Rose L. Horton, MSM, RNC-OB, NEA-BC, is the Founder & CEO of NotOnMyWatch Consulting Partners, an LLC she created 3 years after coining the hashtag #notonmywatch. She created the hashtag out of her frustration at the rising rate of maternal & infant morbidity and mortality. As a nurse she believed that nurses, as the largest healthcare employee contingent, have the power to change the trajectory of morbidity and mortality. The hashtag is a call to action for all nurses to use their collective voices to support, listen to, advocate for, and follow evidence-based practices in caring for all birthing people.

Rose is a Women & Infant healthcare executive leader working as a Specialty Director at Emory Decatur Hospital. She is passionate about safe and equitable care for all women. Rose speaks on the topic of maternal & infant mortality, resilience, empathy, communication and diversity, equity, and inclusion (DEI) locally, regionally, and nationally.

Rose served as the 2012 President of the Association Women’s Health Obstetrics & Neonatal Nursing (AWHONN), a 25,000-nurse member association that is pivotal in creating, supporting, legislating, researching best practices, and evidence-based care of women and newborns.

Catherine Hill is the Senior Director of Nursing Education, Research and Practice at the Association of Women’s Health, Obstetric, and Neonatal Nurses. Catherine received her Bachelor’s Degree from Anna Maria College and her Master’s Degree from the University of Massachusetts, Boston. She has over 30 years of experience as a clinician, educator, consultant, faculty, and APRN in the perinatal field. Here work at AWHONN includes direct oversight of programs and products developed by the nursing team. She was honored to be the AWHONN Nurse Leader who collaborated with the science team on the Respectful Maternity Care Framework, Evidence-Based Clinical Practice Guideline, and Implementation Toolkit.

In this episode we interview Rose Horton and Catherine Hill about the new Respectful Maternity Toolkit developed by the Association of Women’s Health, Obstetric, and Neonatal Nursing (AWHONN). We cover why the kit was developed, how the kit was developed, what’s included in the kit, and tips for getting buy-in and implementing the respectful maternity care toolkit.  

1. Let’s start out a bit broad, can you first tell us about AWHONN, including their
mission and goals, and how it started?
2. Can you also talk a bit about the types of clinicians who are members in AWHONN
and the benefits AWHONN offers to its members?
3. So let’s talk about AWHONN’s Respectful Maternity Care toolkit. What is
Respectful Maternity Care?
4. Why did AWHONN see the need to develop this toolkit?
5. How was the Respectful Maternity Care toolkit developed?
6. Can you describe all of the things that are in the toolkit and how our listeners can get the toolkit?

7. Let’s say we have a clinician listening now who is sold and wants to implement this
toolkit on their unit. What advice do you have for getting buy-in from peers and
leadership?
8. What other barriers are you seeing when implementing the toolkit and how would
you advise teams to overcome those barriers?
9. What is the one thing you would want all clinicians to know about the toolkit?

AWHONN 

Respectful Maternity Care Toolkit

[00:00:00] Nicole: Welcome to the Woman Centered Health Podcast. I am Dr. Nicole Loew. And with me is Dr. Stephanie Edmonds. We are both PhD prepared nurses and the founders of Woman Centered Health. Join us as we talk with health professionals and researchers who can help you improve your communication with patients about sexual and reproductive health.

Please visit our website to learn more and connect with us on social media by going to www.womancenteredhealth.com.

Hi everybody and welcome to the Women’s Center Health Podcast. Today we are speaking with Catherine Hill, Senior Director of Nursing Education, research, and practice. For the Association of Women’s Health, Obstetrics and Neonatal Nursing, or AWHONN for short and Rose Horton, Executive Director of Women and Infant at Emory Decatur Hospital.

They both were part of a team that led the development of AWHONN’s Respectful Maternity Care Toolkit, which we think is a great resource for many of our listeners. But before we start our interview, we want to thank all of you for listening and let  you know that you can earn CEs and get key takeaways, resources, and transcripts by visiting our website, womancenteredhealth.com. 

Also, Stephanie and I put this podcast together in our free time and often use our personal funds. So please consider supporting us. You can support us by subscribing and giving us a five star rating on iTunes or wherever you listen to us. If you are able to offer a financial donation, visit our website and click the “support us” tab.

All right, let’s meet our guests. 

[00:01:38] Stephanie: Hi, Rose and Katherine. Thank you so much for being a guest on our podcast today. So if you could first give us a little bit of details about your background. I’ll start with Cathy. 

[00:01:51] Cathy: Thank you Stephanie, and thank you for having us. So I’ve been a registered nurse for over 30 years and an advanced practice nurse for about 13 years. All of my career has been focused in women’s health, obstetrics and neonatal nursing, and I’ve had roles as a clinician, faculty educator, manager and then more recently have worked in the advanced practice field. But for the last 15 years I have worked at AWHONN, and in my role now I have both direct and indirect oversight of many of our programs and products that are developed by the nurse leaders on staff. So I was really excited to be able to work with our respectful maternity care program and to engage with a lot of our members throughout that work. 

[00:02:34] Stephanie: All right, Rose. 

[00:02:36] Rose: Hi, as you said, my name is Rose Horton and like Cathy, my passion is centered around the birthing community. And I was privileged to get a job in labor and delivery as a new grad, and I never ventured too far from women and infant services and currently work as the Executive Director of Women and Infant services at Emory Decatur Hospital.

I’ve been a member of AWHONN for almost 18 years now and had the pleasure of serving as on the board of directors and then as the president in 2012. So, very connected to AWHONN, its mission, its goals and everything that AWHONN does. So, I had the opportunity in 2017 to do a presentation around morbidity and mortality, and as I was doing research for that presentation and looking at so many of the articles talking about the increasing rates of morbidity and mortality, I felt really angry and frustrated, and I coined the #notonmywatch because I said, I believe that nurses can change a trajectory of morbidity and mortality.

So I created that hashtag thinking it was going to, go viral in the four corners of our hospital. But it was a call to action for nurses and thankfully it has grown and expanded and as a result, I would say of my passion for morbidity and mortality, I am very much more focused on what are the important relationship dynamics that need to occur between clinicians and between patients to ensure that. And then Cathy talked about, “Hey Rose, do you want to be part of this amazing work regarding respectful maternity care?” And I was like “yes. Sign me up”. So it’s definitely fits in with my life’s work.

[00:04:34] Stephanie: Well, and I just want to say too, I feel like this is a big circle moment for me and Nicole. So first of all, Rose is somebody we’ve wanted to have on for a while and heard about her initially through Dixie Weber and Rebecca Vahle, who have been on our podcast also, and hopefully we’ll have another recording with Rose.

And then Catherine and I have worked together in my paid position at the University of Iowa doing evidence-based practice with AWHONN. So it’s really cool to get to record with both of you. So, The next question that we always ask our guests is what informs your perspective? So in other words, why do you do what you do and what is most valuable to you?

And I’ll start with Rose this time. 

[00:05:23] Rose: That’s a great question and I think what fuels me is equitable care for all patients that we care for, but especially the marginalized communities because I’m a woman of color and I know what disrespect feels like. I know the sting of microaggression and of racism.

I am really fueled by lending my voice to really amplifying the need for creating anti-racist workplaces and treating everyone with dignity and respect. not equally, but treating everyone equitably so that they can be successful. 

[00:06:06] Stephanie: Thank you Rose and Catherine.

[00:06:09] Cathy: So, as I talked about, my entire career has been in maternal child health field, and I think for me, I always felt most satisfied in any setting when I had the time to sit and listen and learn for really what people that I were working with, whether it was colleagues or families or patients, what did they need, what did those interactions mean and the outcomes? And so when I moved into the national level, I wanted to keep that piece, because that’s really what I think drives me. So, at this level, I have the ability to impact nurses and the patients they care for with networking opportunities, member engagement.

And so that really drives me to have the time to listen, interact with members like Rose. We bring teams together and we, we listen, we brainstorm and respond to what the requests are from our members from an organizational level. And so I really feel like what’s driving me now are responding to member needs and impacting patient outcomes. 

[00:07:13] Stephanie: Yeah. Thank you. I love that answer to that question from both of you. 

Nicole: We always love the answers and we love when it is responding to the needs of our community because that is quintessentially nursing. And I feel like every great partnership or project starts out with, Oh hey, I have an idea and then dragging someone in. Right, Stephanie? Sound familiar? ? 

[00:07:40] Stephanie: Yes, a hundred percent. Yeah, and while we were getting these very good answers and very serious responses, we have a six month old baby giving us googly eyes and the cutest smiles ever. So it’s hard for us to focus.

[00:08:09] Nicole: Sorry not sorry. Okay, so like we said, today we are going to talk about AWHONN and their Respectful Maternity Care Toolkit. So let’s jump right in. So let’s start out a bit broad. Can you first tell us about AWHONN, including their mission and goals and how it started?

[00:08:23] Cathy: Sure, I’d be happy to share that. So it’s always interesting when we have new staff or new members and we talk about where did AWHONN come from. So AWHONN was originally the nursing branch of ACOG, which was NACOG. So the Nurses Association of the American College of Obstetricians and Gynecologists, and the nurses within that group, were a subspecialty type member group to the physician organization. But really as the nursing profession has grown, and we recognize that nurses need to be accountable for their own practice and really have valued the knowledge we have and the expertise we have within our own community, it was important that we separated off and really focused on the nursing profession. So in 1993, the nursing side of NACOG separated from ACOG and became AWHONN which promoted nursing as a distinct and really autonomous, self-governed professional organization. 

[00:09:25] Rose: The only thing that I would add is I consider AWHONN, as a member versus an employee, I consider AWHONN my professional home. I will always remember the very first conference that I attended, how incredibly magical it was to be there because I didn’t know this existed and there were so many nurses like me in the profession. So I remember how magical it was and the amazing people that I met my first year I met the CEO of the organization. She was walking around in the exhibit hall and just randomly came up. She’s like, “Oh, I see you’re first time at the conference,” and I think the relationship was really forged then that I felt valued. I felt seen. I felt heard. The content was amazing. There were amazing speakers. So I’ll always remember that excitement as I speak to others about, “hey, did you know that there’s a professional association designed for nurses and its membership base for nurses and they provide education for our specialty, like just for us?” So I’m able to share that excitement and I love when I am able to bring, staff in for their first meeting, their first annual convention. Because I see it in their eyes and in their face. I’m like, yeah. Mm-hmm. . Mm-hmm like I told you. It’s magical, isn’t it? So I love the work that AWHONN does and I love the fact that AWHONN is autonomous and we can speak distinctly about us as a profession, but I also love, as part of the work that AWHONN does, the legislative piece, the policy piece, our visibility on Capitol Hill and our visibility and weighing in on very important matters that impact us as nurses that impact our, our practice and our scope. So yeah, I am totally indebted and totally committed to the Association. 

[00:11:15] Cathy: That makes my heart happy. So I can continue on and now focus on, really our mission. And if we think about what AWHONN does, we have really five major strategic goals that we work towards. Number one being diversity, and that’s across everything we do and where we need to be as an organization. Rose spoke a little bit about advocacy and where our efforts go there. We have a strong commitment to our members, in ensuring their voices are heard and they have the resources they need to provide the best care. We really focus on knowledge and education and then the infrastructure to do our work.

But our mission overall is to empower and support nurses who are caring for women, newborns, and their families through research, education, and advocacy. And those can be found in many different ways, whether it’s through an online course or a product, or attending an annual convention.  Rose spoke to the excitement around that, or attend Capital on the Hill and engage with your legislative representatives from your home state.

There are so many opportunities to really empower yourselves and have the resources you need to take care of yourself and take care of your patients. 

[00:12:36] Stephanie: Awesome. Thank you for that background. So can you also give us a little bit more background on AWHONN and talk about the types of clinicians who are members and also the benefits that AWHONN provides to its members.

[00:12:50] Cathy: Yeah, so as we’ve been talking about AWHONN as a professional nursing association or a member association that’s comprised of the majority of nurses. We have about 24,000 members, and we do have the opportunity to be an E-member or a full member. And there are different levels of benefits that go with those categories.

Most of the nurses that are members of the organization are either advanced practice registered nurses or registered nurses within the perinatal space. So that covers all the fields across the reproductive spectrum. So before pregnancy, during pregnancy, after pregnancy, women’s health across the lifespan, and even nursery and newborn intensive care.

Our members come from outpatient settings, inpatient settings. Some of them have their own businesses, and so they’re very engaged and active in their own careers as well as within the organization. Some of the benefits we have, as we’ve been speaking on this podcast and we’ve already been talking about some of the resources that are available, getting engaged in advocacy efforts, but we do ask, members to come forward and work with us. We’re looking for subject matter experts. As we develop resources and educational programs, we are asking members to participate in national research teams. There’s always access to our two journals, so if you’re not familiar with those, we have a clinical practice journal, which is Nursing for Women’s Health, and we have our research journal, which is the Journal of Obstetric, Gynecologic and Neonatal Nursing.

And we have a pathway. So for those who come in as early career members and want assistance with professional development, they can move through early career emerging leaders and we’ll be releasing a newly established fellows program next year. And then they’re all the networking opportunities we’ve been talking about. So we have internal member hubs. You can join a national committee, attending a national meeting. There are so many benefits, but I think the key is engagement with people in your professional setting and the opportunity to impact larger than within your own facility. You can help us make an impact from the national level.

[00:15:04] Nicole: Well, that sounds amazing. All right, so let’s talk about AWHONN’s Respectful Maternity Care Toolkit. Specifically, what is respectful maternity care? 

[00:15:15] Rose: I think that’s a really great question, and the way I would define respectful maternity care is care that allows the patient or client, whatever phrase you want to use of the person that you’re taking care of, that allows them to be seen, to be heard, to feel safe, to feel like they are the priority and that they have a voice in the decisions that are being made about them, their body, their pregnancy, their labor, their birth, where they can, at the end of an interaction say, “Wow, that was really great.” I remember as a staff nurse in labor and delivery, loving, loving labor and delivery and what always made me feel the best was those exuberant, parents, usually dads that would reach across the bed and give me a big hug, after the baby’s born, all of us are crying or the really sweet cards that I would get in the mail sometimes weeks later saying, “I don’t know if you remember me, but having you as my nurse was really impactful. You made a difference. I felt so safe in your care.” And I think that’s what respect is all about. It’s, it’s about that high-end, in my imagination, spa feeling that you can have, but within one of the most vitally important life altering events that happens, which is childbirth.

[00:16:54] Cathy: Yeah, I think Rose did a great job sharing her personal experiences and how we actually promote and provide respect. I think respectful maternity care is really about emphasizing the fundamental rights of women during the reproductive spectrum, specifically in childbirth, we know that’s a really vulnerable phase for people and giving them the space to share and be heard, making sure that they have equitable access to the best care and evidence based care.

But at the same time, we really need to think about how each experience should be individualized, and we need to focus on their own preferences and be sure that we’re meeting what their needs are. 

[00:17:40] Stephanie: Yeah, I remember. So I had the pleasure of seeing Catherine speak on the Respectful Maternity Care Toolkit yesterday at the Iowa AWHONN conference, and you did little activity where we could use our phones and enter in how we define each of us individually define respectful maternity care and people could write their answers in. And then she made this word cloud out of it. And what you could see is that like there was a huge variety of people defining it in different ways. But I think, yeah, I think that that is definitely a nice summary. I think I put kindness and compassion and nonjudgmental, which is I think what we talk a lot about on Women Centered Health. So this is all about what the same thing that we talk about on every episode. Like respectful. Yeah. I love that word. And I think it’s to the word, one of the words Cathy used. And that’s, individualized, right?

[00:18:49] Rose: A saying we have at my organization when we talk about pain, the pain scale and the functional pain scale. But we came up with the terms like, pain is what the patient says it is, plain and simple. And that’s an example of that individualized. So if for you respect is compassion, then that’s how you’re going to embrace it. And that’s how I navigate my care to ensure that that’s what happens to you. For somebody else if it is, respecting me is making sure that that my pain is managed. I really want an epidural as soon as I can have an epidural. Can you partner with me and make sure that happens, ?

So that’s the way that I need to navigate my care towards that need. So being individualized, recognizing that everybody, everybody interprets it a little bit differently, but we are able to meet their needs where they are. 

[00:19:51] Stephanie: Let’s talk about why AWHONN really saw a need to develop this toolkit. Can you talk a bit about that?

[00:19:58] Cathy: Yeah. So I think, we’ve been hitting on some of these things as we’ve been talking, and so as Rose described earlier, we really have a crisis in the United States around maternal morbidity and mortality, and we need to do something. There are really too many people that are dying or having long-term conditions related to childbirth in this country.

And the latest data show that those numbers are definitely increasing. So how do we really make an impact? Especially in those underrepresented populations where, those rates of maternal morbidity and mortality are, are much higher. So we really sat down and, thought about what can we do as a national organization?

And we knew, we know that disrespect leads to distrust, right? So if, if people distrust professionals, which is anyone who comes in contact with a patient, we can have poor maternal outcomes from that which does lead to our increasing rates of maternal morbidity and mortality. So we decided to strategize and think internally.

I will say we were lucky to have our program funded by Huggies Healthcare, and so we were able to make this big and really take it across a whole spectrum. What can we do for resources to impact this? And our overall goal was to develop an entire program that would provide those resources to decrease disrespect and inequities in the care that we provide by starting with individual bias and then looking at organizational and structural barriers that continue to persist in our, in our healthcare system across the country.

[00:21:49] Stephanie: Rose, you have anything to add? 

[00:21:51] Rose: Yes. So for me, within our organization, we started what we call the journey towards equity. It started shortly after the hashtag, and in looking at our patient satisfaction scores and looking at their, their comments, as we looked at the big HCAP buckets, the ones that were huge outliers for us in my organization.

It was centered around courtesy and respect. And I’ll always remember the first conversation I had with the leadership team, as you show, it wasn’t about pain, it wasn’t about timeliness, it wasn’t about how quiet the unit is, it was around courtesy and respect. Oh, and food. Food is another big one.

So I show them all the categories. I’m like, which ones do you think is our major problem? Like, it’s food, it’s cleanliness. We’re not clean. I’m like y’all, it’s courtesy and respect. And we own that. So when we noticed that, we became intentional and said, we need to do a deeper dive into this. So in our leadership rounding forms, what we did was we added a couple of lines to it.

We added race to it because we were interested, hey, was everyone telling us that we were discourteous or was it a specific group of people? So, Shortly thereafter, notice that it was our black patients. Consistently felt disrespected. So then we really started the, the meaningful and the hard work. So we created a, program in 2019 called, Respectful Equitable Care because we wanted to be intentional to say, listen, we’re not going to do this.

And then shortly after that, we followed with a, a program, mandatory program for all of our staff nurses, our unit secretary, everyone who works in our, in our unit. And then we did one about shared decision making because we thought that was the rational next step. And then the most recent one we did was on unique families, really looking at the LGBTQIA and Rebecca Vahle and Dixie Webber, they presented that for us.

And looking at surrogacy and adoption and substance use disorder. And what happened at the end of 2020 and 2021 is that we had the highest patient satisfaction scores we’ve ever had in over a decade. So you can’t tell me that during a pandemic, that having those high scores was just, a gift that dropped from the sky.

I think it was our intentionality. So I’ve been very, having seen what’s possible, I’ve, I’ve been a die hard of, Yes, let’s talk about respect. That’s the root cause and so many great things can evolve. Through ensuring that in every interaction with every patient that we’re respectful. 

[00:24:57] Nicole: Yes. Let’s talk about it. So we’ve kind of talked about our, our why now let’s move into the how, So how was the respectful maternity care toolkit developed? 

[00:25:09] Cathy: Yeah. Thank you. So I think, once we knew we needed to develop a program, we really sat down and strategized what that would look like, and we engaged 10 key members who, applied and interviewed to work with us because we wanted to make sure we really had a diverse group to inform.

What we were doing and everything we do at AWHONN is evidence based. So we really started with a literature search and as we started to see themes come in, the team wanted to begin with developing a framework. So really, that framework took our phenomena of interest. So respect and really helped us map out how those key concept interacted with each other. We pulled those themes, we created that framework, and then we moved into developing an evidence-based clinical practice guideline. AWHONN has a really strong scholarly way that we create our evidence-based guidelines and they, they take a lot of time and we were careful. We made sure we took the time we needed to read every article to really look at the themes and the way they interacted, and then pull the key concepts into a document that provides recommendations and supportive rationale statements all around those key themes that are embedded within our framework. And then from there we said, Okay, now we need to implement because we have these products. How do we support members and others who want to use these in implementation?

And that’s how the toolkit theme arose. And as Rose spoke to us earlier, I reached right out to Rose and said, would you like to come on board with us and help us develop this toolkit? 

[00:26:58] Rose: And I said, yes. That was lovely. So to Cathy’s point, the hard part was really informing the evidence based guidelines, right? So started with the framework, which really informed all the work and all the writing and all the lit literature review that occurred after that. So we had a really great foundation and that was about, okay, how do we operationalize this, how do we make it so that someone can embrace this, replicate it, and and scale it across the United States? And the toolkit was the recommendation that AWHONN had, and it made perfect sense. So we had a really creative team and we started thinking about, okay, what’s really important to us in creating this, this toolkit?

We. It to be something easy. We want it to be something relatable so people be like, Oh, I see. I see what you did there. That makes sense. I can remember that. And we wanted it to be. Just a normal part of what you do every day. Not, Hey, I’m going to teach you a whole new skill set called Respectful maternity care.

That wasn’t, that wasn’t the objective because no one has time for that. And so those were all the things that we were thinking about as we started working on creating the the toolkit. So you’ll see that the toolkit has 10 steps, and as nurses and the birthing community, we’re all very familiar with the 10.

To become a, a baby friendly hospital or promote, breastfeeding. So we’re like, let’s make it 10 steps. And then because we’re nurses and we love acronyms, someone say, Well, let’s create an acronym. And one of our very creative nurses created the acronym care path. So as you look at the toolkit here, the essence of what we all do as nurses, and here’s the path, right, to respect to maternity care.

And then after that, we just thought from a really strategic. Basic operations, what are the steps you need to do to be successful? We started with commitment. We need commitment from somewhere, ideally from the C-suite, because with that commitment comes usually resources. so we started every step layers on each other.

We recommend that you start with one and work your way all the way through. I wouldn’t be mad at you if you wanted to start with a celebration. Not sure what you’re celebrating, but, So we think it should be sequential that you start with a commitment and then you end with a huge celebration because it would’ve been a heavy lift.

But we were intentional. We said assemble a team. that’s one of the vital steps. You want people who really have the passion for this work to be part of the work. And then we said readiness is I. Is your organization ready for the work? And so we have some really great assessments and surveys to help organizations to see while am I ready?

And like baby friendly. We said we want education to be for everyone. Everyone who touches the patient. So not just your team, but consider environmental services because they’re in the room with your patient. Consider food and nutrition. They bring a tray, they need to know what respectful maternity care is.

Consider radiology, they come up and they will do a scan, consider registration. The person who admits, all of our patients. So all of the steps are really, really make perfect sense. We said, let’s do a policy because if it’s important enough first to do all this work, let’s create a policy around it.

Step six is about culture. And we need like a whole other recording to talk about culture. We said adapt culture.  I say that culture is the unwritten rules of your organization, your policies and your procedures. This is what we do at my facility. Then the culture is like, what really happens that nobody tells you about until you have a major event?

It’s like, Oh, that’s what you guys do here. So we need to look at, at the culture, we need to look at measurement. All of that, all of the steps lead to the successful implementation, of the toolkits. So it was a lot of fun. It’s resonating, right, Cathy? It’s resonating. Every place that I’ve been and Cathy has been, We need that song for Cathy.

I’ve been everywhere, man. Because she’s been everywhere. Also speaking to this, but it resonates. I was recently in West Virginia just two weeks ago and it was a, an ACOG and a PQI meeting. and it was the providers who came up to me afterwards to talk to me, the providers. It was a couple of NFMs and a couple of OB generalists.

And my heart was like, so glad. I’m like, You guys are feeling this? This is great. This is great. So yeah, I think the toolkit is great. It’s going to revolutionize, revolutionize the way that we provide care for our, our patient. and we so need that. 

[00:31:49] Cathy: Yeah. And Rose, I just, when you said the, the physicians came up, I had a similar interaction when I spoke at a theology conference in Chicago a few weeks ago, and I was in the, They separate their conference out into physician and nursing sessions. So if you can only come for half the day, you choose. And there were many physicians who stayed for the afternoon and they were the ones who were very engaged and said, we need to change the way we do things here.

And so when you hear that right after you’re out, Speaking and disseminating these really valuable resources for physicians and providers and, and, and, nurses. Everyone who says, What can I do? We need to change. Can you help us? It just, it really helps you recognize that. there are a lot of people who are ready.

Right? They’re ready to commit and they’re ready to move forward. 

[00:32:47] Stephanie: Yeah, exactly. And I think changes seem so big and hard and impossible sometimes, especially when you’re working every day in those front lines. So giving them a tangible toolkit is really a great idea. So can you talk a little bit. You, you did mention some things that are in that toolkit.

Can you talk more specifically about what is in that toolkit and what the 10 steps are? 

[00:33:18] Rose: I’d be happy to do that. So the first step, because it’s pure path, the first step is commit. So we’re going to commit to the decision to do this. The second step is to assemble the team. Ideally, the team should be, Multidisciplinary so that you can have the voices of, of many, many folks.

And then readiness, there’s several surveys to help you have the conversation, Are we ready for this change? What could be a potential barrier? What do we have in place that may be impeding our ability to provide respect maternity care? The next step is education. And as I mentioned, everyone needs to be educated everyone who interacts with the patients, needs education. 

 Then step number five, the P for path is policy. And then adapt culture. And after adapt culture, it’s accountability. Now, accountability is like my favorite word of all. I love it because it really is the linchpin of any successful initiative. if you’re going to do a whole new initiative and you say we’re going to do this, and then you put it out there, and then some people are early adopters and some people are like, I’m just going to wait it out because in a month it’s going to go.

What accountability loop have you created for those resistant folks? So we talk about accountability and in the, we have a video for every step. And in the video for accountability, Tim talks about, it’s accountability to yourself first. And then it’s to your patient, and then it’s to your organization.

It’s to your profession. It’s to your teams. I love the way that he talks about accountability because it is multifactorial as you consider accountability. And then eight and nine is about measurement, tailored data, me measurement. So we believe that an important. Aspect of implementing respectful maternity care is to look at our data stratified and not just aggregated data.

Because aggregated data will tell you one story, but when you stratify your data, it tells you the truth. So that’s important. And in test measurements is step number nine. So within our organization, when we defined the metrics that we were going to look at stratify, we had to go back and do some tweaking, which is why we put in that test measurement because, It, it didn’t make sense for us and it didn’t give us the, the answer that we needed, so we needed to reframe it and come back.

And when we did and we reworded the, the numerator for this one question, it’s like, Oh, now I have all the data that we need. And then step number 10 again is celebration. Again, after you’ve done all this work, let’s, let’s celebrate. my big hairy goal is that in the near future, maybe in a year or two, that AWHONN will have a, an award, an organization wide award respectful maternity care award.

And, and then we’ll have opportunities for people to talk about their journey towards respectful maternity care through storytelling. What did they learn? What did their, their outcomes show? And then of all the submissions, somebody’s going to get. Beautiful, magnificent award, and they’ll have a designation of being respectful maternity care recipient worthy by AWHONN.

I’m sure AWHONN will come up with a very fabulous title, but that’s, that’s what I envision, right? That they have something to work towards. Maybe I, I teased with Huggies. I’m like, Maybe Huggies will put the money towards a wonderful award that people will want to clamor for. Like, I want that award. just like we want you, we want Daisy and we want Magnet, or we want Malcolm Bald.

We’re going to want that respectful maternity care award from AWHONN. So that’s my own vision, but that’s step number 10, is that celebration. And so it’s important.

[00:37:11] Cathy: I think, Rose, thank you for sharing those 10 steps. But for people to know, this is a, it’s a fluid toolkit. It’s, it’s not something that you hold in your hand, right?

It’s available on the AWHONN website. Every single step that Rose just discussed. It’s set the same way. So when you have your access code and you go in and you link to it, it starts with a video. And Rose talked about Tim’s video. Rose actually has a great video in there too that we love to watch. And then there’s an introductory paragraph to the, the key theme of that step.

And then we give bullet points on, important points for that step. And then each step has resources designed around that step. So some of them have interactive tools, some of them have templates to use. There may be journal articles, there are videos, there are podcast. There are policies you can download and adapt.

We have sbar s and infographics. We have links to journal articles, and as we have more resources, we continue to build and drop them into those steps. So our work is not done and we will continue to build on this. And hear from members who are engaged in their own journeys of respectful care in organizations.

As we have feedback, we will keep building on this program. 

[00:38:37] Nicole: It sounds like an amazing program and I am a personal fan of templates. available. So say we have a clinician listening now who is wants to I tool kit. Forrest is really excited about it too. What advice do you have for getting buy-in from peers and leadership?

[00:39:00] Cathy: So I like to encourage, really two things when we’re thinking and talking to leadership, and both from peers peers and leadership. There are two things. The patient. and yourself. Right. So when Rose talked about accountability and being accountable, we have to be accountable to ourselves and in order to be accountable, we provide self-care, as Tim talks about.

So we know nursing is a balancing act, right? We’re very busy. We have families, we do a lot inside and outside of work, and we’re not great at self-care. Which then leads to our inability to be respectful. So I think when we talk to peers and leaders, we need to ensure that we have a healthy workforce environment that allows us to have the time we need to take care of ourselves and our families so that when we’re at work, we’re energized and we’re focused, and we really have the capacity to.

Implement these strategies. We’re talking about the time to sit and listen, the time to actually learn and to hear from our patients. And then the second piece I always like to talk about is, and Rose alluded to this a little bit in the patient discharge data. Look at patient outcomes and can you impact these outcomes?

Right? Are patients being listened to? Are they having the length of stay they need? Are we addressing their concerns and their potential complications to prevent concerns when they go home or readmissions? And when you have goals that you can set around your patient outcomes, readmissions, discharge data, and you see those things changing, you’re going to know.

Using these resources and implementing a respectful maternity care program is really important. And I think Rose, really, you discussed this earlier on, and that’s really impactful to use when you’re talking to your peers and talking to your leaders. 

[00:41:04] Rose: I agree, Cathy, with everything that you’re saying and we, we do have to be sensitive in how we frame an organization’s desire to move forward with this initiative.

Because it can be perceived as, as additional work, and it really, it really isn’t additional work. I think the opportunity exists for us to frame it around, Hey, what would it feel like if all of our patients were 100% satisfied with their care? when you think about the level of incivility that that is happening within organizations, and we don’t know what the root cause is of all incivility, but for some it’s.

Right. For some it’s feeling like they’re not being heard. What would it, what would our organization look like if everyone was a hundred percent satisfied with their care? And how would that make us feel as nurses who are providing care? Because that would, that would feed your spirit, right? To know that every interaction with your patient’s going to be pleasant.

It’s going to be lovely. you’re going to be reengage with. fuels your passion. And I, I think that’s the way to have the conversation is reimagining what relationships could look like, reimagining what outcomes could look like. it’s like, hey, imagine falling in love with your profession again.

This is a way that that can happen. So I think that’s, that’s another way that, that it can be frame. 

[00:42:33] Stephanie: I love that. I know that we talk about this a lot in our podcast. Just yeah, like things that you think will take more, you don’t, will take time that you don’t have at. We think that it will really save you time in the long run over time.

And one of those things is building that trust with patients and having those really meaningful relationships too. Because a lot of, I feel like a hundred percent of us, maybe not a hundred percent, but most of us go into healthcare because we want those positive. Experiences where we feel like we have a really great relationship with a patient and we want all of our interactions to be like that.

So, but like the day to day, we just get wrapped up in the tasks and not the person, which makes me think of that video. So Cathy showed a video yesterday. I think you all created it based on a true story, and I think that is a great way also to get buy-in from people. Nicole and I talk a lot too about.

Not ideal behavior from clinicians. Cause sometimes, like, it’s like with this podcast, we’re preaching to the choir, like the people who are listening to us like are probably giving, great care. And, but we know that, we have seen, we’ve experienced ourselves as patients sometimes where it’s not great care.

And that video that, I think you guys created it off of a real story, but it was basically like a, a woman of color as a pregnant patient. And she is laying. Side, and the nurse is at the computer typing away, and then the OB gen comes in, doesn’t talk to the patient at all, and talks to the nurse only and is like, Okay, I’m going to dilate or break her water now and rupture, rupture her membrane and they, go through the whole sterile thing.

And they don’t talk to the patient all, she just like, Tells the patient to flip over and breaks her, breaks her membrane, and then walks out . So like there was no consent, there was no Hi. How are you doing? I’m your doctor. Like any of that. And, and, I have seen that happen, not just in in reproductive healthcare, but I’ve seen that happen so many times where the provider just kind of comes in, does their task and leaves, and really treating that patient kind of as a thing to do, rather than a, a person who’s there for care.

So I really, I really saw that video as a great buy-in because I think as nurses we’ve all seen that happen. Okay, so let’s talk a little bit more about barriers implementing. So what other barriers do you see teams coming up against when they go implementing the toolkit, and how would you recommend addressing those barriers?

[00:45:26] Cathy: I think,  what we hear people say, and Rose just spoke of this, I don’t have time and. The elements of the guideline and the toolkit aren’t anything different than the care we should be providing all the time, every day in everything we do. And so when people say that, it’s really just we encourage them to really take the time to look at the program and just take a few strategies away to start to work on, and then they’ll see, Oh, this is the way I should be doing this every day. So that’s, a barrier that we talk through. We’ve heard from some teams who are using this and they’re saying one of the barriers that are really differences in opinions between, within the healthcare team, right.

So if, if one provider’s on, they’re maybe doing something one way and if another provider’s on they’re interacting or doing something a different way. And so we really need to focus more on collaboration and communication, maybe using a shared mental model. And so we talk to organizations about that and how to get there.

So we have, barriers within ourselves that need. Addressed and then barriers within our team. And as we hear these concerns come through, we continue to look for ways to find resources to integrate into that toolkit to help people address those barriers. I’m sure we’ll continue to hear more and we’ll continue to work with those who are using it to ensure they have the strategies they need to

be successful.

[00:47:00] Rose: I agree, Cathy, and I think another huge barrier. We should consider, When I say we, I mean the leadership team is definitely something that I consider is, we’re at a very unique juncture in healthcare. I’m almost afraid to say post pandemic. I think we can say post pandemic, but this pandemic has been terrible.

It’s decimated healthcare. We suffered the brunt of the pandemic as it relates to the emotional and the psychological trauma. As it relates to burnout. As it relates to turnover, I saw this really great framework speaking of those who love templates and love framework, and it’s called the empathy framework.

And I really, really, really love that framework because. it talks about what we, what we usually do, that we have an introduction and then we immerse ourselves and we form a connection. But in the empathy framework, it talks about a fourth step. In the fourth step is detachment or to disconnect and, and I think.

I believe, and I may be speaking for myself, but I think I speak for a lot of the profession that for us as nurses, it’s hard to do that detachment piece. So we stay engaged and connected with everyone and with their life stories and with their issues. And that really leads to compassion fatigue, just, and when you have compassion fatigue, you really have a, an inability to be empathetic.

And I think we need to speak to that. We need to speak to, as Cathy spoke to earlier, wellbeing, the wellbeing of us as nurses and as healthcare professionals and clinician. We need to be intentional in making sure that. We detach and that we focus on self-care so that our empathy can be rejuvenated, because if, if you’re in compassion fatigue, there’s nothing that I can tell you. It’s like alarm fatigue, right? I will walk into the nurse’s station, it doesn’t matter, which, it could be labor and delivery, it could be NICU, and I will hear an alarm. I’m like, Y’all hear that? I’m like, What’s that? ?

So it’s just like alarm fatigue. You just don’t hear it anymore and you don’t want that compassion fatigue where you have no compassion anymore. So I think the opportunity is to work on, well, the intentional to work on wellbeing and maybe to like a joint thing. That would be really cool. Cathy, like offer like a, a wellbeing program along with respectful maternity cares.

Like, okay, we’re going to feed you so that you can feed the, the clients that you take care of. But I think there’s an opportunity for those, the two of those to dovetail nicely. And then also, Once we have them back with some empathy and we can say, Let’s reimagine this. Imagine every patient being totally happy.

People are like, Oh my God, I love that. Yes, I can see that. And then they’ll be ready to engage and they’ll be a champions and your cheerleaders and you’ll have a very successful rollout. 

[00:50:13] Nicole: Well, and I think that’ll be our next podcast episode, right? We can, we’ll have respectful maternity care and then we’ll talk about burnout.

And compassion and empathy. I think that’s what I just heard. ? 

[00:50:24] Rose: Yes, ma’am. That’s what you heard.  

[00:50:27] Nicole: All right. So what is the one thing, or one to two things that you would want all clinicians to know about the toolkit? 

[00:50:37] Cathy: It’s hard to narrow it to one or two. I think you need to be ready. Right. So recognize that this is a journey, we’re engaging with and we’re learning, and we’re implementing components of respectful maternity care and learning that we may need to change some of the things we do, right?

Maybe the way we interact with our patients, or their families, or our peers or ourselves, right? That self-journey, giving yourself grace, knowing we’re going to make mistakes, it’s really about. being open and being accountable. And I always say, once you have had the opportunity to have a high-level overview, find your people, find your colleagues who are ready to take the journey with you, who are ready to hold you accountable, and have you be accountable to them too.

You can start small and, and take this journey. On your own. The goal is that it becomes really an organizational journey in the long run. 

[00:51:43] Rose: So I think the one, or maybe just the one thing that I would say about the toolkit, one of our primary goals in implementing the toolkit was to mitigate morbidity and mortality, we’re talking about lives. People die, right? People suffer trauma. At the hands of us clinicians at the healthcare system. They’re not seen. They’re not heard. And an untoward event happens and there’s a loss of life. And I think it was Stephanie that said, all of us went into healthcare because, we wanted to make a difference and we wanted to care for people.

We all want that. And I, and there’s an opportunity to remind everyone. We’re living in the highest rate of morbidity and mortality we’ve ever had in the United States with CDC sharing some data just in September, that 80% of the deaths are preventable, 80%. So that should be jarring enough for our specialty to say, Oh my gosh, not on my watch.

This is not going to happen. Why wouldn’t we put something in. that will benefit us, benefit our patients, and save lives. It’s a no-brainer. So I would put it all around morbidity and mortality. 

[00:53:07] Nicole: A couple things that I really appreciate y’all bringing up too is that this is a journey and I think very often we are like, checklist, I want to arrive there, I want to be there, but this stuff truly is a journey and that that’s okay.

That it’s a journey, but we have to start somewhere. The other piece that I really wanted to talk about as well and that I appreciate and, and this is another theme that we find in a lot of our episodes, is a lot of this is doing. That self-work that, looking inwards and reflecting and challenging ourselves and asking those hard questions of ourselves and that so much of communication with others really stems from within.

And taking those steps to be better within so that we can then have better communication with whomever we are taking care of so I appreciate. That was also very much a part of this discussion. Thank

you. 

[00:54:09] Stephanie: So I was wondering too, Rose, so Cathy showed a video of you and I think that’s on your website where you’re introducing yourself to a hypothetical patient and I wondered if you could just talk to our listeners about what you, what you say when you introduce yourself to a patient.

[00:54:31] Rose: Just so to provide them some tips on how. Be respectful, right from that first interaction. 

Sure. I’d love to. So I think it’s important to initiate conversations with the patient starting with. What is it their preferred name? do you want to be called by your first name? Do you want to be called Mrs?

So starting there, I would just introduce myself and say, I’ve been taking care of patients in the birthing community for 20 years, so I am very confident and I feel very confident to provide care for you. And let me tell you what I commit to in the time that I’m caring for you. The first thing is I commit to treating you with dignity and.

And what that means is I’m going to speak to you professionally and kindly that I’m going to knock before I enter your room. And I’m going to listen to make sure you said, Come in, I’m not going to knock and come in. When I come in, I’m going to close the door behind me. I’m going to pull the curtain because I want to protect your privacy.

The second thing I commit to is listening and believing you. So, Pain is whatever you say it is. If you say you’re in pain, I believe you. If you say you’re exhausted, I believe you. If you say you’re, you’re scared. I believe you. I commit to treating you with evidence based care. We are professionals. We are scientists and researchers in nursing.

We don’t just make decisions haphazardly. We really go by the science. So please know that I’m providing evidence based care for you. I commit to shared decision making. I want to hear what’s important to you. This is your labor, your birth, your postpartum period, and what’s important to you is important to me as well.

So I commit to. I want you to know that I see you. I hear you. I’m your person and I will advocate for you, and I think starting a relationship with anyone with that level of commitment. It decreases anxiety, it allows people to feel seen and heard, and they can focus on the important work that they need to do.

, and that’s, that’s a little bit of what I say in the video. Yeah. 

[00:56:45] Stephanie: And it’s so powerful when you say that. I can’t imagine having a nurse say that to me in the hospital. Also like it took you, what, two, not even two minutes to say all that. So it was just beautiful. And imagine if all clinicians were saying that to their patients at every interaction.

So thanks for sharing that. I think that’s just a really great. Quick tip to provide. Katherine, were you going to add something? 

[00:57:15] Cathy: I was going to say that that right there sets the stage for trust. Right. And when our patients trust us, we have great outcomes because they’re not afraid to talk or share, and that barrier’s been removed.

They trust rose. You can, you can see it in her interaction, in her voice and the way she communicates. 

[00:57:36] Stephanie: Yeah. I love that. So I just wanted, I, I saw that yesterday and I was like, I want to say something about that on the video, because I thought it was just such a powerful clip. Okay. So Cathy and Rose, I would personally like to thank you so much for your time and commitment to advancing sexual and reproductive healthcare through communication.

Do you have any last thoughts that you would like to add before we end? 

[00:58:03] Cathy: Stephanie, thank you. Thank you so much for having us. I just want people. Take time to reflect, be patient and kind to yourself, and really give yourself the space to learn and grow within a framework of respect. Because respect doesn’t only happen in healthcare settings, right?

It is interwoven in everything we do. With our families, with our friends, with our community, with society. So take what you can learn and start to integrate that into all that you do. 

[00:58:35] Rose: I love that, Cathy. I think that’s perfect, right? Respect is a humanistic goal. that we take along with us. no, that’s great.

Nothing to add. Well, thank you both so much. 

[00:58:47] Nicole: Yes, thank you so much. And as always, we hope that you enjoyed another episode of the Woman Centered Health Podcast. We are always looking for new supporters, sponsors, and guests, so if you’d like to be on our show or know someone who you think would be perfect, let us know.

You can find more information on how to support us and contact us on our website at www.womancenteredhealth.com.