Natalie: 0:01

On today's podcast, we're talking with Molly Lunsford about pregnancy and self-advocacy in prenatal care. I'm Natalie and you're listening to the resource doula podcast. Hello and welcome I'm Natalie. And I'm so excited to have Molly Lunsford on today to talk about pregnancy prenatal care. All of the good things. Molly is a student nurse midwife and a student women's health nurse practitioner. She pursued women's health and midwifery, after seeing the fertility and gynecological concerns, people around her were experiencing. She realized that there's a great need for honest and consistent providers who are willing to listen to their patients. The holistic health model guides her care along with evidence-based practice. Her background is in family practice, inpatient care and women's health. Currently Molly works in a local birth center as a registered nurse in gynecological and midwifery. She is also a birth assistant who works with midwives and advanced practice nurses to support laboring clients. Midwifery and women's health are constantly changing to provide the best and most evidence-based practice. Molly serves as a student liaison for Georgetown university within the American college of nurse midwives, where she advocates for positive change at the professional graduate school. Molly holds a bachelor of science in nursing science from the university of Alaska Anchorage. When she's not in clinic, she spends most of her time outdoors exploring Alaska with her husband, daughter, and two dogs. So welcome Molly.

Molly: 1:37

Thank you, Natalie.

Natalie: 1:40

So I want to just start by just kind of talking about. What you do. And for a lot of people who may be unfamiliar with the differences in types of prenatal care. So some women may see an OB, some may see a midwife, some may see a direct entry midwife. What are the differences? And, and how does that all work?.

Molly: 2:00

Yeah. So that is definitely great question because I think a lot, a lot more awareness is being brought to midwife midwifery, especially during the pandemic. And, we're so fortunate to live in a country where we can choose between all these different models. so midwifery means with woman and so in midwifery care, our goal is to support patients in their, in their care throughout the lifespan, as much as we can, but particularly in that prenatal and antenatal care. We are looking for kind of a hands-off approach, not in a way that we're ignoring risks when they come up, but it's, how can we support this person without bringing all of these interventions on that might not be necessary? And obstetric and gynecological care is wonderful in that. It came about as a way to address some of those high risk things. So a lot of people think of like C-sections and inductions and those sorts of things. And while those are often looked upon negatively, it's important to have them. And I think a lot of people. Picture like midwifery care versus obstetric care and there's, they should work really well together. There's that overlap where kind of midwifery care, maybe it's beyond the scope, the obstetric and gynecologist can come in. So it's definitely more of a teamwork thing. And it really depends how much intervention you want.

Natalie: 3:33

That makes a lot of sense that that's great. Can you define the word? antenatal for us for

Molly: 3:38

Yeah. So that's going to just be like all the period before before the patient gives birth. So that can be from the time they find out they're pregnant, it can even be like in that preconception period as they're planning to get pregnant. But we mostly think of that as the time before labor happens.

Natalie: 3:56

Okay. Awesome. Thank you. So where can a midwife provide services? Are they only out of hospital or can they, can they deliver babies in the hospital?

Molly: 4:07

Yeah. So that's actually one of the biggest misconceptions I think right now is I think people think of midwives as, okay, it's a home birth and it's an, a tub and it's like, that is one aspect. There are a couple of different types of midwives, so To answer your question. Yes. Midwives can deliver in the hospitals depending on what type of midwife you are. There are certified nurse midwives who go through a, you have to be a registered nurse first at the bachelor level, and then you can either get a master or doctorate level. And go in and practice in a home birth setting in birth centers or in hospitals. And like I said earlier, they just, they can't do things like be the primary person in a C-section they can first assist. There are a lot of things that they can do. But then there's also a class of certified direct entry midwives and certified professional midwife. And that program looks much more like an apprenticeship and they take very similar classes to certified nurse midwives. And they, they have very intense like clinical rotations. That apprentice model allows for that. They are not allowed to practice in hospitals. And they have strict guidelines for their home birth and birth centers. And I believe I'm still learning about this a little bit. I do believe that they can kind of work with midwives that have hospital privileges and kind of like share care there. So that's kind of there's a wide range that midwives can do, which is lovely.

Natalie: 5:43

Definitely. Definitely. So you're becoming a certified nurse midwife, but you're also becoming a women's health nurse practitioner. Talk a little bit about that in the scope of, of that practice.

Molly: 5:56

Yeah. So when I was looking at programs and trying to figure out what I wanted to do, I, I found the program where it offers this dual track. And for me, I love the birth process and everything that surrounds that. But I also love the fertility aspects and being able to care for the the woman across the lifespan. So that's where women's health nurse practitioner, scope of practice comes in. That's more primary care of women. And we actually can also provide, sexual and reproduction health care for the partners of our patients that come in as well. So that, that scope is just a little more in the primary care side of things.

Natalie: 6:40

That's really interesting. I had no idea that you could do.

Molly: 6:42

Yeah.

Natalie: 6:43

That's news to me. Cool. Cool. so that kind of gives a little bit more continuity of care for it, seeing somebody and, and typically they see you a couple of times postpartum once or twice, and then you're done. But with the, the nurse practitioner, you can see them forever if you

Molly: 7:01

Yes. Yes.

Natalie: 7:02

do okay. so speaking of if they wanted to, let's talk a little bit about advocacy, because this is something that midwives talk about doulas talk about. And it can be a little bit daunting for someone who may not be in the birth of world, or is, is maybe someone who tends to just take everything that science or their doctor provides as truth, and hasn't had that expense. Having to advocate for themselves in any kind of situation medically related. So let's talk about the idea of advocacy first and then how that relates to healthcare specifically in pregnancy and.

Molly: 7:47

Yeah, I think there's been this movement on social media, about people sharing their less than ideal situations with healthcare providers and kind of. Recognizing that just because you go to someone doesn't mean that they can tell you everything to do and expect you to follow that. One way that I like to look at it is healthcare providers may be the experts on the physiological processes, but the patient is the expert on themselves. And so you have to take, you have to take both of those and bring them together. And I even think back to my own birth. So I, I chose to go with an OB GYN who I trust and respect very much, and she participated in my care, but also like really was always asking me what I wanted to do, which I appreciate it. However, when I was in the hospital giving birth, there were a lot of things that I realized after the fact that I didn't necessarily have to do. And I think that, like, I, I looked back on that experience and it wasn't negative. It was just, it was me realizing I'm in healthcare, I'm in women's health and I still don't even know all the ways that I can advocate for myself. I think the biggest thing going into choosing your care is doing the research. If you're going in for an annual exam and you want to ask about certain tests, if you know, there are different. Histories and your family, you can bring those things up and have conversations with the providers. It definitely takes more work on the patients and to make sure that they, you know, present these questions, but it becomes so important. And so empowering because it's not just. The patient being told what to do. It's the patient and giving the provider ideas and looking at evidence evidence-based practice and deciding if it's an appropriate thing, an appropriate test to run or anything like that. And same thing goes with labor. I think, I think we have this. View of labor often as in a hospital setting on your back, like you have the stirrups and everything and that you know, some people want that and that's, and that's great for them, but I think a lot of people don't realize that there are other ways that we can birth and there are other ways for your body and. You know, being able to stand up for yourself and say, no, this is what I want is important. And then knowing you can trust your provider to not force you to do anything unless they need to like persuade you. Oh, this is an emergent situation. Maybe let's do this. So yeah. It's that, it's that balance.

Natalie: 10:38

Hmm. Yeah, that's a really it's a fascinating topic and it's something that I think we could dive a little bit deeper into. Are there any specifics from your birth story that you would like to share of things that you realize later? Oh, I, I could have skipped that. Maybe if I had said.

Molly: 10:55

Yeah, I think this is, this is, so this is such a small thing. But I remember before we were discharged from the hospital, they were like, we have to give your baby a bath. And I was. Oh, okay. And I hadn't done as much research on the time about the vernix, which is kind of that sticky substance that covers babies. And it's really interesting. The micro biome that it produces and just how good it actually is for baby's skin. And it's like totally not necessary to give baby a bath in the first 24 hours. And. I listened to a podcast that kind of talked all about that after the fact. And I'm like, no, this is something that I can, can advocate for it because evidence shows that it's a very positive thing. And so that was, that was one thing. And then there were you know, different things through my breastfeeding experience. There are so many different methods to teach about lactation, and I think there there's one side. Swings more towards you can only breastfeed. That's the only thing that you can do. And the other side that it's like, don't worry about it. And in my case, I think, you know, I, I struggled those first four weeks. I was like, man, I need to give up on this. And the tools that I were given were kind of. Band-aids and they weren't actually like helping address the problems. So once I was able to speak with people who took the time to listen to my story and, and everything that was going on, it was like, no, no, no, you can do it this way. So yeah, I think those are two things that really stick out in my mind. So

Natalie: 12:33

Yeah, and that's, that's pretty common. I feel like those, those specific things are very common from what I hear from clients as well. So it sounds. You're internalizing all of that and flipping it around, flipping it on its head for how you are working with your own patients and your own clients.

Molly: 12:52

definitely. I, I think, you know, In professional practice, there is an appropriate amount of your experiences that you can insert into a situation to share with patients. But of course not in a way that, you know, makes them feel like you're persuading them one way or other. But I have found that being human in all of my interactions with my patients and. You know, sharing, okay. Maybe this was an experience that was positive for me, or it was negative for me. But ultimately reminding them like it is, it is your choice and what worked well for me may not necessarily work well for you may not necessarily work well for the next person.

Natalie: 13:31

Yeah, no, that makes sense. And I think, I think that's true for probably everything in healthcare, but everything in women's healthcare. I was just watching the film. I don't know if you've seen it yet. The business of birth control.

Molly: 13:43

Oh, no, I haven't.

Natalie: 13:45

It's a Ricky lake. And Abby Epstein, they did the business business of birth. Have you seen that one?

Molly: 13:52

I haven't heard of this one that I'm going to have to add these to my

Natalie: 13:54

okay. Okay. Yes. Add them. And with documentaries, of course, you always have to have to watch them through a lens of,

Molly: 14:02

Yes.

Natalie: 14:03

you know, discernment, but they were just talking about all of the side effects from certain types of birth control that were not disclosed appropriately to women prior to prescribing them this medication. To the point where some of these women died from the side effects and, and all of these people are saying, why are we not advocating? Why are we not telling women that this is potentially a problematic thing for their health and screening them better? And so the ultimate conclusion of that was we need to equip women to ask those questions and we need to tell women to advocate for themselves and. Dig a little bit deeper into what their provider is telling them, rather than just going along with it. Because if we try to convince all of the providers and you know, the whole medical system and the pharmaceutical companies to do this, that's not going to move us forward. But if we convince women, that's where real change is going to be made. So have you seen, have you seen that not specifically birth control? Doesn't have to be. With women finding their voice. Have you seen things change now that you've been in practice a little bit?

Molly: 15:15

Yeah, actually birth control is one of the biggest areas. I see it., You know, once again, it's a very personalized experience. What works well for me may not work well for you. And it is interesting., just speaking with people who have been prescribed a certain birth control and are having all of these effects or not being told, okay, once you get off of this, if you've been on it for this long, you may not be able to get pregnant as soon as you would like. And, and that can be really detrimental to people. I think you know, going back a long time ago, there was a hormone therapy called DES and that was given early on. I believe it was in the seventies, but they, they gave it to women and found out later when their daughters were starting to receive gynecological care, that it actually changed the way that they. Their cervix and their uterus where we're lying. And so it's one of those things that. You know, you have to choose for yourself with newer things that are on the market. It's like, okay, we don't have long-term research on this and asking the questions that you can have your provider to see what they know about it. And, you know, I think, I think it's hard to kind of like step into something that's so brand new. When you have all of these things on the market, that may be. Considered safer, but it's always good to ask the questions and know what options you have. Because you know, with some of these things, you're, you're hoping that it won't affect you or your children down the line. So.

Natalie: 16:53

Yeah , I think that that concept of this may affect my children's health is a whole nother level of how we need to advocate for our own health. So if you were someone who's pregnant brand new first time, And you're trying to decide. I want to maybe see an OB. I want to see a midwife. I'm not really sure. What are some questions that you would recommend? They ask their provider when they're there interviewing them as a, as a way to determine like, okay, I'm going to hire, hire this.

Molly: 17:27

Yeah, well, I think even before interviewing the provider, it's important to kind of. Reflect on what birth experience you want. Do you picture it in the hospital? Do you picture it in your home? And, and sometimes those desires will kind of totally separate which providers that you can or can't see, but I think if you were looking and you had no idea what type of birth, I think it would be important to know. Okay. Going into a practice that has a lot of midwives or a lot of OBS. Are you going to be with one provider the entire time? Are you going to be with multiple providers? I think that was a big thing for me is the provider that I see every time I'm going to be the provider at my birth and because a lot of women. I don't necessarily feel as safe if you know, someone that they've never met is suddenly stepping into a very vulnerable experience, so I think that's part of it. And another thing that is important to me and may not necessarily be important to another person, but as good to consider is what does the care look like? After birth? Are you just being seen at six weeks and told, okay, you're good to go. Or are there places where you're checked in on within the first couple of days? And then maybe two weeks and six weeks in and further on it it's interesting. Midwifery care. Less intervention, but I've seen it actually have more visits because it's, it's just checking in with people. and then obstetric care maybe is more heavy on the front end, but a little less on the backend. So those are kind of things

Natalie: 19:12

postpartum visits. Is that what you're

Molly: 19:15

Yeah, exactly. I, I know this is changing as a conversation. In healthcare right now is some OB providers are starting to include more visits after which is, which is great. So they're seeing that that's what people are wanting and, you know, there's, there's not necessarily harm in adding those extra visits. I think another thing is, you know, what resources are available? Does the practice have like a nurses or MAs that you can call? If you have questions to connect you to a provider? Are there birthing classes, is there lactation support? And then I think probably the biggest one is actually something that we do at our practice. If a patient is coming in, we'll have an initial consult and we're looking to see if we're a good fit for you, but also are you a good fit for us? Does our mission? At our facility align with what your mission is for your birth. And so knowing your mission and asking the mission of the people who could potentially be caring for you. Just saying that, you know, as you're, as you're choosing care, figuring out if your mission for your bird. Aligns with however, they're practicing. If you want a scheduled, C-section a midwife is probably not your best option. And if you want if you don't necessarily want to be monitored the entire time during your labor, and you're a low risk pregnancy, you might not like the hospital setting. So yeah, just. Figuring out what your vision of birth looks like, recognizing that it could change. Of course. Because every birth is unpredictable, but like what is, what is important to you at the core?

Natalie: 21:02

I love that. I think. That's something that maybe not a lot of people think about to begin with, like, oh, I'm pregnant. Okay. I'm going to go see an OB. And I just start that whole process because that's what my friend or my sister or, you know, my mom told me to do, or that's just what I understand happens. And I think there's a lot more awareness about midwifery these days with social media as well. But it's important to you're the expert on your own body and while the provider. An expert in, in birth and all the processes around that. They, the more they see you with the added visits with midwifery, the more that they're going to be the expert on your own body as well. And add to that. So okay. So I wanted to talk about, I mean, we kind of, we kind of went over some of the misconceptions with midwifery. Is there any other misconceptions about midwifery that you find. You may be dispelling some of those myths on the regular or.

Molly: 22:04

No, I think honestly the biggest ones were that midwife. Can only practice like at home in a tub. And that was the biggest one. And just a lot of patients are pleasantly surprised that, oh, my midwife can deliver in a hospital. And most midwives in the United States are in hospitals now. So that is kind of interesting. Like there are birth centers around, but you know, they're in hospitals and then yeah, I think that's honestly the biggest one. And then once you start. Reminding your patients and like, we can be here for you. I think that's one that brings them a lot of comfort, so.

Natalie: 22:40

Cool. Okay. And then I want to talk about some of your, some of your resources that you regularly give to clients and what you would tell somebody who is a research nerd like myself. Like I want to know everything possible before I go into the appointment. So what, where are the places that you generally really send.

Molly: 23:02

Yeah. So I'll just kind of like start this off by saying, I am not personally referring anyone right now to different resources, but I'm starting to collect my resources. Things that I could recommend to people. So I think one of the biggest ones that I have really liked is a a doula on YouTube because I think it's naive for, for me as a healthcare provider to not think that my patients are gonna go on to like Google and like find everything. So I'm like, okay, where are the sites that people use a lot? And what are. Valid sources. So Bridget, Tyler is a wonderful doula. I don't know if you've seen her work or anything, but I just love her videos. And I think. For someone who doesn't have access to birthing classes or is just kind of like, how do I prepare for the birth experience? She is a great wealth of knowledge. So I, you know, I even watched her videos before my labor and it was, it was like, I don't have a doula, but this is like my YouTube doula. So this is great.

Natalie: 24:07

Nice.

Molly: 24:09

and then for. For kind of more resources directly from the midwife. There is a gal on Instagram. She goes by midwife Marley and she talks about a variety of topics. And I think she does well too. Address some of the harder issues like postpartum mental health concerns some of the traumas surrounding labor and how we can be perform trauma based care and, and making sure we acknowledge that and also advocating for. Individuals that are experiencing health disparities. So I feel like she's just very well-rounded. And then the other two that I would recommend are the birth hour, which is a great podcast. If you just want to hear more about birth experiences, I love listening to birth stories. I think it's great. And for someone who's maybe never been in labor and they're thinking, oh my goodness, like, what am I heading into? Just hearing other women's experiences. Most of the time, I hope it can be empowering. And then the last one is the empowered birth, I think, is what it's called. I can also send these resources to you. And that is kind of tagging along with how are we how are we performing? Trauma informed care and making sure that if a patient has had a very negative experience in their previous birth, what we can do to prepare them for their next birth or even next wellness exam, whatever it is that they've walked through. And I think that's becoming a very, very important topic in healthcare right now. So

Natalie: 25:37

I agree. And I know most of those resources, So I will add the birth hour to my podcast list. I'm excited about that one. I think a lot of us in women's health Are intrigued by birth stories. We listened to them probably more than the average person, but

Molly: 25:53

Yeah, I do think another book, if, if people want to kind of dive into the nitty gritty as the fourth trimester. Think it is often neglected on those the six weeks following the birth, like, okay, what do I do with myself? What do I do with my body and that book? I definitely errors more on the side of, of hands off. I would definitely like compare with your research and everything and, and speak with your provider about like what's best for you, but so many wonderful resources in there on how to care for yourself in that postpartum period.

Natalie: 26:28

I will link all of those resources in the description of the podcast so everybody can find them easily. So what is your number one piece of advice for our listeners? What would you like everybody?

Molly: 26:43

I think the biggest thing that I am advocating for is for my patients advocating for themselves. I really appreciate when a patient comes in and. Says, okay. I'm experiencing X, Y, and Z. I think it might be related to X, Y, and Z part of healthcare. I feel like a solving a mystery half the time. And the more clues that you have, the better, it doesn't need to be just the provider, finding out all of these clues themselves. The patient definitely brings that in. So whatever a patient can bring into the setting that is the most important. And I'll kind of reiterate what I said before. Healthcare providers may be the experts on the physiological processes, but the patient is the expert on themselves. And without both, both pieces there, we're not going to find a solution for what care needs to happen.

Natalie: 27:44

Well said, well said I liked that. I think evidence-based birth is a really valuable resource for people who are looking for pros and cons lists that align with research. So you may experience people bringing that into you. But that is the one that is pretty popular, I would say. And then. What is, what is your favorite wellness habit that you incorporate into your own daily life? As you're, you're working birth late at night, you've got lots of stuff on your plate right now. How do you how do you stay?

Molly: 28:22

you know, 20, 22, I kind of just like cut a lot of things out of my life. Reasons because I am in school and I'm working and I'm a mom and a wife and all the different things, but a big one for me is I have uninstalled social media apps on my phone during the week. And like I'll re-install them on the weekend, but I found that. That time that I would have been scrolling, I am listening to books and that was something that I really wanted. I wanted to be a more avid reader and I was like, I never have time for reading. Well, actually I did. I was just on social media a lot. So for me, I find that reading particularly non-fiction books is something that keeps my brain active and inspired on topics related to women's health or topics that are totally different. And it just. I dunno, it, it gives me a lot of rest in between the times that you know, I am up late for a burst or something like that. So that's been my biggest wellness thing in, in 2022. And I definitely hope that continues.

Natalie: 29:27

Good for you. That is hard to do. That is a really a challenge. So what are you, what are you reading right now? Can I ask you

Molly: 29:34

Oh, okay. Yeah. So I

Natalie: 29:36

does not have to be women's health really?

Molly: 29:38

No, these ones aren't women's health. So I just finished reading. You are not enough and that's okay by Allie Beth stukeley which I like to choose books that I agree with and books that I disagree with. And so I was, that was one of those books that I was like, okay, I'm a little skeptical going into this and, and learned a lot from it and really enjoyed it. And this morning I just started pagan Christianity, which is about some of the practices in Christianity that are not necessarily. Made from the Bible, but we kind of just assumed we're from the Bible and how they've kind of shaped modern evangelicalism. So I'm a nerd. I like reading about all sorts of things.

Natalie: 30:17

I love it. I love it. I need to add those to my list as

Molly: 30:20

Yeah. They're great.

Natalie: 30:22

Awesome. Well, Thank you so much Molly for joining me and having this conversation today.

Molly: 30:28

Yeah. Thank you so much for having me.

Natalie: 30:31

Yeah, absolutely. Absolutely. And I think I can see us talking more in the future about specific, topics. So we will have you back.

Molly: 30:40

Wonderful. Thank you so much, Natalie.

Natalie: 30:42

It was so nice having Molly on today. I really appreciated her perspective on midwifery as she's in the midst of learning evidence-based practice and the best ways to serve her patients better. My top takeaway from this episode is the importance of learning to advocate for your own body and health using resources, putting in a little more work ahead of time and bringing questions to your provider are all ways Molly encourages her patients to participate in their own care. It can be overwhelming to start advocating for yourself, especially if you've never done it in a medical setting before. An easy way to start practicing. This is by asking questions. Like what is the purpose of this test? And can I get a pros and cons list for this procedure? By working to understand. The procedures and tests that your provider is recommending. You are already advocating for yourself These are skills that will serve you well throughout your pregnancy labor experience, postpartum and into parenthood as well. Just a reminder that what you hear on this podcast is not medical advice. Remember to always do your own research and talk to your provider before making important decisions about your healthcare. If you found this podcast helpful, please consider leaving a five-star review in your favorite podcast app. Thanks for listening.