PREGNANCY

What Your Providers Think When You’re in Labor with CNM Juli Pyle

What are your providers thinking about when you’re in labor? When a tiktok went viral about what bugged labor nurses, the labor community went wild — but in reality what ARE your providers thinking about. I loved having a CNM on the episode to chat about it.

Today’s guest is Juli Pyle (she/her) a certified nurse midwife who practices at a community hospital in rural Pennsylvania. Juli was a stay at mom for many years to five children before deciding to return to school to pursue a degree in nursing. She graduated from Colorado Mesa University with a bachelors of science in nursing degree in 2016 and then began her nursing career as a labor and delivery nurse. She quickly discovered that this was her true passion (as she had suspected since having her own children) and quickly gained a reputation for professionalism, compassion and expertise among colleagues and patients. She then returned to Frontier Nursing University to complete a Master’s degree in Nursing with an emphasis in midwifery. In 2020, she graduated and began as a certified nurse-midwife at a small community hospital in central Pennsylvania where she has been since that time. Her focus as a CNM is to provide evidence-based education to all birthing families, give true autonomy and informed consent throughout their time with her and to share love, understanding, empathy and true shared-decision making. When not immersed in the birthing world, she enjoys spending time refinishing furniture, gardening, raising and breeding different types of chickens, hiking and vacationing with her family.

This episode was inspired by Labor Nurse “icks”

Big thanks to our sponsor The Online Prenatal Class for Couples — if you’re looking to communicate with your healthcare team, come join me in there!

In this episode

What we thought about the labor nurse “ick’s”

Difference between midwives, doctors and nurse’s thoughts.

Producer: Drew Erickson

Check out my other pregnancy podcasts:

It's not going to hur my feelings, so you don't need to worry about me at all.
Transcript
[00:00:00.160] – Hilary Erickson

Hey, guys. Welcome back to the Pulling Curls Podcast. Today on Episode 189, we are talking about what your providers think about when you are in labor. Let’s untangle it.

[00:00:19.700] – Hilary Erickson

Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls Podcast; Pregnancy and Parenting Untangled. There’s no right answer for every family, but on this show, we hope to give you some ideas to make life simpler at your house. Life’s tangled, just like my hair.

[00:00:40.950] – Hilary Erickson

Okay, excited to have today’s guest on the podcast. It’s actually her second time. She is a certified nurse midwife in rural Pennsylvania. I want to introduce today’s guest, Julie Pyle.

[00:00:53.540] – Hilary Erickson

Do you feel prepared for your delivery? In just three short hours, you can be prepared for the confident, collaborative delivery you want. You’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class. I’ll use humor stories from my 20 years in the delivery room to engage both of you. I love how Alyssa told me that she found herself laughing at things that used to sound scary. Most of all, you guys are going to be on the same page from bump to bassinet. Join the Online Prenatal Class for Couples today. You can save 15% with coupon code UNTANGLED. You can find the link in the show notes.

[00:01:29.000] – Hilary Erickson

Hey, Julie. Welcome back to the Pulling Curls Podcast.

[00:01:31.990] – Julie Pyle

Hi, Hilary. Good to be here.

[00:01:33.670] – Hilary Erickson

Yeah. Julie was on in a previous episode where we talked about why you might want an induction.

[00:01:38.070] – Julie Pyle

I got some really good responses from that, and I think a lot of people liked that episode.

[00:01:41.960] – Hilary Erickson

I just think people have to consider what they’re not thinking, which is really hard sometimes because you think what you’re thinking is right, right?

[00:01:49.630] – Julie Pyle

That’s exactly it. We all think that we’re on the right train of thought, and it’s not always that way.

[00:01:55.150] – Hilary Erickson

Yeah. So, Julie and I were chitty chatting after… It’s been a while that there was a TikTok that was filmed a while ago with nurses telling their icks about labor patients and the labor community. And people in general just lost their minds over it. And of course, the labor nurses just started attacking each other, which I always love. Right, Julie?

[00:02:15.760] – Julie Pyle

Oh, it’s a whole different world when that happens.

[00:02:18.470] – Hilary Erickson

Which that is a full other episode. But a lot of people who were going in to have a baby were like, I can’t believe you guys would ever think things like this. And obviously they shouldn’t have recorded it.

[00:02:28.770] – Hilary Erickson

That’s my number one. It’s not something that needs to be public, things that frustrate us in labor and delivery, just because I don’t think it should be public anywhere. Like other ones I saw, like when you were at a hotel, things that bothered them.

[00:02:41.100] – Julie Pyle

Yeah, I felt like, no matter what the profession is, there’s things that happen. But definitely that is not something that should have ever left the nurses brains or their very private conversations.

[00:02:52.130] – Hilary Erickson

Yes. So we want to say that right off the bat. People need to be.. Even I… So I do a lot of Disney stuff, and when Disney creators or Disney employees talk about their icks about when people ask things at Disneyland, I’m like, I paid so much money to be there. I shouldn’t be rude. I’m not saying I should be rude, but if I have a dumb question, that’s part of your job.

[00:03:14.360] – Julie Pyle

And as people that work around birth all the time, things that we think about are so different because the people that we’re taking care of, this is their first time. It’s not our first time. We’ve been doing it for a very long time, but their first time is different. And the things they’re going to ask make sense to them, or they wouldn’t ask it.

[00:03:30.780] – Hilary Erickson

But that isn’t to say that we’re not human. And a lot of labor nurses have young children at home, may not have gotten the most sleep that they’ve ever wanted to have in their lives. That was me.

[00:03:41.650] – Hilary Erickson

A lot of times I would come to work and I was so tired. You’re taking care of a sick kid all night and then you’re at the hospital and you’re just like, this is a forever long shift. And so stuff frustrates you. Am I right, Julie?

[00:03:52.150] – Julie Pyle

Yeah. I think as we’re talking about this today, understanding that we’re all people, the labor nurse is a person, the patient that’s having the baby, that’s a person. We’re all having these experiences together and just being kind and considerate to each other goes a long way.

[00:04:08.370] – Hilary Erickson

Doesn’t it? Because ultimately it just comes down to communication, which we’re going to talk about at the end. But communication is hard. It’s hard in marriage. It’s hard in the workplace. It’s hard at Disneyland.

[00:04:17.780] – Julie Pyle

Yeah. Coming up on 24 years being married and you’d think I’d have it nailed down, right? But no, communication is still a struggle.

[00:04:25.110] – Hilary Erickson

Yes, it’s so hard. And hopefully you guys realize that, too. It’s hard to communicate with your partner, especially during pregnancy because you have all those crazy hormones that are taking you all over the place.

[00:04:35.100] – Julie Pyle

Yeah, you don’t even know what’s going on in your own body, let alone telling somebody else about it.

[00:04:38.980] – Hilary Erickson

Right. Sometimes I’m just like, no words, no words. I’m just like running on DOS, basically. Yeah.

[00:04:47.860] – Julie Pyle

Absolutely.

[00:04:48.620] – Hilary Erickson

So I think a lot of times patients think we think specific things like, will I poop at delivery? Or what does your labor nurse think if you don’t have your leg shaved at delivery? I can tell you she thinks absolutely nothing. Or no, she’s thinking a million things. She’s thinking, “when will I be able to eat?”, right?

[00:05:04.760] – Julie Pyle

Yeah, the things that they are thinking about are not the things that we care about at all.

[00:05:09.740] – Hilary Erickson

No. Or what’s my patient in the other room doing? I’m looking at her monitor while I’m talking to you. There’s just so many things that are on our mind that you don’t understand. Same as Disneyland, same as being at a hotel. Employees just have different things on their mind than you would ever think they thought about.

[00:05:26.980] – Julie Pyle

Absolutely. And I think that’s even more true in the case of when people are having babies.

[00:05:31.950] – Hilary Erickson

Yeah. So I think I have seen on TikTok a lot of people that are like, when you say XYZ, you think I’m judging you as a parent, and we’re literally just checking the box.

[00:05:41.980] – Hilary Erickson

Are you going to breastfeed? And you say no, I’m like, I don’t care. I’m literally just checking the boxes. There is absolutely no judgment going on during box checking time.

[00:05:51.330] – Julie Pyle

Yeah. I think our hope is that you’ve done some research and some thinking before you’ve come in to actually have the baby. And so what you’ve decided or what your thoughts are, those are yours and we’re there to be a part of it but we’re not there to judge it.

[00:06:04.910] – Hilary Erickson

No. And I guess if you told me you weren’t going to feed your baby at all, then I would be like, okay, now we need to have some conversation about this. Or if you were just like, the baby is going to eat, then I would be like, oh, wow. Okay.

[00:06:18.480] – Hilary Erickson

But people are surprised that we get those random answers that are like, I have never considered that the baby is going to have to eat after delivery. And you’re like, okay, you have to realize that we are getting such a huge spectrum of patients. We have gotten some weird answers sometimes to those checkbox questions.

[00:06:36.070] – Julie Pyle

So true, so true.

[00:06:36.940] – Hilary Erickson

Just going to put in a social work consult right here.

[00:06:40.660] – Julie Pyle

And I think you touched on this. As nurses, we’re busy with a lot of different components. And so our brain is probably thinking about something in the other room, something that somebody said earlier in the shift, then focusing on judging what you’re choosing for your birth journey.

[00:06:59.330] – Hilary Erickson

And one of the weird things about labor and delivery that it’s not as true on other units, not only am I watching Jane, who’s my other patient in another room, I’m also watching Marge’s strip. I’m also watching… We glance up at that strip and we within seconds can just take in that entire screen and just make sure all of our coworkers are okay. And that’s really important that we’re doing that, too.

[00:07:22.160] – Julie Pyle

Yeah. Or you’re thinking about the nurse that just called off and what are you going to do for the next shift? There’s a million things, but at the same time, we really are focused on exactly what you need and hoping to make everything perfect for you, too.

[00:07:34.570] – Hilary Erickson

It’s a lot like parenting, right? Because you’re like, what are we going to have for dinner? But at the same time, you’re playing with your kids.

[00:07:40.590] – Julie Pyle

Yeah, exactly.

[00:07:41.260] – Hilary Erickson

We’re the multitaskers of the world. Julie had a really interesting point about how doctors versus how a midwife or a nurse might take your choices in labor. So what did you mean by that, Julie?

[00:07:52.870] – Julie Pyle

Well, I guess talking about the nurse perspective first, as a nurse, you’re trying to balance what the doctor orders are, what the patient wants, what else is happening in your shift. There’s all these things going on.

[00:08:07.300] – Julie Pyle

So I think as a nurse, when we get a question, we’re like, I really wish your doctor or midwife had talked to you about this in the office before showing up for your induction. I really wish you knew this information because I’m happy to talk to you about it, but now it’s new information for you and you haven’t been able to even think about it. So I think that as nurses are battling a lot of those other pieces that are coming at us, and we are the one that’s right in the middle of it all.

[00:08:32.660] – Hilary Erickson

A lot of our need is balancing the unit because if it’s too busy, I literally cannot start your induction because it’s just not safe.

[00:08:39.470] – Julie Pyle

Yeah, exactly. Just that piece of it, you’ve never met this nurse before, but they’re literally the person you’re going to see the most and you’re going to interact with the most, more than your doctor, more than your midwife.

[00:08:50.020] – Hilary Erickson

Yeah, that’s why you got to say your affirmations. I’m going to have a great labor team, right? So you come in expecting them to be a great labor team, and they will rise to your occasion.

[00:08:59.400] – Julie Pyle

And the nurse is the one person you have the least control of who it’s going to be. So it’s an interesting dynamic.

[00:09:06.170] – Hilary Erickson

Or who it changes to. Just because you get Sally doesn’t mean Sally staying with you forever. She may deliver across the hall.

[00:09:13.530] – Julie Pyle

Yeah, that’s exactly right. So I think as a nurse, we’re really trying to put it all together for you. And so a lot of times our thoughts are probably actually directed at the doctor.

[00:09:23.200] – Julie Pyle

Like, when your patient says, oh, the doctor said we’re going to do this. And you’re like, that is not how this works. That’s my thought versus worrying about the specifics of it. You know.

[00:09:32.530] – Hilary Erickson

Yes, there’s much more judgment probably going to the other health care providers than the patient by far.

[00:09:38.280] – Julie Pyle

And I certainly don’t want to act like I’m speaking for all doctors everywhere because or all midwives everywhere, even though I am a midwife. So I’ll just put that out there as a disclaimer.

[00:09:47.030] – Julie Pyle

But my experience has been that your physician, your doctor is going to be much more focused on the timeline of things, focused on what’s happening when he or she’s not there versus the whole experience. And I think as a nurse, we’re a little more focused on the whole picture if we can be.

[00:10:05.280] – Julie Pyle

And many midwives are going to be a little more involved, a little more receptive to some of the different thoughts or ideas that might be coming from your birth plan or what you want to have happen. So those are three very distinct different parts of the journey, and you’re going to get different responses through all of them.

[00:10:22.300] – Hilary Erickson

Yeah, because you have to think that a doctor is trained to come from a very medical perspective. So when you’re like, I’m going to have a three course meal right now, that doctor is thinking, what if we end up in a C section and you aspirate, right?

[00:10:33.980] – Hilary Erickson

Whereas a midwife or a nurse is like, okay, you might throw up, but here’s the bag just in case. They’re thinking 20 miles complications down the road. Whereas we’re like, well, she’s hungry and we know that her uterus needs glucose to contract, so let’s get some in there.

[00:10:54.260] – Julie Pyle

Yeah. And that goes back to my point of your nurse is with you the most out of anyone in the process, and they know you need food and they know you want to move and you want to do these different things.

[00:11:04.500] – Julie Pyle

So yeah, I just think a doctor’s perspective and their thoughts in the journey are going to be a lot more regimented and check box. And again, I hope that’s not offensive to any doctors listening.

[00:11:15.450] – Julie Pyle

And most midwives are a little in between both. They know we have to do some things to have a baby and make sure everybody’s safe, but also understand a little bit more about the whole person that’s having the baby.

[00:11:26.150] – Hilary Erickson

And like you said, I mean, I have seen midwives that act just like a doctor. There is absolutely no difference in how I get orders or what they want to do. And I’ve seen doctors who are way more like a midwife than even a lot of the earthy, earthy midwives I’ve seen. So that just comes from knowing what your doctor is going to do.

[00:11:45.360] – Hilary Erickson

That being said, almost every doctor still has those complications in their mind because that’s what their job is. That’s what we’re paying them to do.

[00:11:52.920] – Julie Pyle

And they’re trained to be the person that is the most responsible in whatever situation happens. They’re the ones that it falls on. So of course, they’re going to have a different thought process.

[00:12:02.900] – Hilary Erickson

Yeah. So it all boils down to communication, which I absolutely hate because it’s so much easier when people read my mind.

[00:12:09.550] – Julie Pyle

I haven’t had that experience yet.

[00:12:11.620] – Hilary Erickson

No one’s ever read my mind. But if you ever wonder what is going on, if you want to know what the nurse thinks, she can’t tell you everything that she’s thinking, mostly because we have to be like, Well, your doctor said XYZ, but she can convey that through body language or things that they encourage you to say.

[00:12:34.540] – Hilary Erickson

Usually, if I was adamant that I really didn’t think this patient needed a C section, and they were like, Well, what do you think? And I’d be like, Well, what do you think? And I’ll be like, Baby looks good right now. I’m not worried about baby. If I was worried about baby, I would be moving a lot swifter right now. Something along those lines.

[00:12:52.180] – Julie Pyle

Yeah, absolutely. And I think maybe a good way of framing it is, what do you think about the Hepatitis B vaccine? Or what do other people do? Because that’s what you’re asking as a patient when you’re saying, should I do this? You’re wondering what else is happening out in the world and what are people doing?

[00:13:08.980] – Julie Pyle

Or I think it’s always valuable to come in and say, here’s what I’ve been thinking about the birth or the labor versus here’s my birth plan on a piece of paper and that’s the end of it. Let’s talk about it. Again, communicate. Let’s discuss it because it’s important to you or you wouldn’t be bringing it up. And we have a lot of experience that we can talk about that are talking about those specific choices.

[00:13:29.820] – Hilary Erickson

But we don’t know if you’re the person who takes Tylenol at the first whiff of a headache. We don’t know if you’re the person who doesn’t take Tylenol until you’re vomiting with your migraine. We don’t know you at all. And everybody’s so different.

[00:13:42.910] – Julie Pyle

Yeah. And I like to approach a subject like, if a patient’s like, Well, do I need a C section right now? Then I just very matter of factly say, Here’s what the evidence shows us. Here’s the research.

[00:13:53.930] – Julie Pyle

Right now, this would not be an indicated C section. We can continue. Baby looks good. Everything looks okay. We can continue. Or on the flip side, saying, This really isn’t a normal situation, and I think we need to proceed a different way. That goes a long way in communicating those ideas and those thoughts that we’re having.

[00:14:09.980] – Hilary Erickson

But I have seen on social media a lot lately, especially because we’re recording this soon after the holidays, everyone was saying doctors push holiday inductions. And I’m like, I think doctors offer holiday inductions because patients appreciate knowing that it’s an option because if your baby’s due on Christmas, most people aren’t like, yes, I’d love my kid to have a Christmas birthday.

[00:14:32.270] – Julie Pyle

Finally, into a patient room, and I know that their due date is the 24th of December, I’m going to ask them, what do you think about having a baby on Christmas? And if they say, Can I be induced? I don’t want to do that. Then we’ll talk about it. Or if they say, I really don’t want to be induced, and I am hoping baby comes after the holiday, then we’ll talk about it.

[00:14:49.340] – Hilary Erickson

Yeah. So they really are… I think it’s best to just think that they’re offering. Like, if you just have that in the back of your mind, my doctor is now offering me a C section.

[00:14:57.950] – Hilary Erickson

It’s my job, just like in a used car lot, because it sometimes does feel like a used car lot when a doctor says, I really think it’s time for a C section, yada yada. Because I am always like, We can totally leave the room and you guys can talk about it yourselves, just like you do in a car lot, right?

[00:15:14.320] – Julie Pyle

That’s true.

[00:15:16.420] – Hilary Erickson

And. I’d be like, This is awkward. But unless there’s a ton of staff in there and you can tell that it is very urgent and the baby is not doing well, that’s really a different choice than your doctor’s offering you induction. He’s offering you a C section or whatever. I think if you just start off with that, what do you think, Julie?

[00:15:32.480] – Julie Pyle

Yeah. And I think what makes the biggest difference in all these scenarios is choosing your care team, looking at different perspectives, does the medical frame of mind really suit what you like? Because then a doctor through the whole process might be perfect. But if you have other ideas throughout what you want the pregnancy and the labor to look like, a midwife might be a really great option.

[00:15:52.680] – Julie Pyle

Sometimes you can have a combination of both. But I think that there’s a lot of different ways to go about it that people don’t think about that part of it. They think I just have to go to the closest doctor’s office. But that may not be the best scenario to fit everything they want. So it’s a process and a journey, and it really does start at the beginning of pregnancy.

[00:16:12.570] – Hilary Erickson

Or it doesn’t have to happen at that first appointment. If you show up at the doctor because I had a first appointment that the guy was just a loser and I switched.

[00:16:20.570] – Hilary Erickson

And yeah, it’s awesome to go in, get that first ultrasound, get that blood work, because sometimes it is hard to get that first appointment in sometimes. And then if you don’t like them, switch because you’re not tied to them forever. Thank goodness.

[00:16:31.150] – Julie Pyle

And again, going back to how we might think about these things. I mean, if I’ve seen you a few times, but it’s just not meshing for some reason and you decide to go somewhere else, I’m not mad about it.

[00:16:41.860] – Julie Pyle

I’m glad that you’re making a decision that makes sense for you and it’s not going to hurt my feelings. So you don’t have to worry about what I’m thinking in that moment at all.

[00:16:48.300] – Hilary Erickson

Oh, I love that because I think a lot of people will think, I like them and they’ve spent a lot of time and discuss things with me, but am I going to hurt their feelings to switch practices? No.

[00:16:57.930] – Julie Pyle

And it’s never too late to switch. I mean, you can switch at the end of pregnancy. You can switch after your first visit. That’s okay. If it starts to make more sense for you.

[00:17:05.420] – Hilary Erickson

Really? I have had seen so many patients about 30 weeks. It gets real hard to change. The doctors are unwilling to take them.

[00:17:13.080] – Julie Pyle

Some practices are a little more hesitant to do that, but there’s no rules or laws or anything saying that you can’t. It might be a little trickier.

[00:17:24.170] – Hilary Erickson

Yeah, call around. And I really liked your thing that a midwife is usually coming from just different thoughts in the background to start with. And so I would definitely plug for you guys to look into midwives. I’ve had so many friends that are really nervous because they think it’s a lay midwife, and Julie is not a lay midwife.

[00:17:42.040] – Julie Pyle

We could do a whole another episode about that.

[00:17:44.660] – Hilary Erickson

I know. How much schooling have you had, though?

[00:17:46.520] – Julie Pyle

I have a master’s degree in nursing. So it’s the equivalent of a nurse practitioner. And a lot of people don’t realize that it’s that same level of expertise. And I do try and tell people that a certified nurse midwife is truly an expert in normal physiologic birth and even some high risk components we get special training in.

[00:18:06.790] – Julie Pyle

And so it’s not like, oh, I don’t want an epidural and I want to have a baby at home. I guess I can have a midwife. I do all of the vaginal deliveries that I do are in hospital, and it’s wonderful. People get whatever care they want. They can labor in the tub, they can have an epidural, or they can have no IV and do absolutely nothing medical, so to speak.

[00:18:27.150] – Hilary Erickson

Yeah. And the beauty is you’re also trained in knowing when you’re like, this is above my pay grade. We need to get an OB in this situation. So then you have a doctor that you hand off to, correct?

[00:18:38.490] – Julie Pyle

Yes, that’s correct.

[00:18:39.760] – Hilary Erickson

And sometimes they just call that OB. And sometimes they hand you off to them and they’re like, It’s better for you to see them for the rest of your prenatal care, right? It’s not always just one and done. You never see them again, correct?

This class really helped prepare my wife and I before our first child.
[00:18:52.630] – Julie Pyle

Yeah, especially where I practice, we collaborate really extensively. So even at extremely high risk, let’s say, preeclampsia, history of postpartum hemorrhage, maybe even a VBAC, that could all be happening in the same person. So the labor process would still be something I could help manage. But the obstetrician would be making sure lab work, medications, any follow up was appropriate for that person.

[00:19:15.640] – Hilary Erickson

Yeah. So I really love bringing that part in because everybody comes from where their background is. I think it’s important to know that midwives have a different viewpoint that they’re coming from, which I adore. I love midwives. If you guys are hesitant to consider a midwife, I say go try one out and see what you think.

[00:19:32.330] – Julie Pyle

Yeah. And there’s no perfect fit. I feel like I connect well with my patients and I really love what I do. But there’s some people who don’t appreciate exactly how I do things. And so they want the obstetrician or they want a different midwife. Or in our area, there’s a lot of late midwives and they choose that. And it’s just a matter of looking through what’s available to you. Not everybody has access to midwives, unfortunately. Hopefully, that will change in the future. But we’re a really good option for a lot of people.

[00:19:57.420] – Hilary Erickson

Yeah. Okay, great episode, Julie. Thanks so much for coming on.

[00:20:00.170] – Julie Pyle

Good to see you again, Hilary.

[00:20:01.430] – Hilary Erickson

Okay, I hope you guys enjoyed that episode because I think it is so important to, one, if you want to know what somebody else is thinking, you can always just ask them. But also mostly just communicating with your health care team, telling them what you want, asking them what they’re thinking, all those different kinds of things. Come join me in the Bump to Bassinet bundle where we have a provider communication bonus video.

[00:20:21.600] – Hilary Erickson

We talk more about talking between your partner and you. We talk all about communication. So I think it’s going to be a great step for you guys to come join me in there.

[00:20:29.540] – Hilary Erickson

Stay tuned. We have two episodes coming up that I know you are going to be interested in. Next week, we are talking about how to get your baby to sleep. And then the week after that, we are talking about tearing delivery and all that that encompasses. So two topics that I know you’re interested in, so stay tuned.

[00:20:44.520] – Hilary Erickson

Thanks so much for joining us on today’s episode. The Pulling Curls Podcast grows when you share us on social media or leave a review. If you do, please tag us so that we can share and send you a virtual hug, which, frankly, is my favorite hugging. Until next time, we hope you have a tangle free day.

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