Transcript

SPEAKER_02
0:04

Hey Denny, how are you?

SPEAKER_03
0:05

Hi, Ginger. So good to see you again. Here we are. We are in live at it again.

SPEAKER_02
0:12

We're at it again, man, and it's a really big day. We can wait for this day.

SPEAKER_03
0:17

We have we're so excited.

SPEAKER_02
0:19

So I think our listeners will catch up with us when we jump into our guests, but we're gonna start with new news, which continues to be something I think a lot of our listener base appreciates, uh, the diversity of the topics. But this one, uh, as I do with most, I try to tie into our guest. So we'll see what we'll see what happens as as the conference uh as this topic uh gets moving along. So this was in the Aspen NPR News two days ago. Uh and that would be in Colorado. Uh and it's a very long interview and an article about midwives uh in Colorado. And I'm just gonna read a little bit of the transcript from the NPR interview just to set the tone here. I think it's important to share that that we are certified nurse midwives. We value multiple pathways into midwifery education, and one of them is the certified professional midwife. And this is in particular reference to CPMs in the state of Colorado suing the regulatory bodies that oversee their licensure. So there's a midwife named Juliana Guy who first saw her home uh home birth experience in the village of rural Guatemala. I think you've been there, Denise. I have been there. And during her time in the Peace Corps in the 1980s, she was highly involved in uh traditional birth experiences and came back to the U.S. and decided she wanted to be a midwife, but she had a master's in public health and did not want to become a nurse. So she took the CPM certified professional midwife route and practiced in Colorado's western slope, of which I'm not sure what that is, until the early 2000s, um, and describes it as some of the state's most rural and underserved communities, uh, which we know is in a major crisis right now. After more than two decades of practicing, that's a long time for a solo midwife doing home birth, she has now joined a group of direct entry midwives in a class action lawsuit filed last week in the Colorado Agency, the direct entry midwife registration agency in the division of professions and occupations with a lawsuit on bias and discrimination by regulators. So I'm gonna set the article aside now and just say my take on it is you know, we've had midwives come to us frustrated with disciplinary and administrative board reporting. So they are reported to the Board of Nursing or their licensure board. And that that can take months, as we know, to go through the process of investigation and conclusion and decision making. Many of them lose their hospital privileges. Um, many of them are without money if their jobs are are uh put on hold for a while. And there seems to be a preponderance of the CPMs in Colorado reported to the disciplinary boards of over 500 days before review and decision making.

SPEAKER_03
3:30

500.

SPEAKER_02
3:32

500 days.

SPEAKER_03
3:33

So they're sitting in limbo for 500 days.

SPEAKER_02
3:36

And they can't practice because CPMs are regulated in the state of Colorado, which they are not in Kansas and a lot of other states, but that means there's no providers uh to those areas to cover those areas and especially those families who choose home birth. So what are your thoughts?

SPEAKER_03
3:56

I I think it's horrific. Like um, you know, I think you we're we're really this is benefiting no one, and um the the punishment um for what may be actually real or not real is the problem. Who is making these decisions? Um and and actually the punishment then falls upon those birthing people in that area and their babies. So I think that's tragic.

SPEAKER_02
4:23

It's it's it's really unfortunate that that they they believe, and I think there's some pretty substantive evidence with comparative data with physicians and nurses and midwives before disciplinary boards having decisions within half or less the time, but they seem to be uh biased against. And I think it's an example of the confusion, and maybe our guests um will learn a little bit from us about the confusion of midwifery in the United States and how discrimination can happen in a variety of ways. But this is one example of how um my son that just graduated from law school said on a podcast a few weeks ago: if I can't figure out what a midwife is and a midwife delivered me, we got a problem in the United States. And and we do. So there's a lot of things that become conflated when you just hear that word. What is a midwife? So um I thought it was I thought it was worth sharing. Uh it's very relevant news, and it's definitely going on in Colorado, which is a pretty liberal, uh, independent practicing state for certified nurse midwives.

SPEAKER_03
5:30

But they're picking really thinking about it's affecting the third side.

SPEAKER_02
5:34

It is.

SPEAKER_03
5:35

Right? Which we'll get into.

SPEAKER_02
5:37

Yeah. So let's just get there right now. Let's do it. Let's do it. I rarely script anything. People who know me well know I don't do this, but man, I'm I'm slightly nervous. So here we go. Um, I want our listeners to understand why we chose this title of our podcast, which takes a while to practice saying it. Um, and then people go, What the heck does that mean? Um there's a series of life experiences that I've had at the ripe age of 70. Uh, when three summers ago I enrolled in the Harvard Business School um negotiation mastery course. And why? Because I was very envious of my lawyer husband who had attended in person the Harvard Law School mediation course, and and he was really good at it, and and I wanted to be that good. Um through my years of leadership uh on the national level, I can't tell you how many times I've referenced people to the book getting to yes. I've even read chapters out of it in high conflict meetings within our professional organization. And then this fortuitous moment happened last fall. I was wrapping up teaching a nine-month midwifery mastery course in consulting, and one of the students shared a book at our last meeting that she had she had found, um, and it was released in 2024, and I had no idea the book existed. And it's right behind me called Possible. Uh, How We Survive and Thrive in an Age of Conflict. I immediately downloaded the book and listened to it twice. Uh his storytelling was like a flint striking a fire in me. What if what if our consulting firm, Grow Midwives, could elevate our reach with greater emphasis and resources to help midwives embrace conflict instead of being afraid of it? Our barriers, as all of us know, are complex. They're chronic, they cause unnecessary restrictions on practice, and this often leads to early burnout and folks leaving our profession. So I decided to take a chance. On December 3rd from 4 a.m. to 6 40 in the morning, I thought about writing an email. I searched his website and I hesitantly pushed send in an uncharacteristic long email asking if he would keynote our conference now this July. Not only was there an answer in less than 24 hours, which my husband was astounded by, but the answer was in quote, yes. I would be delighted to join you and your colleagues for a discussion of what is possible for midwives to face these critical challenges today as carers for our babies and communities in need. I'll link his robust bio to our podcast platforms over a 50-year career, but I'm going to start using the words on the website with this leading question. How do we deal with our deepest differences without destroying everything we hold dear? From the halls of Harvard to the depths of Kentucky coal mines, from the White House crisis center to the deserts of Botswana, from corporate boardrooms to war zones in the Middle East, Korea, and Ukraine. William Uri has devoted his life to answering this one question. That first bring in his mind is a boy growing up under the shadow of the atomic bomb amidst quarrels with his family at the dinner table. Don't we all have those? Traditionally trained as an anthropologist, Uri went on to co-found Harvard's program on negotiation and co-authored the world's all-time best-selling book on negotiation, Getting DS. Today, William Urey, this is a highlight of my career. It ranks right up there alongside sitting in the second row in the East Wing when it was still there in the White House with Presidents Clinton, Biden, and Vice President Harris, two rows in front of me. It is my greatest honor to introduce you. Denise?

SPEAKER_03
9:31

I can't really follow that up so eloquently, but all I want to say is when Ginger um brought up the idea that our podcast would be called The Possibleest Midwife, every everything made sense to me. Um the framework, um, when you listen to um Yuri's work is it makes so much sense. Um and actually, you'll if you once you start listening to that, you're gonna actually go back and probably pull up all the TED talks and the books and spend all your walking your dog moments like I do listening to all of those. Um, because what better way? Um it it makes sense. The the the messages are clear, they're kind, they're compassionate, they're based off of connection with people, they're based off of listening and really resolving conflict and being a middle child, like that is um my role in life, you know, as as part of my with my twin. We we resolve conflict, we have to do that. Um, and then as as a midwife, um we listen. We we midwife means you know, really with women to listen to women. And so this makes sense. Um and we, you know, we really do work in a world where we have a lot of barriers. So I love William Urie. Um and we are we are fangirls, um, but I also want to say that I feel like we're we're partners. So welcome.

SPEAKER_00
11:01

It's a huge pleasure, Ginger Denise. Really, uh I feel like partners. Uh I don't when you when I received that uh email from you, Ginger, I was touched. I was tickled to think of uh possibilist midwives because for me the little that I've understood about midwives is uh is you bring possibility uh onto this planet. Um I mean that's the birth of possibility. Yeah. I remember uh having the pleasure of holding my grandson for an hour in my arms on the day he was born, and uh just kind of gazing into his eyes and just just seeing pure possibility. And for me, you're in touch with that, and that's really where the hope lies for this world in these days of uh such challenging times.

SPEAKER_02
11:50

Yeah, absolutely.

SPEAKER_00
11:52

So I'm touched and delighted and honored to join this podcast.

SPEAKER_02
11:57

It's probably it's probably not your typical interview, right? I I heard you with Simon Sinek, he's another one that I've you know read all of his books, and and we really believe in that concept of why as a grounding, you know, statement. Um But our profession is really challenged, you know, as we've shared a little bit, um the the the barriers are are chronic. Um and it's almost like as an oppressed and yet the oldest profession on the planet, right? Um it's it's it's really a pre an oppressed profession. And when we work with midwives weekly um on, you know, how do I have this conversation about being a full-time employee, but I'm they're making me work 70 hours a week and I get no no remuneration for that, they're they're afraid, right? Their first reaction is fear to learn how to navigate that conflict. And I think so much of what you bring is is important for midwives to understand they can learn, right? Instead of freezing, you know, or being angry.

SPEAKER_03
13:08

Yeah. Yeah, I really do think so, um, ginger, like the midwives that are out there working, they're they're they work hard. They pour their whole heart and soul into listening to women and birthing people and really trying to you know create the experience that they would love to have. But they're tired, you know, they're very tired. And um, so you know, I I I've been in my career accused of being negative, and I said, actually, I'm a realist. And then one day I said, Nope, I'm a possibilist now. So let's let's talk about the possibilist, um, the possibilities for midwifery here. That's so and for all the little Diegos that are in the world.

SPEAKER_00
13:53

That's it. And he now has a little brother. His name is Rafael.

SPEAKER_01
13:58

Oh, okay.

SPEAKER_00
14:00

And uh, and yeah, it's uh it's that that they're my bosses. I see myself right now.

SPEAKER_02
14:07

I I understand that. I got those too.

SPEAKER_00
14:09

Ginger, yeah, them and their whole generation, you know, just like how do we create a world in which they can grow up and thrive? That's yeah, yeah. And uh in this really whirling world, and and it's so uh poignant to me. I have the deepest respect for midwives, and it's so it's like uh I was just saying to you, it's kind of like an endangered minority, an endangered tribe, you know. It's kind of like I as an anthropologist, we often study endangered tribes. It feels to me like it's you know, and and the indigenous tribes are the oldest tribes on the planet, and midwives are one of the oldest tribes on the planet.

SPEAKER_02
14:48

Yes, they are, yes, they are.

SPEAKER_00
14:50

They go way back to time immemorial. I mean, you know, it's like uh I mean, I mean, that was the original form of birth. I was always, I mean, for you know, you know, as an anthropologist, that's just you know, we've been around for several million years, and for 99% of that time, the only people delivering babies were midwives.

SPEAKER_03
15:12

Right, right, right.

SPEAKER_00
15:14

And so our whole we're our whole uh heritage, our whole our whole psychology, our whole everything gets formed in that birth experience, which was through the grace and love of midwives.

SPEAKER_03
15:28

Yeah. Yes, yes.

SPEAKER_02
15:30

Well, you know, we saw we saw the major changes happening in the US with the modernization of obstetrics that that really happened in the US. I mean, Europe sort of was, and still today, laying on midwives as the primary gatekeeper of pregnancy. The midwives might not, they don't care for, you know, 100% of the population exclusively, but they are who you go see when you find out you're pregnant. Uh, in the United States, that is the opposite. In fact, you know, most people believe you are supposed to see a physician. And if you happen to see a midwife, you're going to hear from a lot of people, why are you doing that? You know, so we have a culture in the United States that has medicalized this experience with the belief set that you are sick until you're proven healthy. Um, and so for us as a profession to battle the sociological lens, right? The majority of people in America do not know what a midwife is. I ask every Uber, Lyft, and taxi driver I ever get in the car with, and that was almost all of the month of May, they don't know.

SPEAKER_03
16:41

They don't know.

SPEAKER_02
16:42

Um, and so if you believe in the tipping point theory, we're we're at about 13, 14% of all vaginal births in the US are attended by midwives, but we we need it higher. We need 1820. Um before the before before people really go, oh, a midwife. Yeah, cool.

SPEAKER_03
17:03

I want one of those. And the other the other thing really is like not only do we need more births, there's a need for more healthcare providers. Um, in so many areas of the United States, the rural areas are desperately low. There's maternity care deserts where there are no providers, and um, and yet there aren't there aren't enough of us having some support to go out to work in those areas.

SPEAKER_02
17:33

So I'm gonna I'm gonna ask you a tough question and and just see where you can spin off of this, because these really are systemic issues. And and everything comes down to individual conversations, but when you're looking at big institutions or the payers, uh we will leave pharma out of it for now because they're really not too involved, but um the the health systems, the medical associations, the payers who are fighting constantly for their piece of the pie, um, it becomes an economic battle a lot of times. And so how do you approach that when you're not as highly educated, you don't have the same scope of services, you don't have you don't have the community sort of out there rallying on your behalf. It's complicated.

SPEAKER_00
18:29

Very, very complicated. Um just I'm a kind of a student of systems, and the and you mentioned it's it's a systemic problem. And actually it's not a problem you can solve in the normal way in which we think of solving. It's not gonna be like one organization that solves a problem. It's uh you have thousands and thousands of midwives, you have um and you have all the people who've benefited from those midwives. In other words, the community around midwives that has been supporting midwives, that has benefited from midwives, that has been born through midwives, that have used midwives. And what it requires when you're up against those odds of an economic system, yeah, uh a money system, a power system, a professional barrier system, a regulatory system. Right, it requires creating and knitting together a coalition, what I would call a winning coalition. You know, what does it take to create a winning coalition, which is a complex, adaptive coalition that can morph, that can change, like and it and that's how you get systems change. And and actually, I think midwives have uh a couple things going from them as I listen to you. One is the ability to listen, that is in such short supply in our our culture. You know, we have talk shows, we need listen shows. Yeah, you know, we're you know, everyone's on social media talking to each other, but who's actually listening to each other, right? And and midwives they're they're inherently listening, they're listeners, they're listening even for what, you know, even in the process, I can imagine of assisting a birth is listening, listening to the mother, listening to the baby, listening to what's wanting to happen, listening to what's the right moment. So so you have attuned ears. Listening is what and listening gives you the capacity to um listen for listen to each other. You also are um, I can imagine, you know, the the process of giving birth is an immense, it's a collaborative process between the mother, the midwife, the all the people around. And so it's like, and even the the infant is you know, it's it's it's a it's a complex collaboration that's going on. So if you have the ability to listen and collaborate, you have the two essential skill sets that are necessary to build a coalition. To weave, to weave relationships, and and that's where the power comes from. Because essentially, if you're just one solitary midwife, like that story you told about, you know, these, you know, the midwife out in Colorado.

SPEAKER_01
21:34

Right.

SPEAKER_00
21:35

In order to, in order to, you just have to think what, you know, even in order in order to launch that lawsuit, she had to build a coalition. Yes. She had to get support to do that. Yeah. And that's what's needed is is a kind of um uh collaborative listening coalition that listens to the adversaries. That's the key. It's not just to go into battle, because undoubtedly that that um even that you know most lawsuits, including probably that lawsuit, will eventually be settled through negotiation.

SPEAKER_01
22:12

Yeah.

SPEAKER_00
22:12

So why wait for the negotiation? Start the negotiation, even as you it's important to launch that lawsuit in order to signal, in order to level the playing field, level the playing field of power to get people to take you seriously. But then you got to begin the negotiation. And the essence of negotiation is listening, listening, understanding what your interests are, what are the needs and interests that you're trying to protect that are so important in this case, which is, for example, the livelihood of of midwives and their ability to to sustain themselves in order to serve the communities that they serve, many of which are underserved communities. So that and so it it's a kind of it requires, you know. Um Denise was just mentioning what I call the third side, which is a name for the community, the surrounding whole. You want you have to find a way to mobilize and activate that. And it's done through conversations one at a time, building relationships, knitting together that coalition, and that together can start to create the necessary power to then to negotiate, to sit down at the table with people who might be the regulators or might be the insurance industry or whoever it is to actually forge agreements that address some of their interests, yeah, but protect the interests and advance the cause of midwifery.

SPEAKER_02
23:42

So here's an interesting thought. We had the incoming president of the American College of Nurse Midwives on last time. And Peter was um the division director of Japaigo's maternal child health uh division for 20 years through Johns Hopkins. And so so Peter knows a lot about global midwifery. And I questioned him um about this concept, but we call it unions, right? The Royal College of Midwives in England is a union. And we see unionization happening in our country with physicians, with residents, with midwives, certainly with nurses, which is sort of where it all started. I I think some of the people who are going to be listening uh feel so disempowered and so disengaged. What do you think about unions in healthcare?

SPEAKER_00
24:37

Well, you know, I'll just tell you something. Uh when I started uh almost 50 years ago in the field of negotiation, I was a student of anthropology and uh and I was looking for some kind of any kind of experience that would get me out of the library and get my hands dirty, as it were. And I and I and I I got a job as a mediator in a coal mine in Kentucky. And uh and you know, I my colleague and I, we got down there, and you know, the the miners were going out on strikes. I mean, this is kind of Eastern Kentucky Appalachia, really poor underserved communities. Uh, you know, I spent a lot of time inside the mine, and and I'd learned the history of unions there.

SPEAKER_02
25:26

Okay.

SPEAKER_00
25:26

Um, because you know, uh back in the 18s, between 1875 and 1925, the United States had the bloodiest labor relations history of any country on earth. There were hundreds of people killed, thousands injured in pitched battles as workers who were almost held almost as slaves, you know, because like back then the company controlled everything. The company controlled the company didn't even pay you in money, they paid you in script that you could only use in the company store. And so if the foreman, you know, you imagine you had a family, and in those days they had big families, you know, like seven, eight, nine, ten kids, whatever it is. And imagine the foreman didn't like you and fired you. Your family would be out on the street because you lived in a company house. You lived, you you would have nothing. And so the the power that that that industry had over workers was so inequitable. And when the workers tried to unionize, management organized uh brought in um armed guards, were like private armies, and they opened up fire and hundreds of workers were killed. So there were pitch battles, or it was a battle of Black Mount. So the union movement was born out of incredible inequity and injustice in this country, yeah. And it was a response to there's gotta be a better way. Yeah, and the and the workers need to have some power to be able to negotiate the terms of the labor contract. So when there's huge inequities of power, building a coalition in the form of a union makes makes obvious sense.

SPEAKER_02
27:09

Yeah. Yeah. Um and and it's it's it's rapidly rolling out in healthcare. You know, so some of the ethical and sociological questions, you know, we've we've been talking about earlier is so what happens to patient care, you know, when you go on strike?

SPEAKER_03
27:28

Right.

SPEAKER_02
27:29

Um it's it becomes very maybe very different. I don't know. If the coal mine shuts down and you don't have access to energy, I I guess that could be as as important. But um there are some uh sociology researchers at UCSF in California studying unionization of midwives right now. Their their publication should probably come out this fall, but I personally see it as the most obvious route to gain a coalition movement.

SPEAKER_00
28:03

It is. And just to say, you know, striking is not the only tool for a union. Uh it's usually the last resort.

SPEAKER_01
28:11

Right.

SPEAKER_00
28:12

And and there's just power in numbers and showing up in numbers. If you have, let's imagine you're in a workplace and you have a problem with your boss, right? If you show up and it's just your boss, there's a power inequity, right?

SPEAKER_01
28:26

Right.

SPEAKER_00
28:27

But if you show up with three colleagues, yeah, you know, say, we've got a problem, yeah. The boss then says, it's not just uh it's not just the boss doesn't just fear a strike, maybe it's not even a strike, it just boss says, wait a minute. Yeah, uh, you know, I can I might be able to handle one, but I can't handle like four or five. And what if they leave? You know, you know, it's it's like, or what, or what if uh, or I or what if they're unhappy? It just it's a there's immediately, I I'll give you an example um uh from a different uh maybe even about 30, 40 years ago, I was really interested in uh, as an anthropologist, also in how our primate cousins deal with conflict.

SPEAKER_01
29:10

Okay.

SPEAKER_00
29:10

And I went to visit, uh I was working with President Carter at the time, and right near uh Atlanta, there's a world-famous um research lab studying chimpanzees. And there was a world-famous scientist there by the name of Franz Deval. And I went to visit him, and he's not just studying chimpanzees, we we mostly know what are called common chimps, but there's a smaller breed called bonobos. And and I don't know if you've heard of bonobos, but anyway, they're they're they're they're they're they're even a closer cousin of ours than the chimp is, and um, and what's so interesting, he described to me how he watched, I remember this is a he watched a um male, male bonobo, a male male chimp, um kind of harassing a female chimp and and and make pushing her around. And then he watched as four or five of these females lined up like linebackers on an American football team and just gradually pushed the male back, and it was like the male, you know, is stronger than one, but it's not stronger than five. Yeah, that is a coalition, yeah. That's that's how our ancestors always dealt with things when there's an equity of power, you form a coalition, yeah. And and that's yeah that's what's needed to bring uh because to have you know to I I I've devoted my life to negotiation, but negotiation without power, yes, you know, if you don't have some sense of power, and it's not just it's not it's not power in a negative sense, it's power empowered, it's power for power with each other, yeah. Not not power against the other, but just power with each other, and that's what they had. They have that power with each other. Those female binoas have never forgot that story. And it's like that's that's the secret.

SPEAKER_02
31:10

And and I think what we're seeing, because we have we have a lot of clients that are practices with three midwives, five midwives, ten midwives, and maybe one or two are ready to coalesce and like put together all the data needed to make the case and and start the conversation. And then you have one or two or three who are terrified they're gonna lose their job, they're the major wage earner, carry the health insurance, they're afraid. So fear, fear becomes the immobilizing factor and and everything stops. Because as midwives, you know, we want to stay together. Um and so what we're trying to help people understand is the conversation, starting the conversation is not going to lead to your your loss of the job. You just need to begin the conversation. And I I I I don't know if it's because many feel oppressed in their jobs, many are exhausted, many are tired, they've tried before and gotten pushed away. And the escape route, William, is leaving the profession. We have midwives leaving in the highest percentage ever that have been in their career for less than 10 years. And these are graduate educated, master's, doctoral level people whose average student loan debt is $150,000 walking away from their jobs because they can't do it anymore. And so what we're trying to do is is channel your work um and the skill set to say you can try. You know, you have to at least be willing to try, and we'll help you kind of gather that data and build your leverage and give you some confidence, but man, um it's a it's a it's even post-COVID, Denise. I may be wrong, but I think it's worse now than it was before.

SPEAKER_03
33:12

I I mean, I think it is worse. I'm I'm sitting here listening, and I think those that are most effective are those that are working, you know, the longer hours and their ability to have the energy to come together in addition to the fear is kind of is pretty substantial. So, you know, I think um I I think they like will generally retreat because there's this need to be a little bit self-protective, and how can I go forward and fight when I'm just making it day-to-day as well? Big classic burnout.

SPEAKER_00
33:50

I hear that, and I see that in a lot of uh actually activists uh generally in in other sectors. Burnout is a huge factor. I mean, right now we just have a world that's roiling in issues and problems. Like you know, I work with you know, people work in the in the peace field, for example. They're they're you know, they're experiencing a high rate of burnout, just you know, similar to midwives. And and uh and one thing I would say, a couple things, what I've learned, and even for myself, uh working in a lot of, you know, I'm working, you know, I'm working right now in Ukraine, and I'm working in the Middle East, and I'm working on Iran, and I'm working, and it's very easy. Reading the news is so thickly negative, it's really easy to get uh paralyzed. And so the one thing a couple of things I would just pass on is just it's so important to uh resource yourself uh in these times to in other words to what is it that gives you energy, that gives you joy, that gives you um like for example, working, I I work in a lot of warzones, so I like to live in nature. Just that's that's that's for me, that's uh you know, that's kind of a universal resource. Not everyone has immediate access to it, but you know, I live in nature. I go for I walk, you know. Some people meditate, some people do yoga, some people they talk with friends, uh, whatever it is, it's it's your way. I I like to call it my way of going to the balcony. In other words, the balcony is this, you know, you're you're living in a hard world, you're about to, you know, dealing with uh such a situation, your boss or whatever the situation is. The ability to stack back for a moment, yeah. Even just simply breathing is a way of resourcing yourself because you're just bringing oxygen, you know, just resting, just taking five minutes or taking 15 minutes, or whatever it's a working out, or whatever your favorite thing is to do, that um makes sure that you realize how much stress you're under, yeah, and that you balance it with being an equal amount of resourcing. And the more stress, the more resourcing you need. And everyone has their favorite way of doing it. And I can't imagine doing the work I do without like being able to walk in beauty and in nature, just even looking at a flower, you know what I mean? But just it's just like nature, just like it just calms your nervous system, it regulates your nervous system. Because what happens is the what does burnout come from? It comes from our nervous systems. Um, either we get hyper hyperactive, uh, you know, which is like fear, anxiety, rage, anger. I mean, because in in response to this these situations, we go into hyperactivated, yeah, or we drop then into hypoactivation, right? Which is resignation, despair, sadness, depression, all of that. In between the hyper and the hypo is a is a band, is a zone. You know, uh psychologists will call it the zone of the optimal zone, the zone of uh the window of tolerance is sometimes what it's called. Yeah, and that's where we need to be to be at our best. It's like we still have emotions, it's not about suppressing your emotions, it's on the opposite, it's about listening to your emotions. Yeah, good point listening to the fear, it's not about suppressing the fear or suppressing the anger, it's listening to it. But you know, you still have the ups and downs, but it's within that band. And we need to make sure that we stay in that band, otherwise, burnout comes from being hyperactivated and then being hypoactivated. Yeah, hyperactivated, hypoactivated. And so if we can learn to do that for ourselves, to regulate our own nervous systems, if we can then learn to help others around us, and we can co-regulate, you know, we can help. And and that's to in order to maintain our our our our both our effectiveness as well as our personal life satisfaction, of course, which and that there's a correlation between the two.

SPEAKER_02
38:15

Yeah. Yeah. We we do a bit of um facilitation with midwife practices that are struggling, with state affiliates that are part of the national organization. And and one of the exercises I have them do is a SWAT and a pestle survey before I go, just to get an analysis of the landscape and sort of get a feel. And and and sometimes we're talking about highly conflicting issues within our organization. And we'll just say reproductive choice is one of those, highly conflicting issues within our profession. And OBGYNs as well, I'm sure. Um and it can be so polarizing, the group just won't go any further. But when you sort of put the landscape out on the wall and begin to find ways to say, let's let's set that aside and find out what's common here. It's amazing the power of what the group can do. But it takes somebody to facilitate that, William.

SPEAKER_00
39:16

It takes the third cider. There you go.

SPEAKER_02
39:18

I mean, I I really think it does. And that's your work really, I think, amplifies that the value of that, whether we want to call it mediation or whatever, um, the outside is critically important.

SPEAKER_00
39:34

Really, really, really important uh to uh uh deploy that because you know to actually have a conversation on a polarized topic without creating a safe enough context in which people can be feel safe enough to both speak their truth and be heard and be in a respectful context. If you can create that, you can move through almost everything. You can move through almost, including such a hot button issue as reproductive choice. You know, I remember, gosh, years and years ago, I had a friend who was doing a third cider in those kind of conversations with a it was in Boston, it was a it was a group of nuns, and uh and then you know some some uh some advocates, you know, you know, uh, and they uh they had a year-long conversation, and it and it was astonishing how as soon as they you know they could actually listen to each other, hear each other's personal stories, yeah. And uh and they found wow, there's so much we can agree upon, like for example, reducing teenage pregnancy, for example, yes, which actually takes care of the issue so much more effectively than any battle does. And reducing unwanted teenage pregnancy. I mean, like that alone, yeah. If you took even like 10% of the energy that goes into that fight and put it into like do that, it would have so much greater impact on the issue that everyone cares about than anything. So, you know, it's astonishing.

SPEAKER_02
41:14

I love your example. I'll tell you why. The MMWR and CDC just put out their latest report. We are at an all-time low of teen pregnancy in the United States.

SPEAKER_00
41:25

All-time low.

SPEAKER_02
41:26

Yeah, absolutely.

SPEAKER_00
41:27

Yeah, that's amazing. It is amazing, and you know what? That is probably not known publicly widely at all. And and that that's astonishing progress. Do you know? Do you know we're also at a, I mean, you would never know this, but in most of our major cities, we're at a we're at a we're at a we're at a much at a lower level of violence and criminality. And you would never ever know that if you but if you look at the statistics, yeah, you know, homicides have been going down widely across you you never get that idea. We flood ourselves through social media with so much um yeah, fear information that drives our nervous systems into paralysis that we think, oh, it's hopeless, so might as well do nothing, or or or you know, it's it's like the overstimulation of fear and terror. It is, and and the algorithms of this of the social media thing are designed, they're designed to keep fear, whatever, because that's what gets more engagement for them, and they're and that's what allows them to sell more ads. So we're creating a kind of a self, um, a kind of almost like a self-destruction machine. Self-sabotage. Yeah, no, and our ability to free ourselves from that is key because um, you know, most Americans, for example, they think, you know, we're all at odds with each other, Americans, you know, whatever it is. But when you go out and talk to your neighbors, mostly, you know, most people in America, you know, and you know, even with people of differing opinions and so on, you know, I I I live in a place where you know it's it's it's purple, you know. But you know, people just they're just you know, they're your neighbors, you're just right, you know, and and so it's uh there's so much more possibility than we can imagine. And and and the biggest that our biggest adversary is ourselves, is our own despair. And and uh and because right now, you know, if I was a um if I was an anthropologist from Mars and studying the human human species right now, and I'd come down, I'd scratch my head, and I'd say, wow, it's amazing what these creatures are able to do. And all through collaboration and cooperation. I mean, the most amazing systems they've set up, the most amazing scientific technologies and whatever it's astonishing. And you know, and the the only thing that's in the way of them dealing With all these complex problems that they face, whether it's hunger or you know, periphery or war, anything like that, is they're having a little trouble getting to yes, right? But that's entirely up to us. And and we have it within us. We are, I mean, we're designed to be intensely collaborative creatures. We are. I mean, we language, everything is designed, we naturally relate to each other. If we can deploy these inherent human gifts, you know, then we can create the world that we want our children to grow up in.

SPEAKER_03
44:34

I agree. I, you know, you mentioned collaboration, and we we've been speaking about a lot of the barriers. Um, but the reality is there's a lot of good that is able to happen and a lot of good that is happening. And we do call them, you know, collaborative models of practice. Um, and these are happening in many, many settings, um, which are absolutely in stark contrast to the areas that are obviously struggling. But I I do think highlighting and remembering that those are where some great, great successes are. Um, and you work in one, Denise. I mean, I'm speaking. I'm speaking from my heart because I happen to be working in a large academic setting where over the years, this our ability to of the midwives to work with the physicians and um, you know, and to have a very cohesive learning um respectful team has really grown exponentially. So we have you know doubled our number of midwives that are working in our practice. People want to come to work, and we work with some amazing physicians um who find the value and benefit of working with the midwives. Um, and so much so that you know, we now see a lot of their patience for many things that they don't have the energy or the time to see. So I do want to highlight that absolutely beautiful word of collaboration.

SPEAKER_00
45:59

That's astonishing, Denise. And that's also it's it's it's so vital to highlight success stories. Yes, what actually works, because there's so much focus on what doesn't work, which is important to pay attention to, but it's also important to pay attention to what works. What you know, in order to get a sense of to be a possibilist, you you have to kind of almost envision, you know, envision a future, a future state. For example, um you know, you know, it would be wonderful, for example, to get midwives together and imagine, let's say it's 10 years from now, and midwifery has gone through a revolution and it's now like you're at 18,000, you're 20,000, you're 25,000, whatever it is, you're one million strong. You you you exactly you've hit the tipping point. You know, you've you know, imagine that. You know, if you can just kind of just let yourself, for example, the power of the imagination is so important. Imagine that. Imagine that's 10 years from now, it's like you're doing a diary entry, and you say, Wow, that's astonishing what's happened the last 10 years. We could never have believed it 10 years ago. And then from that point, you use that and you say, Okay, how did we get there? And you start to work backwards. So often when we try when we face a uh an issue or problem, we don't see any way forward because the obstacles are so large, it's it's very hard to imagine going forward. But if we imagine the future and we work backwards, what seemed impossible becomes possible. Yeah, it's kind of a reverse engineering.

SPEAKER_02
47:38

Yeah. Absolutely. Well, and it it maintains the concept of hope, which happened to be the main concept in my PhD. But uh you know, the World Health Organiz um made an announcement a million, we need a million midwives, right? We need um globally a million midwives to say, you know, we've got we've got the call to action. Um we need to spark it in the US, Denise, because I do, I do think so.

SPEAKER_03
48:04

And I want I I really do want to move these all into those underserved areas, um, the areas without people. I I think you know, it if we had more money, I think it would happen sooner. But you know, somehow that barrier will get to.

SPEAKER_02
48:23

I still like the idea of the union conversation.

SPEAKER_03
48:26

Okay, you know what? We're not I don't think that's gonna go to bed anytime soon. I like knowing the history of it as well. So yeah, that was that was fascinating.

SPEAKER_00
48:36

That was I'll just say something about that history too, is that from 1875 to 1925, we had the most violent labor history. Then came collective bargaining and unions, and it and violence went way down. We we actually, it was a huge success in this country to take an issue that seemed so charged and turn it from a destructive way to a constructive way through negotiation, through sitting down, negotiation, mediation, all of those things came out of out of that, you know, the 1925 to 1945. You know, it's just like in in that period, there was this kind of realization that enough is enough, we need to find a better way. Yeah.

SPEAKER_03
49:18

Yeah. Yeah. I think we're I think we're really close. All right, it's on the list. It's on the list.

SPEAKER_00
49:26

You know, I have a friend who used to, an economist used to say, if it exists, it's possible. So if it's happened before, in other contexts, it can happen in this context. And then absolutely. Yeah. No reason why it couldn't. You know, I in in my life, you know, I I I worked uh, I was in apartheid South Africa working, and it would seem like absolutely impossible. It was gonna be race war forever and whatever. And you know, I was there, Nelson Mondela's in jail, you know, everything and then I came back like four or five years later, and the country totally transformed. Nelson Mandela was president, yeah. And the guy who'd been president when I was there was the deputy president, and they were working together, and it was like, how did it happen?

SPEAKER_03
50:09

How did it happen? How did it happen?

SPEAKER_00
50:11

And and and what had happened was through the activation of the third side. It wasn't, and Nelson Modelo was an incredible leader, and and Declerc was an incredible co-leader in that sense, but they didn't even like each other, there wasn't good chemistry, but but it but the whole society, the the women's movement, the labor unions, the business sector, the the religious sector, everyone got involved. So it was the whole society changed. I saw the same thing in Northern Ireland, which was uh, you know, people said the Catholics and Protestants they're gonna be killing each other forever, and it's they drink the the conflict with the mother's blood and everything, and and you know, the troubles and all this terrorists and and military occupation, everything. And then again, I watched the same thing, which is it became possible. People, there was a mindset shift, people said it's got to be a better way of doing it, and you know what? It started with the women, believe it or not. It was the it was the mothers and sisters of the victims on both sides, Catholic and Protestant, yeah, who said enough is enough, and they met, and because they were mothers and sisters of people who were revered as almost like martyrs, yeah, okay, the woman they can talk, right? But they opened up space, yeah, and they they took courage, and then the religious leaders, the priests and the ministers on both sides said, you know, I'm not sure this is the what Jesus Christ actually intended, and whatever. And they began, so they the religious, then they opened up space for the business people to say, you know, this doesn't make any sense. We're losing a lot of jobs, we're driving all kinds of investments and everything. And then the politicians were last, but it started with the women.

SPEAKER_02
52:02

Yeah. You know, we have a window. I think, and I'm I'm thinking as you're talking, and um, you know the name Olivia Walton, um, who just started a campaign to cut maternal mortality in half in five years. I'm on a maternal health advisory board for that working group. And Charles Johnson uh lost his wife, Kira, um, to a routine-scheduled C-section uh many years ago. And Charles, uh a friend of a friend of mine, is the leading uh father voice for black maternal mortality in our country. And Charles just did a big interview on Axio uh with some famous people and joined the movement. And much of the effort is focused on the business sector finally addressing maternal morbidity and mortality and including midwives, midwives and doulas. A lot of people don't know the difference between midwives and doulas, but I'm I'm seeing this door opening more as we talk, William, um, in that collectively organizing our midwifery voices at that critically important table where there is money, there is business, uh power, all of it. Moving forward is an opportunity.

SPEAKER_00
53:23

Wonderful.

SPEAKER_02
53:26

It's an opportunity.

SPEAKER_00
53:27

Yeah, I think there is. There are possibilities.

SPEAKER_02
53:31

Yeah, there are. I just gotta get my mind working more.

SPEAKER_03
53:35

You gotta get we gotta get to the table, Ginger. We will. We gotta get to the table. This is so exciting.

SPEAKER_02
53:42

Oh so I I think what I've I've heard you talk a lot about is is self uh self-preservation, like resetting yourself as you prepare for these kinds of difficult experiences. And um to acknowledge that the lows happen, right? Along along with the hyperactivity. That's just normal physiology. And in order to prepare effectively for a negotiation or or walking into what you know is going to be high conflict, acknowledging that while setting it aside and not letting fear be the driver of the conversation. But what is possible is the driver of the conversation.

SPEAKER_00
54:29

Yeah, if there's one lesson I've learned, it's kind of like befriend your fear.

SPEAKER_02
54:37

Ah, great comment.

SPEAKER_00
54:39

In other words, like um like you have that fear. Don't try and suppress the fear, listen to the fear, first of all. Usually, you know, and uh uh and and um and you know, honor the fear and it has a certain point to make. Listen to it. And then usually proceed in the very direction that the fear says not to proceed in. You know, in other words, but you know, just move into that which I tend to avoid, you know. You know, a lot of us are conflict avoidant, right? Yes, and you know, we grew up, you know, I grew up as I bet as you mentioned in a family where you know, I think, so I got to be conflict avoidant. I you know, it's uncomfortable conflict, conflict shut me down. No, they learned to okay. Actually, conflict is not to see conflict as not as something um bad. Conflict is normal. Conflict is it that's how change takes place. There's gonna be a lot of conflict for midwives to be able to, you know, find their rightful place in society. It it's that's how you engage, but you engage with it and you almost like play with it, dance with it, you know, kind of like uh okay, let's see. And you prepare for it. You prepare yourself with you, you get friends and colleagues and whatever, and you you think about what your interests are, what you really want. You you rehearse, yes, you, you know, if you're if you're nervous about how you can write your boss, rehearse it with a friend and uh or a colleague and whatever, and just and and and think about how to make it easier so that you know, just like you rehearse a speech, rehearse your negotiation, right? And just uh and then just see what you know, just um move towards the thing that you fear.

SPEAKER_03
56:20

So, would you say like turn conflict into challenge?

SPEAKER_00
56:23

I would say absolutely that. And I would say meet animosity with curiosity.

SPEAKER_03
56:29

Oh that's a good one. That's a t-shirt slogan right there.

SPEAKER_00
56:34

Because just be curious, like, oh well, yeah, you know, what why why is a boss angry or what what's going on here? And like, like you know, isn't that interesting? And then suddenly that thing that was afraid of, or oh, that's interesting that I've got some fear going on, you know. I you know, it in uh in in in in possible, I give that example of me with President Chavez, you know, shouting at me, like you know, you know, spittle and you know, you you know, just you're you're a fool, you're this and that, and the other thing, President Chavez of Venezuela, and you know, and I kind of like I was first taken aback, of course, you know, get fear, like what's going on. Back up the president of the country's gonna like putting, you know, shouting at you in front of the whole cabinet. And and then uh I was able to just remember a friend of mine from Ecuador actually uh had said, pinch the palm of your hand.

SPEAKER_02
57:28

Uh yeah.

SPEAKER_00
57:29

I said, Ernest, why would I pinch the palm of my hand? He said, Well, it'll give you a temporary pain, it'll keep you alert. I pinched the palm of my hand, and I was able to say, Okay, what am I feeling? Okay, I'm feeling embarrassed, whatever. Why am I here? I'm here to calm the situation down. Is it really gonna help if I get into an argument with the president of Venezuela? No, okay, let me listen to him. I just listen. And I isn't that interesting. Why is he shouting at me? And you just you I went to the balcony, you know, that place of perspective where you're like looking at yourself as if you're on a stage. And like, you know, after 30 minutes, just watching his body language, his shoulders slowly sink. Yeah, and then he says to me in a kind of weary tone of voice, so Yuri, which what should I do? And that is the faint sound of a human mind opening. And then I was able to say, you know, Mr. President, sendo presidente, you know, the you know, the whole country is on edge, and because there are a million people on the streets on one side, a million people on the streets on the other side, violence was breaking out. I said, Why not? It's almost Christmas Christmas, why not just declare a truce, you know, a tregua in Spanish, you know, a truce and give everyone a few weeks just to go spend Christmas with their friends and their holidays. In other words, a little a cooling off period, a little breeze. He looks at me and he says, You know what? That's a great idea. I'm gonna announce that in my next speech. And his mood had completely shifted. Why through the power of not reacting, listening, and then waiting for that little moment of opportunity to take someone, you know, who was who was furious at me, and he turned it around and and then he invited me to go with him on a holiday. I mean, it was like nice.

SPEAKER_02
59:11

He's probably not used to people listening to him, they tune him out.

SPEAKER_00
59:14

That's true.

SPEAKER_02
59:15

They're scared of him. Yeah, yeah.

SPEAKER_03
59:18

So good information.

SPEAKER_02
59:21

Well, man, we could we could keep talking, but I know you're busier than we are, and you know, we get to welcome you back in July when you're speaking at our conference. And again, I I can't thank you enough for giving so much uh to our professors.

SPEAKER_00
59:35

My pleasure, it's my pleasure, Ginger and Denise, a really huge pleasure. And you know, I mean, the one thing I'll also say, last thing I'll say is it is midwifery is also a metaphor for what this whole society needs to do is we need to midwife in the new, the new, a new society, a new world. And um, it's always been a when I think of midwifing, I think that's actually we know we're hospicing the old, the old civilization, you know, AI, everything we're hospicing the old and we're midwifing the new. So for me, midwives are not just a profession, it's it's a it's a vital, an action. It's an action and it's what it's what all of us need to do. Yeah.

SPEAKER_03
1:00:21

Yes, I love it.

SPEAKER_02
1:00:23

Well, are we gonna are we gonna have that be your call to action? Because that was a pretty powerful one.

SPEAKER_03
1:00:29

We always end with the call to action.

SPEAKER_00
1:00:31

Oh, call to action, absolutely. And then yeah, and I yeah, that would be a call to action. And I would I would just say consider you know, the next time when someone asks you, are you an optimist or you a pessimist in this world? Responding as Denise does, I'm a possibilist. You know, I believe in human possibility.

SPEAKER_03
1:00:50

Yeah, great. Got it. Denise, because of you, thank you for that great framework that you so eloquently always talk about and write about. Okay, my call to action. Ginger, I'm very curious about this union thing. Um I I mean, I think um some something along that line. Let's let's join a union, let's create a union of of a national union of midwives in the United States. I don't know what we'll call it, but we'll call it something. That's my call to action. I want to find out I want to find out more.

SPEAKER_02
1:01:29

Yeah, I I I am I'm confident you're gonna do some research, and I think we've got some leads. Yes. I think we did and it's not the truckers union.

SPEAKER_03
1:01:37

Um, no, no, much much more soft than that.

SPEAKER_02
1:01:42

So so my call to action is is to strongly urge that people purchase the book, The Possiblest, and get it on audible so you can actually hear William Urey tell the stories because I I I I'm sure I can I learn better listening. Um that's just my style. Um but you do such a remarkable job of integrating your storytelling with the lessons and the skills and the tools. This this doesn't happen by osmosis. You have to practice this to become really effective and good and confident in your persuasive ability. And I I've not read anything like it, nor's my husband, who's also listened to the book, and he's a master negotiator. At least many say that about him. So buy the book and uh sign up for our conference July 23rd for some incredible conversations that that William Ure will be leading off. But other people, national speakers, we've invited to help build the business savvy and the leadership savvy of our profession. So we were gonna cut it off for today. And I don't know how we're gonna top this, Denise.

SPEAKER_03
1:03:00

I don't know. I don't know. We can just we're just gonna stay in the present and we're gonna stay in the present. We're gonna enjoy the fact that we got to spend an hour with you, William, and so appreciate it.

SPEAKER_00
1:03:12

It's been my joy really, uh, Denise to do this. So uh and I wish all the good life out there so much in the beginning together.

SPEAKER_03
1:03:23

Thank you. My my last dream, William, is that someday we take a walk together in the mountains.

SPEAKER_00
1:03:28

I would love that. It's a date.

SPEAKER_03
1:03:31

Okay, take care, and thank you again so much.

SPEAKER_00
1:03:35

Bye.

SPEAKER_03
1:03:35

Bye now.

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