bigger, broader spectrum or hone in on the specific? So it helps nurses see like, oh, I'm about this work. I just can't do everything all at once. Yeah.

Britta Bushnell

Well, that sounds important. Yeah,

Mandy Irby

that helps. So, on my website, I'm on Instagram at the birth nurse, all over.

What Mandy Wants New Parents to Know

Britta Bushnell

All all those good things, and we'll make sure to link all those in the show notes too. If you missed any of that and want to go back and make sure you can follow along with what Mandy's doing. So, as we bring our conversation to a close, I end with the same question every time. So, are you ready for it? Okay, here it is. What's one thing you feel passionately about that you want new or expectant parents to see, hear, feel, or know during this profound period of their lives?

Mandy Irby

I want parents to know that all parts of themselves are showing up for this transformation, and if or when you find yourself expressing or experiencing something differently than what feels familiar or how you normally would be showing up, that is the change that's happening for you inside this transformation. That may be exactly how you're meant to be expressing at this point, on this occasion, during this experience, or for yourself, and that's part of your becoming story. I love that. Okay,

Britta Bushnell

that was so good, Mandy. Your sounds. Thank you so much, and thank you, listeners, for sharing this time with us. If something shared today impacted, supported, or moved you? Please share this episode with a friend. I produce this podcast myself, and your support makes it possible to show a little love for the podcast and these conversations. Please follow, rate, and review. If you'd like to continue the conversation, please join us on Instagram at Transformed by Birth. I look forward to being with you again on the next episode of Transformed by birth. Now let's gather what we want to take away from this episode with an inhale, and with our with our exhale, or at least with my exhale, I'll blow out the candle. Until next time, bye, friends.