Your BIRTH Partners

Examining Collaborative Community and the Hierarchy of Medicine #070

October 03, 2022 Your BIRTH Partners Season 6 Episode 2
Your BIRTH Partners
Examining Collaborative Community and the Hierarchy of Medicine #070
Show Notes Transcript

I am really delighted to be just diving deep into some of the issues around community, collaborative relationships, and navigating the medical hierarchy. I am so excited to share our guests with you this week, Dr. Cody Pyke is trained as both a physician and as an attorney, and has some incredible insights to share with you. 

 How do we craft our messaging to connect with legislators and folks who really work on systems, policy levels?  

Have you been thinking about understanding your strengths and where they fit into this larger community and all of the many things that need to be done? 

Are you thinking about how we create equity?  As we bring all folks together at the same table to dive into these issues, how do we get rid of this hierarchy that continues to hold us back as we consider what community can really look like and what true collaborative care means?

Listen in as we explore:
~overcoming intimidation around discussing policies & legislation

~translating your message to be understood by outsiders

~collaborative care and the National Perinatal Association

~honoring the equal voices of parents when designing policies

~recognizing the impact of insurance on healthcare

~exploring the ethics and gatekeeping in perinatal advocacy

Connect more with Cody and their work here.

Support the show

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, and the birth nurse, educator and advocate who has been searching since 2010. 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 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.

In this episode of the podcast, I am really delighted to be just diving deep into some of the issues around community collaborative relationships and navigating the medical hierarchy. I am so excited to share our guests with you this week, Dr. Cody Pyke is trained as both a physician and as an attorney, and has some incredible insights to share with you if you are someone who also wonders about how to really navigate advocacy work? How do we craft our messaging to connect with legislators and folks who really work on systems policy levels? Have you been thinking about understanding your strengths and where they fit into this larger community and all of the many things that need to be done? Are you thinking about how we create equity as we bring all folks together at the same table? To dive into these issues? How do we get rid of this hierarchy that continues to hold us back as we consider what community can really look like? And what true collaborative care means we are exploring some of their journey and how Cody has navigated these spaces, as she seen areas that she wants to improve, as she has noted holes in the community that is available to support the work we do as perinatal care professionals. And we're so excited to talk more about collaborative care what it looks like and the vision for the future. Onto the show. 

Oh, well, welcome Dr Pyke, I am so excited to have you on the podcast today talking about community and what it means to you and how you've kind of moved through a variety of spaces within so I would love for you to share a little bit about yourself and your work with our audience.

Dr Cody Pyke, Attorney  2:29  
Sure. So my name is Dr. Cody Pike, i My pronouns are she or they and I am trained as both a physician as well as an attorney. Though I do not currently practice medicine, I exclusively practice law, I guess kind of my journey into having this career at the intersection of medicine and law has taken some twists and turns. But it started when I had some family members outside of a periodontal context, I had some very many family members are injured by inadequacies in the US healthcare system. And that happens during my senior year of college, which I will not say what year that was because I didn't want to do it myself. But that inspired me to want to go to medical school so that I could try to quote unquote, fix medicine from the inside. And then I get there. And I learn and realize that physicians actually don't hold nearly as much power as they once did. And you can debate whether that's a good or a bad thing. Certainly issues with the way medicine was done in the 70s and 80s. But the reality is, is one physician isn't going to be able to change law policy by themselves. And I really wanted to get a better understanding of how law and policy both at the when I say policy, there's what I call a "little p" policy, which is within the hospital, like what are the hospital's policies. And then there's capital P policy, which is state legislature and federal legislature. And I started to really want to learn more about that. So I went to law school, and then I caught this bug where I really liked being an attorney. So I decided after finishing the joint degree program to practice law, and that's what I do right now. 

Maggie, RNC-OB  4:21  
Amazing, thank you so much for walking us through that. So I think it is interesting how and I'd love to dive a little bit deeper into the kind of little policy and big fee policy because I think that is a big aspect of for many of us who start in first work whether we are out in the community clinical, non clinical, you know, we start feeling like okay, we can we have the bubble that we're in and I think a lot of people are very intimidated by the idea of reaching out and trying to make an impact on kind of the big P policy. Was that did you experience that or how did you kind of walk that line? Did that always feel more natural to you?

Dr Cody Pyke, Attorney  4:57  
No, I think there definitely is a there's both a learning curve as well as to use the word you use an intimidation factor when trying to make the jump from having an impact on a smaller scale to trying to talk to, say, a state legislator or a Federal Congress. And so when dealing with, especially with the sensitive subject of birthing and children, those are typically very hot button issues for a lot of people and people tend to, understandably have very strong opinions one way or the other. And so I think it's natural to be a little bit afraid sometimes to want to break into that space of talking, having these hard conversations with total strangers about what needs to change. In my own experience. I think I had the bubble pop for me, because I took a course my first year of medical school, an elective with an amazing pediatric infectious disease specialist, Dr. Claire Bocchini. And it was all about physicians as political advocates. And so as a bunch of medical students and residents and attending physicians working together in kind of a think tank model, to write policy briefs and policy papers that we then the weird nuance of the Texas Legislature is our our legislature only meets every other year. And so this course is only taught in the years that the legislature is active. And so we would prep all these materials and then actually drive from Houston to Austin. And, and present the information to usually staffers it's very rare to be able to just book an appointment with a legislator directly. But we did pitch it to the staffers and I was simultaneously pleased and horrified with what I saw so pleased in that. Some legislators do listen, they are few and far between, especially in my beloved home state of Texas. But then there are others who don't. And I had a positive experience in that the policy I was working on was regarding perinatal mood and anxiety disorders or postpartum depression specifically, and trying to change some of the way Texas handles its Medicaid billing for postpartum depression. And we actually got a bipartisan support for that bill. And that became law that same year, which was amazing and kind of inspired me to want to look more into the policy realm of things. But at the same time, that one legislator, I think, was probably one of the only ones I felt truly listened to us when we were speaking with her staff. And everyone else, it really felt like physicians were you know, we have medical students, physicians are speaking a lot of medical jargon, data science, and was going in one ear and out the other. I think you've got politicians that speak legalese, usually, because many of them are lawyers, some of them are not. And there's, there's a communication gap. And I think that's where I first started to think I need to go to law school is so that I can learn, I can become bilingual, in the language of medicine and evidence based medicine, data driven science, as well as the language of law, policy, and ethics. And so I have done all of this education, specifically because I want to try to facilitate those conversations and translate the different jargon between the worlds.

Maggie, RNC-OB  8:43  
Yeah, I love hearing your story of how you kind of took that experience, and then you carry it through to like, okay, so I'll just, I'll do this next thing then, and be able to put those all together. We've talked at length on the podcast about how easy it is to get kind of stuck in our silos, where we kind of get like we get a lane, and it's hard to kind of see outside of it. And it's very hard sometimes to communicate between those. I know I am familiar with with you and kind of your background a little bit from the National perinatal Association. I don't know if you can share a little bit about how you I know you'd have started like a med student chapter within that. How did you kind of get into that really, like collaborative piece within that perinatal space?

Unknown Speaker  9:19  
Sure. So interestingly, it was almost by fate. I'm not a I'm not someone who believes in things like fate, but I had a meeting with a obstetrician gynecologist who I was interested in doing research with as a first year medical student, and she was running late to our meeting and she shared an office with another OB GYN who I'd never met, never heard and in key at the time was one of the higher ups at the National perinatal Association. He's our most recent former president, Dr. Jerry bouts. And this is when he was still at Baylor College of Medicine as faculty before he moved to Cal California, but he had posted a sign on his office door that he shared with Dr. Epps. And they were, it was advertising a conference for perinatal, you know, stuff. And I was like, Well, you know, at the time, I thought I wanted to be an OB time, I thought that was my future career as a physician this was very early in my medical education. And I remember asking Dr. Epps, the woman who I was eating, Hey, what's that? She's like, Oh, that's Jerry's thing, you should talk to him. So reach out to him. And he's like, we would love to have students. One thing led to another I ended up going to that conference. It was in Houston that year, had a great experience. I approached the president at the time, Dr. Bailey Phillips, who's a neonatologist, as well as she first trained as a leave as a nurse and a lactation consultant before becoming a physician. And I said, Hey, I want to be more involved, you know, do you have student chapter and like, oh, well, we don't really have a student organization. And you know, I think this speaks to why it's important to just like, go for it sometimes, because instead of Oh, off, they don't have a student organization. I was like, well, that's silly. I'll meet you What and so I went through the process with Baylor College of Medicine of creating a new student organization and got approvals to the MPA board, and I made enpass, National paralegal Association, Student Society. And I think now we're up to like six or seven chapters nationwide. I know he's got several chapters in the Northeast states. I know we have one in the works at Dr. biases, new position. He's working on creating a chapter in San Diego. So it's really been amazing to see more students coming into this and trainees. And again, not just medical students, we've got you know, PT ot trainees, we've got nursing and and psychology and trainees interested in participating. And that was my first big jump in suggestible, community driven aspect of perinatal care. And it kind of took over my life. The board was so happy with what I had done with meeting the new organization, the student organization that maybe board member after I'd only been a student member for a year. And then after that, in 2019, I joined the executive board. And I'm currently in my because of pandemics things changed a little bit, but I'm currently in my last year on the executive board before because of the provisions of our bylaws, I'm required to take a break.

Maggie, RNC-OB  12:29  
Yeah. Oh, wow. So many questions,

I think, first thing maybe is, if we could just kind of maybe dial back a little bit, we often have talked Well, we never want to denigrate any member of our community. We we know that there are many flaws in in nursing school education in medical education, just in the way that we have, like set up the health care in our country. And so we recognize that, especially for medical students who are going to go on to become physicians and kind of step into this place within the current hierarchy of medicine. Oftentimes, it seems like there are not opportunities to really be grounded in like social justice in community health care and stuff like that. Is that something that came up? In your conversations? As you kind of work through that? Do you see ways that? I guess, with me and my fellow nurse colleagues, like our goal is for our thing, it's trauma informed care, we would love for like every nursing student to have that information when they start rather than trying to kind of like backpedal once we've gotten into kind of the system and gotten swallowed up by some of the difficulties that happened in there. When you started having those conversations with other students, what was kind of the what was the response? Or how did you kind of structure what you all wanted to kind of discuss as part of the Student Society?

Unknown Speaker  13:39  
Yeah. So it's, you know, I think there's some self selection bias in that the people that want to be part of the national pyramid, like when I when I pitched and PA, our first recruitment meeting, or new student members, explained exactly what I just said, you know, it's interdisciplinary, it's listed, it's looking at all hang out. And I think for the people that then come up after that meeting and say, sign me up, there's some self selecting. So there have similar mindsets and goals at the outset. I think more interesting is trying to get it into education into the actual curriculum, as an example, and I will say, a lot of schools are making a push in that direction. I know that the other college of medicine where I trained, it has changed just while I was there, as well as since I graduated to include more socio economic determinants health and kind of social justice, nursing education as part of their core curriculum. I also know nationally that the LCME, which is the accrediting organization for medical schools, has increased things like ethics and socio economic determinants of health as part of actual board exams and shelf exams. So it is changing, albeit slowly, because you know, changing culture slow and changing educational standards slow. Plus, there's this balance between, there's so much information, whether you're training as a nurse, midwife, physical therapist, whatever, your there's so much you have to know, to be able to practice. And these are other things that you're piling on top of it, which you and I know Maggie is essential. And you probably should have to know this. But it's convincing the creditors like, we need to make this mandatory because it's so important. But where do you fit it into the curriculum that's already jam packed?

Maggie, RNC-OB  15:35  
Oh, yes. Yeah, that's a great point. I think it's easy to get dissuaded by just like the the amount of things that need to change. And we talked at length in our last season, a podcast was all about how we create change. And then that kind of led us into this wanting to have more discussions about community. Because obviously, this is not things that are done. It's not done in silos, it's not things that are done one individual at a time. However, as your story illustrates, each of us as individuals has that opportunity to like step into these spaces to say this is something I want to see who else is with me and to and to start that. And I think that's really powerful. Switching gears a little bit in your experience as an attorney, if you can share maybe some of your insights about kind of like risk and liability concerns, but they continue to be very heavy throughout the perineal care space.

And I think that too, is I think, as we have when we talk about trauma informed care, when we talk about really upholding patient autonomy, all of those things really rub against this perceived. And, and obviously, at times real concern about how our, our livelihoods, our licenses, our practices are impacted by trusting folks to make their own decisions about their health care.

Dr Cody Pyke, Attorney  16:52  
Yeah, I mean, there's, we could do an entire podcast series just on I think the statement you just made, I want to try to, I guess, break it into like three parts. So one is changing the insurance policy. And then one is liability. And in I think the other is changing practice. So from from the insurance standpoint, the reality is, no matter how good an intervention is, unless it saves money at the bottom line, or makes money at the bottom line, we we all are, are living under capitalism, it's you know, something we have to admit is true, whether we like it or not. And living under capitalism, hospitals, even nonprofit hospitals are not going to implement new interventions unless there is money that's going to come in because of it, or expenses that are going to be saved. And so I think, for advocates keeping that in mind, because as an example, when I worked at the state legislature, as a policy analyst, in 2021, I cover I met with people I met with advocates that, you know, our community come in and talk to me about, oh, this needs to change, this needs to change. And the reality was, is, if it had what the legislature called fiscal note, if it was going to cost money to the state, that bill was dead. And so whether you're talking to middle P policy in a hospital and you're trying to save, you know, prevent increases of the hospital's bottom line, or you're talking capital T policy, and you're trying to change law, you don't want it to increase the cost of health care to the state or uncompensated care, the cost of Medicare, Medicaid, it's been one of the biggest issues trying to convince Texas to expand Medicaid under a PPS. Yeah. Yeah. And so even though it saves money, but you know, whatever. So that's, I think the on the insurance thing like it, it's got to be billable. I think that's one of the best ways if you can convince insurers to make some billable that's one really great way or if you can make a really compelling argument as to why a particular Trump trauma informed care can save money, or you know, it prevents liability or it prevents negative outcomes, you know, anything that you can sell and and it's it sounds cold, and I resist turning anything into $1 Savior because I'm I don't think like a capitalist. But you have to to convince people and I think that's part of the art of advocacy is learning how people who maybe are socially, socially and politically distant from your beliefs, how they think, and how you persuade them and use their language to try to bring them into your cause. The second thing is that I wanted to talk about from your liability, it's huge to your point. We as for clinical professionals, nurse midwives, doctors, etc. We have licenses and if we mess up, you know, and go against things that get in trouble, then we can lose those licenses and that's our livelihood. And that's what we spent our life training for and what we love doing lawyers are the same way we have legal blood instances and hospitals have credit addictions. And I think it that's, I think another reason another wrinkle to in addition to making sure nothing costs more money, you want to make sure it's not going to cost people lawsuits because lawsuits are very expensive and time consuming and annoying for folks who aren't lawyers. And I'll give an example. I mean, it's pretty obvious. I know, it's talked about everywhere, but after the dobs decision, regardless of and and for those who aren't familiar listening to podcasts and Dobbs was the Supreme Court decision reversing Roe versus Wade. And in the wake of that decision, we are seeing, at least anecdotally, I don't have data on it yet. But there are hospitals and practitioners not doing standard routine interventions, such as treating an incomplete miscarriage with a dilation and curettage, because they are worried that it will be misconstrued as perpetuating or trying to help a attempted self managed portion. And that's very dangerous, because, for example, but in the broader scope, if if caregivers are chilled, in the legal community, we'd love to use this phrase, that chilling factor, you'll hear the Supreme Court justices talk about chilling factors. Basically, anytime there's a police brutality case, a chilling factor is something that makes someone so scared of litigation, that it impedes their ability to do their job. And I think we're starting to see that in the medical community more or, and in the provision of perinatal care where it's like, I know what I should do I know what I want to do, I know what the patient is asking me to do under under patient autonomy. But I can't or I won't. Because it'll get me in trouble with my boss, it'll get me in trouble with the law, I could get fired, I could get my license suspended, I could get sued. And so I'm not smart enough to know necessarily what the solution for that is. I don't like the idea of further restraining causes of action against people who commit malpractice or actually cause harm. You know, Texas has already done tort reform 2001. And it's really decreased the ability of patients to get justice sometimes, and it has not decreased medical insurance rates, as it promised. So I don't think that's the solution. But I think that's that's something that, as community we should be thinking about is in a highly litigious society, in a place where corporate entities, shareholders, hospitals, avoid liability like, plague. How do we assuage that fear while also empowering, birthing people and appearance to two years, the third thing you said, which was patient autonomy, you know, ultimately, it's balance, you know, autonomy is not absolute. I can't walk in my doctor's office and demand, I would like this prescription that you don't think I need, but that at the same time, just because the textbook says that you should do something, or just because the hospital policy, little policy says you should do something. If the patient says no, or I want something else that can also cause lawsuits. You know, and so I think, and maybe that's maybe that's where things start is establishing how embracing patient autonomy helps reduce liability, I do think, at least in clinical experience, when you talk with the patient, and they feel heard, and they feel like you're listening, and they feel like they have power over their medical outcomes and decisions. I'm pretty sure there's data out there that shows that that means you're less likely to be sued. Yeah. And so, but it's but it's hard to convince hospitals and bigger entities that you should trust patients. Because, again, it's all we've got, we've got to take the same approach that we've taken in clinical care with evidence based medicine, and start bringing it more and more into the social justice aspect of the economic aspect and say, okay, here are the data driven, economic proofs that trauma informed care is better for patients and will hospital and our bottom line. And again, I know it feels kind of soulless, and especially for the folks that are drawn to this space, like, like me, who's a total hippie and, you know, I want to do drum circles and you know, talk about all of our different holistic birthing options, right?

Maggie, RNC-OB  24:53  
Yeah, yeah. Yeah, like you said, I mean, so many things I we could talk for the next three hours about it. The last few minutes you just explained. But yeah, I think like that piece of that I think it's so hard for us it for obviously for many people are drawn to listen to our podcast I know many of our audience obviously, also identify as folks who are like I, I'm trying to divest from all of these systems like, I don't want to go further down that. And there is a really tricky balance to figuring out, like you said, kind of how you how you have to play the game that is currently being played in order to create a new one. But I really liked that, that piece of that thinking about the language thinking about how how you make someone understand.

Unknown Speaker  25:35  
And I, you know, from I also, we didn't talk about beginning I also trained as a bioethicists because I'm a academic masochist, and bioethics grad school at the same time as medical school, 

Maggie, RNC-OB  25:47  
I have no idea how you did that. 

Dr Cody Pyke, Attorney  25:49  
I don't either I don't think I slept for three years. But from an ethics perspective, I know that there's a gut punch sometimes when thinking about operating within these unethical systems, or capitalist systems that aren't functioning for those who are the least privilege, or the least advantage, or who have been completely disenfranchised, for lack of a better term, and disempowered. And I agree with those feelings, and I hear them and I feel that myself at the same time. And the second is actually something I've talked about, even with my therapist, you have to recognize that, that hold on to that cognitive dissonance of recognizing like this system doesn't work for everyone, this system is not just the system needs to change. And it's not going to if I just am screaming into a silo, or if I'm screaming into the void, and there's not any there's I personally don't think there's anything unethical about doing your best to operate within the system that we have inherited from our forebears and doing your best to operate and systems that you have to you in order to pay your bills to pay your rent and survive. That's not unethical as long as you continue to hold on to your activist and advocate heart. And the thing that I'll share my therapist, and I discovered is the most important thing there is trusting yourself. I think there's a big fear that if we let ourselves operate within unethical systems and capitalist systems that we will become corrupt. And that is very possible. But if you trust if you can trust yourself, like don't let that fear of oh, I might corrupt myself, be the reason you don't even engage in that side of advocacy. Because I think each of us knows, like, if we have in our, in our heart, a true drive for advocacy, and for this very important work, especially in the birthing and Perinatal communities, I think you'll know that it's, it's, you'll know when to pull back, you'll know when you're like, Ooh, I'm starting to not like myself, I'm starting to not and this doesn't feel good trust, trust your own intuition. And don't be so afraid of being swept up in capitalism that you lose yourself. I know it is scary, but I just like it's from my own experience, I want to encourage people that it's okay to to let yourself function in the system you're given that doesn't make you unethical, and you can still even while playing nice, you can still advocate for change.

Maggie, RNC-OB  28:33  
Thank you so much for doing that I echo that is something that I have personally grappled with a lot and discussed with a lot of term people to try to kind of maintain kind of that holding that that duality of, of this experience we find ourselves in as we are, you know, working to change. I also think there is a piece where like when you're talking about the Dobbs decision and how that has impacted both practitioners mental process around what it means to provide medical care in a way that we anticipated, but also watching it play out like that. I have a friend who is personally impacted by a situation from that. And it's really heavy thinking about this interplay between big P policy, how that impacts our practice, how it impacts the care that folks, you know, receive. I want folks listening to this to know and believe it can be done a different way that we can still come back from this.

Unknown Speaker  29:28  
Yeah, it can definitely. I think what you're saying is, it's really hard and it is really heavy, to live now. In the environment that we have been given, and that was created by people years older than us before we were born or could speak and what was created by people who, even when our ancestors could speak our ancestors were silence because of their skin color or their gender identity. It sucks. And it's okay to let to acknowledge like, it sucks. I think anyone that does advocacy work needs good therapists, frankly, Oh, yeah. Because because you can't carry that it is tiring. And you don't want to burn out because burnout can't do work. So you got to take care of yourself. But don't get discouraged. Because although change is slow, it is, in my view, unrelenting Change is the only guaranteed thing in the universe. And so we can guide where that change goes, for better or worse based on our own, you know, conviction. And it's, there's gonna be days where you feel super frustrated. I, when I worked at the Capitol last session, it was very disillusioning for me to the point where I don't think I want to work in politics necessarily, I'll continue to do advocacy. But I thought I wanted to work as a, as a political eight as a policy analyst at that level. And I don't think I ever want to do that, again, in part because of how to solutions I was. But that doesn't mean I stop, you know, means I take a beat, I take a few months to lick my wounds and say, Okay, this, this isn't going to work the way I wanted it to. What's my next idea? What's what's the next way we as a community can can target this. I also want to clarify that a lot of what I've said so far, I think sounds like advocating for like a respectability politics. And that's not at all what I'm saying. I think there is absolutely a valuable place for righteous anger. Because because it's valid, there are so many communities that have been hurt, and they have every right to be angry, and to shout, and to not be polite, you know? And it's it's a yes, and not an either or. And there's a role for that kind of advocacy. And there's a role or the kind of schmoozing with people you hate to convince them to give you grant money to start a trauma informed care project. You know, there's, it's an it's a balance, and I stink. This just came to my mind, I think one of the best things you can do as community is stop gatekeeping, what's the right kind of advocacy, and support each other and not get into a fight about what's the better way to advocate so long as we're all on the same page as to what we're advocating for? I think if we have a shared vision, we can all use our time, talent, treasures and strengths and different ways to, you know, effect change, but we bickering about what's the best way to do it. Yeah.

Maggie, RNC-OB  32:53  
Yeah, and I think that is it just like brings it back to that level, like this is about community, right? We all do have those different ways. We all have different, we all have different identities, we have different positionality, we have different privileges, we have different strengths, we have these different ways to step forward. And, you know, we do we do so much more harm than good. When we try to say that there is there is one, one path that gets us from here to there.

And I think that is where, you know, for folks tuning in and within our organization, you know, as we have talked about, okay, well, what can we do, who can do this piece of it, who who can outreach to this group who has the capacity right now, to put that face on, put a foot on the armor and feel like you're going into battle against these forces who

do not understand what we're talking about, you know, who, who has the energy to still be practicing at the bedside to still be attending births, who needed to step back from that because they needed to take a break for their own mental well, being physical well being to like, step back and do other things.

Unknown Speaker  33:54  
I'm gonna betray some of my own nerdiness here. But as you're describing this, I can't help but think of role playing game or Dungeons and Dragons. Because if you think about I play a lot of these because again, I'm a huge nerd. And it's think about your sporty your adventuring party, you've got to have different roles got to have your warrior who is strong and loud and charges into battle. And you've got to also have your, you know, Archer in the background or your rogue, who's you know, being kind of Sly and working in the behind the scenes trying to set things up the right way. Maybe you have a wizard who has all of the knowledge in the world and has all of the facts and all of the mystical high level you know, esoteric knowledge that no one else does it at but then you also have to have your your Bard, your smooth talking diplomat who can who can convince the orcs on the other side to not kill you. I think that it's silly and maybe comes across as childish. But I liked that analogy, did advocacy work because when you're building a community, you've got to identify what skills you need. And also be humble enough to recognize that you aren't going to have all and you're not going to be able to do all of it your way. And your skills alone are not enough to do the change by yourself. We're only going to do this working together. I'm a lawyer, I'm a doctor, I've got a lot of skills in my pocket. But I don't know the first thing about grassroots organizing. I don't know the first five. I have no idea. I know what a doula does conceptually, but I wouldn't know anything about building a birth plan with someone in that way or, or being a birth coach, or any any of that stuff like that. There's so many experiences I don't have and skills I don't have. And I think we recognize that, that also shows you an outline. So that's what I need. I need to find someone who has those skills and go make friends with them, have coffee with them, take them to dinner. And just ask them, what did they do tell them you know, and building those networks. And those connections is how we build a balanced party, a balanced adventuring group, a community of people that have all of the necessary skills to tackle every situation that arises along the adventure that is advocacy. Oh,

Maggie, RNC-OB  36:24  
I love that. It is the first time we've talked about d&d on the podcast. I think that is a perfect analogy for thinking about how, how this gets set up in real life, right? How we take these things that are like these theoretical concepts, it's one thing to talk about it, you know, here in our in our offices, but how do we actually take that out there in the world? And what does it look like when you know when we recognize taking that time, and we've talked about the power of reflection of journaling? of understanding what what you bring what capacity you have for and the things that you can't touch right now, or ever? You know, where is where is not gonna your your journey was not your ministry. And so finding that in your community, like, it's so powerful that I do, I love that I love that visual, I will enjoy creating some sort of social media posts. But so as we you know, as we kind of wrap up, so many more questions for you. But I would love to just kind of hear what is your what is the future of community birth care, community perinatal care look like to you if you got to spin it?

Unknown Speaker  37:25  
I really think and I am not saying this to just promote the National Perinatal Association. But that what I saw there, as a medical student back in 2016, when I saw it, that's what I thought I started this is this is the future. And it's about creating an equitable space where we can all speak to each other. And also then take that message cohesively as a as a community to outside of our community to convince them that they should listen to us essentially, where parents of NICU babies have an equal voice as the most decorated neonatologist or high risk, obstetrics specialists, were no one rolls their eyes at someone who is a vocational clinician as opposed to a fully licensed clinician. Yeah, I think once that mutual respect is cultivated, we can really do some amazing things. And I think the future of perinatal care is interdisciplinary, I think the future of perinatal chair, by its definition is going to be team based, admittedly, with some of the capital P policy decisions happening and with the dots decision, I think the future of perinatal care is going to be a battlefield in a lot of ways. And to that, I would say, for those of us that do this work, we have to take care of ourselves. And it's not selfish or weak, to take care of yourself. It's actually taking care of your patients to take care of yourself. It's taking care of the people you're advocating for, to take care of yourself. Because the last thing you want to do is burn out where you can't help anyone. And so I think it's going to be an uphill battle. I don't want to I'm not a sunshine and roses kind of person. I've got lots of idealism, but I'm a pretty pragmatic person. But I do think that it's gonna get better. I still have faith that birthing and babies their hotbed issue because people care about these things. Yeah. And I think the more our community as advocates can make the broader public and community bigger community aware of the issues, it's going to galvanize change, because no one no one wants to see negative outcomes. No one regardless As of their political background, or their their religious ideology, we can all agree that we want. If some, if someone is trying to have a baby, there's a way that should be happening where they are supported. And there's a positive outcome. We can all agree that people should be respected, we can all agree that people should be entitled to feeling in control of their own bodies. It's just a matter of translating, translating different ways of talking through different belief systems through different professional or interdisciplinary systems and saying, I think we've just been talking past each other this whole time. And we actually agree, let's figure out a way that we can come up with a policy that makes a reality. Well, we've all want to help.

Maggie, RNC-OB  40:49  
Ooh. Yeah, well, I am like spilling our vision just right along with you. I agree. I obviously I think there is. There is so much we hold so much collective power, there is hope for how we we advocate and we create change, and we create the system that we want to be a part of. So thank you so much, Cody, for coming on and talking about your journey, your experience, it's been so good to connect with you.

Unknown Speaker  41:13  
Thank you so much for having me. And I hope your audience likes my D&D analogies. Thank you. Thank you. Bye.

Maggie, RNC-OB  41:24  
Oh, well, just to do thank you to Dr. Pyke for coming on and sharing about this we will explore so many of these important issues that come up when we think about really expanding our community you know, at your with partners, we are dedicated to cultivating inclusive collaborative birthcare communities that are rooted in autonomy, respect and equity. And we are so glad that you are here and listening to it and also invested in that. So thank you for being here. We would love to connect with you further. Find us on Instagram, Twitter, Facebook, or your birth partners on all platforms. And we'd especially love if you could share this and you know, highlight tag us in your stories on Instagram. Let us know a favorite part that jumped out at you and we will look forward to connecting more next time.