EBB 390 – Simple but Effective Communication Techniques for Hospital Birth with Dr. Amber Weiseth, DNP, RNC-OB of Ariadne Labs and TeamBirth

Dr. Amber Weiseth – 00:00:00:

Information could be left out. The patient’s voice isn’t a part of it. Many of the healthcare decisions are actually made over the telephone. It can get quite messy.

Dr. Rebecca Dekker – 00:00:10:

They’re not at the center of the communication at all.

Dr. Amber Weiseth – 00:00:13:

They’re not the center.

Dr. Rebecca Dekker – 00:00:14:

Hi, everyone. On today’s podcast, we’re going to talk with Dr. Amber Weiseth, a registered nurse certified in obstetric nursing, about how we can improve communication in hospitals using the TeamBirth approach. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. 

Hi everyone, and welcome to today’s episode. I am so excited about this topic of improving communication in hospital labor and delivery units. Before we get into today’s episode I just wanted to share a quick reminder about the 2026 Evidence Based Birth® conference. Registration is closing very soon. In fact there are only a few days left to get your ticket and the final day to register is Friday, March 13. So if you want to join me and other birth workers from around the world, virtually, on March 17 and 18 for your best two days in birth work education, then grab your ticket at EBBirth.com/conference. You can choose to join us for Day 1, Day 2, or both days with the bundled ticket. And all sessions include replay access and the opportunity to earn contact hours. So don’t wait. Get your ticket at EBBirth.com/conference before registration closes on Friday, March 13. And now, let’s jump into today’s episode.     

Today, we have with us Dr. Amber Weiseth, who has her doctorate in nursing practice, as well as her master’s in nursing, and is a registered nurse certified in obstetric nursing. Dr. Weiseth is a research scientist at the Harvard T.H. Chan School of Public Health, and she’s the director of Ariadne Labs Delivery Decisions Initiatives. In these roles, Dr. Weiseth leads a research portfolio focused on enhancing communication, dignity, safety, and evidence-based practice in maternal health. As an obstetric nurse for more than 20 years, Amber specializes in maternal child health, quality improvement, and systems innovations, and she served on the board of directors for the Association of Women’s Health Obstetric and Neonatal Nurses, known to many of us as AWHONN. Dr. Weiseth is here today to talk with us about an innovative, evidence-based project for improving communication in hospitals known as TeamBirth. Dr. Weiseth, welcome to the Evidence Based Birth® Podcast.

Dr. Amber Weiseth – 00:02:55:

Thank you so much, Rebecca. It’s a pleasure to be here. Our team are big fans of the work you do. And so just honored to be able to have time to have a conversation.

Dr. Rebecca Dekker – 00:03:05:

Yeah, we are so thrilled we can feature your work because I think it’s, as we’ll learn, it’s making a big impact in many hospitals. So can you start off, you know, kind of our overall concept we’re talking about today is communication. How does communication hold importance? How does it shape, you know, how someone feels during labor, how their outcomes, how their actual health might be affected? And then if you could also kind of tell us how you got interested in communication in hospitals, I’d love to hear that as well.

Dr. Amber Weiseth – 00:03:34:

Yeah, happy to. At the end of the day, fortunately and unfortunately, we are all humans and we all have human brains. And what has been proven very, very consistently throughout time and in research is that we do not communicate perfectly. It’s just a flawed system. And because it requires bi-directionality, communication is not just what we say to patients, but communication really is this back and forth. And so it’s just critical that it be done correctly in healthcare because the challenges can be really significant when it’s not done correctly. And so I think that goes back to a lot of why I got really interested in communication. It doesn’t take long being a bedside nurse before you realize that communication is one of the harder parts of your jobs. It’s something nurses tend to pride themselves in and are really good at being advocates and talking to their patients. But you have a bad interaction with a provider or a family member and things can go really catastrophic. So it’s just critical. And I think in my early days of being a nurse, I was a part of several interactions where the outcome was not what it could have been. It was a negative outcome. And the failure for that was communication. That is really true when we go back to looking at sentinel events is that, or sentinel being like there was a harm that was unanticipated. That most of those have a root cause failure in teamwork and communication.

Dr. Rebecca Dekker – 00:05:07:

Yeah. Could you give an example of… How communication could… Get in the way of things going smoothly or where it might lead to a sentinel event where something really tragic happens.

Dr. Amber Weiseth – 00:05:19:

Yeah, well, I know we’re gonna be talking a lot about health systems today. And so I might want to lead with that the system of health, let’s just say the larger system of healthcare. Was not set up to have sort of inclusive, bi-directional, transparent communication. It was set up sort of in a game of telephone. I don’t know if you’ve been to an office appointment recently, but you talk to one person at the desk. Somebody else takes you back to the room and does some assessments. The doctor might come in later. And you’re having three different interactions with people all through sort of this imaginary game of telephone. Versus bringing everybody together and having that one conversation, you see the information can get lost in translation. I can give an example in obstetrics where a nurse might be taking care of a patient and have concerns, let’s say, about bleeding. And then has to make a phone call to the doctor or the midwife to discuss it. Information could be left out. The patient’s voice isn’t a part of it, right? Because it’s usually on the telephone.

Dr. Rebecca Dekker – 00:06:25:

At the nurse’s station.

Dr. Amber Weiseth – 00:06:27:

Nurse’s station, yeah. And so bits of information can be lost in translation where then the appropriate response is not done. And that’s how the system has been set up and been kind of functioning or not functioning for many, many years.

Dr. Rebecca Dekker – 00:06:41:

What are some other barriers that can kind of get in the way of clear shared communication aside from, like not everybody being in the same room. I know at EBB, we talk a lot about how like the iceberg beneath your words, how there’s things going on underneath the surface that other than just your words can impact whether or not communications are understood or received or provided.

Dr. Amber Weiseth – 00:07:05:

Communication and this feeling of safety really depends on this bi-directional relationship. It’s not just about I delivered the right information and education on this procedure. There needs to be back and forth. And that feeling of safety needs to be met with a predictable communication pattern or timing. Transparency. And that really kind of speaks to also that trauma-informed care. When we don’t have those things, the physiology or the body, the brain can react negatively and sort of armor up. Those all are things that break down communication in this bidirectional manner.

Dr. Rebecca Dekker – 00:07:43:

So you’re saying that if somebody feels defensive, they might not be able to communicate appropriately or fully. Have you ever seen a situation where maybe a healthcare provider started feeling defensive and just stopped listening?

Dr. Amber Weiseth – 00:07:57:

Definitely. I mean, I’ve also seen that both directions where the families can be defensive and not listen and the communication breaks down. I’ll just put on my nurse hat or my provider hat for a second. And when we think about the demands within that health system or that role for a day, it can be pretty extreme. There can be not enough staff. You could have had not slept enough the night before. You could have had a bad outcome the day before that’s still affecting your sort of mental status or your emotional status. And it can be really hard to show up and be a great communicator. And I think the thing that often is the gap is I truly believe providers come to work every day with the intention to take the best care of patients. But is it the very best for every patient and every interaction? No, there is variability there. And so in creating TeamBirth as this model that supports patient-centered communication, it creates a structure that then you can help be a better communicator every patient, every time.

Dr. Rebecca Dekker – 00:09:03:

What has been the traditional way of rounding on patients and making decisions about patients before the approach you’re going to talk about with us today?

Dr. Amber Weiseth – 00:09:15:

In the United States, in labor and delivery, nurses are doing a majority of the bedside care. Often, nurses might have only one patient, maybe have two if they’re not real active in labor, and they’re at the bedside assessing, communicating kind of constantly there. If a patient has a midwife, the midwife, depending on the care model, might also have a large presence. I think that’s ideal. But for many of our obstetrician physician colleagues, they are coming in and out of this care setting. And making assessments or decisions. For an uncomplicated labor, there’s many times a doctor may just be there in the beginning and then be there at the point of delivery. If there are concerns, obviously there’ll be more check-in points. Many of the healthcare decisions are actually made over the telephone. And I think that’s where, although it seems quicker and easier, but that’s also a portion where patients get blocked out of what is being decided about them, which can lead to distrust. It can lead to misunderstandings. It can lead to a lot of other consequences, but that has been how healthcare has functioned for decades.

Dr. Rebecca Dekker – 00:10:34:

So you kind of have the nurse as the eyes, ears, hands in the room, and then going outside, leaving the room to communicate to a physician or midwife who’s located somewhere else, and then making decisions without kind of the patients being part of that conversation directly, implementing those decisions. And so if the patient says, hey, stop, wait a minute, I actually don’t want this thing. I don’t want you to turn the Pitocin up to this amount. I can’t tolerate it or whatever, then the nurse has to go back and over the phone, like inform the physician that the patient refused. And so you’re having this kind of disagreement over care, but with the game of telephone.

Dr. Amber Weiseth – 00:11:15:

100%. And I had to make that call myself many times where the order was to start Pitocin or to increase it. The patient didn’t want that. And now I was faced with going back and telling the provider the situation. And again, coming up with another piece-mealed plan. Instead of us all just pausing, being curious, coming together and having that conversation with everyone. That is one of the things that people do talk about TeamBirth today is that it can save time because we’re not playing that game that you just perfectly laid out.

Dr. Rebecca Dekker – 00:11:49:

Okay. Another thing I remember from my days of training and how it used to be, and I think more hospitals are moving away from this, but it’s still a big part of practice is if you’re in an academic medical center where there’s lots of students. How does that impact? Communication as well. Can you kind of add that aspect to it?

Dr. Amber Weiseth – 00:12:10:

It definitely makes it more complicated. You’re just adding more layers. More layers with like the right set of protections can be actually helpful. There can be more things caught. You have more eyes, more experts on it. But with more layers, unless you have really clear structure, escalation plans, times when we’re talking together, it can get quite messy. And I would say is we’re working with hospitals across the country. The hospitals that have academic programs are definitely the ones that are just take more work to implement with. Because of all those layers you just described.

Dr. Rebecca Dekker – 00:12:48:

So you might have like the medical student coming in earliest in the morning to do an assessment of the patient in labor. And then you have, the resident come and stop in a little bit later and then maybe the chief resident. And then they all come back later with the attending. The attending walks in, says hi, and then it used to be that they would go out in the hallway. And kind of talk about the patient. Is that kind of what you used to see as a standard around the country in the academic medical centers?

Dr. Amber Weiseth – 00:13:16:

I actually see a lot of variation some facilities the residents work really really independently and are doing most of the care decisions.

Dr. Rebecca Dekker – 00:13:26:

And the attending physician might not be there in the morning.

Dr. Amber Weiseth – 00:13:30:

Yeah, or they’re calling with them and having that game of telephone with the attending. And in some facilities, the residents have very little autonomy and are doing the model that you described. So I think there’s, again, there’s a range and a variation, which also doesn’t help us to have a singular sort of system or expectation. And as learners are coming in and out of different programs across different regions of the country. It looks pretty different. But the theme is… A lot of people getting information, trying to make decisions. And forgetting often to do that with the patient who’s the most important decision maker in this character.

Dr. Rebecca Dekker – 00:14:12:

They’re not at the center of the communication at all.

Dr. Amber Weiseth – 00:14:15:

They’re not the center.

Dr. Rebecca Dekker – 00:14:17:

So, you know, now you’re leading this research at the Harvard T.H. Chan School of Public Health. You’re working on systems level changes through Ariadne Labs. At what point did you as a nurse realize that improving communication required not just changing individual providers and helping them practice their communication skills, but actually changing systems?

Dr. Amber Weiseth – 00:14:41:

Yeah, well, it doesn’t take somebody long to be a healthcare provider before they realize the system is not set up always to get the best outcomes.

Dr. Rebecca Dekker – 00:14:51:

Okay.

Dr. Amber Weiseth – 00:14:52:

You know, I believe I would have been a nurse maybe a year when I had this first really life-threatening hemorrhage. It was a patient who had delivered maybe a few hours before and a series of events were taking place largely because we did not at that time have systems in place to have a protocol, have medications together. We didn’t have blood products in the hospital. These were all systems that could have been set up that hadn’t been. Now, thankfully… This patient went on to recover and all was well, but it really impressed on me that there was truly nothing more I could do in that situation because I didn’t have a system. At that time, I had an amazing clinical nurse specialist that worked at my facility who brought me into the development of hemorrhage protocols, of drills, of all sorts of structures and safety systems for hospitals. So I was really able to go from experiencing the problem to being part of the solution, which… I then became a total hemorrhage junkie, which I know for the clinicians, you’ll get it. For the patients listening, you’ll be deeply concerned. But I… I just became really passionate that so many of these poor outcomes could actually be prevented if we had better systems. So that’s really what kind of transformed my career. I ended up going back to school after I’d been a nurse about 10 years because I knew that if I stayed at the bedside, which I truly loved, I was going to make an impact one patient at a time. But if I truly wanted to make our hospital better or the state better or country better, I had to be able to get more education and learn more about system change and that that would be so much of a larger impact.

Dr. Rebecca Dekker – 00:16:46:

It’s such a good example with hemorrhage because everything could have been going well. Or maybe the birth wasn’t that smooth, but you think things are going fine. And then all of a sudden you found yourself as a nurse. There was no safety net to catch you and your patient. And you were just drowning. And you mentioned… Just different aspects, such as like having… Blood product protocols and on hand and other things that it just shocking to me that at that time you you didn’t have access to those things so it’s a really good example of of how communication but other systems can create a really tragic outcome if you don’t have those systems. Can you explain then, what is this project known as TeamBirth? And I know we’re in audio, you know, most people are watching this on audio, not video. And it’s T-E-A-M, birth. I’m not talking about teen birth or adolescent birth. But can you explain, you know, what is TeamBirth? And how is it designed to improve systems, but then also to improve outcomes for individuals and families?

Dr. Amber Weiseth – 00:17:57:

I think before I describe TeamBirth, and thank you for spelling it out. There is many people confused that we’re focusing on teenage pregnancy, which we are because if they’re pregnant, we want to take care of them and serve them. But no, it is the team, T-E-A-M. Let me take a step back and… Explain a bit around Ariadne Labs because I think it gives a framework for understanding how TeamBirth got created and why it looks the way that it does today. Ariadne, you know, we’re a joint center between the Harvard School of Public Health and Brigham and Women’s Hospital. And we were started with this work around the surgical safety checklist. This was done by Dr. Atul Gawande, Dr. Bill Berry and the WHO. And the goal here was to develop a very simple tool that would help people align, share the same information, and by doing so, reduce morbidity and mortality, which it demonstrated to do that. And now it’s the standard in the United States and it’s used globally. And the principle behind it, when you look at this checklist, it’s super, super simple. You know, it’s a handful of questions, but the power behind it is this pause point and this shared sort of cognitive moment with the staff involved. And that was really what started the organization. Now we go, you know, fast forward a few years to this problem in obstetrics. And we first started looking at this really focused on C-sections. At that time, we had an extremely fast rising rate of C-sections. We had a lot of variation. You might go to a hospital, you know, five minutes from a different hospital, and they would have huge differences in their C-section rates. Or you’d see big differences between a certain doctor. And, you know, as we investigated, what is creating this rapid rise and this disconnect or this variation? And we found that there were so many failures in the team or so many failures in the actual model that it was set up. It was kind of a pressure cooker, in a sense, where, you know, the busier things got, the more difficult things got. It became harder and harder to make the right decisions. So that was sort of the framework where, you know, we’re trying to reduce these sections, trying to make it easier for teams to do their work, needing to center on the patient. And then the fourth thing it had to do was it had to be simple.

Dr. Rebecca Dekker – 00:20:24:

Keep it super simple. KISS. That’s one of my favorite acronyms.

Dr. Amber Weiseth – 00:20:27:

Yeah. If you think about, I mean, when I first became a nurse, I actually learned on paper. I was at the bedside with my hand on a belly and documenting on paper. But everything in the past 20, 25 years has really taken providers away from the bedside, has made healthcare in some ways much more complex. So when we’re developing the model, it had to be simple that it could be done at the Brigham here in Boston, and it could be done in a birth center in Nepal, which is actually where I’m headed at the end of this week to implement at a birth center in Nepal. So the model itself… Is basically a structure that teams come together. And we define the team first by the patient, their support people, and then the nurse, and then the decision-making clinician. So that could be a pediatrician, it could be an obstetrician, a midwife, anyone who’s in that sort of category. And it’s a structured communication that these team members have together. Where they go through sort of four topics, you know, using it similar to a checklist. And that we have not only that structure that’s verbal, but also written on a shared planning board, which… You know, basically what that is, is just a dry erase board. You can imagine a large board on the patient’s room so everybody can see it. And then these conversations happen at specific time points throughout care. Around admission and then key decision moments or at the request of any member on the care team. So that’s sort of TeamBirth in its most basic form.

Dr. Rebecca Dekker – 00:22:04:

Is that you have the conversation in the room with the patient and their support system, and you can write. Different things on the whiteboard. What is typically on the dry erase board?

Dr. Amber Weiseth – 00:22:15:

Well, there’s four sections of that dry erase board. And the first section is the team. And that is really meant to start with the patient and their support people as sort of the captain of the ship. Some people will say, or the leads were the ones that are coming around them as a team, right? It starts with the family that’s in having their baby. And then underneath that, it’s the providers that are involved. Like I said, the nurse, the physician, if there’s residents involved, their names should be there as well. And that section that’s purpose, yes, so we know each other’s names, super, super helpful. But more importantly, that’s that invitation and opportunity to speak up and to be a participant in the conversation. We don’t want patients just to be receiving plans. We want them to actually participate in them. That’s the first section.

Dr. Rebecca Dekker – 00:23:05:

So should the doula’s name be on the board if there’s a doula in the room as well?

Dr. Amber Weiseth – 00:23:10:

100% yes. And we always train people that that should be the model. When we train doulas, we often give them a dry erase marker, like a TeamBirth marker and encourage them like, go use this board. This is a place for you. And we do have some doula education materials that are on our website for free that help doulas know about the model so that when they come into a hospital with a client that in the hospital uses TeamBirth, that they feel more empowered to be a direct participant as well.

Dr. Rebecca Dekker – 00:23:40:

Okay.

Dr. Amber Weiseth – 00:23:41:

But yeah, thank you for calling that out. The second section is preferences. In this, It’s meant to work with a birth plan, but it’s… It’s more… Changing over time than a birth plan, which is sort of a static ideal wish list. But this preferences is meant to adapt as care continues. And this should be elicited every time that we’re making decisions. So this is really that opportunity for the patient’s lived experience, what’s unique about them, what do we need to know about their preferences in order to make a plan together. So that’s the second one. The third is the plan. What are we actually doing? And that’s sort of probably the most straightforward section. And then the fourth section is when we’re going to come back together again as a team. So when’s our next huddle? And this is sort of our agreement to each other, our accountability, that we’re going to talk again in two hours, or we’re going to talk again when you feel the pressure to push, so that everybody on that team shares the same understanding of what’s happening next. And I will tell you as a nurse. So many times a provider would come in the room and have a conversation about the plan and what we’re doing and leave. And the patient would look at me and say, okay, what are we doing? And it doesn’t mean that that provider or that doctor did a bad job communicating, but we only can take in so much information. You’re scared, you’re in pain, whatever. So by having this information, both verbal and then written. Patients can see it after that conversation is over. And much of our data feedback from patients speaks to that, how much they appreciate being able to see it and know what’s going on.

Dr. Rebecca Dekker – 00:25:23:

It makes sense that they would also maybe feel… An enhanced sense of control power autonomy because they’re not clueless. Like they’re a part of the decision making. Everybody knows what the plan is and it’s written on this board, but the board is also erasable. We can change the plan if needed.

Dr. Amber Weiseth – 00:25:42:

Yeah. And I think that’s exactly right. It does give people a greater sense of control and like, okay, we know what we’re doing, what we’re focused on over the next couple hours. So, and you know, sometimes if people don’t speak or read English, we have ways of providing translated phrases on there. Some teams, I like to use pictures. I’m not a good artist at all. But if the plan is like for the patient to rest and to listen to baby, I can usually draw a stick figure laying in bed or stick figure walking. And so point being that we have this closed loop of communication that we all do agree with this plan before that conversation ends.

Dr. Rebecca Dekker – 00:26:24:

I love it. It’s, you know, it’s interesting how much a birth is symbolic and I love having a symbol on the wall that shows like who whose body this is, whose birth this is, and that we are all in this together as a team. Yeah. What’s the other part then of TeamBirth aside from… The dry erase board and the huddles. Is there anything else?

Dr. Amber Weiseth – 00:26:49:

Well, probably the biggest thing, which is how do you actually get people to do it? The implementation.

Dr. Rebecca Dekker – 00:26:56:

Yeah.

Dr. Amber Weiseth – 00:26:57:

You know, I know you have a great podcast on sort of like that evidence and to practice gap that exists within healthcare. And, you know, TeamBirth is not immune to some of those same challenges. We can provide a structure. We can provide education. We do a lot of data collection so that we understand what patients are truly experiencing. But it is a behavior change. It’s a culture change. I think often when people look at the model, they think, oh, that’s very, very simple. I can put up a dry erase board. It only has four sections. How hard is that? But… It’s breaking and shifting our system and cultural norms. We do not want the game of telephone anymore. Every time there’s a decision-making conversation, the patient needs to be involved. So if the provider can’t come to the room, that needs to be done on speakerphone. And that in itself is a huge-

Dr. Rebecca Dekker – 00:27:50:

Huge culture change for sure.

Dr. Amber Weiseth – 00:27:53:

Huge shift. Yeah. And the patient having a speaking active voice and participating in care decisions, depending on where you live in the country, that’s a huge shift. The bigger part of TeamBirth is enabling teams to not only understand the model, but understand how to continue to sustain it and to support towards that cultural change, which just takes a while.

Dr. Rebecca Dekker – 00:28:21:

So how is Ariadne Labs doing that then? Like, how are you? You mentioned going to Nepal and I’m sure you’ve gone to many other places. But, you know, once a hospital decides, you know, we want to implement this and we want help. What are the next steps?

Dr. Amber Weiseth – 00:28:36:

Often people do reach out to us and ask that very question. We’ll always meet with them. And the first thing we always say is that everything that we create at Ariadne Labs, we do put on open source or Creative Commons. And most of it lives on our website. So we have actually probably too many resources at this point. But hospitals, patients, anybody can go onto the website and access a bunch of free resources and materials to implement TeamBirth. That being said, there’s very few that have done it independently because of… It’s not hard to put up that dry erase board. What’s hard is the cultural shift and having external experts and support can be really helpful. So at this point, hospitals that are looking to have that implementation support. If they’re wanting to also do additional research, then we’ll have that conversation at Ariadne Labs. If they’re wanting just for the implementation support, we refer them on to Unravel Healthcare, which is an organization that was set up two years ago, actually, to support implementation. And they can work with either, you know, the TeamBirth as a program looks the same. But that’s how hospitals can go from, I want to do this, to having actionable steps or support.

Dr. Rebecca Dekker – 00:29:55:

Okay. So would someone from that organization then… like meet with your hospital staff? How does it all work?

Dr. Amber Weiseth – 00:30:02:

Yeah. And so just to be 100% transparent, I am the CEO of Unravel. And part of why it was created was because in an academic system like Harvard, they’re really there to be doing teaching and training of students.

Dr. Rebecca Dekker – 00:30:18:

And research. Yeah.

Dr. Amber Weiseth – 00:30:20:

Yeah. You got it. Exactly, Rebecca. And. They did not want us working directly with hospitals that doesn’t match their model. And so we had to find a different system to be able to support hospitals. That’s where it was created. But yes, somebody on the Unravel Healthcare team would meet with the hospital, they’d figure out exactly what type of support they want and need, and then, you know, develop a contract that would meet their needs. And hopefully, work for them.

Dr. Rebecca Dekker – 00:30:46:

Okay. And sometimes, would that mean in person or virtual or both?

Dr. Amber Weiseth – 00:30:50:

Both, we do go in person, both to walk the floor and also to do training, because that’s really critical to do in person. I will say at this point in my career, I’ve probably stepped in over 300 hospitals. And you know, within a few minutes, what type of culture, what type of things are normalized in that space. It’s really interesting. But we do think that’s really important to get, you know, on the ground, meet the providers, meet patients, see the health system in order to really provide the support that they need.

Dr. Rebecca Dekker – 00:31:23:

Yeah, to give them like kind of customized advice on here’s what you might want to do. I think, it’s so fascinating to me that it seems so simple, but yet it is hard. What are some of the… Reasons, let’s say maybe the nurses are on board. But maybe the providers are giving pushback. What are the, the main things they push back against and how… Do you or your team help? Help them deal with that, help the nurses deal with the pushback.

Dr. Amber Weiseth – 00:31:53:

So that is the, like nail on the head. That is the biggest challenge that hospitals have across the country is physician buy-in and willingness to do the model. I think from our perspective, we try to approach this with a lot of empathy. If you look at the job requirements or the job as it’s laid out for physicians, especially and midwives, but across the country, it’s almost inhumane how much they’re meant to see patients every 15 minutes and manage somebody who’s in labor and have these really meaningful conversations. It is almost impossible.

Dr. Rebecca Dekker – 00:32:36:

Yeah. So if they’re in the clinic, you know. 15 or 20 minutes away and they have all these clients booked to see them in clinic, can they just come over to the hospital to talk about whether… or not an epidural is needed, or some other intervention. Is that even reasonable?

Dr. Amber Weiseth – 00:32:53:

So for that type of situation, it’s probably not unless the clinic is in the hospital. And so that’s where we try to facilitate those speakerphone huddles so they can still be a part of that conversation. What many physicians will report back to us is that once they adopt the model and they utilize it, it does actually save them time. You know, if we think back to when we were talking about that induction or the Pitocin that was ordered that the patient didn’t want. If I then had to call that provider back, I’m now interrupting them two, maybe even three times when they’re trying to see patients versus us having one conversation that maybe took a couple minutes longer. So it does save them time. I think the other thing it does for providers is- And actually some of our older physicians, more near retirement age, have said, I love TeamBirth. This brings me back to the bedside. This is the way I learned to be a physician. But now I spend so much time on the computer and documenting that I’m not actually doing the thing that I went into medicine to do, which was to connect with patients and make meaningful, positive impacts in their health. So it does bring providers to the bedside. However, we still need to do a lot of payment reform, policy reform. Physicians need to be. Actually incentivized to participate in quality improvement versus penalized. So there’s still a lot of work to do in the larger ecosystem. But for providers that resist, if they will embrace it, I do think it helps with some of their burnout. And it also, it helps with their time management.

Dr. Rebecca Dekker – 00:34:36:

What about privacy concerns with the speakerphone model?

Dr. Amber Weiseth – 00:34:41:

The speakerphone huddle, again, that would be in the patient’s room, right? At the bed. So patient’s sort of communication, there’s no privacy concerns. The provider themselves in the office will need to go to a private location or into an exam room where they would have a conversation versus out in an open area. But also, you know, when we’re training people. If I was the nurse calling a provider, I would always want to consent them. So, hey, doctor, and so and so I’m calling because we need to do a TeamBirth huddle with this patient. Is this an okay time to put you on speakerphone?

Dr. Rebecca Dekker – 00:35:17:

Okay.

Dr. Amber Weiseth – 00:35:18:

Don’t want to surprise people, right? That’s like not going to go. You’re not going to make any friends by just randomly putting people on speakerphone.

Dr. Rebecca Dekker – 00:35:25:

And what about if there’s like additional family or support people in the room that maybe… You know, do you need to be sensitive to who the patient wants to have as part of the huddle?

Dr. Amber Weiseth – 00:35:37:

Yes. Definitely. I think that goes back to even how much the involvement the patient wants. So that is something we often train providers when eliciting preferences is how involved in decisions do you want to be? You know, our team believes we should empower everyone to be involved, but ultimately that’s not going to be everyone’s preferences. Some people won’t want all the information and that’s okay, but that needs to be talked about and assessed early on, or you can inadvertently have communication errors. So along that line of questioning is who’s on your team? Who do you want involved in these huddles when we have them as a team? So I think those are really important to assess when we’re sort of establishing the norms. And also when you’re writing something on the board, is this an okay thing to write on the board? Are you comfortable with that? There may be preferences that patients have that they don’t want actually written on a board in the room because of privacy issues. So that is definitely a part of the model and a part of the training. To ensure that… that communication space is really a safe space.

Dr. Rebecca Dekker – 00:36:46:

That makes sense because I think you could run into some complex situations. I mean, I’m thinking domestic violence or surrogacy or other areas where you might have people in the room that, the birthing person may… not necessarily want them like, but they don’t want to say it openly like I don’t want you to be part of this conversation so I can see how it could get really complicated

Dr. Amber Weiseth – 00:37:09:

Yes, 100%. I remember when I was, you know, admitting a patient in labor, I would always have a private conversation with them, usually like maybe helping them to the bathroom or at some point, letting them know like, I’m, I’m, you know, your biggest advocate. And if you need me to help control who’s in the room or not in the room, you just let me know, like we can have a word or if there’s somebody you want me to kick out, I’m happy to be your bouncer. Because the most important thing is that patient to feel safe and to feel like the care team is working for them.

Dr. Rebecca Dekker – 00:37:42:

I love how the whole concept just revolves on making them the center of their own care and bringing this team around so everybody’s supporting one another but really not losing focus of like… who we are advocating for who we’re supporting. Are there any specific tools you want to mention that are on the website. And how does one get to the website to get these tools?

Dr. Amber Weiseth – 00:38:07:

Yeah, so the materials are all just on the Ariadne Labs website under TeamBirth. So if you just Google TeamBirth, Ariadne Labs, it’ll take you right to it.

Dr. Rebecca Dekker – 00:38:17:

And we’ll make sure we put that link in the show notes as well.

Dr. Amber Weiseth – 00:38:20:

Thanks, Rebecca. Yeah, for patients, you know, I think… I was thinking about this question, like, what would I encourage people to do after the show? You know, they maybe are going to be delivering in a TeamBirth hospital. They may be not. I mean, there’s about 300 TeamBirth hospitals now, but we have a ways to go before it’s everywhere.

Dr. Rebecca Dekker – 00:38:41:

And there’s a map on your website, correct?

Dr. Amber Weiseth – 00:38:44:

There is a map, so you can see the hospitals that have implemented as well as those that have received our TeamBirth recognition, which means we’ve sort of done a check or an assessment on the fidelity of the program and they’ve met the criteria. Often when people are preparing for birth, They do birth planning or birth education, and there’s often a lot of attention to what they want to have happen. I want Pitocin, I don’t. I want a vaginal birth, I don’t want a vaginal birth. Around the things that we ultimately can’t always control for, but littler attention to how do they want to feel. And I think if patients can spend some time thinking about like what makes them feel safe, how do they want to feel and work with their care team? That is really helpful information to provide to your care team. So I’ll give you an example from me personally. Unfortunately, on a work trip several years ago, I ended up being hospitalized very, very ill in Zanzibar. And because of that, you know, I definitely have a little PTSD when it comes to healthcare experiences. It just makes me feel uneasy, even though the rational part of me knows that I’m safe. I, you know, it was traumatic. And I had to go in. Yes, I’m of the age. I had to go in for my first colonoscopy. And when I sat down and, you know, these are standard. They do these, what, every 15 minutes all day long every day. It’s just a normal day for them. For me, I was super anxious. And so I, you know, said the most important thing to me is that I feel safe. And if you’re moving really fast and not pausing to listen, I’m going to not feel as safe. So I wasn’t telling them what drugs to use or… You know, how I wanted to recover. I was really trying to advocate for what I needed emotionally. And I think that I don’t ever want to put the onus on patients because it’s not their job to fix the healthcare system at all. But to spend some time trying to understand themselves and what they need to be safe and to advocate for that.

Dr. Rebecca Dekker – 00:40:49:

That’s such great advice. It reminds me of like, and it could be different for everybody. Like for someone with diabetes or someone who gets low blood sugar easily, it might be, I want you to keep my blood sugar in mind at every point of the way. Or I want you to explain everything that you’re doing. Or I don’t want you to tell me exactly what you’re doing. So everybody feels safe in different ways. That’s really, really good advice. So on the website, you said there’s lots of resources. Is there like, are there different templates or what are some of the things that just let our listeners know that are available to them for free?

Dr. Amber Weiseth – 00:41:26:

Yeah, definitely. I mean, there’s training videos that are all on YouTube as well as also links. There’s some information on like our manuscripts that are published. There’s… Like a data three pager that’s sort of a snapshot of some of our research findings. There’s training materials, a little vignettes to sort of practice different scenarios. There’s different TeamBirth dry erase board examples. I mean, there’s literally are so many resources. We’re actually going to try to work to decrease the amount to make it the most meaningful ones that are used. And for clinicians, definitely there’s or hospital leaders get on there. There’s so many resources for how you could implement this at your facility. And I think if I could encourage clinicians towards… Any like one thing because there are people who are listening may not be working in a TeamBirth hospital as well. And so it, you know, it’s just different, but. To get really good about eliciting patient preferences and going beyond the, do you plan to breastfeed, skin to skin, cut the cord, like sort of the standard things that are just basically standards of care now, but to get beyond to what is unique about that patient, what are they worried about? Often when you ask that question, people will tell you. Things that you never thought to give them education about or to even address because they weren’t on your radar. So getting really good at asking those questions around preferences and understanding what what values your patient has. And to nurses, like, yeah, my sort of biggest reflections on my own career given to light that, you know, I spend a lot of time doing TeamBirth now. Is that when you’re faced with a tricky situation and you find yourself playing the game of telephone, You don’t have to have a TeamBirth hospital. You don’t even have to work in obstetrics. This can work in any area of healthcare. To just get your provider on the phone, ask if you can put them on speakerphone and have one conversation with your patient or ask them to come to the bedside. It’s really powerful how just having one shared space where everybody is sharing their expertise, their knowledge and coming to a plan together, how much that changes dynamics from me on the phone to one other person on the phone and the friction that can be created in those situations that aren’t easy.

Dr. Rebecca Dekker – 00:43:56:

You don’t you’re right you don’t have to be a TeamBirth hospital to to have a huddle to get someone on the speakerphone that’s incredible advice and and this not just changes the experience for the patient but you have research showing that this approach works, right?

Dr. Amber Weiseth – 00:44:15:

We do. We do collect a lot of data. I thought we would stop after the pilot trial because we’re like, oh, we have data. But then we realized that the data itself was actually part of the implementation. The people need to see how it’s working in their own community with their own hospital, their own patients to really be able to support all those behavior changes. And I will tell you extremely consistently the data that we have. Is that TeamBirth makes a positive impact on all patients. Patients who have TeamBirth huddles report statistically significant better experiences, whether you’re looking at trust measures, autonomy measures, respect. And that what we see is when you break that down by further demographics, we see the largest impact is in the non-Hispanic Black population and the non-Hispanic Native American population. We also see this making a bigger difference on folks that are on public insurance and those that have complications in their birth. TeamBirth seems to be sort of protective on how they view their care, how they view their experience. So we definitely have very, very consistent research out there. We have some data on how it impacts clinicians, but that is something we’re focused on here in the future is really being able to understand how this impacts clinicians and their workflow, but how it also could be protectant a little bit from some of the challenges with burnout and moral injury that so many providers have really struggled with in the past years.

Dr. Rebecca Dekker – 00:45:54:

I imagine improving, enhancing communication can help. With liability as well, legal liability, that could be something else that providers are worried about. So another reason that they should implement these huddles.

Dr. Amber Weiseth – 00:46:09:

Yes, exactly. Definitely something else that we’re interested in studying as well, as we have several states that have implemented statewide. At this point, it’s Oklahoma was our first. Washington State, New Jersey is maybe two-thirds of the way down there. And then just starting in New Hampshire and then in Nebraska as well. So once we have more time and more hospitals, we can look at whether there are impacts in some of those malpractice concerns that you mentioned.

Dr. Rebecca Dekker – 00:46:41:

Thank you so much, Amber, for all the education you’ve given us today and all the work you and the whole team are doing at Ariadne Labs. We’re really excited for this new advance. It’s simple, but super important as well.

Dr. Amber Weiseth – 00:46:57:

Thanks, Rebecca. It was a pleasure to talk with you. And I hope this was helpful to your listeners.

Dr. Rebecca Dekker – 00:47:02:

This podcast episode was brought to you by the book Babies Are Not Pizzas: They’re Born Not Delivered. Babies Are Not Pizzas is a memoir that tells the story of how I navigated a broken healthcare system and uncovered how I could still receive evidence-based care. In this book, you’ll learn about the history of childbirth and midwifery, the evidence on a variety of birth topics, and how we can prevent preventable trauma in childbirth. Babies Are Not Pizzas is available on Amazon as a Kindle, paperback, hardcover, and Audible book. Your copy today and make sure to email me after you read it to let me know your thoughts.