The Birth Nurse

We talk about obstetric violence as something that happens to patients.⁠
It does. And it does not stop there.⁠
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The consequences of obstetric violence culture ripple outward in three directions, and the research documents all of them.⁠
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Birthing people: Mistrust of the healthcare system. Birth trauma. PTSD. The decision to avoid care in future pregnancies. The self blaming, shaming, internalized silence that follows when no one believed them.⁠
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Clinicians: Moral distress. Secondary traumatic stress. The specific kind of injury that comes from witnessing harm you were not able to stop, inside a system that told you it was normal. Clinicians leave the workforce. ⁠
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Systems: Institutional silence. Poor outcomes data that gets attributed to patient factors instead of culture. A workforce that is burning out for reasons no retention strategy has ever addressed.⁠
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This is a systems problem that requires a systems response.⁠
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The good news: systems can be disrupted.⁠ 🔥⁠
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Because if we keep doing things the way they've always been done, we'll continue contributing to an oppressive system, compounding generations of trauma, and abandoning ourselves in the process.⁠
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💪 Up next, get ready to find your countercultural avatar.⁠
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SAVE this for citations. SHARE it with your leadership team. ⁠
Tag someone who needs to see the full picture.⁠
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Read the full concept analysis here:⁠
https://onlinelibrary.wiley.com/share/author/JTHI9CQHYJVNRTRQ7FPJ?target=10.1111/jan.70323⁠
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Authors:⁠ Maggie Runyon, Mandy Irby, Paula Rojas Landivar, Cristen Pascucci
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Image source: The Birth Nurse, https://lnkd.in/eHcQTZbf ⁠
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This is what obstetric violence culture looks like in real life.

Four attributes. Have you seen any of these at play?

Disbelief of violence: A patient says she was held down during a procedure she did not consent to. The response: "That's not how we do things here."

Her experience is treated as impossible before it is investigated.

Blaming the victim: A patient had a traumatic birth. The explanation: she was "too anxious," "non-compliant," "didn't bring a doula," or "didn't advocate for herself." The system stays clean, and carries the blame.

Revictimization: A patient reports harm. The follow-up process requires her to relive it, justify it, rely on inconsistent clinician charting that's full of microaggressive language, and prove it to the people inside the same institution that caused it. The process becomes the second wound.

Disempowerment: Information is framed with incomplete details veiled in "doing what's best for the baby." Decisions are made without her. Her questions are minimized, told that this is very normal. She leaves not knowing what happened to her body or why.

None of these 4 require malicious intent. But they are all normalized so that they're difficult to name. Do you have a feeling that comes up when reading these?
Any familiar to you?

Save this series. Share it with your charge nurse, your educator, and your CNO.
Now...we disrupt...

This framework comes from the article published in the Journal of Advanced Nursing, 2025
The authors are speaking globally on this topic. Join us in MD, FL, and Portugal in 2026!
Read it here:

https://onlinelibrary.wiley.com/share/author/JTHI9CQHYJVNRTRQ7FPJ?target=10.1111/jan.70323

Image source: The Birth Nurse, https://lnkd.in/eHcQTZbf

Obstetrics was not built by or for women.

It was built by men who experimented on enslaved Black women without anesthesia, who removed birth from homes and communities and put it inside institutions designed for control, and who decided that the person giving birth was a body to be managed rather than a human being to be supported.

This is the foundation of obstetric medicine inside hospitals today.

We do not wake up one day and decide to perpetuate harm. But we did inherit these systems, train inside them, receive orientation inside them, learn when to stay silent by shame, and which shortcuts get rewarded when the unit is slammed and short-staffed.

It is built slowly, through the systems we train inside, the silence and shame that's rewarded, and the shortcuts that stay when the unit is slammed and short-staffed.

The literature calls these antecedents - the building blocks of today's obstetric violence culture. It looks different from the late-1800s, but carries the same roots.

Before we can disrupt something, we have to understand how it took root. That is what this graphic is about. It comes from a paper I had the privilege to co-author.

Save this series. Share it with someone on your unit who is tired of doing things the way they've always been.

Next up: what obstetric violence culture actually looks like and how to spot it.

https://onlinelibrary.wiley.com/share/author/JTHI9CQHYJVNRTRQ7FPJ?target=10.1111/jan.70323

Image source: The Birth Nurse, https://lnkd.in/eHcQTZbf

Obstetric violence isn't a choice -
It's the result of a system that benefits when childbirth can fit into a neat box.

This box serves to protect the healthcare system from expense, lawsuits, and exposure.

This is nonsense, though. Anyone who's witnessed childbirth (of any kind) knows the innate power and energy within that experience.

There is nothing box-like or structured or 90-degree-shaped about birth (unless you're referring to a v***a, then go for it)

The more we try to contain a birth experience or control a birth experience, the worse our outcomes are as a result. (check out March of Dimes morbidity and mortality data, unnecessary cesareans, and PMADS rates)

According to the literature, we're all clinicians who've been instructed, received orientation, and worked within this obstetric violence culture.
All of us.

So, in order to reverse the harms that can happen as a result of a system that relies on this protective culture, all stakeholders must understand it and disrupt it.
We're working individually and collectively to disrupt the harm that obstetric violence culture has on all of us.

SAVE as a reminder. SHARE with someone who is also working against the status quo.

Read more here and stay tuned for a series on what disruption can and should look like.
(and how we got here in the first place)

https://onlinelibrary.wiley.com/share/author/JTHI9CQHYJVNRTRQ7FPJ?target=10.1111/jan.70323

Image source: The Birth Nurse, https://lnkd.in/eHcQTZbf

220 nurses registered. 🎉

We're presenting at Maryland AWHONN on 4/22, and this is what the session is built on.

Swipe to see what obstetric violence culture has been asking us to do —> and what we're doing instead.

Based on our 2025 paper in the Journal of Advanced Nursing with

See you there. 🦀

For years, handing patients peanut balls felt like good nursing. We had them on the unit. I knew the positions. I offered them with confidence. What I did not have was the full picture of what I was doing or why.

When I started learning about trauma-informed care, something clicked. Introducing a tool to a laboring person is not a neutral act. It requires informed consent, attunement, and an understanding of what is happening in their nervous system. I had been skipping all of it without knowing.

The peanut ball workshop I bring to hospitals centers on one insight: use a familiar tool to open the door to the skills nurses need at the bedside. Informed consent in practice. Trauma-informed communication. Learning designed to change how nurses show up, shift after shift.

Peanut Balls: The Trojan Horse for Trauma-Informed Care • The Birth Nurse - Mandy Irby Learn how peanut balls can help ease labor, promote comfort, and speed up delivery for expecting mothers with this simple, effective birthing tool.

Birth is one of the most vulnerable experiences of a person's life. The nurses in that room shape how it feels, how it is remembered, and whether it becomes something a person has to heal from.

This is not a supply problem. It is an education problem. Real peanut ball training teaches nurses how to introduce a tool with respect, how to listen when a patient says no, and how to support someone through one of the most physically and emotionally demanding experiences of their life.

Trauma-informed care is not a specialty skill reserved for nurses with extra certifications. It is the standard every person giving birth deserves. Training the people in the room is where it starts.

Peanut Balls: The Trojan Horse for Trauma-Informed Care • The Birth Nurse - Mandy Irby Learn how peanut balls can help ease labor, promote comfort, and speed up delivery for expecting mothers with this simple, effective birthing tool.

Most nurses on labor and delivery have a peanut ball somewhere in the supply room.
Very few know how to use it well.

That gap costs patients.

Peanut Ball Learning Days exist to close it.
I come to your unit, work directly with your team, and give nurses the clinical foundation and hands-on practice they need to use this tool with confidence.

1 day
Trauma-informed skills
Nurses and patient outcomes are transformed

DM me or visit

https://mandyirby.com/peanut-balls-labor-training-for-nurses-trauma-informed-nurse

Your unit already has peanut balls.⁠
What it probably does not have is a team of nurses who are trained to use all sizes. How to introduce it. How to explain it. How to read the room and the monitor at the same time.⁠
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That gap shows up in c-section rates, patient satisfaction scores, and nurse turnover.⁠
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One training day changes all of that.⁠ 💃🪩🕺
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If you lead an L&D unit and want to explore what a Peanut Ball Learning Day would look like for your team, check out the news blog post at the link in bio.