A Mining City Story: Dorothy Troutman - Doula & Birth Educator

Guest: Dorothy Troutman, BSN, RNC, C-EFM, CLC, SBD, SpBCPE, CCE, CEIM, Certified Body Ready Pro, and Body Ready Birth Educator - Doula (Sacred Birth Doula Services); Labor and Delivery Nurse (Intermountain Health St. James Hospital)

Join Emily and Cass in conversation with Dorothy, who works with families at all stages of pregnancy and birth, and has been instrumental in increasing options for birthing families in the Butte area. 

https://intermountainhealthcare.org/locations/intermountain-health-st-james-hospital

https://www.sacredbirthdoula.net/

https://www.spinningbabies.com/

https://bodyreadymethod.com/

https://evidencebasedbirth.com/

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Transcript

 Emily: Welcome to Mother Love Season 4. I'm Emily Freeman, Storytelling Coordinator at HMHB and your new host of the podcast. This season we're launching a special series, A Mining City Story, co hosted by Cass Weber, whose motherhood journey we shared with you last season. The series will highlight the work of five labor and delivery nurses in Butte, Montana, who realized that more could be done for moms and babies in their care.

Through individual effort and community collaboration, they were able to expand resources and services for birthing families. Over three years and two pregnancies, Cass benefited from a transformation of Butte's perinatal landscape. This season on the podcast, she and I will speak to these nurses and care providers to learn more about what they did, why they did it, and the impact it had.

Our hope is that their stories might inspire you to seek out or create additional resources that your own community may need in order for families to thrive. I'm Emily, and you're listening to Motherlove.

Hello.

Cass: Hello. So good to see you.

Emily: You too. I'm so glad to be here. Can you give listeners a brief description of who you are, where you live.

I am Cass Weber and I am a mom and a creative and a wife. And I live in Butte, Montana. Have been here since 2015 and have given birth to my two kiddos, Rowan and Isla here in Butte. 

Emily: This story of your births in Butte. Why is this an important story to share? 

Cass: What I found captivating about the story that we're going to dive into was the way that it demonstrated some of the work that I'd been doing before I got pregnant with my first kiddo, which was systems work in early childhood. So I was trying to help locally improve things for parents and young kids in my community. And so then I got to dive into the system for real life with myself and have my first kid here. I went through that first birth and first pregnancy and early infancy with him, and then I did it again in a couple years, and I noticed a bunch of cool changes within the community for that second birth when I had Isla, there were a bunch more services and a bunch of people available that weren't for my first kiddo. And when I started thinking about it, I came to the realization that all of those people had been labor and delivery nurses for my first child, Rowan. And they all helped improve things in Butte for moms and babies by expanding their careers and making changes and opening up services that didn't exist before.

Emily: When you talk about systems work, can you define that in really simple terms for someone who's not familiar with that phrase?

Cass: Systems are created by humans, sometimes without a lot of intention behind them, and then sometimes with intention. And those systems that are, that just kind of form unintentionally often need review and adjustment later.

Emily: So take us back to your first pregnancy. How do you seek out the care you need? 

Cass: Yeah, it was helpful that I was in the early childhood world and system before I got pregnant. And so I had personal relationships with providers around town. And I am also the type of person who just pays attention to my community pretty closely, just out of interest and that sort of thing. So I kind of knew who was available in town, what was available to me. 

My husband and I were really aligned and had done some previous talking and research about how to find providers and what we might want. So we knew that we could go and meet with providers for the pregnancy and do like kind of interviews with them before we decided. So we did that. We're like, okay, maybe we want to use the OB GYN and we want to go that route and see what that looks like. And so we went in and met with the OB GYN and we left that meeting. Kind of going like, okay, well, that felt like a doctor's visit, kind of normal. And then made an appointment with a midwife, her name's Sue Burton, and she was the only midwife in town who was delivering babies kind of the one option for working with a midwife But we met with her and ended up having I don't know at least 45- minute long conversation with her where she really took her time to get to know us and do some education and really have a more personal more generous time with us.

And so that felt like a really good fit right away. We walked out of the appointment knowing that that's what we would both of us knew that we would go that route.  She'd been delivering babies for over 25 years in Butte and had a very like motherly, grandmotherly feel to her, and was just super comfortable right away.

So it was great to work with Sue.

Emily: So that seems like that was a wonderful resource that was available to you. When did you first notice gaps or absences or things that you kind of had either wanted or assumed would be there along this birth process that weren't? 

Cass: In doing some research and knowing some things ahead of time, I would have liked to have hired a doula for my first pregnancy, but there were no doulas available close at all. Maybe within an hour there was somebody, but that didn't feel feasible at the time. 

Emily: What is a, plain language, what is a doula for someone maybe listening who's not familiar, or who isn't fortunate enough to have a doula in their own community yet. 

Cass: Doulas kind of range in the way that they provide services and stuff in so many ways, but a birth doula is somebody who helps you kind of in a more hands on long capacity during your actual birth of your child, and they often get to know you pretty well ahead of time to and do some birth education and planning and Help you kind of along that process of giving birth and especially for folks who've never given birth It's really great to have the wisdom of somebody who's of you know attended lots of births and kind of knows what's normal and knows how the tips and tricks of pain management and they can help, you know kind of advocate for you within the hospital system if you're gonna be in the hospital or sometimes people will have a doula in a home birth and As well as their midwife to just be that extra support person.

And they can often also be a really good support for your partner. If you have a partner supporting you, they can be that person who's like making sure that they drink enough water and making sure that they have a snack and sit down and take care of themselves as well. So you don't have like husband passing out.

In the middle of birth, the doulas are, a lot of them, I think, use like an apprenticeship model where they follow around another doula, they attend a lot of births before they start doing it solo, and they're not medical providers, so they can't, you know, be hands on doing any kind of medical services, but they're really good advocates within the delivery room or at your home to help you have the birth that you want, or as close as you can get.

Emily: Nice. Fast forwarding to your second birth. One practicing doula in town, Dorothy, had begun providing services. So I was really excited and I knew when she started her business that I would be reaching out to her as soon as I knew more. And she also does the birth education for the hospital and does like private birth education and stuff. So she has a lot of knowledge and resources available that I was very excited to access in my second birth with Isla. 

Emily: You talk about these women in Butte who have started to provide a lot of services that are filling in the gaps in this system. Who are they? And why did you feel that it was important to kind of shine a light on their story?

Cass: There's two midwives who used to be labor and delivery nurses, and now they're certified nurse midwives working with St. James, Jenna and Megan, and they're incredible. And Jenna was my midwife. And then there's also a IBCLC, which stands for International Board Certified Lactation Consultant, and that's Jessica Walsh. She was also in labor and delivery when Rowan was born, and she works out of St. James as well now. We did not have any lactation consultants available when Rowan was born, so that is a service in this community that was extremely important and needed, and that gap being filled is wonderful. And then Dorothy, who is my doula, she was, she's still a labor and delivery nurse a couple days a week, but then she also has her own business and is a doula, and so she gets to navigate both worlds in a really unique and interesting way. Great to have her. And then Amy is now –  she was a labor and delivery nurse too – and is now a certified massage therapist and craniosacral therapist, and she's working on becoming a postpartum doula as well, and kind of focusing on that like post-birth mother-baby care.

Emily: So Butte seems like it's turning into a really great place to have a baby. 

Cass: Yeah, there are so many additional services that are really great to access. And I mean, bigger places might have five people providing these services, but for a place the size of Butte, having these available is huge. 

Emily: And these women, were they, were, was it their employer who requested that they get this additional training and specialty or?

Cass: Yeah, that was kind of one of the reasons why I wanted to do the story was because I was curious about how this happened. I wanted to know more about each of their individual stories to know if they had like an outside push or if it was all internal passions they were following and excitement for their own careers.

Emily: So just individuals one by one doing something different. That's great. What do you hope that listeners will take away from this podcast? 

Cass: Well, when I think about listeners, I think about multiple groups. Like I hope that anybody who's thinking about giving birth, or, you know, on that path in Butte or surrounding areas, gets to know some of these providers that they can access that maybe they didn't know about before.So I'm excited for Butte to become more aware of what they have access to, and and see how wonderful it is. 

And then I'm also excited for hopefully other providers, maybe other nurses or other people in the medical field, to have the example of of these women's choices and changes guide them on their own journeys if they're wanting to make a change or wanting to fill a gap, and sometimes that feels really insurmountable when you're noticing the problem and you don't know how to fix it or you want to change but you don't, you know, you need that extra push and it takes courage to do that. So I'm hoping that it can maybe inspire some folks to do that. 

And I'm also hoping that anybody who has systemic power within this world. So administrators within health systems and other folks who have access to funding, that sort of thing, can hear how much of an impact filling some of these service gaps can have for a community so that they can leverage their power, hopefully, to make this possible in other places and expand the possibilities here in Butte too.

Emily: Yeah, so maybe in some ways providing a playbook for how this is done.

Cass: Yeah. 

Emily: Because it seems like from what I understand about these stories that we're about to hear, that these are people who individually took initiative rather than seeing gaps and then waiting to be told. How to fill them or when to fill them. Or here's, here's an opportunity to get some training, you know, that they kind of got out there and figured out on their own how to do it. 

Cass: I think it's a Montana characteristic too. Just get to work when you see a problem, and it certainly is here in Butte. We like to just, you know, put our heads down and get stuff done when we see the need arise, and it definitely feels that way for these stories.

Thank you so much for taking the time and coming to see us. 

Dorothy: Well, thank you for having me. I'm Dorothy Troutman, and I'm a labor and delivery nurse and doula. 

Emily: Cass, how did you meet Dorothy? So you two have an existing relationship here. Can you tell me kind of the back? 

Cass: Absolutely. I had my second child in 2023 my little Isla and was really excited that there was a doula available in Butte. It's a small, for people who don't know, it's a rural ish town. It's considered one of the metropolitan areas of Montana, but that's just for Montana. According to everyone else's standards, Butte's rural. And I didn't get the opportunity to have a doula my first birth. And Dorothy, just so you know, the impact of having that service available and getting to work with you was just amazing. And it brings so much to the community and the moms and the families of the community to have a birth doula available when we haven't, always. I definitely don't take it for granted. 

Dorothy: Thank you. It was a lot of fun working with you guys and yeah, it's, it is something that Butte doesn't have a lot of. We're starting to find a few more doulas and that's exciting. 

Cass: That is exciting. Yeah. The more, the better. 

Dorothy: Absolutely. 

Cass: Folks, we know how much doula care can improve birth outcomes and do so much for families. So I had my first son in 2020, April of 2020, quite an auspicious time. And I was in the hospital long enough that I met all of the labor and delivery nurses while I was there because we were in labor for a long time and then had an emergency c section. So everybody had masks on. So it didn't feel very connected or like, remember people, was that like that for you? 

Dorothy: Oh, it was the hardest time and at first, you know, I actually couldn't even use the regular masks and so I was in like this space suit during deliveries and it was awful. There was like air blowing up my back and I couldn't hear and my glasses fogged up. I couldn't see it was probably some of the worst emotionally, for the birthing time. 

Cass: Yeah. Yeah. So technically, we met then, but neither of us remember. We have better memories now. 

Dorothy: That's right. That's right. 

Cass: So we hired Dorothy to be our doula pretty early on in that second pregnancy because we had wanted a doula the first pregnancy. It would have been great, Matt and I did our own like birth research and education,  and because I was working in the early childhood field I knew there were no doulas available in Butte so we didn't even have to do a search For Rowan and so as soon as I knew that there was I was super excited and we were also able to utilize your awesome birth education services more one-on-one because that's another piece of what you do, right?

Dorothy: Absolutely. And at the time I was only offering Spinning Babies, which is a fantastic kind of physiology-based like where's baby at, and how do we move the baby through the pelvis. And now excitingly, I'm also offering Body-Ready method, which is even a deeper dive into how can we help moms in pregnancy to prepare for the birth process.

Cass: I love that. 

Emily: And do you kind of tailor your approach with your, with each client to what they need or what the hospital, is there ever a situation where the hospital is providing some level of education? So then you kind of... 

Dorothy: Absolutely. I actually am the childbirth educator for the hospital. So, we offer free childbirth education classes at the hospital and then we offer small group Spinning Babies classes and then that allows me to really focus like the one-on-one Spinning Babies classes either for families who can't attend or want a little bit deeper dive, have some questions that they would feel more comfortable asking just one on one. And then of course, my doula clients get a little bit more tailored information as well. 

Cass: Yeah, I found it really helpful because I was dealing with preparation for VBAC, or vaginal birth after cesarean section, for my birth with Dorothy. And so we were able to cater that a little bit and really try to prep for that as much as possible. And I did some other body readiness and ended up feeling better at the end of my pregnancy with Isla than I did before I got pregnant because of all of the people who helped me get my body as ready as possible and prepared for birth.

Dorothy: Yeah. And, and I'm finding, you know, we have some great massage therapists and chiropractors and we have a lot of people that most of the community don't necessarily know about that and they're all really here just to support women in birthing experiences. 

Emily: What do you think could be done to help more people know about those resources?

Dorothy: I actually recently met with a family that, you know, that they didn't even know the dad didn't even know what a doula was. And so, you know, the mom was like, Hey, I want to hire a doula. And he was, I don't even know. Right. And I think that's where a lot of our families are everywhere else. Seems like this is a kind of common practice, slow to move into Butte. And I mean, I was, I've been here 16, almost 17 years. And the only time that I'd ever seen a doula used was actually an adoptive family that brought their own doula. And yeah. And so that, you know, that just kind of set the stage for, I think, just education and our providers are really amazing at helping to start offering that education to our families. I think so. 

Emily: Do you meet with resistance ever from providers in more formal medical settings who maybe are, you know, doula averse, or just sort of not clear on what the role would be? 

Dorothy: Sure. I think I am in a unique situation. I am a labor and delivery nurse and I have been for 22 years and I currently work about one day a week up at the hospital. And so when I practice in view as a doula, I already have a really great working relationship with. All of the providers, anesthesia, nursing staff, and interestingly, the birth that I served with in Bozeman, I didn't even tell them that I was a nurse and it was actually this beautiful, relieving. I just got to focus on being a doula. I didn't feel like there was any expectation. So I haven't, I know that there are, you know, some instances where it's challenging, but sometimes I think it's, it goes both ways, right? And so sometimes as doulas, we don't see the medical side of things. And so it can be challenging for both sides, I think.

Cass: Yeah, it's something to navigate for sure. And you navigate that dual role wearing both hats so often, even in your contract with patients, you like have an explainer for what happens if I happen to be your nurse instead of your doula when you're giving birth. So how, what have you figured out? to help you navigate those roles.

Dorothy: You know, so far, thankfully I've never missed a birth. I've had some really long days and nights. You know, I just, I try really hard to focus on the mom in the role that I'm in. And there is a lot of overlap, but actually part of the reason that I love being a doula is that I really am just focused on mom. And so I can separate some of my nursing, but I'm trained. I'm a certified fetal monitoring expert, and so I can't ignore that fetal monitor. So as much as I want to, if something's going on with baby, it's still in the back of my head. And I'm probably going to be the first person to be like, Hey, let's maybe, you know, go back to bed or try this position. So I often tell people I”m probably the most medically minded doula that you'll find. And so I'm not a great fit for everyone, but, I'm hoping that I can just provide a service to create a birth environment that's normal and natural and not scary or hospital- like, even though we're always in the hospital for my births. 

Cass: Yeah. Well, I mean, speaking from the personal side of things, the medically versed side of you definitely clicked well with me because I have, my mom was a nurse and two sisters are nurses. And so I vibe well with the nurses. I like that medical side, but then completely unpredictable benefit of the whole situation of you being enmeshed in the labor and delivery unit was when Isla needed to have a semi-emergency C-section, you were able to be on an entirely different level of support than you would have been able to be for me as a doula only because you were in the room when I got my spinal, which in my opinion, if you've never had a spinal, that is the most isolating, scary moment in the entire experience. And someone's messing with your spine, that's scary to even think about, right? So I think a lot of people feel that way. And I also, having experienced two C-sections, every mom, in my opinion, would be benefited by having not one, but two support people in that OR, and you were able to be because you have that experience and you're able to help advocate along with my midwife to have my full C-section plan realized with the surgeon and the anesthesiologist who probably thought I was crazy because I was the first person who wanted a clear drape and I wanted music playing and the lights dim.

Dorothy: Thankfully you have not been the only one. 

Cass: That's awesome. But there's that moment in a C-section for a mom where. The baby's out and doing well and they're, they quickly, hopefully for every C-section mom, baby's healthy and, and they do a quick check before it comes back and oftentimes dad leaves then. That's when they get to cut the umbilical cord if they're going to be involved in that way. And so you're suddenly by yourself right after the baby's gone and then your support person’s gone. Then you were there and being able to have that extra support was amazing. 

Dorothy: You know, and it depends. Every C section is different. Every situation is different, but I'm hoping that we will start trending towards as other doulas start to be introduced. that maybe we can, you know, kind of move towards having that available, not just to me. I feel like right now I have some special privileges, which I try to always walk that line of respecting both roles and, and understand that I may not always be allowed in there, but I'm incredibly grateful for the opportunities that I have had to serve my moms even in the operating room.

But yeah, being able to be there just to offer, we had a relationship, you know, and, and being able to continue that even when the unexpected was a beautiful thing. 

Cass: Yep. It really makes a huge difference. 

Emily: What are some of the reasons that people would want to have a doula? Like for, you know, for someone who's, who's listening, who's maybe new to this whole idea.

Dorothy: I feel like every mom should have a doula. It doesn't matter whether you have the most wonderful, supportive husband in those situations. I get to support both of them. And so, you know, it can be, I've had moms that I'm their only support person. I've had moms who know that they want an epidural, but are really terrified about having to cope even, just in that brief time before they get their epidural or during the epidural process. I've had moms, you know, that their goal is an unmedicated birth. I've had a couple that were a planned C-section. So it just, you know, I feel like every mom would benefit. 

We meet several times during the pregnancy. So we develop that relationship, really starting to develop what goals mom has and dad has and working with them about what education pieces. Are there things in your mental health that need to be addressed, and then you know we get to just really form a deep relationship and then meet postpartum. I only do usually one to two visits, it just allows for education and empowerment of getting the birth or hopefully, you know, having a higher chance of getting the birth that you really want.

Emily: And when you have those visits, those, you know, those home visits, that's pretty intimate. Do you have any, you know, go-to moves? If a mom is feeling that terrible mom shame, that the thing we all do when strangers walk into our houses and we start apologizing, do you have any go to moves that you do to just put someone at ease?

Dorothy: You know, in the last probably year, I've actually started moving a lot of my families to my house. And, I always offer to meet in their home, but I started realizing that that was an issue for a lot of families, or maybe they didn't have a lot of space or, you know, different things. And I have a great setup and, and my family's, our kids are old enough that they can kind of scatter and, and yeah, do their own thing.

And it just, then it just takes that pressure off of, you know, where am I going to set up my stuff? And do they feel like they have to clean their or, you know, wherever we're meeting. And so it just, it kind of opens that. door. But if they want me to be in their home, I'm happy to go there too. So, and then there's never judgment. I have kids and life is challenging enough without, you know, having people judge you for where you're at. 

Cass: Yeah. And you know, some houses, you have a 90-pound dog trying to cuddle you while you're doing a Spinning Babies instruction. 

Dorothy: Yes. Uh, more than once I've had dogs, either in my business or in mom's business or, I had one that like laid on the bed on top of the mom while we were doing Spinning Babies and I was like, well, I mean, that's going to be fun. But we managed to, we had a good laugh about it and then, you know, we put the dog out the next time. 

Cass: So funny. 

Emily: Do you ever encounter partners who feel resistant or is it more just they're not sure sort of what you're all about.

Dorothy: Yeah, I actually have. And unfortunately, I've had a couple where they persuaded their wife that they didn't need to hire a doula for the most part. I feel like if I'm able to help them understand what my role is, that I'm never there to replace them, that I'm there to support. And then I reassure them that if that is okay with mom, that he's, you know, hanging out on the couch, reading a book or whatever, that I'm okay to be the only person supporting. So, you know, if I'm there to support whatever level either of them need, but I'd say probably 95 percent of the time, once they realize that I'm there as an advocate for both of them, it almost takes some pressure off of them to feel like they have to be the only one to know how to help their wife. 

Cass: Yeah, I know Matt really appreciated it and liked learning all the things he could do to actually be useful and help out with birth prep and all of the Spinning Babies pain relief options and ways to help in that regard and then, I don't know, it gives them like a task They like you like to have a task. 

I'm curious, you know, you said you've been a labor and delivery nurse for 22 years. What made you start to think about adding, being a doula to that.

Dorothy: Actually, I went back to school in 2018 and completed my bachelor's degree. And so I finished that in 2019 and I love learning and there was a part of me that considered going to midwifery school at that point. And then I think, you know, God obviously knew that Covid was coming and that was not going to be a good thing, but I really love laboring moms, and the unmedicated ones are my favorite, and as a nurse sometimes I don't get that opportunity because I have other patients or I have other responsibilities; I'm charting on both the mom and the baby even if they're my only patient. Unfortunately charting has to take precedence sometimes, and it was a hard shift to realize that I wasn't always able to do what I wanted. Or I might be scheduled in the nursery, and I love the babies, but my favorite are the moms. And so I kind of started talking to my husband about like, what are my options? Midwifery school again, wasn't really. In the cards at the moment. 

In June of 2020 I took my first Spinning Babies class. I fell head over heels in love with the process and the way they explained things. I actually told the instructor, I will become a parent educator. And she was like, well, you know, there's like 20 steps to that. Okay. And so I went through all 20 steps and I completed a five-day course in Texas in November of 2020 and became a certified instructor by January, opened my own business in January of 2021. It just kind of all fell into place. I get to do education, which I love, and I get to labor moms and be there as the support person for mom and dad without any of the extra parts that, although I love, being a nurse, the responsibility that comes with it. 

Emily: What about someone, someone in Montana, maybe they're already working in the healthcare field or, or not, who's curious about becoming a doula, getting into this work? What are the steps, whether it's someone who's based in the Butte area or just Montana in general? 

Dorothy: You know, Montana, we're actually working towards, we have a coalition that's kind of starting to bring some community to our doulas. There really aren't any requirements at the moment. There are some fantastic certification corporations, and I highly recommend choosing one that fits the model of care that you think that you'll be using. And so if you're, you know, thinking that you might be a homebirth doula, then, you know, finding a doula program that is more centered on that way. And then, you know, just really doing the research of what does it require, how much time will it take and, and then attending as many births as you can, doing research on birth and supporting. 

But also learning a little bit about the medical side, if you don't have any knowledge of that, because I find from the nursing standpoint, the biggest parts of resistance I meet with other nurses, in regards to doulas, is that sometimes they feel out of touch with -  as the nurse, we have responsibilities. We have to take care of certain things and as much as we would love to meet every single need or desire for that birth, it's not always possible and it almost can create a challenging situation between the nurse and the doula, or the nurse and the mom, if we don't have really good communication and understanding of both roles because they are so valuable to everyone, both sides.

Emily: Sure. But I imagine you don't always meet until you meet that day and so you don't necessarily have rapport with, or the nurse doesn't necessarily have. 

Dorothy: Absolutely. Absolutely. And I've been trying to find time in my schedule to bring together some of the birth workers, doulas, midwives, you know, just to kind of have a meet and greet, just like, hey, these are all the people out there.

Emily: It's a great idea. 

Dorothy: So, you know, if anybody wants to volunteer to organize that, I’ll show up. So, you know, at some point I think that that would be a fantastic way to just kind of even just within, you know, not the nursing side of it, but just the birth work side of it to even know who else is out there. 

Cass: That'd be really valuable. I mean, Butte’s kind of a special place. 

Dorothy: Very special. 

Cass: What do you think, what have you seen, like some of the challenges that you, in talking to other doulas around the state and around the country and other nurses that, you know, what do you think some of the challenges are about Butte? 

Dorothy: You know, I think really the lack of education around just what a doula is, is probably the biggest one. Even just the need or desire to become educated about the birth process. We tend to have families that they're still in kind of the really medical model centered mindset of like, well, my, my doctor, my provider said I need to do X, Y, and Z, and really not even having any sort of second thought about it. And like I said, I'm the most medically minded, so I'm not saying challenge the providers, bbut sometimes we don't always know that we have options, I guess. And so just helping families to understand that they, they can get an epidural or have a C-section or be a high-risk mom or have a hospital birth and still have a doula and still have some, I guess, control over a very uncontrollable situation, because birth is kind of unpredictable.

Cass: Very. 

Emily: When you provide child birth education through the hospital, are doulas on the curriculum? I mean, you talk about it as an option, or does that put you in a weird position.

Dorothy: It does. So I have a community resource packet that I give out that includes every doula that I am aware of. Every massage therapist that I have either worked with or know offer, you know, prenatal massage. And so I really kind of approach it more as like in our community who's available. I can't self promote, but I also really can't separate that I am a doula and a nurse and the childbirth educator, so some of my clients have come to me through meeting me at the hospital, but primarily, you know, I try to keep that as separate as possible just to maintain the integrity of both programs. 

Emily: And I imagine that's, that can be a hard thing in a rural area. I mean, certainly where I live in Dillon, you know, we all know one another in various capacities. We wear different hats each time we, you know, see one another throughout the day in a professional setting or, you know, so it makes sense. 

Dorothy: And I think because I just, I feel like the families that are supposed to be mine are mine. And the ones that aren't, that's okay. And I am so very happy to try to find a doula that would fit better. And I'm like, I will provide you with childbirth education, like whatever other services, if I'm not a good fit for doula, I can provide other things. 

I met with one beautiful mom and all she really needed was a referral to a counselor. And I knew some great ones and that was my only role that I served in her birth officially, and that was okay. And it was what she needed. 

Emily: Yeah. That's lovely. Cause the money becomes, you know, it's expensive, but that idea that maybe this isn't someone who could manage the full, you know, doula package, but you could give her some resources. Just guide her towards the other person or service that she might need.

Dorothy: Right. And I never want finances to be a hindrance. I know that our rural families do have a doula in the medical model that is offered to them. And so we have another great doula in town or kind of in our area that can offer those services if they're a part of the program. But as far as, like for me, I do sliding scale, I do payment plans, and I do some either, you know, completely free or just kind of a love offering of what the family can afford, because I have a hard time saying no, for sure. And I really want moms to feel like they have the support that they need. 

Emily: And that's a nice benefit of working for yourself, that you can make those choices. So Butte is fairly concentrated population-wise, but do you get clients from more rural areas around Butte, and if so, how does that work as far as the travel to and from one another? 

Dorothy: I do, I’ve had moms down in Dillon and Deer Lodge and White Hall, Anaconda. And the beauty of my flexible work schedule is that almost always I can schedule our doula sessions before or after their prenatal visit, if they're coming into town for those visits. And so I usually will see them at my house. I live pretty close to the hospital, which makes it,pretty convenient for most of them. But I'm also willing to travel. And so, I have had to add a travel fee to my contract just because gas is expensive. 

Emily: Is doula care something that any insurance companies are starting to be open to covering in different parts of the country, or do you know anything about?

Dorothy: In different parts of the country, Medicaid especially is. Montana's actually working towards trying to figure out how to become a provider for Medicaid. It's a very long, difficult process. However, insurance companies and Medicaid, they're really starting to see that hiring a doula, or paying that expense, it’s actually decreasing the length of hospital stay, decreasing the number of C-sections, decreasing the number of epidurals or adverse events, all sorts of things, inductions, you know. And so they save a lot of money by hiring a doula for their family or allowing the family to hire a doula.

Right now, health savings accounts, so HSA or flexible spending, I believe both. I know HSAs are, but I believe flex spending will also allow you to use that money as part of education for childbirth education and doula services. 

Cass: We were able to use our HSA for that. So it's a huge benefit. I'm curious, we're kind of talking about Butte right now and obviously I experienced a huge lack of services in 2020 when Rowan was born and across the board, that's kind of what this whole podcast is about because then I got to have those services later. And you're really embedded and you know, and you're creating community resource guides for people. Are you still seeing big gaps in Butte for specific needs for folks, or have you seen like a closure of some of those gaps that you've seen previously? 

Dorothy: You know, I think we're working on it. Jessica Walsh is an internationally board certified lactation consultant and yeah, high praise. In fact, I have it in my contract that if you're planning to breastfeed, then you will meet with her because I say as passionate as I am about birth, that's how passionate she is about breastfeeding. So that was an area that we were really lacking. And she has stepped in and just supports our moms and our families in such a way that it just is beautiful.

And I've met with and had coffee with a couple of newer doulas in the area. They're kind of still trying to get their feet under them. They're not necessarily advertising a lot. And some of our doulas have little kids. I mean, it's hard enough to have two teenage boys and have, you know, one client every other month or so. I don't know how they do it with toddlers because birth is unpredictable. So the 2 a. m., all day, doesn't matter. But I think we're getting better. We have physical therapists that specialize in women's health. We have two up at the hospital. And then Ashley Wold has always been my favorite down at Lone Peak.

So we have women who are doing physical therapy for women's health, pelvic floor, and other, you know, issues that we've always just sort of assumed were normal. Like if you have these issues, that's just part of being a mom. So we're starting to make those changes. I'm starting to see, Amy Lowney is doing massage therapy and craniosacral therapy. And so she's really embedded in that birth world as well. So yeah, we're getting there. 

Cass: Ashley was a hugely important part in my physical well-being both after Rowan was born and during pregnancy with Isla. She's amazing. 

Dorothy: She is amazing. Yeah. 

Cass: So knowledgeable. 

Emily: Do you have a story you can tell us about a particular mom who you think really benefited from doula care?I mean, I think, we all know that everyone benefits from it. But is there one that comes to mind where you're like, this is someone whose birth outcome just might've gone a different way had you not come into her life? 

Dorothy: You know, I do. I think every birth benefits in, in different ways. Sometimes it's our mental health and just being able to figure out what mom needs. But I have a mom that I had the opportunity to work with. She was a first-time mom and you know, labor was slow to start. We were post-dates and that's always a challenge trying to wrap your head around like today's still not the day, you know, and, and her labor actually stalled at one point. She ended up kind of in that seven centimeter range for several hours. And I really feel like if I wouldn't have been with her to help her know what positions that she could try, that we probably would have ended up in a C-section.

Her husband was amazing and very supportive and the nursing staff was, they were doing their role, but having somebody there that, you know, I could kind of speak to the relationship that we already had, so I could encourage her and give her, you know, I had developed that sense of really where she was at and who, you know, what her goals were. And so I could push a little bit where maybe the nurses felt like they couldn't offer certain things because they didn't know if she really just wanted that epidural or, you know, those kinds of things. And so when we were able to do some position changes and it took a little bit, even though I was there, she didn't initially want to, and I kept offering gently. And eventually her midwife actually was like, hey, we're kind of looking like we might end up in a C-section. And so I finally, like one more time was like do you think we could try this? Like, I know you don't want to move, but do you think, and she did. And like half an hour later, we had a beautiful birth of an almost nine-pound baby, but yeah, you know, I think when you get stuck in that place, whether it's in your head or physically at like six, seven centimeters, and that's a challenging time for every mom, but I think if you don't have somebody there to just cheer you on, you're, you're ready to give up, you're ready to throw in the towel, whatever. Like if, you know, I think she would have been like, sure, let's do a C-section, like I'm all done. So I was able to kind of walk that really hard space with her.

Cass: You feel so helpless and like lost in those moments where there's, it feels like there's not a solution or you, you get in that headspace of this is never gonna end. I'm just stuck here in this pain forever, which, you know, is not true, but emotionally, that's really how that feels. I feel like for a lot of people in that moment and being able to listen to somebody who knows, say, really, we got to try a different position and it might change things and then to have it change. That's awesome. 

Dorothy: Yeah. I offer a program called Daddy Doula. And so I have had moms that are like, you know, I just, I just want my husband there. And I'm like, fantastic. And so I'm like, I can help them learn everything that they need to know about how to support you. But it's those moments that they don't know, right? Like that's where, you know, I have 22 years of helping moms and I see what they need, and so when A plus B doesn't equal C, then the dad sort of, he has the tools. He just doesn't know what order to use them in, or he doesn't know that. If, you know, if that didn't work that now you try this one instead and plus that one and then we get back on track. It's like I can read the situation of the room, both physically and emotionally and in progress, you know, as well as the baby, how's the baby doing along this whole journey, because they're working really hard too. And I think sometimes we forget that. And so we have to support all of them. 

Cass: That's amazing. I'm just thinking about your timeline a little bit. When you took that first Spinning Babies class, and because I've been in Butte since 2015 and involved in different levels of the early childhood world, you were really instrumental in bringing all of the Spinning Babies education to Butte, to St. James, and to all the nurses, right? 

Dorothy: Yes. 

Cass: How did you go about that advocacy? 

Dorothy: Oh, I always say I'm like the poster child for certain things, and Spinning Babies was one. When I took my five-day class, I actually cried, because it finally made sense as to why sometimes the things that I told my moms didn't actually help. We looked at physiology and it was taught in such a way that it just made sense. And then I started just digging into their research and showing that we could decrease C-section rates by offering their Spinning Babies three balances. So I went to Debbie Forkin at St. James and she's our boss and lovely, wonderful, supportive of all of those things. And so I said, what can we do? So I reached out to the trainer who did my class in Helena and I said, I want this. I worked with the Spinning Babies corporation and had a trainer come out to Butte and we ended up with 70, I think 75 participants, all of the nurses from the hospital that were employed at the time. We did it over the course of two days, the same class so that everybody could go now. So that not only is St. James, but that was midwives and doulas and health workers from all over the state, and now everybody, it's part of our protocol. We are supposed to offer it on every admission, especially for inductions, that's just part of what we do to help decrease our risk of C-section. And you know, I think it's been helpful. I know in other larger hospitals where they really have been tracking it, they've seen a dramatic decrease in their C-section rate just by offering those couple of things.

Cass: Have you seen or heard from some of the other L& D nurses about  the value of having that education? 

Dorothy: You know, I think that not all of them are as comfortable using it, but the ones that have kind of jumped in or drank the Kool-Aid or however you want to phrase it, I think they do. It's exciting to see when it actually helps. And it doesn't always because sometimes space isn't the issue. Spinning Babies, we offer space and gravity and balance. And if those aren't the issues, then we still are going to have outcomes that maybe we didn't expect, or they're going to be longer, slower labors, or, you know, any of those things, but you know, I've had a few nurses that, you know, they, especially when we were first starting, they'd call me at home and sometimes they still do. I'm happy to take those phone calls and it's like, we've tried A, B and C. What else, you know, what else can we do? And in addition to spinning babies, we added peanut balls. I have done some peanut ball trainings and I have some stuff, hopefully when I get a little bit more time, we'll bring that back to the nurses again. 

Emily: Can you explain what that is and why it's called that? 

Dorothy: Yeah, so, you know, it's the kind of peanut-shaped ball that you would use in like physical therapy. We have three different sizes. They help to open up the pelvis and allow babies some more space. And the statistics on those show that it can decrease pushing time by like half an hour and overall length of labor, like 90 minutes. 

Emily: So that's like a sort of just a simple tool. Simple. Very easy, really affordable. 

Dorothy: And it's not even something that anyone needs at home. It's really beneficial during the birth process. 

Emily: I'm thinking like affordable for a hospital to invest in.

Dorothy: Yeah, and it's passive, meaning like we have induction moms, I’m like, so as you're watching your TV show, you're just going to drape your foot over this ball, like nothing fancy. I find the peanut balls can be even more beneficial for our epiduralized moms, which we still have a really high epidural rate and that's okay. That's what moms want. But I think as we start to educate that birth doesn't have to be miserable, we can be upright and mobile and all of these things. And if you have the support, then it gets easier. But peanut balls are fantastic, especially for those epiduralized moms. We can kind of utilize the positions and the ball to kind of just open the pelvis and let baby continue their journey, because they're actually having to work through the pelvis. Like they don't just fall out. We wish, we wish, right?

Cass: Oh man. That reminds me of the fact that as my doula, you were like, here's my peanut ball. You get to have this at home for your home laboring process. And you know, when we got close to that guest month of due date, you let me have that, and just keep it at home and Roan thought it was very cool. And keeping him from jumping on it was hard, but yeah, those sorts of services and also the TENS unit, that is another like low barrier for entry pain relief option. 

Dorothy: It's fantastic. I actually now have three of them that I rent out because I've had. So many moms that that's the only pain relief they needed. The TENS unit, again, it's just, it's inexpensive, you turn it off and it goes away. So it's sort of like acupressure. It's, you know, it's really affordable and easy to use. I'm very few contraindications, but you know, we can flood the pathways with some of those feel-good things. And, yeah, it can be really beneficial. 

Cass: It's great to have, in an under-resourced community, those sorts of like, oh, I can rent a TENS unit. Like maybe I can't do anything else, but for a really affordable price, I can try to have this like pain relief thing. And you know, it can be used at home. 

Dorothy: It can, I've actually had moms use it after a C-section to help with some of that. You know, we don't put it on the incision, but putting it above or even on the thighs to kind of help to alleviate some of the pain, which I didn't know about a few years ago, so learning new things even now. 

Cass: Yeah, that's awesome. I didn't know that. I don't know if this happens for vaginal birth, but for C section moms, you have to pee before you can leave. It's an important part of the process, post-surgery, post-catheterization. It's probably for anybody who's had a catheter. 

Dorothy: It is. Yeah, so any of our epiduralized patients, anybody that has a spinal. And even, you know, we're now really actually measuring for our non-medicated moms because we realize medicine has shown us or research has shown us that it actually affects our pelvic floor if we let that bladder get too full.

Cass: But you have a sneaky trick, peppermint oil trick. I was so, when you said peppermint oil, I was so confused and then it worked like magic. 

Dorothy: Yeah. You know, again, it doesn't cost very much. It's not putting anything, you know, I don't have to put another catheter in you. So I'm decreasing your risk of infection and trauma, emotionally and physically. So it's another little tool. We're utilizing more aromatherapy even, I think, even since you've had your baby, we now have little peel packs for nausea and for calming and different things that we can actually utilize at the hospital. 

Emily: So when you're working as a nurse at the hospital.

Dorothy: Sometimes I, you know, as the doula, I have a little bit more. Flexibility in my out of the box thinking, but yeah, I think it's, it will start, I think, coming a little bit more mainstream. 

Cass; Just to clarify for people with a peppermint. I don't want anybody doing something stupid with the peppermint. How does it work?

Dorothy: You can either just smell it, or you can us. a single drop, like in a measuring hat or in the toilet. So it's not going on our body anywhere. It's just a single drop in the toilet or at the hospital, like we measure in a hat, a special little thing that catches the urine and you would just put a little drop.

But even just having mom sometimes smell the peppermint oil is enough to help them. We used to do like warm water, you know, and sometimes still do, or turning on the faucet or, you know, hearing all those things. It's kind of in that same realm. 

Cass: That's fun to be able to. See those just slightly off-from-mainstream techniques get to be able to be infused in the hospital because then it brings it to all of these people who don't have the education ahead of time. They're just there following whatever provider told them to do, but they get the benefit of it. 

Dorothy: I always joke that, you know, my labor patients, when I do get to have those moms as a nurse, they get to have a doula for free because I can't separate my doula-ness from that either. And so I bring all of that education to my nursing side, and then, you know, it's a beautiful, beautiful thing, I think. 

Emily: It sounds like you're fortunate to work for a hospital that's open to these things that are, as you said, sort of slightly outside of the mainstream. What would your recommendation be for somebody working in a larger hospital that maybe is not to whether it's peppermint oil or doulas. 

Dorothy: Or even being out of bed? 

Emily: How do you encourage someone to navigate the system within which they are currently working? Say it's a labor and delivery nurse listening, and she's like, wow, peanut balls. I'm all about it. But maybe doesn't have a supervisor who's open to anything outside of the norm, are there skillful ways to advocate? 

Dorothy: I think that there are, I mean, I was that nurse way back in the day. I remember bringing my CD player and my massage oil to my patients as a first-year nurse, because that was just, I was like, I, it's gotta help. I hadn't had babies yet, but I was like, it seems like it should. Right. And so just having the passion, finding the research, I think that for most supervisors research really does actually play a part into how can we champion this or how can we make this happen? And so, you know, there's always someone else whether it's a midwife or I joke that Dr. McGree always channels her inner midwife. She's one of our family practice doctors and and does OB care. 

There's always someone that you know, you can find that's going to be in your corner, but bring the research, do the, do the deep dive and figure out, you know, does this actually make a difference? Is it cost effective? And if not, like, how can we, you know, how can we bring this? And then, I've been known to just bring my own things and offer it to my patients. And does it only help one patient? Yep. Only helps that one patient, but then, you know, maybe they're going to tell their friend that like, Oh gosh, I use this, and then, you know, we get to, to bring those things in a little bit more here and there and. I think across the country, especially in ways that we can decrease our C-section rates, that is a huge JCAHO, which is our hospital governing body, that's one of their big pushes right now is how do we decrease the primary C-section rate. So if you can bring it and say like, this will, if we are using these things, decrease our C-section rate. You just have to find those key phrases. Use those key phrases and, and then you're going to find somebody that's going to listen. 

Cass: That's huge. Yeah. I felt pretty educated in Rowan's birth. I felt like I kind of knew what was happening and I didn't like many things. You don't know what you don't know going in. But still, it was probably more so versed than a lot of first-time moms and dads. And then, because I needed to attempt a VBAC, for Isla, I just took the hugest deep dive into VBAC education, and I remember just thinking, oh my goodness, this would be so valuable for first-time parents in avoiding a C-section too, and I just listened to hours and hours and hours of podcasts and read so much and learned so much about physiologic birth. 

Do you have any, for like just parents who are across Montana: rural, under-resourced, they don't have somebody in their community who's teaching Spinning Babies, who's doing the things. Do you have any go-to YouTubers or podcasts or information that people can seek out online for themselves to start that education process? 

Dorothy: You know, my new favorite is Body-Ready Method. Lindsay McCoy is the developer along with Lauren Ohayon. So either of those women have fantastic stuff. Some of it's free. Spinning Babies has a lot of free resources. As a birth pro, I have ways that I’ll eventually be able to teach online classes or live online. And so, you know, reaching out to me, trying to get hooked up with some of those resources, but they have a lot of great education and exercise-based programs. So we're not talking any sort of really CrossFit or intense, but more of kind of your yoga Pilates, just mobility and flexibility and getting our body prepared for the birth process. But yeah, Evidence-Based birth. If you're a nerdy person who likes research, Rebecca Decker has some great information out there.

And of course, because I have the nurse side of me, there are some great people out there with blogs and podcasts, but sometimes there's some Interesting things, so it can be a little bit overwhelming to try to navigate what is medically sound advice, even if you are kind of looking for maybe a little bit left or right of center, but we don't want to be so far out in the field that we cause harm to mom or baby 

Cass: I found that Evidence-Based Birth website really useful when I would listen to a podcast and it would bring something up that I had no idea about, like the vitamin K shot or something. And then I could listen to the podcast and hear what they said and then plug it back into Evidence-Based Birth and look at the nerdy research side to try and really make sure that I was foundationally balanced in like the most up to date data. 

Dorothy: Yeah, and she's a nurse who didn't have a fabulous first time birth experience, and so she really just is dedicated now to what does the research actually say? Sometimes the things that we say, it's not actually backed up by data or science, but it's also really hard to do data and science in pregnancy because who wants to be the guinea pig? Very few people. So unfortunately, a lot of times we're learning as we look back on, oh well, that didn't actually work. Or, oh, wow. really did work beautifully. But yeah, there's some great information out there for low cost and our hospitals, a lot of them are doing either in person or online childbirth classes for free. St. James's are free,  and I don't care where you're delivering. I've had a lot of wonderful families from across our community, some of them aren't even delivering at our hospital. 

Cass: That's great to know. Is there anything that we didn't cover or that you can think of to share that? Didn't come up.

Dorothy: Oh. Everybody needs a doula. 

Emily: Preaching of the choir.

Dorothy: I think we did a good job. 

Emily: I'm super excited about the shift of awareness in Montana and especially at a legislative level. Like if there is work being done, you know, the fact that they're trying to figure out how to make it, you know, Medicaid- coverable, it just, that feels really important, and slow, you know, things change slowly here. But the fact that it's even being discussed is a big deal. 

Dorothy: Yep. And you know, we look at like our breastfeeding rates, they're going up, right? So we look at other things that maybe we struggled with in the past, uh, we're getting there. It's just, it's going to take some extra time and some extra patience and extra people to put in that effort.

Cass: Well, and there's so much good data and research about the data-specific benefits of doula care to low-income or marginalized folks. I mean it really helps those specific people. So being able to find a way from Medicaid to cover Service. 

Dorothy: Even on top of that. I mean AWHONN, which is the governing body for obstetrical nurses, and ACOG, which is the governing body for obstetricians, both have come out with positive statements for doulas and they phrase it kind of like one-on-one care, which can be given by a nurse, or a doula or other birth attendant, so they kind of leave it broad, but not all hospitals are going to have time for the nurse to be one-on-one with an unmedicated birth. 

I know that's part of my frustration is that as much as I love my role as a nurse, it can be challenging to meet all of the needs and be one-on-one with that mom who really needs some extra support and love. So, yeah, doulas are needed, not just for our underserved, but I think you're right. I mean, that is a huge population that maybe doesn't even know that we exist. And so helping to get the word out I know that we have some rural health programs that are trying to get that as part of the standard. 

Cass: Well, thank you so much. 

Dorothy: Thank you guys. 

Cass: So good to have you. 

Dorothy: So fun. 

Emily: Mother Love Season 4 was produced by Brooke Boone Miller, with music by Fred Krase. Special thanks to Shelby Carver with Platinum Real Estate for use of her podcasting studio.

Mother Love is a project of Healthy Mothers, Healthy Babies, the Montana Coalition. A non profit organization dedicated to improving the health, safety, and well being of Montana families by supporting mothers and babies ages 0 to 3. Opinions and views expressed in these interviews do not necessarily represent the views of HMHB as an organization.

Visit us at hmhb-mt.org to learn more about who we are and what we do. If this episode of a Mining City Story resonated with you, and you're interested in finding similar services in your own community, We invite you to check out LIFTS, our statewide online resource guide, at hmhb-lifts.org. If you're a provider of care to moms and babies in Montana, we encourage you to get in touch and list your services in LIFTS at no cost.

Thanks for listening. We hope you'll join us next time for more stories of pregnancy and parenting in Montana.