#58 The Pitocin Predicament: Redefining Pitocin Use in Labor & Delivery with Jen Atkisson

In this episode of Happy Hour with Bundle Birth Nurses, Justine and Sarah Lavonne are joined by guest Jen Atkisson who is the industry expert on Pitocin administration, safety and legal issues, and they discuss the use of Pitocin in labor and delivery. We know that Pitocin use has been normalized in our industry, but there are the risks and benefits of the medication. As professionals, we need better education and understanding among healthcare providers for how to practice safely and avoid lawsuits. They emphasize the importance of treating Pitocin as a medication and using it only when necessary, rather than as a routine intervention. They also encourage nurses to advocate for their patients and to continue learning and growing in their practice. Overall, what would it take to see a decrease in the use of Pitocin and a greater focus on physiologic birth? Thanks for listening and subscribing!

Helpful links:

- Join us in this LIVE, online Pitocin Paradigm Class taught by Jen Atkisson!

- Download the Motion App Today!

- Attend the Physiologic Birth Class!

- Visit Bundle Birth Nurses

Transcript

Justine:
Hi, I'm Justine.

Sarah Lavonne:
And I'm Sarah Lavonne and we are so glad you're here.

Justine:
We believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every single person and patient you touch.

Sarah Lavonne:
We want to inspire you with resources, education, and stories to support you to live your absolute best life, both in and outside of work.

Justine:
But don't expect perfection over here. We're just here to have some conversations about anything, birth, work, and life, trying to add some happy to your hour as we all grow together.

Sarah Lavonne:
By nurses, for nurses, this is Happy Hour with Bundle Birth Nurses.

Justine:
Today, we have Jen Akinson back for the third time. We must really like you, the fans really like you. We love you.

Sarah Lavonne:
So, we love having Jen with us. And if you didn't know, Jen actually is one of our Bundle Birth educators here and so she's a part of our team and it is so fun to have her on and listen and learn from her. And we're talking about something a little controversial today, I feel like. It shouldn't be controversial.

Jen Akinson:
It's sexy, is what it is.

Justine:
It is sexy.

Jen Akinson:
I mean, oxytocin is part of sex.

Speaker 4:
That's true.

Jen Akinson:
That's true. I'm just going to state it how it is. I feel like there's a problem and it's a pitocin problem, and there is so much fear and lack of education and damage, I guess you could say, happening because of the use of this high risk medication that we get educated on, it's not very high risk.

Justine:
I don't know about you guys, but Jen, in your class, you talked about how it's on that ISMP list of high risk meds and there's not very many of those meds on that list. And I was like, "What?" I had no idea. I wasn't-

Jen Akinson:
now.

Justine:
... super high risk. I'm like, "Heparin, insulin, those are scary. Those are scary drugs. Pit's normal." But it shouldn't be treated as so normal, right?

Jen Akinson:
Right.

Sarah Lavonne:
So we're going to talk about Pitocin today, friends.

Jen Akinson:
Well, and like what you're talking about is this idea, it's called normalization of deviance. So we do things that deviate from the norm so often that we just normalize it, right? You roll through the stop sign over and over and over. You just think who really stops all the, okay, grandma, stop and start to normalize that behavior. And so it is definitely our drug of choice in obstetrics, both Pitocin and normalization of deviance. We definitely do that.

Justine:
Well, and I think one of the things about you that I find such a fun combo deal that we get from you is your expert witnessing background and the amount of legal cases that you've reviewed. And what I've heard from you, and I'd love for you to speak to that angle as well in this episode is, and you can correct me if I'm wrong, that a lot, if not the majority of cases that you see go through legally include some mention of or misuse of Pitocin. Is that the truth?

Jen Akinson:
Oh, it's not even just a majority. It's 85%. This is not of my cases, specifically. This is statistics from large databases. It's over 85% involve the mismanagement of Pitocin. So as nurses, we were like, "Oh, I don't want to get sued." That's a real driver for behavior for us. And yet, the number one thing that causes lawsuits, we can't even fathom using it less. We have no inclination as a clinical culture. And so I guess named the Pitocin paradigm, which a paradigm is a common example of something.
And so back in the day, the most normal example of birth was unmedicated, unmonitored. That was the paradigm. That was the birth paradigm that most people came in or stayed home. Most people stayed home, gave birth, attended by home birth, attendance of some training, and that was it. Then we've shifted throughout time and now our paradigm is highly monitored, highly medicalized, highly Pitocinized patients, and we don't want to swing totally back all the way. We like certain aspects of what we get with modern medicine, but one of the things that's definitely not helping, and I think it's pretty clear, is hurting, is our relationship with Pitocin.

Sarah Lavonne:
That's such a good insight and you guys said something earlier that made me think we can't fathom not using it or not increasing it. And one of the things I see all the time is that I see my new grads or my new nurses way more scared of it, but then they feel like they have to keep increasing it because then if they don't increase it, they're just going to think like, "Oh, they're just scared and new." And then it takes the older, more experienced nurse to be like, "I'm not increasing that. I'm turning it off and having more balls, I guess is the word I'm going to use there to turn it off."

Jen Akinson:
Bigger ovaries.

Justine:
Yes, bigger ovaries, now, turn it off.

Sarah Lavonne:
And so I had a DM yesterday from a really well-known sticker making nurse that you guys probably all know that she turned her Pit off from tachysystole. The MD went to his VP who then went to her director who came down on her for turning off Pit for tachysystole. But she was like, "I'm standing with... Well, you can come, turn it back on if you want to turn it on, but I'm keeping it off."

Justine:
Wow.

Sarah Lavonne:
As a new nurse, you wouldn't do that. You would be so scared, you would turn it back on.

Jen Akinson:
And I think this is the interesting part of culture, the hospital unit culture that really plays into this because I worked last Friday and my patient was getting an epidural and she was an induction, so she had gotten started with cervical ripening over the night. I inherited her in the morning on four or six of Pitocin and she went to get her epidural. She's like, "Can you turn it off?" And I was like, "Absolutely. Don't ask me twice." And then, all said and done. I walked back out and I tell the midwife, I was like, "Oh, hey, we turned off the Pit." And she looks at the monitor. She goes, "Great." Because the patient had continued contracting as they do because in our unit where our culture is, sure, use it when you need it, turn it off as soon as you don't. And so that unit culture really can change place to place.
And I had a monitoring class I taught yesterday and it was nurses from all over the country and there's this nurse who'd been a travel nurse, but she's settled in Kentucky. And I was asking patients or nurses, "Well, when do you guys turn off your Pit if you don't have monitoring?" And some of them were like, "What do you mean?" And she was like, "At my hospital, it's 10 minutes. If you don't have monitoring for 10 minutes, you turn off your Pit." So this whites, there's a lot of discrepancy in practice and people feel that, right? I think when they start commenting like, "We're sharing all this knowledge on social media now that we didn't have access to, and it is starting to make people question the unit cultures that they're maybe never did question it that way before."

Justine:
Well, and one of the... I'm sure many nurses are thinking like, "Well, I don't want to get yelled at from my doctors." We talk about unit culture and the pressure. If I was able to freely practice the way that I am assessing the patient, I'm looking at the Pit, I'm looking at the contractions, I'm looking at the baby. And per my assessment, the Pit either needs to go down or off. I am 100% thinking in my head, who's my doctor? What are they going to say? What are their preferences? Am I going to get yelled at? Should I push it a little harder? And in theory, that needs to be somewhat removed, but there's this bigger overarching looming provider pressure that many units experience because or I have doctors come to the bedside and they'd increase it not knowing when it was last increased. I'm like, "I just went up. What are you doing? Stop touching my pump. What?"

Jen Akinson:
[inaudible 00:07:56]

Justine:
Get the baby out. Fair.

Jen Akinson:
And the sad thing is that they not only do many nurses lack very foundational physiologic knowledge, which I know that's what you guys are going after a big time or I guess us now that I'm part of Bundle Birth team is upleveling that basic knowledge that nurses should have giving them access to this really good, really foundational knowledge. But if nurses lack it, guess who MDs do to? They don't have. So we have this drug that we use a lot and we started using it more and more starting about the nineties. And there was all of these papers and cautions and all of these things from different various professional groups saying like, "Okay, you got to slow down on the Pit and it didn't slow down."
So the ISMP is like, "If you can't figure your shit out, we are going to figure it out for you. We're putting oxytocin on the high-alert medication." So it was put on that list of high-alert medications because we were starting to have this upward trajectory and starting in the nineties that our professional groups could not get control of in the clinical realm. And so the ISMP was like, "Well, we're going to put on this list and then you're going to have to have boundaries, safeguards, protocols, checklists, education." And since 2007, I think we all, it's a bit of a rhetorical question, but what happened to our use of Pitocin? It absolutely accelerated. It was like, we just rolled right through that flashing red light. And so we have this thing that we're using a lot. It's involved in a lot of patient harm.
We know patient harm is... We know lawsuits are mostly preventable, and yet we still have providers who they say they don't want to get sued, but they don't do the thing that won't get them sued. They say they want fast deliveries, but we all know Pitocin does not make your delivery go faster. It causes dystocias, it causes all of these things that, and you either not in a vaginal birth or a labor dystocia or this thing dragging out and all this stuff. So I am very interested and we'll be diving into probably some study design around what are these cultural sociological factors that are... Just defy logic? I think, all of us can see that we're all scratching our heads. Why is things this way?

Sarah Lavonne:
I didn't even know it was on the high risk med until I took your class. And then I know there's a sticker on it that says high alert. And then I know some units make two nurses check before they start it. You got to put the stickers on the line. But really I feel like the safety checks should come a couple of times a shift. "What's it at? Why is it at that much? What's your progress been? Can you turn it off? Not necessarily, how are you hanging it?"

Jen Akinson:
I know.

Sarah Lavonne:
I know you know, I'm sure, every day.

Jen Akinson:
Did this one time, the lights were down and we're double checking my Pitocin. This other nurse comes in and I had it capped. I thought she had plugged it in. She thought I had plugged it in. Four hours later, we kept the lights down and it was like here was the computer on one side of the bed, and then the IV pulls on the other side. I was increasing it, but it drips so slow. It took four or five hours. And the dad was like, "Why is this wet spot on the floor?" I mean, she was in labor at that point.

Sarah Lavonne:
Honestly, worked out much better than the antibiotic.

Jen Akinson:
I'd rather have the [inaudible 00:11:15] going on the floor. Yeah, so I think we were talking, I know when we were all together in Palm Springs, the idea of... There's this culture stuff, but some of it's housed in provider hierarchies and stuff like that. Some of it's this, this is just what we know, this is what we've always done. I think having an understanding that no, it's not is absolutely, not right.

Justine:
But it's what we've done in our lifetime and in our practice. And so that's why it's normal for me. I'm so curious to talk to somebody who's almost retired and remembers.

Jen Akinson:
That's why it's truly a Pitocin paradigm now. At one of the A One's state conventions, we were talking about this because we'll do this exercise. Imagine your last patient, raise your hand if they had this. And after all these things, and most people have, that's their new paradigm. And this midwife who was about to retire, she'd been a nurse and a midwife, and now she did education or something like that. And she was like, "When I started, if we had an induction, we had to scramble to find the protocol book because it was so uncommon." You were like, "I want to hear from someone about your retire." She stood up, she told us, and it was chills through the room because she was like, "We had to go find the policy on how to do this because we never did this."

Sarah Lavonne:
Now, it's almost the opposite on some units. It's like, "How do we not have an induction? What do you mean I'm taking an active labor? What does that even mean?"

Justine:
[inaudible 00:12:50] are anyways.

Sarah Lavonne:
Right, they have epidurals by the time they're in active labor.

Jen Akinson:
I'm not to say we want to go back, that's how we've always done things because I mean a phrase of an over a phrase is game changing and some of the things we want to keep, some of the things we want to go back and some of the things like really accessible tools for nurses. I mean, if you can't use Pitocin, you do need another skillset.

Sarah Lavonne:
Yeah. Right.

Jen Akinson:
[inaudible 00:13:16] You need a motion app.

Justine:
[inaudible 00:13:19].

Jen Akinson:
I mean I know I'm going to be at bedside with both the app and my little cards because I do, those things are worn down. I had a slightly slow start to my morning and I had my position, I don't know what is that called?

Sarah Lavonne:
The position guide?

Jen Akinson:
The position guide, and you know you have that slow start to your shift. So you grab some alcohol and you just wiped on your phone, you wipe down your thing. And I wiped on my position guide and I was like, "Oh, Jen." I should probably do that more than once or twice a month.

Justine:
I think about that every time I wiped down my badge, I'm like, "Oh, this is so gross."

Jen Akinson:
We're disgusting.

Justine:
But I've been thinking if Jen was to write a one pager on this is the policy for Pit for the whole entire country slash world, what are some points?

Jen Akinson:
I love it. Well, in fact, I do write those sorts of policies for anybody out there.

Sarah Lavonne:
Your intellectual policy.

Jen Akinson:
And honestly, I think everybody... The information's there, we have the Avone fifth edition, Oxytocin induction augmentation guide. That thing is chock-full worth the price of admission of an A One membership. If that's all you ever got out of A One was that, money well spent. And it has pretty clear criteria in it, but it's going to be just, I think really starting to treat Pitocin like a medication, which sounds silly, but we don't. So treat it a medication. Do you have an indication? Do you know the risk factors? Do you know the side effects to watch for? Is this patient consented? Do they know?
Because Pitocin's a medication but induction's a procedure. And so we sometimes mix the two together. So they need to be consented for the induction, but by joint commission, they also need to have education on Pitocin and nurses have to have knowledge of the medication. In nursing school, you went to the unit the night before clinical and you had to look up your meds and before you could give those meds, somebody was like, "Tell me 10 side effects of a Tenolol." And you'd be like, "You had to know all of these things."
There's probably not many nurses who could fill that sheet out from memory for Pitocin and we give it most days of the week. So my dream policy is going to be something that's like, "It has to be a... Really, why not about Pitocin? Why not start a little Pit?" We're very, why not? But we need to be like, "Why should we? What compelling reason do we have to need this intervention?" Which is how we treat every other medication. Nobody's like, "Just throw some Oxycodones at them, why not?" There's no other medication that we're just sort of like, "Yeah, shits and giggles. Let's try it out in the infusion setting."

Sarah Lavonne:
And again, I don't know if I can share this because you said it in your class, but it really blew my mind when you were like, "You don't give four milligrams of Morphine and it works." And you're like, "Oh, it worked. Okay, let me give more."

Jen Akinson:
Let's give eight.

Justine:
[inaudible 00:16:24]

Jen Akinson:
If they stop breathing.

Justine:
Lowest dose.

Jen Akinson:
Right. Because we do that with Pit. We give it until tachysystole, until fetal heart rate changes. And saying things like Pit to distress is really like, "Oh, we don't do that." But that's exactly what that is. Pitting until you see fetal heart rate changes as Pit to distress. So yeah, just really normalizing it back to where it should be, which is it's a medication that you need to have an indication for. Right there, consent and education and having an indication you're not going to be giving it at least half the time, probably.

Sarah Lavonne:
We have so many people that it's like, "Admit them and Pit them." Why do we have to pit them? You are admitting them for labor.

Justine:
From your perspective, what would be some compelling reasons to start Pit? That you're like, "Okay."

Jen Akinson:
Yeah, so I mean that's the nice thing in, I feel like I have a very clear conscience because I'm definitely not the person, but do my patients occasionally end up on Pitocin? Yeah, it's pretty rare. And I'll say the ones that I have tracked. So my last two patients that I've had Pitocin I can think of because it takes me a lot to get there, but one was PPROMed at 36 weeks, and she waited 30 hours to get anything and she did a dose of Miso and that didn't kick her into labor. And she had high amount of knowledge, she was a data analyst I think is what she was. She did a lot. She was a data person, but she was also very high stress, all of these things. So before she just was like, "I don't want anything." And so I'm like, "Okay, cool, cool, cool, cool."
We did sideline release, I did the little fascia jiggle where they're on their side. She told everybody she got a full body massage from me. And I'm like, "You did it. You got 20 minutes of a fascia jiggle." But she felt very seen and loved and she was in the bathroom and her husband was like, "So what do you really think?" And I was like, "Well, you all are data people. So the data for somebody in PPROM who has not kicked into labor, we're coming up on 48 hours."
Most people who PPROM, the chances that she's already brewing an infection are very, very high. That's a number one reason why people's bag of water breaks, preterm and pre labor and I was like, "She's probably already brewing an infection." So I was like, "If her goal is vaginal birth, I do think that her chances at this point of her body kicking into labor are pretty slim." So they thought about it, we jiggled, we sideline released, we did all the things, and then she kicked into labor on 2 million units of Pit, and they ended up turning it off in the middle of the night and she delivered eight hours later.
And so was it the Pitocin? No. Even then, I don't believe it was the Pitocin, it was the setting her up, the feeling safe, all of that stuff. And she was one of those people who just needed that little kick. Maybe it would've happened in six more hours or something. But I gave her the data and the information, the education, and then the provider talked with her and that was the choice that she felt really good about. I don't think it would've worked if she didn't feel good about it, if she would've been like, "Oh, I got to do this and I'm sure I'm headed for the OR now if we wouldn't have been able to talk through some of those fears."
So that's one case is like PPROM I think is a pretty compelling reason. And then the last one I had was she was a mole tip and she was stuck at eight for many hours. And I did all the things and the baby was OP, and so they were like, "Should we do a little Pit?" I'm like, "No." I was like, "I'm not doing, I'll do everything I can to try to rotate the baby." We got the baby rotated and we did try a little bit of Pitocin, but it was just the tracing started to not look good. The baby was 11 pounds. That baby had tried OA-

Speaker 4:
Oh, poor thing.

Justine:
I'm really nuzzling-

Sarah Lavonne:
Crazy birds.

Jen Akinson:
... And it never descended past minus one or minus two. So that's where we were like, "This is a big baby." She really wanted to play every card available to her. So that was when we used it. So those are the two situations that I'm like, "Obviously." If somebody is consented and wants an elective induction, I believe in patient choice. I believe in people's autonomy and freedom of consent and all that stuff. So if people want an elective C-section, cool, whatever, as long as they have all the information. So some elective inductions of people are truly choosing that from a place of empowered and consent, not just this last case I had, they said she consented for her induction, but when she was asked, well, what was that consent process like? She said, "They asked me, am I ready to meet my baby?"

Justine:
Wow.

Jen Akinson:
And of course, you're going to be like, "Yeah, sure, informed consent, whatever." But then I say PPROM and somebody who's like, "You're playing it as a last card."

Justine:
Well, and I think what's really interesting here is to have you with your extensive knowledge of Pitocin, your legal background, and then coming from a unit where I think your unit, every time I talk to you about your unit, I'm like, "You are the anomaly of the world. We all need to do and study your unit because the fact that you have a culture on your unit that doesn't really use Pit." First of all, I want to say I think our biggest barrier to that in that kind of an environment because that's the environment I've only ever known is, well, I just don't know what else to do because my first line of treatment of what I'm learning is like, "Oh, no contractions." We know how to create contractions through some Pit, throw some Pit at them, just give them a little whiff of Pit, just a little spank on the booty to help push things along.
And so I think I'd love to hear from you, what culturally do you think is different about your unit and your practice that you're trying and seeing work before you get to Pitocin in those circumstances? Because I think there's also a cultural... I mean what we see and why our whole physiologic birth class exists and why it's the most popular product that we sell and the most probably useful product that we sell is because of that shift towards giving other tools other than Pitocin. So I'd love to just pick your brain on what you're seeing and what you see as different.

Jen Akinson:
We technically have... Statistically, we have the same amount of inductions and augmentations with Pitocin as the national average. So we do use it. We just use it much lower doses and we tend to turn it off. So those are two big things. So we do believe labor to be self-sustaining. And I've been in my unit since 2012, and I think something that's unique about it is that when I joined it was you died or retired, no one left. And it was really strong, nursing. The provider respect for nursing was incredibly high. And the provider respect for birth is incredibly high, very, very high.
I mean, we survived by this old doctor, Dr. Nielsen who was just this, I mean, in a lot of ways probably, you might've looked at him and been like, "Oh, that guy was probably a nightmare. Oh, total pain in the ass." Really, really, he would go toe to toe with you, but if you push, but if you were like, "No." I remember I was incredibly pregnant and we were on a little bit of a standoff about something and he's like, "Well, I'm going to go talk to so-and-so." Am like, "You do that." And he goes, "You're going to be a great mom." And I was like, "Thank you."
So he really respected birth and really respected nurses, and we have a really healthy environment for conflict, historically. We're in a little bit of a shaky spot right now, some things. But I think one of the things we've maintained is our culture around birth and respect, and we have a really strong midwifery presence. And then I joined in 2012 and started doing case reviews in 2013. I also happened to work at a hospital that has always been very happy that I do that work. They're like, "Tell us everything."
And so you hear about nurses who want to have a side hustle or teach a class or do expert work or something, and their hospitals are like, "No, we don't like that." And mine's been like, "Spill the tea." And we'll actually make changes because of it.

Justine:
Wow.

Jen Akinson:
They actually let me write our Pitocin policy. So for the whole system, which is the largest nonprofit healthcare system in the country, so it's huge. It's close to the size of an HCA type system. So it's a massive system that they were like, "She should write her Pitocin policy."

Justine:
Well, and imagine actually looking at the resources that you have on your unit in your staff and not taking advantage of, but utilizing those around you in a way that is, it plays to their strengths.

Sarah Lavonne:
I remember us talking about this in a previous episode, Justine, about that. But if you're a manager or a leader, look at who's on your staff and look at the resource. There might be somebody like a gen literally on your unit that has all of this knowledge and experience and expertise about something like that that you could pull in to be best practice and look at the impact of one unit, let alone there're many others that are doing things like this in our country and worldwide.

Jen Akinson:
Right? Yeah. Truly empowering. Respecting nursing. The gifts that we have to give because no shade, but OB-GYNs typically are very busy and they have to have expertise in everything from puberty to menopause to this type of surgery, to birth control, to HR. I mean, their amount of knowledge that they have to stay current on is massive and inpatient part of birth is a small sliver. They're all prenatal care, postpartum care, all of that. We are hyper, hyper focused, and we're a lot more able to keep up on fetal monitoring all of these things to make a real difference in this space because we aren't spread as thin. We feel very spread thin, but clinically speaking, we're hyper specialized, which is really lovely too.

Sarah Lavonne:
Mm-hmm (affirmative). So, what I'm hearing is that since we have the opportunity to specialize, and we talk about that on here, the professional responsibility, we have to know your ish, and I think Jen on one of the episodes with you, you talked about your friend and the CVIC maybe of how you know everything. Oh my gosh, I got to work on my game.

Jen Akinson:
It was shocking.

Sarah Lavonne:
And so it's like, "Okay, so you want to have the ovaries to stand behind your decision then know what you're talking about, get really good at interpreting fetal monitoring strips no more." And we talk about this in our fetal monitoring class. We're like, "No more happy baby talk, no more." It doesn't look good. I don't like it talk, actually, name it what it is. Know the patho behind it. Know what tachysystole is and what that means. And yeah, know about Pit. I'm a little... I feel inadequate right now because I don't know if I know the risks and benefits. I know risks, and I know the risk of tachysystole and the benefit of-

Jen Akinson:
Birthing sexually.

Sarah Lavonne:
... Birthing your baby. That's a big one.

Justine:
You know the half-life. You made a post on it. I saw it.

Sarah Lavonne:
Yeah, yeah, I did. But if you're listening to this, it's not all for, you can just keep learning, keep doing. You're already listening to those podcasts. We know you have the interest in growing and learning and changing and being better. But I got to say, and I think since knowing you Jen, I am frustrated at the lack of uniformity with Pitocin and misuse, and let's just make it better. Let's just all get on the same page and make it better.

Justine:
Well, and if we all had the nursing skill to promote physiologic birth and had an entire toolbox to help keep labor going, then some of our... We wouldn't even have to face the Pit conversation because labor is just progressing the way that it should. And then somebody, and mind you, I would say we don't have to face it. We probably will still face it because it's just so normalized they're like, "Oh, we'll just start some Pit." But then you even have more tools to say, "No, we've done this and this and this. I've palpated contractions every 30 minutes. They were mild and now they're strong. The patients affect has changed. They're now coping through contractions. They just got an epidural. Their cervix has made change, or it's too early to see change. It's only been XYZ amount of time."
And so that's where, again, I'm going to come back to the physiology always because that's my jam, as well. But if we knew the physiology, we were able to actually assess labor as normal versus abnormal, and we actually trusted in the normal components of labor, we would be less apt to jump on the Pitocin train quite as quickly and especially, if our patient's refusing so often, I still see all the time that nurses, they're like, "Oh, I don't want Pit."
And well then, just figure it out. What do you think is going to happen? I remember recently I had a birth. I was like, "Well, what do you think's going to happen?" Then you're just going to have a C-section. And I'm like, "Oh, my God." And I was like, "Uh-huh? Just deep breaths." And I gave the look of, "We'll come back to that in a second." And then the nurse leaves the room and I'm like, "Let's show them what your body can do." And we did. And that's where the physiology of birth and taking a physiologic birth class and using our new Motion app to help you apply all of that knowledge and help give some guidance to the strategy of the physiology of birth is to me the bread and butter to our jobs. How do we not know this and how are we not applying it? And I think it's one of the antidotes to the current culture of Pitocin is what I'm hearing.

Jen Akinson:
We only got Pitocin in its current form in the fifties. So post-World War II, it was first discovered in the early 19 hundreds or so by this guy in Britain. He was studying a different hormone with the pituitary and doing research on cats, which is horrifying. And he injected pituitary gland extract to this cat that he didn't realize it was pregnant, and she's like, "Shout out kittens." So he was like, "Huh-uh, what's in this pituitary gland extract?" And was able to extract it, but they were primarily then extracting it. They could only extract it from animals. So it wasn't even chemically synthesized in the lab until somebody here in the US in Cornell synthesized it post-World war II won a Nobel Prize for it, which is like, "Screw you, dude. I've been making this my whole life. You can't get the Nobel Prize for it." So to say what's going to happen without Pitocin takes a special lack of-

Justine:
Socialization?

Jen Akinson:
Yeah. The total lack of perspective on their place in the world in time, in history and human evolution to say that nobody had babies, everyone had C-sections prior to the 1960s or seventies when we actually started using it in inpatient birth. That's a special... That's a few leaps that they're making logical. It has not always been this way. And when people say stuff, you probably have a way better poker face than me.

Justine:
I have the best poker face. You'd never know. But it also, people I co-regulate with my clients. So if I'm stressed, they're really stressed-

Jen Akinson:
Can't just slap in someone's face.

Justine:
... And I'm like, "It's okay. I wish everyone could see my face." And I'm like, "Oh, got it."

Jen Akinson:
Wow.

Justine:
And then they leave and I'm like, "Oh my god." In my head, "Please stop." Just to wrap it up, I would just love if you could give some words of wisdom to this audience of what do you want them to do as a result of this? Whether it be think different, do something different. What would you love to see in changing the game? This is even more towards physiologic birth and all of that, but in maybe the decrease use of Pit or whatever it is. What do you want nurses to do as a result of all this?

Jen Akinson:
Basically, just try to imagine a world that we use it less, right? It's going to be more satisfying births, it's going to be less bad outcomes, which are traumatic for us. We didn't go to work, we didn't sign up to do birth to be Pit pushers. So we need to be able to imagine this world. And also just to know that there are other nurses out there that are like, "I will be your mama bear. I'll be your charge nurse. I have your back. I am on a personal mission over the next few years, very purposefully working to dismantle this." And so previously, my work's always been just education or the expert witness stuff, but I've started now working towards doing more writing and publication and doing work with our national organization, and I'm going to be getting in with the docs.

Justine:
Good.

Jen Akinson:
So, to this maybe not feel so helpless or hopeless, there are nurses out here that we are, it's really hard at the bedside. When we think about changing things, it's really a progression. We tend to really focus on advocacy. How many DMs do you guys get from brand new nurses are like, "How do I advocate?" And you're like, "It's really hard to advocate until you have the knowledge, the skills can communicate well." Because if you don't know what to do, it's hard to know what skills to use. If you don't have the skills, it's hard to know what to advocate for. And if you don't know what to communicate, it's really hard to be an advocate. So give yourself some grace. Start on those building blocks. Take the classes. People are going to get there. I do think we are going to get there.

Justine:
Well, and what I love about this community is just the fact that it reminds you that you're not alone. And sometimes it can feel so isolating and so does no one else care. And everyone's yelling at me that I need to up my Pit and I really don't feel good about it. And you get unconfident or whatever. But there is an entire community and movement of nurses all over the place who are fighting for this and who are advocating and who are trying to figure it out and publicating things. That's not a word probably, right?
It sounds right that they're publishing things to help support your practice. And I think if we can all take part in our place, I think it's easy to compare and easier to be like, "Well, I want to be them, or I want to do that too." And really ask yourself, "What's my place?" And it might be just how do I apply the skills and knowledge that I do know to help support birth, to continue progressing or ask the patient and actually pursue real informed consent and when they refuse, have the tools to help them and if they consent and it is appropriate to help them still have a positive birth experience, et cetera, et cetera, that I'm grateful for people like you Jen, who are willing to put in the work and publicate.

Jen Akinson:
I'm designing a little qualitative research study right now I'm very excited about, but I love it. All of the concerns, all of those really legitimate reasons why nurse feel scared and documenting them, because I think we know it behind curtains. We know it in our DMs, we know it in our nursing groups, what it's like. I think that we need a big wake-up call nationally of saying, "This is what's going on in our hospital units. This is how physicians treat nurses who try to be safe. It's widespread and we have to deal with it."

Justine:
Anybody works at the New York Times or Good Morning America. Put me, I'm just kidding.

Jen Akinson:
I'll like, "Put our culture on class."

Justine:
[inaudible 00:36:07].

Jen Akinson:
No, just kidding.

Justine:
So fun.

Jen Akinson:
Yeah. But I will say my unit was great and is great, but I think we did really take a focused approach to it. And I noticed, I think you posted, somebody had shared with you Justine or they tagged you guys, was that they took your class and they just kept showing up shift after shift and doing a little bit more, trying a little bit more. And then it's been now some months or year or two, and the providers trust them and is it a little lame that we have to prove ourselves? But I have to say, I think staying on a unit, building those relationships and keep applying your knowledge day after day, it's a long game and we like a quick fix, but this is a long game. This is a year two, five down the road that everyone's going to be like, "Call so-and-so they're going to help you or you do take a little time, don't get frustrated or give up if it's not better next week."

Justine:
Mm-hmm (affirmative).For sure.

Sarah Lavonne:
So Jen, we've shared before, but where's the best place to find you? If this is the first time they've heard of you?

Jen Akinson:
Jen Atkinson on Instagram or my website is just also my name.com.

Justine:
Everything down below.

Sarah Lavonne:
And she offers great education on both her Instagram and classes. And yeah, I've learned a ton from you. Same. Great. Perfect.

Justine:
And if you're listening to this episode and you are feeling challenged in your practice to know more, to be able to know more and do better, we have a class for you. So we'd love to see you in one of our physiologic birth classes. We have them multiple times a year. They are live and online from anywhere, but they're also recorded. So if you can't make the date, you can watch it later. And then in order to put that into practice, that'll give you all the know-how and how to critically think your way through. But we would also love to see you in our new Motion app. And if slash when you become a game changer, you can access a world of tools that help you when you get stuck, particularly for our labor dystocia for our malpositions, and helping to provide strategic position changes and strategic tools to help promote physiologic birth. And ideally in this case, hopefully avoid Pitocin and use it only when necessary in those cases. So we'd love to see you in our Motion app. We'll link everything down below.

Sarah Lavonne:
Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both. If you subscribe, rate, leave a raving review and share this episode with a friend. If you want more from us, head to Bundle Birth or follow us on Instagram.

Justine:
Now it's your turn to go and believe labor to be self-sustaining. We'll see you next time.