Your BIRTH Partners

Encouraging Perinatal Systems Change #056

April 04, 2022 Your BIRTH Partners Season 5 Episode 1
Your BIRTH Partners
Encouraging Perinatal Systems Change #056
Show Notes Transcript

Welcome to Season 5: "Stepping into Our Roles as Change Agents"
We want to focus on the ways that each of us can encourage necessary waves and change in the way we provide birthcare.
When we look at the healthcare system...we've touched on over and over and over again through the podcast that we need to make changes. We need to keep making moves towards more birthing person- centered, trauma-informed, collaborative care. 

We are thrilled to share this conversation with Claire Phillips of Nursing the System.  Claire is a self-titled "systems nurse," and her platform is dedicated to educating folks about system change: what it is, what it isn't, what it takes to adopt systems thinking.  I think you'll be surprised by some of the mindset tips that she has to share as we consider what lies we've been told about change, and how we push forward to create a difference in birth care. 

Listen in as we explore:
~The biggest lie you've likely internalized about change
~Reflecting on your stated purpose and the purpose you're achieving
~The four skills for systems thinkers to strengthen
~Recognition of common threats to relationships for systems change
~Challenging the healthcare hierarchy
~The pyramid of change: internal to external to systems
~Stepping into a leadership role in any position
~The inevitability of change and how YOU can guide it

Get all the details to connect with Claire further!

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 Maggie, RNC-OB  0:03  
Welcome to Your BIRTH Partners, the podcast identifying gaps, acknowledging biases, and co-creating a trauma informed standard of birth care with change agents across the spectrum of birth work. I'm your host, Maggie Runyon. I'm a birth nurse, educator and advocate who has been searching since 2010 for the answers to how to provide better care during pregnancy, birth and postpartum. Through my own pregnancies and supporting births in home and hospitals around the country. I've seen firsthand many of the systemic flaws that exist in perinatal care. Through these conversations, I'm thrilled to share with you insights and inspiration as we work collectively to transform birth care.

Well, to kick off season five, our season dedicated to stepping into our roles as change agents, I could not be more thrilled to share with you insights into what it means to be a part of systems change. You know, change is the thing we need to do individually in our practices, and collectively, in groups and as a system. When we look at the health care system, absolutely something we've touched on over and over and over again through the podcast is that we need to make changes, we need to keep making moves towards more birthing person-centered, trauma-informed, collaborative care. And you'll leave this episode knowing more about how to integrate this work that you're doing for yourself, for individual clients and patients to change your practice. And with a sense of how to keep moving forward and pushing the needle to affect the system, the community you operate in. Our guests for this episode is Claire Phillips, who is a nurse who has named herself a systems nurse. And her platform is dedicated to educating folks about system change, what it is, what it isn't, what it takes to adopt systems thinking. And I think you'll be surprised by some of the mindset tips that she has to share. As we consider what lies we were told about change, and how we push forward to create a difference in birth care. On to the show! 

Well, Claire, welcome to the show, I am just really eager to dive into this conversation with you about change in the ways that we can step into it. So if you want to just tell our audience a little bit about kind of yourself, your your journey as a healthcare professional and kind of what's where you've landed in your career. 

Claire, Systems Nurse  2:08  
Sure, Maggie, first of all, thank you for having me. I'm really excited about this conversation as well. Yeah, my name is Claire Phillips, I have a background in sociology as an undergraduate student. And then I got my master's in nursing and began working as an emergency department registered nurse, my most recent position working as an assistant nurse manager in an emergency department. And I'm currently working on completing a Doctorate of Nursing Practice in health innovation and leadership in my specialty area is in systems change and redesign. So I am probably the perfect person to talk to when it comes to you know, getting people excited about system change, because that is just a huge nerd for change and all things systems thinking.

Unknown Speaker  2:53  
Yes. Oh, well, yes, you are like the perfect lead in for this whole season. So in this whole season, we're really talking about like, how do we step into our roles as change agents. And you know, we settled on this theme for the season. This is certainly something that is like popped up probably in every episode that we've had so far of, you know, the podcast, as we talk about issues that are happening, how do we change the way that we hold space for folks? How do we recognize biases we have? How do we change the way that the MIC works, how we function as part of it? And so I wanted really through this season to, to focus on how do we step into change, and I'm really excited for you to maybe share some kind of the mindset knowledge behind change systems, especially because I think that can be really intimidated. For those of us who work in healthcare, it is it is a huge system to be a part of. And you know, we are, especially as those who work within it keenly aware of the flaws, the areas any change. And so sometimes I think when we have these conversations, and we get all fired up, and we know what has to change, but figuring out like the how, how do we get from here to there? What is the part that's like my personal responsibility? What is the part that I need to be changing for others? So I am just so excited to dive into this with you. I think it's really helpful for our audience. So I think maybe starting off first, like what's the first maybe the biggest lie that you think we hold as a society about like, what it means, how do we change?

Claire, Systems Nurse  4:09  
Oh, that's a great question. I think the biggest lie is that there is one right way to change something or the way that something needs to be and you know, I have fallen for this myself, especially when we look at like the right way to deliver health care and things like that. We see someone doing it one way in one country, and we say, well, that's the way that it needs to be. That's the answer. And usually, there are multiple ways to I hate to use the phrase skin a cat, that's my Kentucky roots coming out of there multiple ways to solve a problem to come to a solution. And so I think, getting out of the mindset of I'm looking for the answer instead of I'm exploring multiple answers and all of them have value and it's just whichever one we can make happen. That is the one that we should pursue.

Maggie, RNC-OB  5:00  
Whoa, that yeah, obviously I've fallen for that many times myself, I wonder to how much of that is particularly for those in healthcare. Like, I think we are trained that there's a solution, right, like portraying that you have this problem. And we walk through this. We've talked a lot about, you know, algorithms and how they can be helpful to, you know, assessing risk and understanding next steps in healthcare and keeping us, you know, sometimes eliminating biases, and I'm adding their own. But, you know, we've talked about that, but I think there's that piece of change that we feel like there is this one, right way to do it. And if we could just walk through these steps, we'll get there. Like, I think there's that rigid piece that comes from maybe some of our training as healthcare that makes it even harder for us to like, think outside of the box in that way. Yeah,

Claire, Systems Nurse  5:40  
I mean, in your expertise, like a great example is, there's no one right way to birth a child. Right, that looks different. So many different people in so many different contexts have so many different resources. And so those are contexts and resources, and personal preference are all things that need to be taken into account to create that one, right experience. And really, like, my friend just had a baby, and you have your birth plan. But then you also recognize that like your needs and wants might change through the course that is giving birth. And so having resilience built into your plan into how you understand the change that you want to make is so important. Otherwise, if you don't have any flexibility in your plan, then you're you run into trouble.

Unknown Speaker  6:33  
. Yeah. Oh, that's an interesting, yeah, I do think like we we're getting better at that, right, we're getting better as I think as a as an industry in perinatal care of really accepting and believing at our core that people can want different things for the birth experience, and that all of those things are valid. I think that's the thing that still gets like some pushback, certainly in certain circles. But I think that's a great way for thinking about how when we approach just as everyone's gonna want some different from their birth, each hospital system might have to do something different to, you know, create the culture that their patient population needs, and deserves, and what resources they need, rather than thinking that it's all, you know, cookie cutter, which would be easy and helpful. And sometimes we we want that. And if we don't have that I think we get stuck a little bit. I wonder too, I think the the piece that comes up over and over when we have these conversations is really the difference between like changes I Maggie could make in my practice to be you know, more trauma informed to be more patient centered to you know, be more aware of all these things that are going on? And then how does that play against like the system change that needs to happen? Can you maybe do a little like definition for us around like system change and kind of your your work there?

Claire, Systems Nurse  7:39  
Yeah, so I actually didn't say this in my intro, but currently, I am a what I call a systems change coach to nurses. So I run a business called Nursing the System where I provide fun education for nurses who want to learn systems thinking and get involved in change making. And so that's me applying my education and sociology background to my, my nursing peers. Okay, so a system is basically an entity that is made up of different parts that work together to achieve a purpose. And that purpose can either be a stated purpose, so like our hospital mission, or it could be a purpose that has kind of run away from us, right. And so we have our stated mission, then we have the mission, and we're actually achieving, and those do not always match up. So when we talk about systems change, often a key component of that is looking at the discrete parts of the system, looking at the relationship between those parts, and then tweaking the relationships between the parts, or the structure, so that our actual purpose is meeting up with our espoused purpose. So yeah, that's systems change. In a nutshell, it's systems thinking is, if you're not familiar, it's a worldview. It's a way of seeing the world and the complex systems and problems that exist in it. And it is critical for making effective change in a system because you need to have that big picture perspective, in order to understand which levers to pull and what those intended and maybe unintended consequences might be. And then if you experience unintended consequences, how you can adjust your change making efforts to adjust those.

Maggie, RNC-OB  9:25  
Ooh, okay, so many threads to pull from there. So, one piece I want to touch on right there is so when we were in the system, sometimes I think we just it's very easy to get stuck in the day to day, right. So are there certain like, tips, techniques, ways for us to step outside of our like daily, I'm at the bedside as a nurse taking care of my patients. To see some of those more like, are there certain like books or resources out there like podcasts to listen to that? Or is there like mindset shifts we take to like be able to do that with technology? Like, especially the last few years, like it's really freakin hard to be a healthcare worker. And so I just want to say that like an acknowledgement, there is so much that goes on in the day to day that we've just been like reeling from that, I think it's, it can feel overwhelming to have to like, step back even more to think of all the other things that have to change.

Claire, Systems Nurse  10:15  
Yeah, absolutely. So I teach to nurses, I teach kind of four different zones of mastery, for systems thinkers to strengthen. So I guess, four skills rather, one is seeing the big picture. So our ability to zoom out and see the systems within the systems within the systems and how things connect. And alternatively, also, we need to be able to zoom in and see beneath the surface, and look at all of those invisible structures that are at play in our society and in the systems that we live within. Yeah. And then also, we need to honor our perspective. So what that looks like is, is trusting that our experience in the system is valuable, and that sharing that with others, is a meaningful way to contribute to making change. And then on the other side of that, is honoring the perspective of other people. And so within those those four skills, are there different tactics that you can use to strengthen those? But those are the big four.

Maggie, RNC-OB  11:23  
Okay, well, that's really like helpful to think through maybe where we're at in our personal breath. For everyone who's like listening, do a little journaling around that, like, what is your ability to see the see the bigger picture to narrow in to look beneath? And then how are you kind of honoring? I think, maybe on to that piece of it like the, we've talked with guests in the past about, like, kind of the imposter syndrome piece that could come up, as we examine like, Okay, what do I actually know about this issue? Like, I feel like I'm seeing all these gaps, all these holes, all these things we need to change. But I've only been practicing for so many years, I've only been in this type of environment, I've only worked at this facility, and how that can maybe kind of hijack our ability to like step in to, to leadership to being a change agent.

Claire, Systems Nurse  12:07  
Right? I mean, you could have someone be working in emergency department for their entire career. And they could tell themselves, Well, I can't be a leader, because I don't understand any other part of the hospital system, I lack a diversity of perspective. Or you can look at that same person and say, wow, this person has very deep knowledge. And that is super valuable. And so as a person, you just need to get real with yourself, what type of knowledge do I have? What type of experience do I have? I know that whatever type you have, it is valuable, but the way that you choose to use that and implement that in your change making efforts is really what matters. So it's not about having the right experience or the right expertise. It's just taking the experience and expertise that you definitely do have, and knowing how to appropriately apply it.

Maggie, RNC-OB  12:52  
Yeah. Oh, that's big. Okay. So the other piece of that feeds into is, I think we talked so much here on the podcast about the value of collaborative care. And, you know, certainly we believe everyone has a unique perspective, their personal experience, their professional experience, or education, and that we really do thrive, when all of those individual roles are able to like, do their part well be in concert with each other, you know, rather than people feel like they have to be one person has to meet everyone's needs, which is exhausting and impossible and makes everyone feel left down, or feeling like you know, there's if you can't trust other people to be part of it, I think that comes into it too, as we try to, like understand our role within it, work through some of these really like complicated dynamics that have been upheld within perineal care. So I'm wondering how that piece of it, when we are trying to like one stand firm in Yes, I believe in me, I believe in my experience, it is valid. And all you also have to believe the same thing about everyone else. Even when I've often thought of them as like the bad actor. In this piece, like do you have maybe insights into how we, how we foster some of those relationships and maybe kind of get it like the web idea of system change? And how that's all kind of related? Yeah, for

Claire, Systems Nurse  14:05  
sure. I think the first idea that comes to mind when I think about the group of people I work with, so nurses is this nursing versus healthcare leadership kind of narratives. Yeah, has especially especially strengthened during COVID. And I have the unique pleasure of going from, er charge nurse to ER nurse leader in the middle of the pandemic. And so I got kind of the best of both worlds, or the worst. And yeah, I think what you just said is key and that is healthcare leaders hold a perspective and a set of skills that is valuable health care workers, so frontline staff also hold valuable experience and perspective. And instead of pitting these groups against each other, which I don't actually really believe in. But this is the prominent narrative right now, I would be so much more curious about looking at how we can strengthen partnerships between those groups and get rid of healthcare leaders and we're not going to get rid of healthcare workers and so it doesn't make sense to me to Yeah, to portray either one. Is this like, fun feeling it not that anyone's doing that with with nurses or healthcare workers...

Maggie, RNC-OB  15:27  
Oh yeah, absolutely. I think I mean, we certainly see that certainly the impact of like, you know, leadership, whoever, you know, whoever makes all these rules, and you know, we see that play out a lot in, in perinatal care as well. When we think about policies, who's making these are they evidence based? Where do they come from? When some of the rules feel arbitrary, and we feel like okay, these are obviously written by someone who maybe they were never were you ever a nurse? were you ever involved in birth care? because it doesn't feel like it based on this. I think having that like ability to acknowledge like, okay, they're fulfilling a, a role, a job, I don't have that same perspective. I think the other one we see certainly really common within. perinatal care is certainly like the demonization villainize doctors, right OB-GYNs, or as kind of the, the top in quotes of, you know, the health care hierarchy, that they are, you know, ultimately responsible for outcomes for issues that that have evolved within, you know, birth care. And absolutely, there is ownership to take in how the OBGYN as a role came to be some of the historical concepts that are there that are obviously based in racism and oppression and bad stuff, we can all agree about that. However, I think there is a way to be aware of that, that history. And that context, without also saying, or believing that like every OB right now who's practicing is out to get birthing people. And that comes up way more often than it shouldn't I think it makes it really hard for us to create relationships and to make headway when we forget that us versus them thing. And then I also think kind of the flip side of that coin is the us versus them between even like our patients and ourselves, you know, like it's the nurses and the health care workers in the hospital, versus like the patient and whatever community resource they have. That's their doula, their partner their family. Like there's a lot of ugliness that creeps there into how we understand like, our roles, our perspectives. And I think it's really overwhelming to like, think through, be aware and conscious of like all of those valid perspectives, valid needs, valid concerns, and be able to hold all of those, hold them as true and also still push for things to be different and acknowledge that, like, what we have now isn't good. And I think we get really tripped up there, which maybe wasn't so much of a question. But I would love to like your your insight into into that dynamic, because I don't think it's I think we deal with those particulars in perinatal care. But I also don't think it's different than probably the way many systems companies organizations work, but in any other environment as well.

Claire, Systems Nurse  18:00  
Yeah, I think first acknowledging how complex this is, is kind of the first step. And I think one thing that we can do as individuals is acknowledge the complexity and tell ourselves that we have a perspective of these other groups. And just as they have a perspective of us, and neither of those is going to be complete. And in honoring that complexity, we recognize that we are never going to have a full picture of everything that's going on. And I think sometimes the mistake people make on their path to becoming a systems thinker is well, then I'm going to have the universal truth about who's good, who's bad, and what needs to happen. But really, what you recognize is just how little you do know, and how much need to rely on relationships with other people in order to fill in those gaps that you have. So really quickly on your change making journey. If you're using a systems thinking perspective, you're going to realize like, I cannot do anything by myself. And that's incredibly humbling. And sometimes people struggle with that lack of control, but we can look at it as very rarely seen, because nothing is all on you, except your own actions. And there's power in having total control over your own actions. But there's also released in having control over no one else's actions and realizing that you need to heavily lean into partnership if you want to see any change.

Unknown Speaker  19:35  
Ah, yes, it is as easy and as hard as that. Right. Like, there's a huge release in being able to like, no acknowledge and really believe that. And I wouldn't say that I'm all the way there on that personal journey either. You know, I think it's it's hard to let go of how much we don't have control over. And I you know, I wonder when we talk often when we're talking with folks and you know, education programs, you know, birthing people And with professionals alike, there's this feeling that we're talking about what what you can do to change, right? So we are giving you those tools, the steps you the things you personally can do. These are ways you can change your practice easily as you can inform your birth experience, you know, whatever the context is, we focus on those, right, because that that is what you can control. But we've seen an end, particularly when I talk to, you know, nurses about the, you know, the unique power and position we have, you know, in the birth room, the way we're kind of still between, and we have this opportunity to really influence progress play out. But we are not in control of the birth outcome, ultimately, and had some recent conversation with folks just feeling really just down about that doubt about the fact that they have made so many changes in their personal practice, you know, they read the books, they're doing the work, they're doing the journaling, they're walking through all that. And it's still just, it's not creating a shift in in their colleagues, is that creating a shift in the people around them? And, you know, do you have advice for them? Do you know, something that speaks to that, or things they can work through for that?

Unknown Speaker  20:59  
Yeah, absolutely. So I've developed what I call the change pyramid, and it looks like a triangle. And like the food pyramid, at the bottom, the biggest piece is changing yourself. And that's where we always need to start with change work. So you've just described to me people who have done a lot of like interchange work, they've taken responsibility for the role that they have played in this systems failure that they want to see with the different outcome. And so that's your always your first step. Well, how am I perpetuating that which I want to change? The next chunk of the pyramid to that middle bit is changing others. And that is when you step outside of yourself. And in us, like we've talked about a lot, start to look for partnerships. So you recognize that change to work is community work. It is not competitive, but collaborative. And so now it's your job to start to do more systems mapping, to see what opportunities there are around you to collaborate with other people to take your change work one step further. So for people that you've just described, their next step is to start thinking about how can they expand their perspectives by partnering with other people? Yes, the third step, the stem, so that teeny tiny part of the top is when we actually get into changing systems structures, and looking for leverage points and strategically doing that more technical change work. But people always want to jump straight to the top right?

Maggie, RNC-OB  22:36  
who wants to be in the bottom of the pyramid? [laughter]

Claire, Systems Nurse  22:38  
And who wants to sit with with that inner reflective work? That's so uncomfortable there,we're calling ourselves in, it feels yucky, but that is where we have the most agency. So that's why we have to start there. 

Maggie, RNC-OB  22:49  
Yeah. Okay. Great. And then I think there's like, there's two pieces of that. So one, I know I sound like a recent post you did about kind of leader as a as a position versus a role. And kind of like that piece of it. And I don't know if you want to maybe expand on that. Because I think that plays into this here where we feel like kind of disenfranchised me where we fall within the hierarchy and are unsure of what what steps we take.

Claire, Systems Nurse  23:09  
Yeah, for sure. So it's actually the opposite leadership is a role, not a position. And so I think that we a lot of times I hear like, well, that's not my problem, because I don't get paid to worry about that, or that's above my paygrade. Comments like this are super common, I think in health care units, particularly, especially in acute care, because that's where the hierarchy and all that fun stuff is particularly strong, but like I just said, leadership has a role, not a position. So if you basically you can be a leader in any capacity, you do not need to earn a certain amount of money, or have anything on your resume or get hired into a specific position in order to be a leader. And I mean, leadership qualities abound, right, you can be a good listener, you can be someone who steps in and takes action when other people feel unsure, you can create an inclusive environment, in your workplace, you can act as like a safety officer, for your department, where you are always looking for opportunities to ensure that your team is safe. Lots of different things go into leadership. And that's kind of like a whole other whole other conversation. But basically, like, you did not need a permission slip to step into the role of leader you can do it at any point in your career. And in fact, those who do set into that role are the ones who have the most opportunity for those formal positions of leadership. Should they want them down the road?

Maggie, RNC-OB  24:39  
Ooh, yes. Okay. So then I think that leaves you like the kind of the last piece and it's something that maybe it's a little bit specific to perineal care, but I think it also happens in you know, in other areas, too. So the way that healthcare hierarchy set up, and we've talked a lot about it, you know, kind of the top down version is, you know, physician, hospital leadership kind of on top, you know, trickles down through you know, In our case, midwives, Pa as resident physicians, the nurse, the doula down to like always at the bottom is like the patient, the actual person who's having the experience. And obviously, that's completely wrong. It's not how it should be for folks who find themselves though, at the bottom of that hierarchy. So there's maybe two questions. One is like, how do we re envision hierarchy? How do we be aware of levels of expertise and education and you know, evidence based knowledge, that piece of it, which is certainly important in healthcare, with that patient centered person, first piece of it. And if you are someone who's listening to this, and you don't, you're not employed by the hospital, you don't work there. You're not a nurse, midwife, physician, etc. You know, you're a doula. You're a community birth worker, you're a pregnant person who's listening to this and feeling overwhelmed by how much you want to see change and how, how little it feels like you have connections to step into that. And if you can speak to that piece of it, too, because I think it's there is I recognize it, like as a nurse within prenatal care, I do have a times I absolutely have more ability to like influence the way a birth plays out than a doula and that that's not there's nothing right about that. That's just the way the current like structures are set up. So when we're working kind of outside in the community, how do we address some of those? I don't know if that's something you can kind of speak to a little bit.

Claire, Systems Nurse  26:21  
There are just so many things in there that I feel like we could run with.

Maggie, RNC-OB  26:25  
Okay, 85 questions for 85 episodes. Okay, go. [laughter]

Claire, Systems Nurse  26:28  
So I think one thing to say is if you are a healthcare worker, and you are feeling the, the hierarchy just very strongly in your unit, or your department, and you feel like that is influencing your practice that happens to all of us. I think our self concept as professionals is forged in our conversations in interactions with other professionals. And so we start to internalize what the dominant narrative is about our profession, and believe that to be true, so especially for nurses, I'm just in nurse people's mouths, like I've heard emergency department nurses I've worked with say, Well, I'm just a nurse, I'm just gonna do what the physician said. And I don't think people like to go into nursing school with that mentality. I think that's something that I mean, maybe they do, because that starts young, and then we see it on medical television shows all the time. Sure. But that concept is reinforced for us throughout our professional career. So I think our job as healthcare professionals, is to call that self concept into question at all times. So if ever you are finding yourself staying silent or afraid to approach a colleague, just check in with yourself and ask why. Because usually that is more about the Imagine position that you have of them rather than reality. And sometimes there are like structural realities that make it very scary to deal with an issue. So I'm not discounting that. But I think we need to begin, start at the bottom of the change pyramid start within ourselves and say, How am I perpetuating this hierarchy? Am I telling myself a story about how I can't go talk to Dr. Nichols about this problem, because I'm unworthy. And therefore I'm like, not addressing the safety concern, because we have responsibility as as actors ourselves. So adjusting the healthcare hierarchy from that angle to and also, I think, just not accepting, when the hierarchy is presented to you. I have worked with physicians in the past who have referred to miss practitioners or physician associates as mid levels or non physicians with just my, like, the most unclear term ever, so like, everyone who's never been to medical school, and I just do not accept that language. Like if someone says to me, blah, blah, blah, the mid level, I'll say, Can you be more specific? Who are you referring to just pushing back? Respectfully, but you do not need to exist in an environment where the hierarchy is pushed down your throat? Do you have the power in your voice to request that people address you differently or address others differently? From the like, doula perspective, I never been a doula. But I think kind of the same thing. And I my experience is not in birth work that I have. On social media, I seen very interesting suggestions and hurdles around this. And I think it's a similar tactic. It's just act stupid, in that you, like, basically, like, go in with zero preconceived notions of what the healthcare hierarchy is, and just believe that your voice is important. This is going to be different depending on if you belong to a certain marginalized group, or your positionality. It's all very relevant, but very generalized advice. Just go in believing that your voice is valuable and make them tell you that it isn't. If that's something that they believe,

Unknown Speaker  29:55  
yeah, no idea did a week a few episodes back at the end of season four, we had a I had called with Traci Weafer, a doula and she is a very staunch advocate for doulas really existing in that advocate role. And that's something that like, in the perinatal world, there's a lot of back and forth about there had been has been a lot of like conversation about our doulas advocate, how are they supposed to, you know, support the birthing person for what they want. And I absolutely agree with you know, Traci's perspective that absolutely doulas are advocates like, that is what that is a part of their role, they are there to support the writing person. And part of that means making sure that their, that their voices, their wishes are, are acknowledged that they're there to support them in stepping up and in speaking that to speaking their truth to whoever is there whoever might not understand what they, you know, desire. And, you know, she had talked to you about, kind of, you know, when someone makes comments, make dismissive things or pretends to, you know, kind of doing that thing like, Oh, could you explain that more? Like, can you spell out what you're saying? Because that sounds really dismissive and terrible. So either, you're going to have to totally sound it out, which may will really make you realize how bad it sounds? Or you're going to change your mind, because you're gonna, you're gonna catch yourself and realize like, oh, yeah, that's not that's just coming out the right way. You know, and having that whatever. But I mean, she absolutely echoes as you know, as someone who I think of as a really staunch leader and mentor for doulas in having just that faith, and that ability to step into it and believing that it does make a change. It does, there has been shifts. And I think maybe that's another piece of like system change that it goes slower than we want it to. Oh, you know, when we, when we look back at what has changed in birth care in, you know, in perinatal care over the last couple of decades, like there have been big shifts, some shifts, not in the right direction. Absolutely. There. But there are changes in how we are having these conversations in you know, I see big differences in how, you know, how new nurses, new physicians, new midwives, like there is a different complexity, a different baseline, a different historical content that they are like bringing into their work, by and large, that absolutely, like informs it differently than even a decade ago or two decades ago, you know, when I was first kind of getting into this mix, and so I think there's, there's power and like recognizing that those shifts do make a difference, even when it does feel like they do for that, that that one birth that you're a part of right there. Like it's you don't really see it out right away.

Claire, Systems Nurse  32:12  
Yeah, totally. So two things. One, tell me more about that is my favorite phrase for just like, I call it exploring questions, like, tell me more about your decision to do this thing. It's something that you agree with, or it's something that you requested them not to do. And then the other thing is, systems change is the work of generations. I heard that on a podcast like five years ago, and I just, I can't quote the person and but it's so true. And like you said, we've seen shifts decade over a decade. And that feels, well, if you look back 20 years, you can say wow, that's been pretty quick. But in the moment, it feels so, so slow. But I think trusting that the work that you're doing today will be impactful in the next generation is is really empowering. And the more collaborators that you get on board, the more hope that we have of making a bigger impact.

Unknown Speaker  33:06  
We can make change, I really do. I believe it. And I'm excited like throughout this whole season as we explore folks who have who have seen an issue and the way that they have stepped into that the way that they kind of push through and make those changes in individual ways they do it in the organizations that they found in the in the groups that they pulled together to make it happen, like I think there is there just is so much power in that piece of it. So well. Thank you so much Claire for sharing all this with us. Is there anything else you want to leave our audience with as we wrap this up? Yeah, I think

Unknown Speaker  33:34  
to go off what you just said systems are like, basically living breathing entities. And so change is inevitable. And so it's not whether we can make change, it's what kind of change are we going to direct the system to endure. So it's less as we have to work really hard to create all of this energy to move the needle just a little bit. But rather, we are as Donella Meadows, who's a huge Systems Thinking theorist, one of my faves says we need to dance with the system in a careful, nuanced, deliberate way, those levers in the system to make it do more of what we wanted to do and recognize that it is a much more fluid process than than we imagined that it is.

Maggie, RNC-OB  34:23  
That it's so powerful. Yeah, it's gonna change whether what do we want it to or not where we think it changing, so we may as well make it change the direction we're looking for. Right? Well, thank you so much, Claire, can you remind everyone where can they find you on the internet? Where's the best way for them to hook up with you if they're interested in like, find more of your work or participating in your course? Yeah,

Unknown Speaker  34:41  
I'm on Instagram, most of the time at nursing.the.system, and my website is You can learn more about all the work that I do there. I do some private coaching for nurses, and I have some Changemaker courses coming up in the next quarter. So really excited about all of that. I'd be happy to talk with anyone who has more questions about our conversation today. Beautiful.

Maggie, RNC-OB  35:04  
Thank you so much, Claire, appreciate you.

Claire, Systems Nurse  35:06  
Thanks for having me.

Unknown Speaker  35:10  
Well, I am just so grateful to Claire for coming on and sharing her wisdom with us. I know you'll be sitting here like myself, reflecting on those four cornerstones. This was changed the clear shared with us, as you look to understand the bigger web that is around outside of your personal practice, as you look underneath, to examine the roots, the foundations of our care, as you go trust in yourself as a change agent. And as you look to incorporate the perspective of others in the system. I encourage you to find community share this work with, we would certainly love to hear from you over in Your BIRTH Partners Community, our Facebook group, and learn what you're processing and how are you bringing this vision to life. We're in this together. Till next time