The Ordinary Doula Podcast

E74: People, Place, and Policy: Birth's Hidden Players

• Angie Rosier • Episode 74

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Birth is influenced by three major stakeholders with different objectives: the birthing people, the birth place, and the policies governing care. Understanding the "Three P's" helps expectant parents navigate their birth journey and identify where their interests align with the larger healthcare system.

• Birthing people want safety, support, a voice in their care, and a positive, meaningful experience
• Hospitals focus on clinical safety while balancing risk management, efficiency, standardization, and resource allocation
• Insurance companies prioritize cost management but share interests with families in reducing unnecessary interventions
• Birth centers often have more alignment with birthing people's objectives than hospitals do
• Doulas create value by improving outcomes in ways that benefit both families and insurance companies
• Even within large healthcare systems, families can make requests that personalize their care
• Human connection and compassionate care significantly impact the birth experience

Please reach out today and make a human connection. Do something kind for someone nearby – whether a stranger or someone you know – and you won't regret it.


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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Speaker 1:

Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2:

Hello and welcome to the Ordinary Doula podcast. My name is Angie Rozier, I'm your host and I appreciate you being here with us today. As always, I like to cover some interesting or important points about all things surrounding labor, birth, pregnancy, postpartum, lactation. That's kind of a big package but lots of different pieces and parts to it. So today I want to talk about I call it the three Ps the three Ps of this whole experience. So the experience being getting a tiny human here. However, you, you know that journey looks different for everyone. So I want you to envision a little baby just sitting there, right like it's. It's arrived, it's earth side, it's maybe it's being held by its parents, it's hanging out in the warmer. It's cute, it's tiny, it's little and um, think of all the moving parts that had a hand in getting that little baby here and all the interested parties. So what matters most about birth and to whom does it matter? So the three P's I like to consider in this are the people, the place and the policies People, place and policy. So the people, of course, are those that are giving birth, those that are having babies, those that are expanding their families, the people generally it's a woman and a partner. Those are the main people, those are the main players here. But their experience has a lot to do with the other two Ps, which is place and policy. So the objectives about these, the same experience from these different groups, is a little bit different. Um, so the people, especially if they've chosen right, they've sought after this pregnancy, they've chosen to deliver a baby at this time, hopefully they had some choice in where to do it and with whom to do it. But sometimes they don't right, sometimes that's all driven by insurance, right, and what choices you do or you do not have when it's based on insurance. But the heart is at the matter. Like they want a healthy, happy baby. They want a healthy, happy mom at the end of that experience. That's their whole goal is that they have. You know, they bring this baby into the world and it should be a happy, joyful time. Not always the case, of course. The objectives of the other two Ps the place and the policy are a little bit different. They're driven by different factors of just. We want a great experience, we want a healthy, happy baby. They do want those things, especially the health of the baby and the mom. That's hugely important to them. But what are their drivers for that right? There's a lot of times financially driven that they're. That's what's driving their objectives.

Speaker 2:

So let's go over these three Ps, the main objective from the people right, the people having the baby. They want to feel safe and supported and they'll hopefully choose a place that they feel safe and hopefully feel supported by the team they surround themselves with. That's not always the case. That's another rabbit hole we could dive into a little bit later. They also want to be heard. They want to have a voice. They want to make sure that in that place and with the people whom they choose to be surrounded with, that they have a voice, that their concerns are heard, their fears are heard. The people want to be heard.

Speaker 2:

They also want a sense of empowerment so that they're taking part in their birth experience. It's not just being done to them, they're not just, you know, an object going through the motions there, but they want a sense of empowerment and autonomy around that. They also want continuity of care and compassion to be given to them. They think they honestly think and hope that those caring for them are going to look out for them, have their best interests in mind, really, genuinely, truly care for them and provide compassion for them. That may or may not be the case, depending on the places and the policy that surround that, but they want continuity of care and compassion, so being with people they know they trust, even if they just get to know them over a period of hours and they want to believe that they're being taken care of. They also want a positive and meaningful memory, so they want to be able to look back on this birth experience and say you know what? That was awesome, we were well cared for, I liked that experience. That's not always the case. I work with people all the time who look back on their birth experience and it was anything but positive. Meaningful maybe, yes, but it might not be meaningful in a very great way. They also want, of course, a healthy baby and a healthy parent. So those things feel safe and supported, be heard and have a voice, have a sense of empowerment and autonomy. Continuity of care with compassion, positive, meaningful memory, healthy baby, healthy parent that's the main goal of the people.

Speaker 2:

Let's move to the next P the place. So the place is oftentimes a hospital. In the United States, we're most often delivering in a hospital setting, so pretty clinical setting. Our hospitals range from very small to very large, that they both have benefits being small, being large, being rural, being urban, being a research hospital, being a teaching hospital, being a small community hospital there's lots of different hospital settings. This is in, but here's the main objectives from the place, right? So all the drivers that go into this, from hospital administration to the hospital marketing team, to your medical director, to your teams of OBs, midwives, to your nurse manager, to all the teams of nurses, to the housekeepers, to the you know we've got kitchen and food services, nutrition services All of that is the place. There's so much tied up into place.

Speaker 2:

So here's what they want out of this Getting a little human here. Here's what they're looking for Safety of parent and baby Great overlap. That's what the patient wanted as well, the people being the patient. So that would be clinical outcomes. The clinical outcomes are good. That means we're having healthy moms, healthy babies. Everyone's safe medically at the end of the day. They also are looking at risk management and liability avoidance, right. So they're going to set policies into place that are going to keep their personal, well, financial, corporate, bureaucratic risk low. They want to manage their risk and they want to avoid liability so that if any mistakes are made, anything's done. That shouldn't, that that is not going to cost them a whole lot of money in a lawsuit or in court, right? So risk management, liability avoidance, efficiency they want efficiency. This is a machine, these hospitals, and regardless of their size, they want efficiency and throughput. That means like systems going through as we're putting patients on the conveyor belt, getting them through, and we've kind of standardized care to do that right.

Speaker 2:

Another objective is protocol adherence and standardization. When we are cranking a bunch of moms and babies through a system to be efficient we have to have some systems in place. So standardization of care and protocol adherence. So that's protocol for every piece of the team and that includes all the people we talked about labs, pharmacists, nutrition and food services, nurses, providers. There's protocol adherence. So your staff is being really well trained on what to do, how to do it, why to do it, when to do it and, of course, how to document it right. So we crank people through on this pretty standard system.

Speaker 2:

That doesn't always overlap well with what people may want. They may want something a little different outside of that standardization, and a curious thing is how are they treated? How are they, you know, does that compassion remain in place? If somebody wants something a little bit different, it depends on the place in the hospital. So another objective for the hospital is data collection and reporting. So they are collecting data. You know that every single thing is being documented. Charting is going on, almost more than patient care charting is going on, so that they're collecting data. They can learn a lot from the data that they collect, because a lot of places they're working in higher volumes, right, and they're gonna report that data to different entities, to themselves, to their corporation, to the NIH, to the CDC. Like there's data collection going on. We're kind of being data mined as being a patient, any patient is being data mined. And then also resource allocation and staffing. So they have a certain number of people that they have to do a certain amount of work with. So a lot of human hours go into resource allocation and staffing and that's resources all the way down to your linens, to the foods, to the medications, things available from the pharmacy to the man hours available, woman hours in many cases. So staffing with a certain amount of nurses, other staff, that's if we have techs, if we have providers on call, all that resource allocation and staffing. That is because of the size of the system. That is a whole lot of human hours going into getting a baby here, right, they make a corporation out of it. They make a whole big to-do about it and it's a billions and billions of dollar corporation doing that.

Speaker 2:

Okay, we're going to move to the third P and that's policy. So policy can come from a couple of different places. I'm going to speak specifically to policies generally from healthcare providers. So this would be like your insurance companies, your healthcare plans. These are pretty big players as well who are definitely interested. They have, you know, a lot of skin in the game when a patient is delivering a baby. Another piece of policy we're not going to talk a whole lot about is legislative policy. So every state and on a federal level there's also legislation, of course, that affects policy. But for now, for the purposes of today, we're going to talk about policy as coming from health plans and insurance companies who provide medical insurance. So your private employers are going to be involved with this Also. We might have definitely Medicaid involved with this, and here are some things, the objectives that they're interested in Cost management and risk reduction, all right.

Speaker 2:

So whatever happens at the place, at the hospital. This is who's paying for it by and large, right. So cost management the insurance policy is going to be very alarmed with a c-section rate that's extremely high or NICU stays that are extremely high. They want to reduce costs and reduce risks, right? So the more interventions we have and the more risks, sometimes, the more the cost. Of course, they also want to promote preventative and value-based care. So this is awesome. This is kind of goes to what the people want in a lot of cases and, because this is a doula podcast want in a lot of cases, and because this is a doula podcast, this aligns really well with what doulas objectives are as well to promote preventative and value-based care. So a doula is a cost item. It takes, you know, a doula requires some money from someone that that doula is getting paid, but the value of that can really prevent a lot of other cost management, extremely high cost management things by having a value-based care system in place. So the insurance companies are pretty interested in that and that can include, like it says, preventative things childbirth education, lactation support, doula support. Hopefully those go into the postpartum period as well.

Speaker 2:

Another objective from the policy the health plans the insurance companies is network management and utilization control. So they may have a certain number of members or lives, they call them, maybe it's 30,000, 100,000, we can get up into the millions. They need to manage that network. Also, systems are required there because of the size of things and then utilization control. So, depending on what their members and those who have that health plan are doing, um, their population, whatever their population is doing, they have to you know what are they're going to assess data all the time too, like what are we utilizing? Are we ever utilizing, um, you know, coverage for uh, urology or for ortho? Like there's all different kinds of things we could look at. They're also very interested in data collection and quality control for a little bit different reasons, but they want to know where's our money going, where's our pain points, where's our value-based points, when can we kind of reallocate that?

Speaker 2:

Another objective of theirs which I absolutely love and where they align really well with doulas is reducing cesarean rates and unnecessary interventions. Their purpose might be different than the patient's purpose, but that's great. We're on the same page there about reducing cesarean rates, which in turn reduces costs, right, can reduce NICU stays and unnecessary interventions. That can be anything from, you know, internal monitors to forceps, vacuum delivery, any instrument, assisted deliveries but they want to reduce those kinds of things. For them it's about money, but we love that it aligns with what the patient wants. They also want to encourage alternative care models when it's cost effective, right. So alternative care models might be kind of thinking outside the box.

Speaker 2:

I work for an insurance company right now who happens to provide doula services on their health plans Awesome, they're thinking outside the box and that's a value-based preventative promotion where they can provide doula services to encourage more cost-effective care, to keep down those costs and other risks that can be involved with childbirth with higher interventions. And then member satisfaction and retention that kind of comes last on the list, but they want people to be satisfied with their care. They want to provide quality products at quality places so that their population remains healthy right, so that they are taking care of their people at the lowest possible to them. So kind of interesting as we look at that simple act of getting a baby to Earthside and all the different players involved in that, it's kind of more complicated and there's a lot more fingers in the pie, if you will, than we sometimes realize, but it's interesting to note that, again from a doula standpoint, doulas and insurance companies have a whole lot of overlap when it comes to the objectives they're trying to achieve. So, going back to and this is to impact and affect all people, right, people of all different backgrounds, around different parts of the country when we can add a value-based care item, which a doula is and that can have good impacts on birth outcomes, which has good impacts on costs, that's going to be very helpful. It helps everyone out.

Speaker 2:

So keep in mind the people, the place and the policy. Wherever you're having a baby, kind of dig into those things, do a little research, ask some questions. What people are going to be involved, of course you know you yourself having a baby and or the people you choose to surround you with from your immediate circle, the place you're in. Now, this is all different for a birth center, right. This is kind of looks a lot different for a birth center, where there's a whole lot more overlap in objectives between birth centers and people than there is from hospitals and people, for a variety of reasons.

Speaker 2:

And then policy, whether that's legislative policy based on this particular place you live or the healthcare that is available to you and not everybody has amazing healthcare available to them. That also is going to affect the experience as we look at getting a little human earth side. So take a look at those things. They're very important. People play some policy. Hopefully you can have good options available to you. You can tweak a few things, make a few requests Even in these big systems we can make some requests that might go against quote unquote policy so that you have a more compassionate experience, use some continuity of care and have high quality care given to you.

Speaker 2:

That's my desire and goal for everyone that I work with is that they have stellar health care given to them, not just clinically, but human to human. That human to human contact and connection is going to be important in their experience. So we'll wrap this up today. Again. I want to end with as I do with all episodes please reach out today, make a human connection, whether that's with a stranger or someone you know. Reach out and touch the life of someone around you, do something kind for someone nearby and you won't regret it. Thanks for being with me here today. Again, this is Angie Rozier with the Ordinary Doula Podcast Looking forward to seeing you next time.

Speaker 1:

Thank you for listening to the Ordinary Doula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving Birth.