Midwife researcher Priscilla Hall encourages women’s personal power in labor

As a midwife researcher and teacher at Nell Hodgson Woodruff School of Nursing, Priscilla Hall has contributed to many valuable studies.

She was the co-lead author on a study that addressed the impact of military service on women’s health, and the No. 2 researcher on a systematic review and meta-analysis of neonatal outcomes. That study underscored the importance of knowing how to do water birth safely, and communicating this to hospitals and doctors. “Water immersion in labor is a very effective method of pain management, and it decreases the need for an epidural, but it’s not available to most women because hospitals just will not implement it,” she says.

Amidst this important work, there’s one set of data and findings that drives Hall, that she says she’d “stand in front of a burning building” to talk about. She is committed to exploring and revealing “how women experience their own power during birth.”

That idea covers both how women can have a say in creating the kind of birth experiences they need and want, and how each can feel like a person powerful enough to bring a baby out with her own strength of person, Hall says.

“We have clear evidence that a sense of powerfulness contributes to a woman’s well-being after the birth, her relationship to the baby and her own definition of herself,” she adds. “The quality of the birth experience matters, and a woman’s expression of self matters. Since we tend to think of birth as medical, we tend to feel that if all the medical parts were taken care of, the woman is well. That is not the case.”

A big part of assuring more power for women during their birth experiences is making the benefits of midwife care better known, Hall asserts. “Culturally, there is such a focus on the risks of pregnancy, women might perceive they need a physician or that the person with the higher education level is better,” Hall says.

To her way of thinking, “if a woman is healthy, she should have access to all the birth options that we know enhance a healthy birth, and not just choose from the hospital’s limited menu,” she says. “One of my fantasies is that women will just show up at the hospital en masse and say, ‘No, I don’t want that. I heard what you said. I still said no. I am not going to do that. Thanks for your advice. Not going to agree, don’t think I need that.’”

She hopes to work towards a world where individuals can “identify what is really important about the birth and work towards that,” she says. “If the plan needs to change, you should feel respected, included in the decision and have all the information you need to accept a new plan. There are moments in pregnancy when a woman is bleeding to death that a provider might bypass that kind of discussion, but those are rare, and for the most part, women should feel like they were full participants in the decision.”

A registered nurse and certified nurse midwife who earned a Doctor of Nursing in 2015, Hall has long known this was the profession for her. She was a little kid, 10 or so, when she started reading a series of books, sort of in the same vein as Nancy Drew or the Hardy Boys. Only this was a series about a nurse, Cherry Ames. “I read those books, and that was kind of it,” Hall says. “I thought, ‘I want to do this. I want to be a nurse.’ I liked her adventures. I liked her perspective on human beings. I liked what she was about and what she did for people. Those books really captured how nurses are concerned about the whole human being, in illness and in health. That caught my attention.”

The real-life role models she follows intently are all midwives working in the normal healthy birth area. “Shawn Walker is one of my friends who went out on a limb to try to study physiological breech birth, and when it is safe to birth a breech baby vaginally. This knowledge has been decreasing for the last 20 years, because breech birth moved towards a required Cesarean. Shawn started out doing breech births here and there, and now she runs a breech birth clinic.”

Another mover and shaker admired by Hall is Soo Downe, a researcher studying normal, healthy birth in the U.K. “She talks a lot about the medical culture that thinks of pregnancy as a risk waiting to happen, instead of an opportunity for growth and transformation in a family,” Hall notes. “She interviewed women who had positive birth experiences, and they talked about feeling ecstatic and blissful in labor and after that they felt a joy they had not experienced ever. She wants to know why we are not talking about that in the media or in the obstetrical space or in nurse-MD-midwife education.”

Hall says if Soo Downe’s ever offered a chance to work with her, “I would give up one leg and one eye.”

Her nurse education began with a bachelor’s from Biola in Southern California. She then became a midwife at University of Southern California back in the days when you could practice with just a certificate. When the requirements changed and midwives needed a master’s, she completed one at what was then the University of Philadelphia, participating in an innovative online program for practicing midwives who needed a master’s.

Pursuing a PhD, now such a meaningful part of her life, was incidental at first. A combination of odd circumstances unexpectedly left her without a spot at a school where she’d been invited to apply. She learned on social media that registered nurse and doctor of nursing Jennifer Foster had been funded to initiate a research project aimed at understanding men’s and women’s beliefs around public maternity and newborn services. Participants would be community workers and health providers in the Dominican Republic.

Hall wrote to Foster “out of the blue,” she says. She told the senior researcher how she’d worked in Latin America and spoke Spanish from the decade her family lived in Puerto Rico while her father worked there. “I’m fully bilingual and went to public schools there,” Hall explains.

Foster was interested, but she mentioned offhandedly, “Yeah, but you should be a PhD student if you’re going to work with me.”

So Hall applied and got accepted. At first she also took a midwifery position in a clinic, but she gave it up when it “didn’t go very well with grad school,” she says. “It was very busy there, and I don’t do well working like that. I really need to be able to sit down and ask my patients, ‘How are you doing? What’s been going on with you? Are you eating?’”

She says she does miss having her “midwife mojo” and plans to complete the protocol of 15 supervised deliveries that will enable her to resume her certification later this year.

Practicing or not, though, she wants fellow nurses to understand the important intersection of medicine and the women who give birth. “We need healthy women to have access to healthy birth care,” she says. “Women need to require, expect, and negotiate for care that respects their needs and wishes.”

So often, an individual woman enters a hospital with a birth plan and the fervent hope she can achieve their birth according to that plan. “And she encounters all kinds of resistance to what she wants,” Hall notes. “We need a system that considers a woman’s choices, wishes, desires and wants as a fundamental tenet of care and operates from that space.  She needs to feel like she is a full participant in her own care.”

Hall also encourages nurses to see how their view and skills are needed in the world of academic research. “Medicine wants to fix the body in illness, or maybe prevent an illness,” she explains. “Public health wants to know how to help entire populations prevent illness. Nursing looks at the problems of health and illness closer to the patient: What is happening with the person, their family, their spirituality, their sleep, their eating, how much dust there is where they live... Where medicine wants to know what medicine will cure a disease, nursing wants to know what is going on when a lot of patients are non-compliant and won’t take that medicine properly.”

It takes a toll to offer up your own time and work hours to deliver this valuable perspective, Hall admits. For her, the most difficult aspect of working in academia has been the utter lack of boundaries between life and work. “As a midwife, it’s a little easier. Oh, you’re still working long hours and sometimes holidays or being on call, but when you aren’t delivering a baby, you can go home.”

She says she finds the culture of PhD pursuit “super, super excessively busy. It’s not right to be busy all the time. I’m on a campaign to point that out! If you’re expecting really good problem-solving from yourself or others, you need to not be fatigued and cranky and burned out.”

Hall says she was particularly grateful for her two sisters and two brothers during the stressful time when she was studying for her doctorate. “There is a lot of sanity in them, and they are very solid human beings,” she says.

When the PhD process became difficult, they rooted for her. “They’re like, ‘You’re on your own pace, you’ll get this done, you don’t have to get it done tomorrow on someone else’s timetable.’”

She particularly remembers stewing about not finishing a portion of her dissertation precisely when she’d planned. “It was unfolding,” she recalls, “but unfolding a little slow. My brother said, ‘You know, a cake has to bake so long. There’s no way to make it bake faster...’”

At this point in her career, Hall has goals both personal and work-related. “Professionally, I would like to get as much out of this PhD as I can while maintaining balance, creativity and joy,” she says. “I want to collaborate with people I really like who laugh a lot, and have good, innovative ideas to study and make birth better for women. And I’d like to kindly support all the PhDs and nurse clinicians coming up behind me, so together we can create a new culture of nursing science that is kind, balanced and creative.”