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Episode 5: Simply Birthed

Cara is joined by Shandra Scruggs, RN, a Certified Doula and the founder of Simply Birthed, an online platform dedicated to providing comprehensive maternity wellness resources and childbirth advice. Shandra recounts her nursing journey and the inspiration behind launching Simply Birthed. Their conversation centers on the challenge of inconsistent childbirth policies in healthcare facilities and the ripple effects it has on nurses, patients, and mortality rates. Together, they explore potential solutions to address this issue and delve into the common problem of rushing the childbirth process, examining its adverse impact on patients, infants, and healthcare professionals.

Shandra Scruggs, RN and certified doula, is the founder of Simply Birthed, a service dedicated to providing compassionate, holistic care to individuals during the transformative journey of childbirth from prenatal health, labor and delivery, to postpartum and newborn care. Shandra began her journey in health care in 2012, first as a critical care nurse and later as a labor and delivery nurse. Along this journey, she developed a deep commitment to empowering and supporting women during the birthing process. Shandra acknowledged the emotional and psychological aspects of childbirth and strove to provide compassionate, personalized care beyond the clinical. It is Shandra’s belief that every woman deserves to be respected, heard, and supported during this significant milestone in their life. After realizing that the medical system often lacked the holistic and emotional support women truly needed during childbirth, Shandra decided to create Simply Birthed to bridge this gap in care.

Key Takeaways

  • [02:02] Introduction to today’s topic and guest.
  • [06:10] Shandra discusses the purpose of 'Simply Birthed' and the driving force behind her decision to start the company.
  • [20:00] The lack of standardization and policy in maternity care and the impact it has on nurses and patients.
  • [28:00] How the business of healthcare can sometimes result in the hastening of the childbirth process, highlighting the vital role nurses play in advocating for patients in such scenarios.
  • [44:24] The importance of individualized plans of care in childbirth.
  • [49:10] Closing thoughts and goodbyes.

Episode Transcript

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsford

Oh, hey, nurses. Welcome to the Nurse podcast.

Giving nurses validation, resources and hope. One episode at a time.

Oh. Today on Nurse Dot podcast.

Shandra Scruggs

I wanted something to where I can still be able to reach people anytime, anywhere, and they can ask whatever questions that they need from someone who actually has the answers and without sifting through tons and tons of information. I wanted to reach people.

Cara Lunsford

Joining us today, Shawn Dre Scruggs, the force behind simply birthing with years of experience as an obstetric nurse. Along with her expertise as a qualified pedulla, Chandra is revolutionizing the way we view and approach childbirth. She passionately merges her abundant medical knowledge with holistic practices to empower women through their birthing journey. Whether you're an expectant mother, health care professional, or simply fascinated by the miraculous process of birth, this episode promises to be filled with valuable insights.

I'm your host, Kara Lunsford, registered nurse and VP of community at Nurse AECOM.

Oh, now that I know your name, Andre, I'm really passionate about what you do, and I'm going to let you tell everybody what you do. But I'm really passionate about what you do because I had a homebirth experience. I get. So we'll talk a little bit about that at some point in this episode. But tell us a little bit about yourself and like that.

You're a registered nurse, but how you got started and then maybe how you pivoted into this area.

Shandra Scruggs

So I'm a registered nurse. I've been nursing since 2012. I started off in cardiac. I've always wanted to do labor and delivery. When I was a kid, my dad worked in a OBGYNs office and I would come to work with him sometimes and I would see these women with these giant bellies. And I was just completely fascinated. So I always knew that I wanted to work with moms, specifically pregnant moms.

And so after maybe two, two and a half years working in cardiac, I started working as a travel nurse, and then I transitioned into labor and delivery, which I absolutely love. So I've been doing labor and delivery for the past decade. And then over time I kind of just wanted to reach or connect with my patients a little bit more or go a little bit more on the holistic side of things because, you know, when I mean, you had a homebirth, so I'm sure you know the difference between a hospital birth and a home or so for a lot of people when they think about having a baby, the only thing they can think of

is just coming in to the hospital, see the doctor have the baby. And it's such a big medical procedure when it doesn't necessarily have to be for some moms, you know, if they have medical issues going on, whether it's their blood pressure, diabetes or something else, it's totally necessary to be in the hospital because it's safer for mom and baby.

But for many people who are completely healthy, have a completely healthy pregnancy and everything is fine. Having a hospital birth is not necessarily ideal and you miss out on a lot of the one on one connection with your support person, whether it's your, you know, your nurse or your doctor or even your midwife. And so at some point I wanted to incorporate a little bit of more holistic care into just my general patient care.

And so I started looking into becoming a Dula as we would have, you know, a lot of do list who would come in for moms who wanted to go more, the more natural route. And so I ended up taking the course. It's been a few years now I forget and I went and I, you know, I learned all the things to do.

I went on this beautiful retreat in Mexico and learned all of the business side of being a Dula. And so I kind of just jumped in feet first and started working as a Dula, in addition to in addition to my labor delivering nursing in the hospital. Originally from Nashville. So I started my business in Nashville. And so as I was starting to gain a little bit more clients, so I ended up moving to New Jersey.

So I kind of had a switch it up and learn a whole new city and meet people and things like that. And so I ended up transitioned our business from just being just me because it's such a large population in New Jersey, because you have New York upstairs and you have people from Pennsylvania that's in the area. And so I started to build a little bit of a team.

So I had a couple of dealers who was working with me and then another nurse. The year that Calvin started was when I wanted to kind of expand a little bit more. I loved the business side of working as I do, and I enjoyed working as a do as well. But to be honest, it would completely stress me out just knowing that someone can call me any time in the middle of the night.

But I love connecting with the patients or the clients. I love answering the questions that they had and things like that. So I wanted to kind of build a team so that way I could do more of the things that I actually enjoy and love and still have that connection with my patients and my clients that have, you know, someone else who's a little bit more passionate about it to go to their homes and and work with them.

But then of course, COVID strikes and then they took all the doulas out of the hospital and no one wanted do was into their home. So I kind of had to take a step back for a while and just figure out exactly what would be the best way to go about connecting with my business. Of course, you know, I still work in the hospital as a labor and delivery nurse, and that portion of my care never ended, but I just kind of took a step back and just wanted to see what would be the best way to go about it.

And somewhere along the way I came up with an idea to just have an app. So I have, you know, I have tons of moms who come into the hospital, first time moms, and they, you know, they go to the doctor to see their provider for their prenatal care, and then they come to see us. And then they have all of these questions that are missing and they they're almost clueless.

And you know, there's all of these pregnancy apps, there's all of this information on Google. And of course, they have their provider that they can talk to in the office. But there's still this big gap that was missing for people who just needed to talk to someone about about little things, sometimes just big things that they're, you know, feeling certain symptoms if they're having a pain or they're having, you know, some type of discharge or, you know, they're having a headache and things like that.

But sometimes it's just like they're out to lunch and, you know, and I eat this and they don't want to get on Google because Google tells you a million things that are completely irrelevant. I wanted something to where I can still be able to reach people anytime, anywhere, and they can ask whatever questions that they need from someone who actually has the answers and without sifting through tons and tons of information.

And so that was my big piece, just wanted to reach people. And then also, I guess working as a do, I noticed that not everyone could afford to have a do over because it's more of a almost like a luxury item to be able to afford to do. Like most studios, they charge anywhere from $500 up to 1500 dollars or more.

And so I remember having to turn down so many clients just because they couldn't afford the fee. And I was told, don't need that. You shouldn't necessarily go down on your fee. You know, you should be paid what you're worth and things like that. But, you know, there were so many people who I realized they need that support, they need that connection.

And even if it's just the educational component, they were missing that. And so the idea was born somewhere in the midst of all of that. And that's how I got to where I am now.

Cara Lunsford

That's amazing. Well, my hat's off to you that you have done that. And also just kind of creating health equity. I think that what you're doing and you're creating like this health equity by saying, okay, well, here's a lot of information. And do they pay for the information like a small fee or something like that?

Shandra Scruggs

Now it will be subscription based. So the lowest subscription that I have there is just ten bucks a month now, I guess, to compare paying for a do live versus paying $10 a month for just, you know, a connection with someone. I think that it should be pretty affordable for everyone. There's different levels to it. So the lowest tier would be $10 and then the highest is $30.

So that way, if you you know, if someone wants to pay a little bit more, if they have a little bit more money, they can get more. But at the bare minimum, if all they need is just the connection with the do or nurse 24 seven, they can have that. It's totally affordable so they don't have to worry about breaking the bank just to talk to a do.

Because even now, if you want to talk to a do low or even a nurse, you can't. There's just no way to go about that. I mean, you can submit an inquiry and just ask a couple of questions, but just to have like a person who's dedicated just for you and knows your history and someone that you can actually make a connection with and have someone to talk to you from the beginning of your pregnancy or even before during pre-conception, just to have someone there for you.

And it's totally affordable. And that was my main thing. I didn't want to sell myself short or anything like that, but I do want to reach people who I wouldn't be able to reach otherwise.

Cara Lunsford

So how many jewelers do you have currently working with you on the platform and and how many people do you have who are utilizing those doulas?

Shandra Scruggs

So in the New Jersey area, we have four. Like I said, I'm from Nashville, so I constantly go back and forth and so I have two who are in the Nashville area. So if someone reaches out, you know, because I've even had some people after I moved, they were reaching out to me and I'm like, Oh my gosh, I'm I'm not there anymore.

Let me see if I can find someone for you. And so I wanted to have a couple of people in the area still so that way they can at least have a resource that they can reach out to. And, you know, I'm not just completely turning people down and just leaving them out to their own resources and just like, figure it out, you know, do whatever you can, do it on your own.

I hate to have to just leave people in the dark when it comes to that. So we built a really nice team in both areas and so that's really nice. And then I have a couple of nurses who work with me in the New Jersey area as well, because sometimes they want someone to come to their home postpartum after a baby is there.

And sometimes it's just little stuff where they they just need help with diapering or preparing bottles and things like that, or just need someone there when they take a nap. And then sometimes if they do have some other issues going on, some moms, they may have had blood pressure issues when they were in the hospital. And so now they're coming home and there's like certain little things that they should look out for.

But you get so much information when you discharge from the hospital, it's like you can't remember everything. So having the nurse there just to kind of check up on not just baby, but also mom has been a really nice piece to it as well. And so with the app, we'll be able to reach so many more people in more than just the local areas, which is what I really love, because I can't be everywhere.

You know, I can't assign due to every single city across the States, although at some point I would love to do that. So if they need someone to come out to the home, will have someone who can do that. But for now at least, they can reach out and be able to connect with us and not have to worry about.

Are you available? Can you do things like that?

Cara Lunsford

I find really interesting just about your whole story is that and this happened to a lot of people during the pandemic, that it forced people to have to think outside the box. It forced them to pivot to other models when in-person stuff was no longer an option. People started looking at, well, how do I do it virtually? How do I do it?

How do I use technology? How do I leverage technology? And it seems like that's in a way, it was like a benefit that you had to kind of experience this hardship. But out of that hardship was opportunity. Yeah, Now you can actually.

Shandra Scruggs

Reach more people. That's exactly what happened because I had to like when I had to take a step back, I really I just didn't know what to do at that time. And that was before everything was becoming so virtual and so popular in the virtual world. And I'm just like, how can I be a dollar if I can't show up?

I'm going to be a do I If I can't go to their homes, if I can't physically put my hands on the client, how does that even work? But a lot of times people just they just want to talk to someone. They just want to have someone to reach out to if they're feeling a certain way or if they're just wondering about anything.

That's the main piece of it, I think, is just having someone that connection with someone and not necessarily have them physically present.

Cara Lunsford

Now, what about if people want to be trained to become doulas? Is that something that you offer or thinking about offering?

Shandra Scruggs

I have considered it, yes. I don't know as far as if there's like certain places that I have to look into for like certifications and things like that because I know anyone can technically be a do a if you're, you know, you had babies and like you had a home birth, I can do this. I want to help other moms.

Like you can just be a Dula but then some people prefer their do us to have a little bit more credibility with their credentials and have the certifications so I can totally train anyone to be a doula. But as far as like certifying bodies and things like that, I would definitely have to look into, into that. But all of my do is they're all certified just because for me, I feel like it's an extra layer of cushion for the clients.

They know that not only are we trained, we have a certification behind it. So that's a really big key component to that as well. And I always felt like, I guess just me being a nurse was a big help too, because they're like, okay, like you're a do you know you're certified as a do a but then you're a registered nurse.

And in the hospital I see firsthand what's going on. And I've even delivered a couple of babies on my own that actually just delivered one two nights ago because the baby was coming and the doctor didn't make it. And I'm just there like, okay, just breathe, girl. You got this, mom, You know? So sometimes that happens. So I'm not a midwife.

I do not want to be a midwife. I love being a nurse, but I do have a little bit of experience with that as well, which is exciting. And I always know like if the babies are coming, they're coming. So sometimes you you need an extra set of hands and sometimes the babies are so ready to get into the world, they're coming either way.

Cara Lunsford

That is so true. They come when they're good and ready. So I had a woman say to me when I told her that I was having a homebirth and this is I should have like not. Well, you know, sometimes you offer up information and people offer their opinion. And so this woman was like at a pizza place where I was eating.

And I think she probably asked like, where are you having the baby or something? And I said, I'm having a homebirth. And she said, Home delivery is for pizza. That was literally like what she said to me. And I was like, Oh, okay, well, that's an opinion. That's your opinion, and that's valuable. I also recall her being actually like a physician, which was why she felt, I think, strongly about it.

I had watched the documentary The Business of Being Born. Did you see that?

Shandra Scruggs

Seen part of it? Yes.

Cara Lunsford

So Ricki Lake and I think it was Abby I've seen did the Business of being Born, which is a fascinating documentary on just the business around birth and just how we kind of compare to other countries, how other countries treat birth versus how we do the number of inductions that we do and the consequences to those inductions and just beating up birth like unnecessarily, which then results in the babies, obviously having complications sometimes like lady cells and stuff like that.

And then it's like, Oh, well, now we have to do a C-section. And it's you can see that how maybe one decision has resulted in the result of a C-section, maybe an unnecessary C-section. And C-sections are surgery. I mean, it's not something to be. I think we kind of poo poo it a little bit. I think we're kind of like, oh, you know, it's a C-section.

No, it's like major surgery. And the person then has to go and care for a baby after major surgery. So we shouldn't be flippant about it.

Shandra Scruggs

And I think a lot of that is because the moms are still awake during the procedure. So most people feel it's not a big deal because they're still awake. But at the same time, it's major abdominal surgery. They have to go through every single layer from the skin to the fat to the muscle, to the uterus, and then they have to come all the way back up to stitch them.

And it's not only is it major abdominal surgery, on top of that, they've had a baby. So it's it's a lot, you know, and it's taken very lightly, I think, because of the fact that the moms are awake during the procedure, but they've just, you know, perfected this amazing spinal situation and everything is kind of numb from the belly button down.

So they can't really feel what's happening. But that doesn't take away from the major ness of the actual surgery itself.

Cara Lunsford

Yeah. And the recovery, I mean, you have to recover from that.

Shandra Scruggs

It is an actual recovery. You're recovering from major surgery and recovering from having a baby at the same time, and they expect the moms to just bounce back And some are able to like I've seen both sides of it. I've seen moms who they just had their surgery a few hours ago and they're walking around and they're they're doing okay.

And then I've seen moms who just completely it's almost like they were hit by a truck. And a lot of it, I think, has to do with the actual surgeon. And so some people are a lot more aggressive with their techniques. Some people, they take their time, they're very gentle, and then some people they're in there and you know, me and some of my friends, we we have coined the term of calling them a butcher because it's literally what it looks like.

And I've been in the O.R. with some providers, and I'm just like, almost sick to my stomach because of the way that they handle this. You know, this person. It's not you know, they're not just there. They're a mob. They're a wife, their daughter, they're a sister, and they're a person. You don't have to if there's not a major emergency, if you don't have to get the baby out in 4 minutes, there's no reason to rush.

There's no reason to be aggressive about it. You don't have to, like, rip the person to shreds just to get the baby out if it's not a true, true emergency. And I mean, there are special situations where you do have literally minutes to get baby out and, you know, you have to move very quickly. But then I've seen situations where it's a scheduled and they're in and out in like a minute and it's like, what happened?

Why are it why are we doing this? And these patients go so horrible after and they can't they can't bond with the baby. They're so tired, they're in pain. It's just so rough.

Cara Lunsford

It was the major determining factor for me in wanting to do for myself. And not that I'm advocating one way or the other, because I think that you have to choose whatever is right for you. I think that it is on this the responsibility of the hospitals and the providers that we are acting in the best interests of the patients.

So if you are choosing to have a child in the hospital, you should be getting the best quality of care and standardized care. And interestingly enough, I don't know if you know this, but reliance, they have an OB product. It's actually amazing. It really is so focused on making sure that there's like standardization of care and so making sure that everyone kind of understands like estimated blood loss and they know how to estimate blood loss and that there is more of this continuity and standardization when it comes to what is the recommended dose of Pettersen.

You know, if you're inducing it shouldn't just be that this practitioner thinks they can give this much and this other practitioner thinks they can do that. But it's like there really needs to be much more of a standardization so that the outcomes are better and more predictable, that the outcomes are like better and more predictable. So I really appreciate what some people are trying to do to provide that education, but then it's really the responsibility of these practitioners in these hospitals to make sure that that is what's being practiced in their facility.

Shandra Scruggs

And I mean, for me, like I said, I've been a travel nurse for years. I started working as a travel nurse in 2014, so I've worked at over a dozen hospitals across the country, East Coast, to West Coast, and I've seen so many different ways to do the same thing. And you have some hospitals who place so much emphasis on one thing and then you go to another place and they're like, Yeah, we don't do that here.

And it's like if one thing is so important and one facility and then it's like an afterthought at another, and then a lot of times I've even seen it's, it's kind of the luck of the draw for the patients. Whoever is on staff today, that's who you get. This provider may be a certain way. You know, they like certain things and a lot of the hospitals or the units will accommodate to what they want to do specifically.

And like you were saying, you know, if this provider wants so much Pitocin, you have to give it because they're like, okay, keep going up, keep going up. And I always tell my patients, like, I'm very conservative, very gentle with my Pitocin because I've seen people who are very aggressive and it almost always stresses the babies out. They almost always end up with complications.

They have extra bleeding, they end up in a C-section. And I've seen providers who will say, you know, to distress type of thing. So they're like, we're probably going to end up in the O.R., but let's go ahead and make sure we get them in. No more. So let's keep going up on the petals and let's keep going up.

Keep going up. So that way we have to, like, see and prove that there's a really good reason to take them to the O.R..

Cara Lunsford

That's horrible.

Shandra Scruggs

It's horrible. And I've seen it.

Cara Lunsford

Like, Oh, my God. I'm, like, mortified. Just when I think I can't get shocked. And I, you know, I've been a nurse for, like six years again, 17 years. I'm still shocked. I still people tell me things and I'm like, what?

Talking about? That's a term.

It's literally I don't know, I just. What do you think the solution is? Okay, Because, like, I do think that I mean, I really love one of the products that we have over it really is the whole OBE product. I love it because I think that trying to create that standardization where you as a travel nurse are not going to ten different hospitals and experiencing ten different ways of caring for a patient that really needs to stop.

Shandra Scruggs

I think some hospitals are trying to because ACOG is like they have a lot of recommendations on things that they should do. So a lot of hospitals, they try to kind of meet the guidelines based off of what ACOG wants to do. But at the same time, the hospitals, they had policy in place before ACOG and they kind of they do like a blending thing is what happens.

And so if they have a policy that was already in place and then the ACOG recommends something else, they'll either blend it to where they kind of meet somewhere in the middle or they'll just do one or the other, depending on. And I think they worked at hospitals. They just didn't have policies on certain things. I worked at one place in Texas, and I guess they were going through some kind of shift with management and rewriting policy so they didn't have any policies.

All this, which is a traveler, is very concerning. To go to a hospital where you're giving Pitocin, you're giving other medications for inductions, and there's no guidelines, no policy whatsoever to follow. And you just have to go based off of someone saying, well, this is what we do here, this is what we've always done. And that's not only is it unsafe for the nurse, it's extremely unsafe for the patient, unsafe for the hospital.

You run into situations where you're just doing things because someone said, this is what I'm supposed to do. And so in the culture of people having complications, a lot of people sue. You know, the first thing they ask is, well, what's the policy? If there's no policy in place, how can you defend what you've done? If there's nothing in place to say, this is the reason why I did this?

You know, you can say, well, so-and-so who was working with me that night said this, This is what I'm supposed to do. You can't go off of that. And so I think it's really nice that ACOG is a big governing body that creates these guidelines. But again, like you said, it's up to the hospitals and the providers to go by that.

And you will have places where you have providers who like to do things a certain way because either they've always done it that way or that's just how they are. And you just have to kind of go along with it. And working as a traveler, you know, you coming in, you know, you're just meeting everyone, you just meeting these providers, the people who work there, they've been working a certain way.

They've been working with these providers. And it seems, I guess, almost normalized for them to just have random things that they do with no really good rationale behind it. So, yeah, I've seen so many things.

Cara Lunsford

Do you think that it's a lack of knowledge on the nurse side of things as well, not having enough experience maybe, or not being at other places, being at one place so long that they don't realize that there's other ways of doing things. That's kind of the advantage of traveling, right? It was one of the things I actually experienced when I did Home Health because I would get people who were getting out of this hospital, getting out of that hospital, and their discharge orders would look different.

And I'd say, Oh, well, you no, gosh, why is it like this and why is it like that over here? And I realized that going into Home Health, I had a lot more information available to me so that I could be more well-rounded in my approach to physicians where I would say, look, you know, I know you feel strongly about this, but I've worked with this, I've worked with other patients at other hospitals, and they're discharged with this and the outcomes are much better.

They end up not going back to the hospital. This nurse. But I have that experience so I can bring that to the table and I can have a conversation. But we're getting to a point now where the average amount of expense depends on any given floor, in any given hospital is an average of two and a half years.

Shandra Scruggs

Oh, wow. I'm not surprised. I've worked at a lot of places where the floor is full of new grads. You may have one or two seasoned nurses and then a handful of travelers, and then you just figuring it out and it's like, see the nurses, they're trying to help the newbies out and they're trying to show the travelers the ropes at the same time.

But then if it's really busy, it's really difficult to do. And a lot of the nurses who are seasoned, they've been in their unit for years and years and years, they don't know. They're they're unaware that there are other ways and sometimes better ways to do things. And the new grads, I mean, they just start it so they can't help it if they don't know what to do.

They're still trying to figure things out on their own. And then you have travelers coming in and we're just like, yeah, that doesn't seem right. Why are you doing this? Like, you know, I see them. And I remember once I was working with a resident and I think they wanted to break the water of a patient and just kind of like you were saying before, just to speed things along.

And so I don't know what it is about the inpatients of everyone. They just they want the labor to go so fast for some reason as if the body it doesn't respond well usually. And so I was working as a charge nurse that night and they wanted to go break the patient's water and the baby was already kind of so-so on the monitor.

The heart rate was it was okay, but it wasn't a beautiful strip. And as I would say, and so before they did it, I told the nurse who had the patient, I was like, Hey, I don't think the baby's going to like that. I don't know if the baby will like that very much. You know what you guys are going to do.

So course they went in and they broke her water doing all these things, and then they come out and of course, the baby's now in distress, having these T cells and now they're having to flip the mom and do all these interventions. And then I sat with the resident. I was like, Yeah, I knew that was going to happen.

And his response was, how would you know that was going to happen? I was like, I've seen this a lot of times and I've seen at that specific hospital. I was like, I've seen how aggressive you guys are with these patients, and the babies don't love it. Well, his response was, once the research behind that I've worked over here at this other state, and that never happened and we always did this.

And I'm like, that's a different patient population. And the patients here are much sicker and they have a lot more things going on. And I don't have to necessarily have pages and pages of research to defend what I see all the time. Like I see this over and over and over. And if I say that, yeah, this is probably going to happen if you do this and then it happens.

And now your response is, well, where's my research behind, you know, knowing that that was going to happen?

Cara Lunsford

Guess my years of experience as a nurse. Are you there? Is there is your research.

Shandra Scruggs

You're a resident. You just started like I worked everywhere. And I see this all the time. Of course, I'm sure I could probably find some research if I really dug deep and looked for it. But no, I'm not going to pull out pages of research for something that I know in my gut was absolutely going to happen. And it did happen.

I don't know if it's just the way that they're taught, and especially with the resonance. Everyone wants a certain level of experience, so they have to learn how to break waters, they have to learn how to do all these things. And then they're feeling all this pressure from the provider and from the attendings to move things along. And it's just you see so many stressed out babies and so many more C-sections than necessary.

It's very sad.

Cara Lunsford

What do you think the financial benefit is to moving things along.

Shandra Scruggs

Just more births? I think the more deliveries you have, obviously, the more you get paid. If you have one birth a week, you'll get paid for your one birth week. If you have 10 to 20 births a week, that's a big difference. And of course, C-sections pay a whole lot more than a vaginal birth. I've worked with physicians to.

You can tell they do not do vaginal deliveries because.

Cara Lunsford

Are you kidding me?

Shandra Scruggs

Yes, they want a C-section. They try to figure out a way to create a situation where they can end up in the O.R. because that's what they're comfortable with. That's what they're good at. It could be a money thing. It could be a time thing, because I've seen providers who had a dinner party or they're going out of town for the weekend.

So we need this patient delivered via induction before. So that way their schedule would be clear and they don't have to come running back from their dinner party or wherever.

Cara Lunsford

So, you know, Shandra I just got it. Makes me sad. It makes me sad because I just there's this part of me that always wants to believe that that is not the case, but I am consistently proven wrong.

Shandra Scruggs

Sorry. Okay, But it's dying.

Cara Lunsford

Oh, is your laptop dying?

Shandra Scruggs

Sorry. Sorry.

Cara Lunsford

Maybe we need to take it to the O.R.. Oh, God. God, no. I'm just. It makes me sad. So, like, I'm always trying to figure out when we identify that there is a major problem, This has obviously been identified. I remember feeling really upset when I watched the business of being born, but I think in some ways I was kind of like, well, you know, that's maybe that doesn't happen everywhere, but I really think it does health care as a business.

And so obviously, until we start to prioritize different things, if the money is not based around the number of births, but the lack of interventions that are needed to get to that birth, that.

Shandra Scruggs

Would make huge difference.

Cara Lunsford

And then I don't know what would happen. Like, I think the issue that then you come up against is like, oh, when somebody really does need a C-section, will they not get it because they're penalized in some way for doing a extreme, some type of intervention or something like that. And we just have to have this ability to act in a way that is ethical and moral and I know that our system obviously needs to be profitable because it's a for profit system.

It just is. I guess what, I'm coming to is that I don't know the answer.

Shandra Scruggs

It's it's like I don't.

Cara Lunsford

Think I know the answer.

Shandra Scruggs

Over a decade in a dozen different hospitals, I don't have the answer either. I've seen so many. Like I said, I've seen so many different ways to do the same thing.

Cara Lunsford

And it's but I think you actually do know the answer. And you know what? As soon as I said, I don't know the answer, I thought to myself, that's not true. I think you've done it. You are doing patient empowerment. And really the only way you can create change is by empowering the patients with knowledge around what they should expect, what they should ask for, what is a standard of care If someone wants to speed them along, why?

Why can't you give me a reason why I have to speed this along? Having an advocate in the room with you. Because when you're in pain, you can't focus. You're just going to say yes because that person is. You're relying on the person to point you in the right direction. Right. Also, as nurses, we are patient advocates. That is, our job is to be patient advocates.

So not only are you training the patients in the public, but I think you also have this incredible ability to really empower nurses is all over the country with the knowledge that you have because there is some benefit to the fact that you've worked at ten different hospitals, nurses should be taking advantage of that knowledge that you have so that they can become more well equipped, so that they can become more knowledgeable and they can advocate for their patients and they can say to inpatient providers, and I say inpatient meaning they don't they have a lack of patients with a C at the end that they can say, you know what, that is not a

safe practice because we do have the ability as nurses, if we're knowledgeable, we have the ability to say, no, we do.

Shandra Scruggs

And I have I've had doctors who they know, which nurses they can get over on and they know witnesses that they can't pull certain stunts. So I've had a situation where I had a provider come in and normally when they examine patients, they're supposed to have a nurse at the bedside. If you're breaking waters, you're supposed to have a nurse at the bedside.

And I was juggling two patients at the time. I was in a patient's room and the provider decided to take it upon herself to go in, examine my patient, and bring her water without me being frozen. I had no knowledge. And now I'm in the patient's room and I see my baby being in distress. And I'm like, What's going on in this other room?

She was gone a few minutes ago, and as I'm coming down the hall, here comes the provider coming out of the room. Oh, I think we need some help in there because, you know, I broke her water and now the baby is not doing so well. Excuse me? You went in my patients room without my knowledge and did interventions that will directly affect the baby.

And the baby was negatively affected. And so I went into interventions turning in different things. I had to pull her to the side and let her know, like, Hey, you can't do that. You're supposed to have a nurse present at all times when you're doing any type of vaginal exams, any type of interventions. And she learned that day and that, hey, okay, I can't do this with this nurse.

But that never stopped her from doing it with other nurses because some people feel like, especially the new grads, they don't realize that they can push, that they feel intimidated or bullied. And the doctor says that this is what I'm supposed to do, even if I'm not totally comfortable with it. They do it because they feel like what?

This is what the doctor said. This is the order. And, you know, for the newer nurses still learning the ropes, they don't have enough knowledge or enough confidence to push back for things like that.

Cara Lunsford

Anyone listening right now can obviously do the math right if we've just let it slip that the average amount of years of experience on any given floor, in any given hospital is around two and a half years. And we know that those younger, more impressionable nurses with a lack of knowledge, a lack of experience, are more inclined to just follow an order, which is not what we're taught to do in nursing school, right?

We do not just follow orders. We have to be very autonomous in our thinking. We have to be we have to use critical thinking. And this is a recipe for disaster.

Shandra Scruggs


Cara Lunsford

When literally you have just a complete lack of experience across all of the United States. And, you know, look, I don't want to sound like there's lots of doctors out there that are lovely, wonderful providers, wonderful physicians, lots of them, like, I don't want this to seem at all like it's like some sort of bashing of physicians.

Shandra Scruggs

I have something that I absolutely love. I remember the first time I saw a vacuum.

Cara Lunsford

They just don't make the headlines.

Shandra Scruggs

The first time I saw a vacuum used correctly in the most appropriate way. I couldn't believe that that was how it was supposed to go. Like I worked for years and people just put the vacuum on. And for those who don't know, I guess what a vacuum is. It's like a little round device that the providers put on top of the baby's head.

So when mom is pushing and baby's not coming down all the way, they can kind of pull a little bit on the baby's head with the vacuum and help the baby along to come on through the vaginal canal. But I've seen a lot of providers apply this device when the baby's way far back off in there. If you have to put the vacuum inside the vagina, it's probably not appropriate to put on a vacuum.

And so for years I saw different techniques of how the vacuum was used. And the very first time I'll never forget the provider put the vacuum on and the baby just came right out and it was beautiful and everything was fine. And I was like, Oh wow, I can't believe that that is how the vacuum is supposed to be used and how I've never seen that and I've never seen that since.

And people just put it on because, again, they're impatient. They're trying to get the delivery along so they can either get out of the room or go wherever, or they're just I don't know if they just don't want to be there. I'm not sure what the case is, but it's a rushing thing and it's just it's very difficult to be a nurse advocate or be a patient advocate as a nurse, as we're taught.

If you don't know the correct way to do things, if you don't have the experience to say, Hey, don't do that, hey, you can't do that, you know?

Cara Lunsford

Yeah. I also think that it's become very litigious. You know, is an awful thing because it makes you do things that maybe you otherwise wouldn't do. And if you're afraid that you're going to get sued, I think the level of anxiety that comes up in some of these physicians and these practitioners that are responsible for these births, right.

That it's the longer that baby is inside, the more anxiety that that physician starts to have. It's like when the baby's out and the baby is out and breathing and all of a sudden their anxiety gets to go like they can take a deep breath, they can breathe. They know, okay, I have a mom, I have baby, they're both alive and we're good.

Okay? I just think that they can't wait through. The anxiety is too much for them. Mom is in labor for 15 hours or something like that. Oh, my gosh. What's going to happen? What's the complication? The longer that this babies and they're like their brain starts, get in the way and they start to spin. This is what I believe probably happens for some of these physicians who maybe, you know, don't have the intention of wanting to send everybody to the O.R. and just pull this baby out.

But they just get so overwhelmed by the fear of something bad happening and then getting sued.

Shandra Scruggs

Then that can kind of gear them more towards being safer or quicker, whichever route that they're choosing to go. If you have a bad outcome, you kind of way all of your patients on the scale of a bad outcome is going to happen or it could happen. And, you know, I need to keep this from happening instead of just allowing the body to do what it's naturally designed to do.

Before we had hospital births and had OB-GYNs, we had midwives who delivered all the babies at home for years and years and years. And then someone got the idea that we need all these and this needs to be a medical procedure in the hospital.

Cara Lunsford

And I know that, like when I've had this conversation with people who are obese, they say, Oh yeah, but how many women died in childbirth back in the eons ago? You know, how many women were dying of childbirth, How many babies were dying during childbirth?

Shandra Scruggs

And I know look at our mortality rate compared to the rest of the world.

Cara Lunsford

It's exactly, exactly. So something we're doing isn't right. Right. So, like, even if you try to say it's safer to have a baby in the hospital, okay, But maybe it's safer in some aspects. But there's something we're doing that is not right. And because although they are coming into a hospital where, for all intents and purposes, we should be having like a really low mortality rate because they've got everything available to them, They've got excuse in nick use and all this stuff and the crash cards right down the hallway and they have all these people.

But yet somehow our mortality rate is not better. Really. It's actually the worst in the world. So that being said, I just think that it takes a lot of combined effort between people like you who are doing what you're doing with simply births, where you're educating the masses, you're trying to get all of that education out to them like any of those kind of fake news, frequently asked questions, trying to provide them with resources and people that can answer questions for them and create those connections for them and those relationships.

I hope that you'll start training more nurses. I think that that would be amazing. But I also love that there are products out there similar to like what we have over at Reliance that can really help create more of that standardization of care so that it's not different at every hospital you go to. And yeah, maybe the physicians won't like that.

Some of the autonomy is being taken away from them because I think that's their beef a little bit about saying like, Oh, well, I don't want to have to follow this roadmap or I don't want to have to follow this care plan. But if it's safer, it's like if this is a proven to go back to what that resident said is, you know, well, where is the evidence?

It's like, well, here we'll give you the evidence. Okay. Like, this is the safest way for this percentage of patients that present with these, you know, as long as they fit in this kind of box, intervening in this way is the safest option. If they're outside of that box, then it's understandable that you have to make certain deviations.

There needs to be certain deviations from that care model. Right.

Shandra Scruggs

Every woman's body responds differently to certain medications and if you have other health issues going on, whether it's something that's new during the pregnancy or something that you've had previously, you know, your plan of care should be more individualized based off of you and not based off of this is just how we do it or this is just how I like to do it kind of thing.

Yeah, it makes a big difference. And for me, you know, especially when I have my first time parents coming in with a million questions, they're constantly apologizing for asking me questions and I'm just like, No, ask me everything. I want you to know. Every single thing that's happening. I want you to understand everything that's happening now that could happen, that's going to happen.

I want you to know everything so that they can not only just be informed, but feel comfortable and confident that what's happening should be happening instead of the doctor coming in and they're saying, We're going to do X, Y, Z, and then they leave out and then the patient is like, Well, the doctor said, this is what we're supposed to do.

So I guess this is what we're supposed to do rather than being fully informed on, Yeah, we could do this, but what if we don't? You know, you could break my water right now. But what happens if you don't break my water? What, do I still have my baby? Absolutely. You still have your baby? Your baby can be born in the bag of water if you prefer, which you never see that.

I've never seen that in my career. I've seen videos. I've never seen it. It doesn't happen. I had a provider once who I was laboring with the patient and she didn't have an epidural. She wanted to go natural. She was standing up and baby was coming. And so finally the provider comes in and I'm just standing there with my gloves, just waiting for the baby to come on out.

And he's like, Oh, no, absolutely not. We have to put her back in the bed. She needs to get in the bed. So we put her in the bed and she legs up in the stirrups and all of that delivered her baby. And then he pulls me to the side after and he was like, Next time you need to get the patients in the bed sooner.

And I was like, Hey, you know, people can deliver standing up. Well, not my patients. And I'm just like, But if that's what it feels natural for the mom, why not allow her body to have her baby in the way that feels most comfortable and natural for her? So I couldn't understand that. But it was I don't know if it was just a comfort level thing for him or he just.

Cara Lunsford

Probably afraid he's going to drop the baby.

Shandra Scruggs

Is going to drop the baby. You know, I understand they're slippery. I always have like a small moment of panic when that when I'm holding a very slippery baby and they're wiggling around and I'm just like, oh, my gosh.

Cara Lunsford

Had a big old pillow. I mean, like, maybe we just need to get something to put under them so that they can, like, deliver the way they are most comfortable, as opposed to, we're afraid that you're going to drop the baby. But again, that goes back to fear, right? It's when we start to make decisions out of fear.

It clouds our vision and it clouds our decision making ability. And I think we're not making the right decisions when they're sourced out of fear.

Shandra Scruggs

Decisions based on what they want and not necessarily what the patient needs or wants. If you have a patient who's going natural and they're moving with their body in the most natural way, they're in positions that are most natural for them and what feels most comfortable for them. If the baby is fine, where's the issue here, You know, designed to do this?

It's made to have a baby. The uterus does a beautiful job of expelling the baby just fine. But a lot of times you need that movement. You need the gravity to be in a certain position and allow me to come, because I always tell moms, babies in charge. However, baby wants to get here. When baby wants to get here, the baby will come.

So, you know, don't worry about how long it takes. Don't worry about any of those things. When the baby is ready, the baby will come. And it's just the providers. They can't think in that mindframe of babies in charge. No, the doctors in charge, absolutely. How they think this is my patient. This is what I want to do for my patient.

And this is what should happen rather than allowing things to naturally occur as they should.

Cara Lunsford

One of the distinct things and then I won't keep you much longer. But one of the distinct things that I think is important for people to take away is that when you work with a midwife, they will say to you, I'm there to catch your baby because you are the one that is delivering your baby. Your baby is the one that is coming out.

But I am just there to catch work in the hospital. It's always that the physician is the one that delivered your baby or the practitioner in some way is the one that delivered your baby. And I think that just that language alone speaks volumes about where the priority is. And it's not necessarily on the person who's actually delivering the baby.

Shandra Scruggs

That's the big difference between a midwife and an OBI provider. In some places I've worked, they utilize their midwives in the exact way that they're supposed to be utilized. If you have a very low risk pregnancy, a very healthy mom, a very healthy baby, a midwife is appropriate to manage this labor in this delivery. If you have something that's a little bit more complicated, of course an OBI would be more appropriate for that.

And then I've seen places that treat midwives as a first year resident and that's not what they're they're not there for that. They're not there to run around and do all these things that the residents do. They're not in training, they've done their training. They are a provider. They can deliver babies, they can give prenatal care and advice and things like that.

But you have some places where physicians don't see them on the same level with them. They see them as beneath them for some reason. And it's I find that so bizarre because they can do the exact same thing outside of surgery. So the only things that the midwife cannot do is surgery. They can literally do everything else. They can repair, they can deliver, they can do the prenatal care, they can do the postnatal care, they can take care of her baby, all of the same things.

But they just can't cut the moms open. So they somehow are lesser in their experience or knowledge when they've been a nurse before. So not only do they have the experience of just being more nurturing and having that one on one time in conversations with patients, they're used to that because that's just part of their background. It's not all medical for midwives.

I love when people have midwives in and that's the primary person that they see, because I do notice that they they're more well informed. They're more inclined to say, No, I don't think I want to do that right now. I don't think it's a good idea to go ahead and break my water. I really don't want to start Fred Thompson right now.

I really want to get up and just move around. Can I be off the monitor? Can I take a shower? Can I eat some snacks? You know, it's a different mindframe. And I think a lot of it is just the education that they get from their midwives to just tell them what to look out for things that are normal and should happen if you naturally feel certain things within your body.

They're more in tune to that when they have a midwife as a provider rather than an OBE. And like I was telling you before they see their providers in the office, they have a quick little visit and then somehow, along with the pregnancy, they end up at the hospital. I have a baby and there's just no knowledge that they get from their OB just because that's not part of their training then bedside manner.

It's not a part of it. They don't have these long conversations with their patients, you know, unless they just have a patient who just wants to talk to them forever. But they always seem to be in a rush. And in my opinion, they always seem like they're somewhere else or they're on their way somewhere. And they just they don't take the time to really understand what the patient needs or what the patient truly want.

Cara Lunsford

And I wonder what the pressure is that they're getting to like, because I think we all go into our these professions with a certain ideal, an idea of what our job is going to look like and the time that we're going to get to spend with our patients. And some pressure is coming down from on top that is creating this kind of ripple effect.

And I think that that's where we just have to have like some sort of systemic change where we have to just prioritize things differently as a health system. And we do need to be more health focused, not more sick, focused, right? Because we oftentimes benefit and profit off of sickness and a lack of wellness. So just trying to get to that shift is, I think, where we're all trying to head.

Yeah, I'll try to get there. I'll try to get there to the actual health care and not sick care right? And so this has just been a wonderful, wonderful interview with you. I enjoyed it so much. Where can people find you? So if someone's looking for you, where's the best place to find you?

Shandra Scruggs

I would say the best place would be on her Instagram page because we have tons of information on there. There's a link to our website on there. There's a link. I actually just published an e-book yesterday. I'm constantly giving like I have giveaways and there's like link on there where they can enter to win gifts and things. And then at the very bottom there will be a link for the app.

Right now I just as coming soon. So on her Instagram page you can pretty much find the link to everything. That'll be the easiest way. And you can like they can send out an email and and get to me directly if they need to as well.

Cara Lunsford

At simply.

Shandra Scruggs


Cara Lunsford

Yes, you grab the best name that you could grab on Instagram like no little underscores or ones or asterisks or anything.

Shandra Scruggs

And interestingly enough, because when I first originally started the business, I've gone through three different name changes and logo changes to get to where AM Now, which I, I assume entrepreneurs go through that, you know, throughout their their business ventures. What I started off with, it felt like the right thing at first and then it changed and that felt like the perfect thing.

And then but where I am now, the name is perfect, No logo. Just a little fun fact. My aunt who's passed away a few years ago, she used to have a tattoo of three butterflies on her chest for her three kids. So the butterflies in the logo is just like my tribute to her. I love that I have that and that.

That's like a little piece just for me that no one else would know. But every time I look at it, for me, that's who I think of. It's her because she was just such a beautiful person and she had the butterflies. And every time I look at it, I think of her and it's like my connection to her at the same time.

Cara Lunsford

So my logo for Holly Blue and Holly Blue actually was a blue butterfly. Yeah.

Shandra Scruggs

Yeah, I actually listened to one of your I forget which one it was on one of your podcasts, but you were talking about the Holly Blue and the Butterfly and how you came about it. And that's a beautiful story.

Cara Lunsford

We have that in common, and I know what it means to look at your logo and have that sense of that beautiful feeling inside of having it tied to a story and to a person. And it'll keep you going in the dark times and the hard times. It'll keep you going. And so my hat's off to you. Well done.

You ever need anything? Please don't hesitate to reach out to me. Have a wonderful rest of your day, and I'll see you soon.

Shandra Scruggs

All right. Thank you. Bye, baby.

Cara Lunsford

If you're a nurse or a nursing student who enjoyed this episode, don't forget to join us on the nurse dot com app where you can find the nurse dot discussion group, a place where we dissect each episode in detail and delve deeper into today's topics. Nurse Dot is a nurse dot com original podcast series Production music Sound Editing by Dawn Lunsford, Production Coordination by Rhea Wade, Additional editing by John Wells.

Thank you to all the listeners for tuning in to the Nurse Dot podcast. Until next time, keep spreading the love and the care.