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Essential Oils: Toxicity & Contraindications

This is a tricky subject for a number of reasons. Essential oils are quite safe, especially when compared to modern medicines. However, in spite of being natural, they are not without risk. There are practitioners passionate on both sides of the argument. Depending on one’s training and experience, they may or may not recommend ingestion of essential oils or applying therapeutic oils neat or with a carrier oil. Others may recommend using essential oils daily, while some will instruct to limit exposure or suffer the consequence of damaged organs.

Essential oils have been used throughout time, and were spoken of often in the Old Testament. The number of toxic reports are so few, that basic common sense supports their use as a health modality when applied sensibly. Perhaps the larger issue is that common sense is not always common.

Many adverse effects can be avoided by using pure essential oils. When steam distillation is used and the essential oil is pure, without adulteration, there are no byproducts for which to interact. If one is especially allergy-prone or consuming a number of medications, adverse reactions are more likely.


Ingesting essential oils has potential for greater toxicity than diffusing or diluting them and applying to the skin. When used in this way, essential oils are clearly being utilized for medicinal purposes and unless the practitioner has a license to prescribe, this could be argued as practicing medicine or nursing without a license. However, one could also argue that the utilization of herbs in the United States is not a regulated practice and therefore, no licensing is required. Reports of toxicity to date are almost exclusively in doses ingested much greater than what is normally advised, and quite often in children.

A study performed by Burfield, in 2001, found 74 of 100 essential oil poisonings in children were from ingesting eucalyptus. Access was gained through their home vaporizer. The range of safety varies greatly. For example, death in adults has occurred after ingesting as little as 4 to 5 ml, which seems minimal, but rarely does someone survive after ingesting more than 30 mL (MacPherson, 1925). There have been cases of recovery however, after ingesting 220 mL of eucalyptus essential oil (Gurr & Scroggie, 1965). There are additional case studies of toxicity from children ingesting as much as two teaspoons of tea tree oil and various amounts of lavender essential oil.

Skin Reactions

Essential oils are thought to be dangerous by some when applied to the skin undiluted, otherwise called “neat.” These are typically oils high in phenols (clove, oregano, and thyme) or aromatic aldehydes (cinnamon). Negative reactions are typically related to irritation, allergic sensitivity, or phototoxicity.

When skin irritation does occur, a local response is almost immediate. Avoid using water to wash away the oil, which will only push the essential oil into the dermis. Rather, apply a carrier oil, and then wash with soap and water if necessary to eliminate any heat or burning. Those who utilize essential oils, and especially share them with others, should always have at hand a carrier oil for this purpose.

Sensitivity to an essential oil occurs over time. There is no response at first exposure, but with repeated application stronger reactions occur. These can range from very mild to severe, and can initiate with the very next exposure or occur after long-term exposure. A rash, sneezing, or shortness of breath are common responses when sensitivity occurs. This is reason why some experts caution against long-term use, in effort to avoid sensitivity. Again, those taking a number of medications or those with allergies, asthma, and eczema are more likely to respond negatively.

Sandalwood, thyme, and guaiacwood oils have caused sensitivity in those who have adverse reactions to balsams. Ylang ylang may cause a similar problem with those who are sensitive to perfume products. It is believed that sensitivity to essential oils has developed because of the increase of fragrances within food, household products, cosmetics, paints and medicines.

Photosensitivity can occur with selected essential oils. When applied and exposed to ultraviolet rays, reactions can vary from pigmentation of the skin to severe full-thickness burns. The most common essential oils to cause this reaction are furanocoumarins (lemon, lime, orange, and angelica root oils).

Inhaled Toxicity

No reports of any toxic effects have been documented, to my knowledge, from inhaling essential oils. However, one should diffuse oils within a ventilated area.

Essential Oil Dynamics within the Body

Because of the highly lipid nature of essential oils, they tend to gain easy access to the brain. As they travel through the bloodstream, they are also readily available to the adrenal glands and kidneys, are excreted by the kidneys, lungs, skin and feces. Nursing mothers also excrete essential oils via their breast milk. Essential oils can compete with pharmaceutical drugs at the cellular level.

Essential oils containing b-asarone or d-pulegone may increase the toxic effects of some pharmaceuticals because they both induce the detoxifying enzyme cytochrome P450. Progesterones (birth control pills) and diphenhydramine (Benadryl) are two examples which could have adverse outcomes when used in combination with wintergreen, cultivated carrot seed, calamus, and pennyroyal. However, Tisserand and Balacs (1995) state the amount of exposure to these essential oils for aromatherapy is insignificant and does not pose a risk. A review of the literature shows that those who are medicated with anti-seizure medications should be cautious when using essential oils, as their medication may reduce the effectiveness of their medication.

Acetaminophen is a common analgesic that is considered safe during pregnancy; however, it reduces the level of glutathione in the liver, which is responsible for absorbing free radicals. When glutathione levels fall, reactive molecules can attack the liver and can be fatal. While this is extremely unlikely in doses used for aromatherapy, if taking the maximum recommended dose of Tylenol, it might be wise to avoid essential oils containing transanethole, estragole, and eugenol. These would include fennel (also used to support lactation), aniseed, basil and clove.

A Closer Look

Wintergreen is often recommended as an essential oil to avoid in pregnancy. This is likely due to its high levels of methyl salicylate, which is related to aspirin. This is also true of sweet birch (Tisserand & Balacs, 1995). However, wintergreen is found in several proprietary creams for sprains and strains, as well as a number of chewing gums and candy. It would take more than 10mL to equate 250mg of methyl salicylate, equivalent to a single aspirin, and only half would be absorbed. It can however be absorbed through the skin and affect warfarin anticoagulation therapy (Littleton, 1990; Yip et al 1990).

Essential oils that are typically recommended as needing dilution in a carrier oil include oregano, clove bud and leaf, cinnamon bark, camphor, and red thyme. Although no published data to my knowledge demonstrates a direct correlation between essential oils and hypertension, it is suggested that rosemary, spike lavender, hyssop, juniper, thyme, and clove be used with caution in those with hypertension.

Homeopathy and Essential Oils

Generally speaking, it is recommended that homeopathy therapies and essential oils not be used simultaneously. Homeopathy and essential oils are by their very nature, completely opposite of each other – one very concentrated and one very dilute. This opinion is not shared by all, but oils in particular to avoid when working with homeopathy are peppermint, eucalyptus, thyme, and those with strong aromas.

Essential Oils and Pregnancy

The use of essential oils in pregnancy is largely a mystery. The first three months however, are a vulnerable period for the growing fetus and the typical recommendation is to avoid any potential toxin during these first few weeks in effort to diminish risk. Some aromatherapists simply won’t work with pregnant women. It is believed that essential oils do cross the placenta. Oddly, perfume does not carry a warning sign cautioning use during in pregnancy. Many midwives utilize aromatherapy and essential oils for therapeutic use in pregnancy and throughout labor. Hospitals are also incorporating their use as a nursing measure in labor.

If you believe your child has drank an essential oil, call the Poison Control Center. Encourage them to drink milk if they are capable of drinking safely. If essential oils get into the eyes, wash them out with milk as well, or use a carrier oil and then rinse with water. Keep in mind that essential oils do not mix well with water.

Store your essential oils safely away from children. If used within the hospital, essential oils should be in a locked cabinet.

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My Mother Would Be Horrified

As a child, I was guilty of speaking my mind without thought to what others might think and as a very inquisitive child, this horrified my mother. Very little made me uncomfortable, and everything intrigued me. I was always eager to learn, and always asking questions. Social norm didn’t occur to me, and I was completely unfamiliar with peer pressure. I asked hard questions, without appreciation for whether such discussion was appropriate or not. I don’t mean to say that I humiliated my mother as a child. Rather, I genuinely shamed her.

Certainly my character required discipline as I grew older, but I have learned to appreciate this particular attribute in myself. Serving women in such an intimate way, as a midwife, puts me in a unique position. I am privy to very private thoughts, concerns and experiences. I am not uncomfortable or embarrassed. Rather, I am honored that women trust me with their secrets, those which are otherwise shrouded in mystery, or even shamed. My mother, having been born in the late 50′s did not tolerate such discussion, or thinking. It just wasn’t talked about, and I was quickly hushed if I were to engage. This leads to feelings of rejection. So, this blog is dedicated to her… a sharing of questions I am frequently asked during an average clinic day.

What do you teach your children to call their private parts?

There is likely no right or wrong answer here, but I teach my children that their arm is their arm, their thigh is their thigh, and their penis is called a penis. I do remind them to wash “their privacy” in the tub, because while taking baths together, I want to remind them to keep their penises to themselves which little boys aren’t always inclined to do.

Why is it that sometimes I smell fishy?

This is an infection that many women suffer, called bacterial vaginosis. Unfortunately, many women assume this is nothing more than a hygiene issue. Some tolerate it, or maybe change their underwear more frequently, while others douche fairly regularly in attempt to decease the odor. I have to restrain myself from pulling a woman aside in a public restroom after she has left the stall and an intense odor consumes me. Does she know this can be rectified? You don’t have to suffer with this odor.

It is typically more potent after sex or at the end of the day. Any disruption in your normal vaginal flora can cause an overgrowth of the bad bacteria, creating the fishy odor. Sex with a new partner, more frequent sex, or even less frequent sex can cause an imbalance. Some women have bacterial vaginosis, or more simply called BV, after their menses and many suffer this fate after a round of antibiotics. Often we haven’t any identifiable cause, although pregnancy and childbirth are other common causes. My standard recommendation is yogurt therapy, but if this is a routine scenario every month, I suggest Chasteberry because it is likely related to a hormonal imbalance.

Will breastfeeding make my boobs droop?

Nope, but pregnancy will make them increase in size and following pregnancy and lactation they will “involute” like an inflating balloon and sag to some degree. Age will do the same.

How should I prepare myself for a pap smear?

Most shower, some trim, and the overly eager woman may spritz on a little fragrance prior to the pelvic exam. Beyond the shower though, no extra fuss is really required, and those who douche should really not. This not only negatively affects pap results, but when your vagina is that squeaky clean, it can be rather difficult to advance the speculum with gentleness. Instead, the plastic will stick to the vagina walls in spite of our lubrication, your discomfort will be greatly enhanced.

Another little piece of advice, avoid the cheap toilet paper in your physician’s office. It always leaves behind wades of paper in the nether regions. This is another reason to choose Believe Midwifery Services, LLC. We invest in high quality toilet paper so you aren’t dangling bits of white paper when you present for your pelvic exam! Yes, we care that much.

Have you ever had a client lose their tampon?

Yep. Several. It happens. Don’t be embarrassed, but don’t wait for it to fall out though once you’ve realized your tampon is beyond reach, because it gets more and more fragrant the longer you wait and although your nurse-midwife or physician will be very compassionate and sympathetic, after extraction you might be abandoned in the exam room as the odor disperses. Yes, this can be a shocking aroma.

I can’t stand the smell of my husband when he is aroused.

This isn’t uncommon when a woman is pregnant. There are very few aromas women can tolerate. My best suggestion is to add an essential oil or lotion to your upper lip for the few minutes that require distraction, or engage in intimate acts within the shower. This position is also favorable to pregnancy, although be cautious not to slip!

What is the purpose of pubic hair?

I remember once getting a pap smear at Planned Parenthood several years ago and getting a ten minute lecture about pubic hair from the nurse practitioner. Either she had seen a lot of crazy, or she was stuck in a routine of teaching the same material, because she was informing me that waxing, dying, piercing and tattooing my genitals was unhealthy. Clearly, she didn’t look up to see that I was a mother of five and most certainly didn’t have time for that kind of excitement. Her teaching was wasted on me and I felt saddened that this advance practice nurse failed to make any connection with her client, or extend any facet of individualized care, but she did have a point. Pubic hair does serve a purpose. The vagina is a delicate organ that requires some protection. Like eyelashes, pubic hair can help ward off infections. However, one of the more interesting rationales I’ve heard is that the pubic hair (and hair under the arms) traps pheromones, attracting potential mates, and not just any mate but ones with “specific genetics, promoting biologic diversity for the purpose of creating stronger, more genetically healthy offspring who are better to ward of disease” (Rankin, 2010, p 35).

What if I prefer to shave my pubic hair?

To each their own! However, keep in mind shaving has a few drawbacks. Razor burn. Ingrown hairs. Itching. Burning. Regrowth. If you shave, do so with well prepared skin, either soaked first in a tub or with a plentiful supply of shaving cream, and a sharp razor. Go with the grain when shaving. Use a loofa afterwards to remove dead skin cells that clog pores, and then you might try aloe or witch hazel afterwards for cooling.

Why is it the area where my pubic hair grows puffy, or my inner labia longer than my outer labia, or why is there hair around my bum?

While there are more similarities in women’s genitalia than differences, we are all very unique. The mons pubis (puffy area where pubic hair grows) is a fat pad of sorts, with some being more fluffy than others. If you have gained weight, you will likely gain weight here and even along your labia majora. This is the same as breasts. We all store weight a little differently. Sweat gland distribution is also unique to our ancestry and genetics. If you have more sweat glands through your perineum and along your bum, you will have pubic hair here too.

Inner and outer labia offer their own unique traits. Some women’s outer labia completely covers their inner labia, while others have inner labia (inner lips) that hang longer than the outer. Some women even have one labia that hangs longer than the other inner labia, appearing somewhat lopsided. This is all completely normal. Women often ask me about the look of their vagina too, especially following childbirth. It is common, and normal, for the vagina to lay a little open after birthing a child. The tone will never be the same, although perineal muscle exercises can do wonders!

Why is it that my wife’s hymen broke in labor? That doesn’t speak well of me, does it?

It is a misconception that the hymen is a door or a passageway that must be burst through at the time of first intercourse. I like to think of it more as a ring. This tissue is thicker when we are young, to protect our delicate areas from infection before our ovaries are producing vaginal thickening estrogen. As we get older, the hymen is less prominent; however, it isn’t necessarily a one time scenario of hymen perforation.

I like to tell a story about my little sister to explain this phenomenon. (My family is going to be so very thrilled to read this post.) My little sister had a pair of underwear when she was quite young that she especially favored. As she grew older, the elastic bands around her legs grew tighter. Not wanting to depart with these panties, she rather ingeniously took a pair of scissors and cut little slits in the elastic so they would stretch a little farther. Translate this to the hymen, and we can understand that a few minor tears may be necessary for intercourse, and then with the birth of one’s first child, a few more tears may be required to further enlarge this opening.

My husband and I had little to no exposure to discussions about intimacy or our bodies prior to getting married, and are quite honestly, lost when we try to explore down there.

Join our sexuality series!! This is a safe place to talk about much more intimate issues that all women wonder, and are afraid to ask. Men too! We have one class for couples, and another specific to just women. However, there is no shame in sneaking away in the bathroom or your bedroom, with a mirror and taking a good look around.

Being a midwife isn’t about vaginas and boobs, in spite of the focus of this blog post. It is about people, about women. We all want to know that we are normal. I hope this post offers some reassurance that we are all unique, and beautiful, and it’s okay to ask questions. If you are curious about your anatomy, about intimacy and sexual disorders, menses, child-spacing, understanding your cycle, vaginal health, fertility, or menopause, please join our sexuality series!!

Essential Oils: 101

Essential oils are completely foreign to most, which is unfortunate since this healing modality is ancient and created specifically for our use. It is a growing passion of our practice as well. Each of our midwifery team members have a respectful adoration for the healing properties of essential oils. We hope to share with you as we deepen our own understanding. Penny has written about essential oils on our boutique website as well.

One interesting point, that is often misunderstood, is that essential oils are not actually oily. Meaning, they do not contain the fatty acids that create the consistency we expect when we think of oils. They are more the essence of the plant, or the highly concentrated plant constituents. These fluids are necessary for the life of the plant, and many aromatherpists describe the essential oil as that which contains the “life force, intelligence and vibrational energy.”  Their molecules are minuscule, so they are readily absorbed by the skin and can be utilized by the body efficiently.

Fragrance oils, or those used for flavoring, are not essential oils. In fact, if you see the word “fragrance” or “fragrance oil” or even “perfume,” avoid it for medicinal purposes. Avoid those sold with a rubber dropper. These oils are exceptionally potent and should not be used on the skin directly, nor are they natural. Therapeutic grade oils however, can often be applied directly onto the skin, otherwise known as “neat.” Carrier oils such as coconut or jojoba oils can be utilized to dilute the essential oil, and should certainly be considered when essential oils are applied to the delicate skin of children, babies or pregnant mommas.

Most essential oils are high in antibacterial, antifungal, and antiviral properties. A growing body of evidence regarding the efficacy of essential oils does exist; however, you will never find them within pharmaceuticals and rarely will they be recommended by medical practitioners because they can not be patented, meaning drug companies can not make millions from their use and so funds for research is largely absent.

Essential oils can be utilized for health maintenance, healing, and even for protecting your environment. Oils most commonly used to protect the home are lemon, grapefruit, eucalyptus, peppermint, tea tree, lavender, and rosemary. Thieves and OnGuard proprietary blends are also exceptionally popular for this purpose.

They aren’t cheap however, as it does require a rather enormous amount of plant to produce essential oils. For example, rose oil requires about 4,000 pounds for a single pound of essential oil. Lavender requires 100 pounds of plant material to produce a pound of essential oil. This demonstrates their concentration and subsequently, one can imagine their effectiveness. While higher price often equals higher quality, this isn’t an absolute.

A bottle of essential oil typically lasts a decade, and because each use consists of a drop or two, most remedies cost mere pennies. This is far less than your typical co-pay with far more health benefits. Citrus oils do loose their potency more quickly, in a matter of only a few years. Be sure your essential oils are stored in dark bottles and are out of direct sunlight.

While essential oils can be used on children, babies even, and pregnant mommas, there certainly are those that should be avoided. It is important to speak to your healthcare practitioner and/or aromatherapist regarding these risks, as some side effects include loss of early pregnancy. For this same reason, be sure to store your oils out of the reach of little ones. Our practice has certainly heard from parents whose little one gulped down an expensive bottle of essential oil, which poses risks to their immature systems, as well as your pocket book!

Want to learn more about essential oils? Join our Essential Oil of the Month Workshop!




Book Review: Getting to Yes

Getting to Yes: Negotiating Agreement without Giving In by Roger Fisher, William Ury, and Bruce Patton was recommended to me by Dr. Janet Engstrom, my doctoral advisor. Midwives are in a position of oppression, facing restriction of trade, and need to improve their negotiation skills if we are going to see system-wide change. Not only do nurse-midwives require greater recognition, but should be permitted, encouraged even, to practice to the full scope of their training.

getting-to-yesEveryone negotiates. You negotiate with your spouse about what to eat for dinner, or with your kids on how chores should be completed. Back-and-forth communication is a necessary process so that anyone of us can attain what we want from others. The goal is to reach agreement. The dilemma is when one becomes either too soft, or too hard (Fisher, Ury & Patton, 1991).

“The soft negotiator wants to avoid personal conflict and so makes concessions readily in order to reach agreement. He wants an amicable resolution; yet he often ends up exploited and feeling bitter. The hard negotiator sees any situation as a contest of wills in which the side that takes the more extreme positions and holds out longer fares better. He wants to wink; yet, he often ends up producing an equally hard response which exhausts him and his resources and harms his relationship with the other side” (Fisher, Ury & Patton, 1991, p xvii).

The third way to negotiate is to neither be soft or hard, but rather both hard and soft. This method is termed, “principled negotiation” and was developed at the Harvard Negotiation Project. One focuses on issues and merits rather than focusing on the process and what each side will or won’t do. Look for mutual gains and when interests conflict, insist on fair standards consistent independent of the players.

“The method of principled negotiation is hard on the merits, soft on the people. It employs no tricks and no posturing. Principled negotiation shows you how to obtain what you are entitled to and still be decent. It enables you to be fair while protecting you against those who would take advantage of your fairness.” ~Fisher, Ury & Patton, 1991, p xvii

Fisher, Ury & Patton (1991) have written a book that can assist anyone, no matter their profession or lack of, to negotiate agreements using strategies of integrity. Multiple examples are presented establishing context in which one can relate, and apply with practice. This book may not have discovered new ideas, but certainly presents them in a manner that builds confidence in the reader, and is one that I plan to keep on my shelves so that I may return to it over the years, and freshen my skills. These tactics may make the difference between a successful career, and a dreamer. Here are a few notes from my reading; however, go purchase your own copy. You will not regret it.


The Hard Negotiator

This person or group is at risk of clarifying their position and defending it against attack to the point that they become more committed to it than the underlying concerns of the conflict. In the end, their ego won’t let them waiver from their position so resolution is very unlikely. The attention then becomes on saving face rather than devoting one’s time to meeting the underlying concerns of the parties. This sort of positional arguing also risks the hard negotiator taking an extreme position simply because they recognize future negotiations will require compromise, but this deceives the other party as to one’s true views.

The Soft Negotiator

This person or group considers the parties friends, and trusts without necessary evidence, and yields at every turn to avoid confrontation. Resolutions may be obtained, but they won’t necessarily be helpful or wise. This is a vulnerable position, and favors the hard player.

The Alternative

Separate people from the problem. Focus on interests, not positions. Both sides should see themselves as working jointly in attacking the problem. However, possible solutions should be considered outside of the meeting where pressure from an adversary narrows one’s vision. These can then be presented as a solution worth considering. Invent options for mutual gain. Ultimately, one must insist on using objective criteria rather than what either party is willing or unwilling to do so that neither party gives up to the other. Yield to principle, not pressure (Fisher, Ury & Patton, 1991).


Separate the People from the Problem

There are three basic tenets, per Fisher, Ury & Patton, one must remember regarding people problems within a negotiation: perception, emotion, and communication. The conflict lies not in objective reality, but in people’s heads. The conflict is in their thinking, whether fears that must be dealt with or hopes that must be unrealistic. Facts may offer nothing to the problem. “It is not enough to know that they see things differently. If you want to influence them, you also need to understand empathetically the power of their point of view and to feel the emotional force with which they believe in it. It is not enough to study them like beetles under a microscope; you need to know what it feels like to be a beetle” (Fisher, Ury & Patton, 1991, p 23).

Tips worth keeping in mind:

  • Negotiators are people first.
  • Don’t take a firm position from which you can not move.
  • Separate the relationships from the substance; deal directly with the people problem.
  • Make your proposal consistent with their values.
  • First recognize and understand emotions, theirs and yours.
  • Allow the other side to let off steam.
  • Don’t react to emotional outbursts.
  • Speak to be understood.
  • Speak for a purpose.

Preventing an argument is certainly an important lesson as well, and building relationships prior to the anticipated negotiation is a step towards building the relationship on trust. “Benjamin Franklin’s favorite technique was to ask an adversary if he could borrow a certain book. This would flatter the person and give him the comfortable feeling of knowing that Franklin owed him a favor,” (Fisher, Ury, & Patton, 1991, p 37).

Often during difficult negotiations, the two parties find themselves in a face-to-face confrontation and every sentence seems like a personal attack when the strategy should really be a side-by-side effort in accomplishing a specific task. Authors Fisher, Ury & Patton (1991) suggest sitting on the same side of the table and to have in front of you the contract, map, or blank pad of paper. This works to separate the people from the problem.

Focus on Interests, Not Positions

This point hit home for me; it is important to recognize the difference between one’s interests and one’s position. “Interests motivate people; they are the silent movers behind the hubbub of positions. Your position is something you have decided upon. Your interests are what caused you to decide” (Fisher, Ury & Patton, 1991, p 41). Positions can be hard to change, and in spite of differing positions, often there are compatible and conflicting interests which can be utilized to find agreement.

An example: as I’ve worked on my doctoral project, my assigned adviser has changed four times. Each new adviser has offered new perspective on my project, and as one can imagine, this came with new direction and conflicting counsel. Now in my final term, weeks from my oral defense, I am assigned yet another adviser who true to form, has again offered yet another perspective on my project. I have to ask myself, do I want to stand firm in my position regarding my project, or recognize that we have shared interests? We both have at heart the desire for me to complete a doctoral project, although admittedly, it might not be the project I have envisioned.

A common error is assuming each side has the same interests. This is almost never the case. The most powerful interests, of course, are basic human needs. Security. Economic well-being. A sense of belonging. Recognition. Control over one’s life. The purpose of negotiating is to serve your own interests, which must be communicated if one is to succeed. Be specific. Listen. Reassure the other party they are being heard.

Another common issue in many negotiations is arguing about the past. One or both sides will seek justification, validation, and recognition. Many times neither are listening to the other. “If you ask two people why they are arguing, the answer will typically identify a cause, not a purpose,” (Fisher, Ury & Patton, 1991, p 52).

Be hard on the problem, soft on the people. Commit to your interest, not your position, and then go in hard. This should inspire creative solutions. Attack the problem, without blaming the people. Show them your respect. Show them you are attacking the problem, not them. (Wishing right now I could rewind time and try that last staff meeting again!)

Invent Options for Mutual Gain

Fisher, Ury and Patton suggest that in a negotiation, particularly when discussing contracts, people involved rarely sense a need for options. Rather, they believe they know the right answer and are instead vying for position. The four obstacles that inhibit creative thinking and recognizing options are: premature judgment, searching for the single answer, the assumption of a fixed pie, and thinking that “solving their problem is their problem” (Fisher, Ury & Patton, 1991).

Judgment hinders imagination.

“Under the pressure of forthcoming negotiation, your critical sense is likely to be sharper,” (Fisher, Ury & Patton, 1991, p 58). One wants to think practically, not risking wild idealization. One also fears revealing too much or providing options that they ultimately would not desire for themselves. Considering options seems contrary to getting down to the matter. When sides are having difficulty seeing eye-to-eye, one doesn’t want to mucky the waters by adding extraneous discussion. Fisher, Ury, & Patton (1991) state, “If the first impediment to creative thinking is premature criticism, the second is premature closure” (p 59). The final obstacle is true to nurse-midwives; we become so emotionally attached to our self-interests that we lack the ability to achieve the detachment necessary to think up wise ways of meeting the interests of both sides. Therefore, the solution is to separate the activity of inventing options from the act of judging them, broaden the options available to each rather than demand a single answer, search for mutual gains, and invent ways of making their decisions easy. Gather a creative team and brainstorm!

Seek shared interests, even if better understanding your disagreements allows for dovetailing of interests. Take time to learn about your opponent. What are their principles, their interests, their positions? What would benefit them? Look for a decision or statement that the other side may have made in a similar situation, and try to utilize that to your advantage. “Invest first, decide later,” states Fisher, Ury & Patton (1991, p 80).

Insist on Using Objective Criteria

There are certainly negotiations that appear to have no room for creative solutions. In these situations, and I would argue in all negotiations, seek objective information independent of either side. Bring in experts and gather information, then create a principled negotiation. This strength can become a weakness; however, if one sticks to their guns and claims they are standing on principle, yet fail to recognize the other team may be doing the same, again, we are in a no-win fight for position (Fisher, Ury & Patton, 1991).

A principled negotiator is open to reasoned persuasion on the merits; a positional bargainer is not.

“Never yield to pressure, only to principle,” (Fisher, Ury & Patton, 1991, p 91). The goal is to consider a strategy that you can vigorously pursue without the high costs of positional bargaining. The authors give examples of negotiations that are quite ingenious, and certainly worth having this book on your private bookshelf for occasional refreshing of your negotiation skills.

What if They are More Powerful?

Step one, protect yourself.

What if They Won’t Play?

Change the game simply by starting to play a new one; concentrate on the merits. Step aside of the argument. Don’t defend. Don’t push back. Invite criticism. Hear the argument in their attack on you, and turn it towards the problem. Ask questions and pause. Become the mediator and create a proposal for criticism, revise and ask for additional criticism. This moves sides out of their position and into assessing the problem.

What if They Use Dirty Tricks?

Negotiating for some can be exceptionally challenging because they trust too easily. Sadly, this can allow others to take advantage. The theme continues: separate the people from the problem. Make your decisions independent of trust.

Dr. Engstrom, once again, provided excellent advice. This book is one that every nursing leader, and DNP student, should be quite familiar. I am even going to have my son read it as a high school course study!

Food for Thought

Food for Thought

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has." Sir William Osler

Food for Thought

Happiness is underrated and critically important to health. Seriously! Unfortunately, many people just have no idea how to be happy. Aviva Romm

Food for Thought

Physicians simply do not have time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs. Snyderman and Weil

Food for Thought #1

They say that time changes things. But you actually have to change them yourselves. Andy Warhol

Food for Thought

To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking. Johann Wolfgang von Goether

Food for Thought

"Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole." Rixa Freeze PhD

Food for Thought

Why I appreciate being a certified nurse-midwife, as opposed to choosing another route for midwifery: I feel learning the science is vital so the art of midwifery is safe and effective. Dr. Penny Lane, nurse-midwife

Food for Thought

When the debate is lost, slander becomes the tool of the loser. Socrates

Food for Thought

To accomplish great things, we must not only act but also dream; not only plan, but also believe. Anatole France

Food for Thought

"Science and uncertainty are inseparable companions. Beware of those who are very certain about things. There are no absolute truths in biological sciences - only hypotheses... 'We need to train medical students and residents more in the art of uncertainty and less in the spirit that everything can be known or that it even needs to be known.'" Grimes (1986)

Food for Thought

American physicians are rewarded for doing things to patients, not for keeping them well. Grimes, 1986

Food for Thought

The false idol of technology. "Having a widget screwed into one's scalp has become an American birthright." Grimes, 1986

Food for Thought

"Between 1985 and 1987, a hospital instituted a successful program to reduce its cesarean rate. The rate fell from 18% to 12%, losing the hospital $1 million in revenues - no small sum in those days." Goer & Romano, 2012, p 37

Food for Thought

"Obstetricians are much more likely to perform a cesarean when they wrongly believe the baby weighs 4000 g or more based on sonographic estimates than when the baby actually weighs this much but the obstetrician did not suspect it." Goer & Romaro, 2012, p 35

Food for Thought

"If you play God, you will be blamed for natural disasters." Marsden Wagner (2006)

Food for Thought

An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you know and what you don't. Anatole France

Food for Thought #3

"Birth is not only about making babies. Birth also is about making mothers - strong, competent, capable mothers, who trust themselves and know their inner strength."

Barbara Katz Rothman PhD (1996)

Food for Thought #4

Believe there is always, always, always a way.

When you have exhausted all possibilities, remember this: you haven't. THOMAS EDISON

Food for Thought #5

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer

Food for Thought #2

Yet you brought me safely from my mother’s womb and led me to trust you at my mother’s breast.

Psalm 22:9