How Doulas and OBGYNs Can Work Together with Dr. Nicole Rankins
Do you believe it’s possible for birth doulas and OB-GYNs to *actually* get along?
In this episode of the Birthworker Podcast, I'm joined by Dr. Nicole Rankins from the All About Pregnancy and Birth Podcast, who is sharing her insight and experience from supporting births and collaborating with doulas as a practicing OB-GYN.
In this podcast interview with Nicole Rankins, we discuss:
Eliminating the combative atmosphere between doulas and OBs…
How to diffuse tension in the labor room…
Why nobody should feel the need to “save” birth…
… and a whole lot more!
Nicole Rankins: I have been in practice for 15, 16 years actually now, which is crazy. My podcast is All About Pregnancy and Birth, and very shortly it's going to cross a million downloads. That is my baby, I love my podcast. And also, yes, I have a childbirth education class. So, you nailed it. And I’m a mom.
Kyleigh Banks: And you’re a mom to two girls! Yeah. I think everyone else also loves your podcast as much as you love your podcast.
Nicole Rankins: Thank you.
Kyleigh Banks: A million, yeah, I would be pinching myself and I'm sure you are. That's really cool. So from watching you, listening to your podcasts, and watching you on Instagram, you seem drawn to helping moms understand how important it is to advocate for themselves. Would you say that's right?
Nicole Rankins: That is 100% correct. Because although, it's not all bad, and I certainly don't want to paint a terrible picture, but the reality is that birth in the US is typically a patriarchal approach. It can often take away power from women, and for some, it's also racist for those who fall into marginalized communities.
So there are things happening on the system’s side to try to make changes in our system, but that stuff is really, really slow to happen. And I believe that birthing people can empower themselves with information and help make those changes come about faster and be able to advocate for themselves when they go into having birth. Especially in the hospital, that's what I know, so that's what I talk about. And it's just really important that you educate yourself and you're prepared and ready to advocate for yourself.
I always say, “I would be delighted if I was put out of business and I didn't have to talk about any of this stuff anymore.’’ But the reality is where we are, folks just need information. So I want to provide evidence-based information that really centers the birthing person, so they can advocate for themselves.
Kyleigh Banks: Mm-hm. Do you feel like a unicorn OB-GYN?
Nicole Rankins: Ok so here's the thing, like a lot of people say that I’m a lot like a unicorn, and honestly I'm not.
Kyleigh Banks: Ok, that’s good.
Nicole Rankins: There are a ton of us who are like hiding in the shadows. People call us crunchy, granola, or those kinds of things. It's just that I felt comfortable finally speaking up about it. I actually get messages from folks sometimes. They're like, thank you, and you know, we appreciate your content, and I can send folks your way. I have some birth story folks in the podcast where people share that they have great supportive doctors. So would I say that I'm the majority? No. But there are folks who are out there that believe similar to what I believe.
Kyleigh Banks: And I hope over the next decade, it's just more and more. And more people feel confident coming out from the shadows. Yeah.
Nicole Rankins: I think that it’s our culture and how we've been taught, and it's just, I mean, even myself, I used to roll my eyes at birth plans. Cause I didn't know any better. And then just kind of taking a step back and realizing this, this isn't right. This doesn't, you know, what, why am I doing this kind of questioning things? So it made me realize, like, this is not the way that we should be doing this.
Kyleigh Banks: Yeah. That's really fascinating. Was there a specific moment that made you question what you had been taught or what you thought previously?
Nicole Rankins: You know, honestly, part of it came from my own sort of like self-discovery process and figuring out like what I wanted to do with my life, or my work. Reading books like the Alchemist, or the Untethered Mind….
Like, just sort of like developing myself and thinking about like how I was showing up in the world. And then it just sort of slowly happened over time, this shift in the way that I was thinking and realizing that I was taking an approach that was very patriarchal. Like, oh my God, especially as a black woman, someone who experiences both sexism and racism potentially, being on the flip side of that and actually propagating that was a big realization.
One of the biggest moments for sure, that like hit me in my chest is when I asked someone, “Is it okay if I check your cervix?” And this was something that I hadn't even really thought about, that I should be asking. That's sad to say, but like we’re just not taught that that's an invasive thing. You should really ask if we can do something like that. And she looked at me and she sincerely asked like, “Do I have a choice?”
And it just really was like, oh my God, everybody needs to know they have a choice on what happens in their own bodies. Period, hard stop. And really since then, I've gotten more and more comfortable in talking and all of those kinds of things.
Kyleigh Banks: That's amazing. You know, the book, the Alchemist was what started my life change also.
Nicole Rankins: It’s a great book.
Kyleigh Banks: It’s really a great book. Yeah. So this conversation, I wanted to jump in and have a conversation with you about how doulas and OB-GYNs can work together to support moms being the authority over their own birth. So knowing that they can decline things if they want to, or they can speak up if they don't feel heard. I guess my first question for you is how many of your clients have doulas?
Nicole Rankins: Yeah. So at our hospital, and actually I would say throughout my career, it's getting more and more, but I would say in general, it's roughly about 20-25% of folks will have a doula. So still most folks don't have a doula.
Kyleigh Banks: Yeah. And do you notice the clients that have a doula, the women or birthing people that have a doula, do you notice an impact on their birth? On the outcome of their birth, maybe a lower rate of intervention?
Nicole Rankins: Yeah, definitely. But I also like to say, that it actually doesn't matter what I think. Because the research is super clear that having a support person, like a doula, improves outcomes, improves your satisfaction, decreases your need for pain medication, and increases your chances for vaginal birth. That data is very clear. So irrespective of what any of us think, we should all be supporting folks having continuous labor support from a doula, because it helps. The end.
Kyleigh Banks: Now what have you seen from working in the hospital setting? Do you see that most other providers also support a doula's role?
Nicole Rankins: It really depends. And not just speaking of the hospital, but also online groups and things like that, it's all over the place. There are some people who are really comfortable and they know the benefit of doulas. As physicians, they've actually had doulas themselves for their births. And there are some who are definitely really supportive. I would say as a whole, we're not at the point where most folks are supportive.
Now where I happen to work, yes, people are totally supportive of doulas. Like in my hospital, it's not even an issue at all. Nobody even bats an eye. But that's not the case at all hospitals. And actually, that's the case with most hospitals in my area, but it's not the case at all hospitals.
You can really have situations where one, you can have, you know, someone in labor room 2, someone in labor room 3, when in labor room 2 in the same hospital, their doctor is like “This is great, you know, you have a doula.” And the one in room three is like, “I hate doulas.” And that's one of the reasons why I tell folks this isn't something you want to find out when you get to the hospital. You need to ask these questions during your prenatal appointments so you're prepared and you can change and find another doctor if you want to.
Kyleigh Banks: That's a really great idea for people to ask their provider, how they feel about a doula. Do you have conversations with your patients and almost encourage them to hire a doula?
Nicole Rankins: Yeah. I only work in a hospital, and also I don't do prenatal care. But I would certainly say, I say in my childbirth class and the podcast, definitely consider a doula. Instead of like 5,000 onesies on your registry, ask for some money to get either a doula during your labor or your birth or postpartum as well. So I 100% recommend that folks should consider a doula because again, the evidence shows that it's going to help.
Kyleigh Banks: Mm-hm. Since you're a hospital-based OB, do you take care of the women who come in from transfer situations, from home birth?
Nicole Rankins: Yes, I do. Actually, that is one of the things that was important to me in my role at my hospital. I actually reached out to one of the birth centers in the community that does birth center birth and home birth. And I work in a hospital where we have nurse midwives, we work side by side.
So me being the director of my program and the nurse-midwife director, we went out, and we met with them. We said, hey, we want to be a place where you can send folks, and it’s a place that's a welcoming place for folks to come. That's one of the things that I believe is really important. That we all need to just start from what best serves the person giving birth and then develop a system around that.
And one really key piece of that is having a seamless and easy transfer from home birth to hospital if need be. So yes, I 100% support that.
Kyleigh Banks: I love that. You know, speaking to moms, and I'm sure you've seen this too in your courses, speaking to moms, and even speaking to new doulas, a lot of them don't realize if they haven't given birth before, they don't realize that the midwife or the obstetrician typically is not going to be by their side the whole birth. That surprises moms.
Nicole Rankins: Yeah. I have a class on making a birth plan, and this is one of the questions that I tell people to ask: Will you be there for my birth? And not only that, but a lot of people, you're right, don't like, the doctor pops in a couple of times during the labor. It's really your labor nurse who is with you for the vast majority of the time. The doctor or the midwife is not there as often. And yes, people are definitely surprised by that. And I often say like, you know how your doctors, when you go to a doctor's appointment and they're in the office? They have patients who are in labor while they're still in the office. So they can't be all places at once. It's just sort of the nature of the way our system works.
Kyleigh Banks: And that's why having a doula is so awesome because the doula is like literally by the folks’ side, the entire time. Now from your personal opinion or your professional opinion, are there certain things that you see doulas do that you're like, “Wow, like that changed that woman's birth, like that was such a great idea. You supported her in such a great way.”
Nicole Rankins: Yeah. This is going to sound simple and straightforward, but just being a nice person and not like creating a combative atmosphere. It's actually on both sides. There are OB’s who trash doulas, there are doulas who trash OB’s, and neither one of us should be doing it. Yes, we need to talk about some of the problems that happen, but we don't need to like set a foundation of constantly trashing each other….That is not helpful for anybody.
So if we can all come to that situation where we're like, hey, we're all here to support the birthing person, then I think that is what makes the biggest difference. So I think some things that I find particularly helpful are when mom is having a difficult time making a decision about something, really, sometimes moms will turn to the doula and ask her like, “Well, what should I do?” And I really think in those circumstances, it really should be pushed back to the mom in the sense, like, you know, here are your options and this is the choice that you should make for yourself.
They shouldn't get put get into a situation where they're making decisions or choices for people. I think that that helps to empower the woman and helps her feel good about how things went during the labor and the birth.
Kyleigh Banks: Yeah. I love that. And I think even if the doula is witnessing a conversation between the doctor and the woman, the doula can also play a role and say like, “Bring it back to the birthing person.” If the doctor's not doing that. Bring it back to that birthing person and say “In the end, this is your choice. What do you want to do, mom?”
Nicole Rankins: Yes. And then one thing I also think is helpful is that for a doula to kind of put some space in between when a conversation happens and when the decision happens. So saying something like, you know, “Do you want a few minutes to talk about it? Just the two of you guys, and we can step out for a minute.” That often helps to like slow things down, gives them a chance to think about it. Because doctors are often gonna ‘du-du-du-du’, and not necessarily stop and give people some time to think about things. So I think that's also a really important role, to just bring up that possibility of, “Hey, do you guys need a minute? Do you want us to step out?” Those kinds of things.
Kyleigh Banks: Mm-hm. Is there another way beyond that to de-escalate, maybe if there's tension in the room between, maybe between all three parties, between the doula, main care provider, and the mom?
Nicole Rankins: Yeah. So this is something that I’ve thought a lot about. Something that I've seen, which is that doulas are getting a lot of pressure, and I don't think it's always necessarily fair to be like the savior during the birth experience. And that's a really difficult position to be in, and to expect someone to be in. That this one person is going to be able to save you from all of the things.
It's actually not fair, I don't think. So I don't want any doula to feel like they have to save everything. Everybody does the best that they can. So I would just say helping the conversation to be more human. So in the sense that, like, are you saying that you are scared because you're worried about xyz, or are you trying to say, like, you're worried about what is going to happen when your water breaks. Or you're worried about what could happen. Or do you want to know some of the risks of XYZ.
So trying to lead the conversation in starting it with feelings. People tend to relate to feelings. And then sort of try to tease out like how the conversation can just be about information, and then making a decision. I hope that makes sense.
Kyleigh Banks: Yeah. Like feelings first, rather than this information. And especially like, over-medicalized information where maybe mom isn't even quite sure what's being spoken about.
Nicole Rankins: Yeah, Exactly. Exactly. Because we sometimes get lost in the fact that we do this all the time, and that person has not. So we just need to like, take it down and help people understand that this can be scary, even though for us it seems straightforward, it's not the case for that person, and helping us to see that and slow things down in that regard.
Kyleigh Banks: Yeah. And I love how you started off your answer. You said, I forget exactly what you said, but you said like, bring everyone to the same level, make it more human again.
Nicole Rankins: Try to connect with people on a human level first. Now by all means, if people don't listen and they get nasty, then you get nasty right back. But you want to start by trying to make those human connections, that typically works best.
Kyleigh Banks: Yeah. I think that was one of my biggest skills as a practicing doula, is seeing you as Nicole. And seeing the mom as Rachel, or whoever. And not seeing you as an authority in some way. Like you're literally just Nicole, and you care as much as I care about the outcome of this birth.
Nicole Rankins: Absolutely, absolutely. Or unfortunately, in some cases, you find that maybe people don't care as much. And then you can adjust the course as needed too, but yeah, seeing people as humans is really, really important.
Kyleigh Banks: You bring up a really good point. If the doula, or really the mom, if the mom's noticing that she's not receiving optimal care from her care provider, is there something that the mom can do? Is there something that the doula can help facilitate?
Nicole Rankins: Yes. So one of the things, it depends. So if there's one thing that can help is maybe change nurses. If the, if it's like a nursing issue. So if you're not having a nurse who you're connecting with, or you don't feel is supporting you, you can definitely ask for a different nurse. So that can help. It can be challenging during the course of labor if you're butting heads with a doctor.
I mean, there's just no way to get around that. It is theoretically possible that you could say, you could always say like, “I don't want you here anymore. I want someone else.” And you know, they can call one of their partners, or in the case where we work in the hospital, we as hospital lists step in, in those situations, those rare situations when that happens. But so yes, you can do that to the extreme.
But one thing is to ask for a good, you know, a different nurse. You can ask for a different doctor, but again, that's challenging. I teach folks to try to know as best you can go into the situation, who's going to be there and whether or not they're going to support what you want for your birth so that you can avoid those surprises because it's much better to avoid it than to try to have to deal with it in the moment.
Kyleigh Banks: That's a really good point. Do you think it's possible to have a hospital birth and to decline most of the routine procedures? And I think from a doula standpoint and from what I've seen in person, I think the hardest things to decline or what moms get the most pushback on are things like they wanna catch their own baby, or I guess that probably really depends on the provider.
Nicole Rankins: It really, it really, really does. And I, again, I encourage folks, if you have ideas of things about what you want to do, talk about it during your prenatal visits. So you're not like springing this on somebody just when they get there. And then you can talk through it, and you can have an idea. Maybe you can come to an agreement about what could happen. For instance, if a dad wanted to be part of the birth, sure, put on gloves. I've done this thousands of times, I can guide you through this. I can take anybody and walk them through how to do this.
But not everybody feels so comfortable with that. So I can't stress enough like, I don't want you to wait until… like you’re hand[ing your care team your] birth plan and say, “Here are all the things”, and then they look through and they're like, “We don't do any of that”, and then you're trying to scramble to figure out how.
You really need to push that conversation to during pregnancy so that there are as few surprises as possible when you get to the hospital. Birth is an unpredictable process and you can't guarantee anything, but you can control how prepared you come to the process. That you can 100% control.
Kyleigh Banks: Your patients that you serve, you're meeting them for the first time when they're in labor?
Nicole Rankins: Mm-hm.
Kyleigh Banks: That's cool. That’s special. It’s different.
Nicole Rankins: I have the unique task of establishing rapport fairly quickly. And which is, thankfully, something that I feel like I've gotten pretty good at. But yes, I don't meet folks until they are in labor.
Kyleigh Banks: And is one of the first things that you want to complete is getting clear on the birth plan and mom's wishes?
Nicole Rankins: Yeah. So I always ask, “Is there anything that you want me to know about what you want for your birth?” And some folks have several things that they want, some folks are just like “hmm.” So just sit down, who I am, how things go. I always set the expectation that birth is a normal and natural process, and that's how we approach it. It's not a disease or a medical condition, so we really just need to let labor happen. However, if there are things where we believe interventions need to happen, then we'll talk about it first. And we're prepared to deal with the full gamut of emergency situations if they come. But we start from a baseline of this is a normal, natural process. Some OBs, and part of it's the way that we're taught, start from thinking that every birth is a disaster and we're just a burning disaster. But I like to flip that and say it's normal, but I'm prepared for any disaster if it comes.
Kyleigh Banks: Yeah. Is that, that's kind of, you said, that's kind of how you guys are taught, to err on the side of, “We need to help people.” Yeah.
Nicole Rankins: And part of it is because when you're in training, especially you see all of the, I mean, I have seen some things that can be challenging. I had a patient who was a home birth transfer. I ended up, she got 26 units of blood products from a severe postpartum hemorrhage. She did fine. And she said that the care that we gave her actually restored her faith in medicine. She had chosen a home birth because her experience was so poor before.
So I have seen the gamut of things that can go wrong, but that doesn't mean that I still don't believe that like, birth is normal. So we sometimes see those things and it makes us on edge and nervous, understandably so. But we have to kind of reset the culture and approach it as normal, but you prepare for things that can happen.
Kyleigh Banks: Yeah. I think you are like the dream doctor for most women. Especially most women that I know, and that follow me and her in my community, we would be honored to have you as a doctor.
Nicole Rankins: Thank you. I try. Because it also helps to create trust, so that when I say that this baby needs to come out now, you understand that I'm not saying that because I'm trying to hurry up and get this over with, I'm saying that because there are things that are concerning, and this is what I believe is the safest for you and your baby. So, it helps to create that trust when you start.
Kyleigh Banks: It really does. I mean, I very specifically remember one birth where the doctor was telling us that the baby needs to come, it's probably an urgent situation, but she couldn't answer questions about what potentially was happening. And at one point she talked about maybe the baby was too big, and the mom had had prior births before. And this baby seemed smaller to mom…. So just mentioning that the baby might be too big, put on our red flag alert.
…And it made us question whether there was really an emergent situation. And there ended up being, it was a placental abruption and everyone ended up being fine. But you're right, in the sense that like, it was a little bit like the boy cried wolf. So when something was really happening, it was hard for the mom to know what the right decision was.
Nicole Rankins: Exactly. Yeah.
Kyleigh Banks: Well thank you so much for this conversation. That was phenomenal. I have one last question for you. If a mom, or if a doula is helping a mom find a doctor, or if a mom is just looking to find a doctor that aligns with her beliefs, do you look for recommendations? Do you just call around and ask? Do you bring up your wishes on the phone to the receptionist? What do you do?
Nicole Rankins: So, yeah, I made a whole podcast episode, about how to find a good doctor. I can't remember what number it is, but it can be challenging. You're not going to find that in like, the first visit. It may take that you have to meet a couple of folks. But you have several things. One, you need to figure out like, well, number one, who your insurance takes. That's the reality where we are. Number two, the hospital that your insurance works at. So start from there, and then definitely ask for recommendations.
Doulas, I think can be a great source because you can see birth at different places, and different doctors. Like, I don't know how my colleague down the hall delivers necessarily. I'm not in the room with them. Whereas a doula can be in different places. Actually, I think that this is something doulas can potentially charge for, because we all know the doulas are not, you know, you want to help folks, but you need to eat too.
So you need to get paid. So just like, a phone call. It doesn't have to be a lot, it can be, you know, 50, 75 bucks for a half-hour discussion of different doctors and who you recommend and why, and those kinds of things. So doulas have that perspective, which I think is good. Asking your friends or people in the community is definitely good.
And you want to ask people who are similar to you, because someone might be like, “I'm getting an epidural like three days before I go into labor,” there are some people who are like that. And then there are some people who really want low intervention. So you want to ask people who are similar to you and what you want for your birthing day.
You may not know all of the things that you want, and don't be afraid to change if you find that whoever you're with is not, something's not right. My last piece of advice to that is to 100% trust your gut. Those little signs and intuitions and things that we get in our bodies are there for a reason. So you have to listen to it and say, “Hey, is this something that I need to pay attention to? Or am I being overly anxious?” It doesn't always mean that something is wrong, but if there's a body signal, that's saying like, something's not right, listen to it and investigate it.
Kyleigh Banks: Mm-hm. And you can change providers up until the very last minute.
Nicole Rankins: Up until the last minute. Up until the last, you can change. You can still change. It gets harder the further along you get. Especially, something I learned, and I know we're getting towards the end, something I learned is that some practices now are collecting the deductible ahead of time. So, yeah. So you're having to pay—
Kyleigh Banks: Monthly.
Nicole Rankins: Mm-hm. And you don't want to end up losing out. And most of, a lot of them will want that paid by like 28 or 30 weeks. So you really want to try to figure out fairly soon if you want to change. So you're not roped into paying for care for someone when you're going to see somebody else.
Kyleigh Banks: And if you just want to show up to the hospital in labor, you could be lucky enough to be graced by Nicole as your doctor.
Nicole Rankins: And I'm fortunate. I practice with another set of hospitals, a hospital list who we practice similarly, the physicians in the community. So there are places that are great. You just have to figure out where, cause it really is dependent. I interviewed a birth photographer for the podcast and she talked about how one hospital, same town, was awful for the way that they treated people. And the other one was great. So you just have to do your research.
Kyleigh Banks: Mm-hm. Absolutely. Listen to women's stories and believe women and what they have to say.
Nicole Rankins: 100%. Yes.
Kyleigh Banks: Thank you so much. Thank you for the work you're doing, really. I'm honored that you exist and I'm just, I wish more obstetricians could see you and see what you're doing and feel confident in doing the same thing and following your path.
Nicole Rankins: Well, thank you for reaching out to have these types of conversations, because they're really important that we all work together to provide the best care for those who are giving birth. That should be our north star. And I wish you the best in your new business. I know it can be challenging. I really, it's important because I think so many doulas, and I'm sure you'll talk about this, have a heart for their work, but I don't want them to forget that they need to be compensated.
Kyleigh Banks: Yes. 100%.
Nicole Rankins: I mean, you can do sliding scales and things, and you can decide where to give your time and things like that. But you know, you have to live, so don't be afraid to like charge for your work.
Kyleigh Banks: Yeah. I'm going to teach them to how to do like what we do, and create online courses too. So they don't feel like they have to rely on going to birth to feed their family. They go to births for fun and charge what they want to charge because they're already getting the recurring revenue from their courses.
Nicole Rankins: Yeah.
Kyleigh Banks: That's the secret. We found the secret!
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Meet your host, Kyleigh Banks, a side-gig doula turned CEO of a multi-six-figure birth-focused business. Her passion? Teaching birth nerds, like you, how to build an incredibly successful doula business that allows you to quit your day job, stay home with your kids, and most importantly, make a lasting impact on the world.