Labor & Delivery Nurse Angela Genzale On How to Improve the Birthing Experience
An Interview With Lucinda Koza
Birth is a deeply personal experience, and every birthing person deserves to feel empowered and supported in their choices and decisions. There are countless choices that are made in labor, and it’s easy to forget that even small choices can make a meaningful difference. I remember a patient who assumed hospital rules meant she had to wear a hospital gown during labor. When she learned she could wear her own comfortable pajama pants and t-shirt, it helped her feel more relaxed and in control. This is why we use tools like Team Birth to promote open communication and shared decision-making. When we take time to explain all options and support their choices, they feel more confident navigating their birth experience.
The birthing process is one of the most significant moments in a person’s life, yet the experience can vary greatly depending on numerous factors. From the quality of care to the emotional and physical support given to the mother, there are many ways to enhance and improve this life-changing experience. As a part of this series, I had the pleasure of interviewing Angela Genzale.
Angela Genzale, BSN, RNC, Angela Genzale, BSN, RNC, is a Labor & Delivery nurse and Certified Life Coach. She is passionate about helping nurses destress, ditch self-doubt, and build unshakeable confidence so they can find personal success at work and beyond.
As an award-winning Registered Nurse with over 30 years of experience, Angela understands the unique challenges of working in healthcare. Combined with her Life Coaching Certification, she brings a unique and holistic spin to guiding nurses through career transitions, personal growth, and finding balance beyond the bedside.
Angela continues to find joy and fulfillment through labor coaching, life coaching, and mentoring the next generation of nurses.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you tell us a bit about you and your backstory?
Thank you for having me and for the opportunity to share my story. My fascination with labor, birth, and the mind-body connection began when I was ten years old. Watching my mom practice Lamaze breathing during her pregnancy with my baby brother, I remember thinking “How could something as simple as breathing help manage the pain of childbirth?” That question planted a seed that grew to a lifelong passion.
Fast forward to when I was 18 years old and hospitalized for surgery. A nursing student helped care for me, and her compassionate care sparked my interest in the healthcare field. Soon I began training as a medical assistant and landed a job as a Unit Secretary in Labor & Delivery. There I witnessed the profound impact nurses had on women’s birth experiences and knew this was my path. With the encouragement and support of those amazing nurses, I applied to nursing school.
After graduation, I was fortunate to work as an RN in that same L&D unit for a few years, then shifted to travel nursing to expand my skill set. My travel assignments ranged from a high-risk unit for complicated pregnancies, to a low-risk birthing center with only remote access to anesthesia. I noticed in the birthing center, patients arrived mentally and physically prepared to manage even long hard labors without pain medication or interventions. I saw firsthand how their mental attitude toward birth, along with preparation and support, decreased stress and cope with the pain of labor.
Curiosity motivated me to study more about this mind-body connection and how it worked. In those pre-internet days, I immersed myself in books, cassette tapes and seminars and learned everything I could about overcoming limiting beliefs and changing physiology using the power of the mind. Applying these practices, I was able to overcome health challenges, increase my confidence, and achieve some ambitious personal and professional goals.
Today, as a Labor and Delivery RN and Certified Life coach, I help others discover their own innate strength and build unshakeable confidence. I believe each person has the capacity to achieve their highest goals, and I’m honored to walk alongside them on their journey.
In the specific birthing experiences that you have been a part of or witness to, what were the key elements that seemed to have the most influence on the quality of the process, outcome, and aftermath of the birth? Can you please explain what you mean?
In the thousands of births I’ve been a part of, key elements that influence the process, outcome and aftermath of birth are dependent on who is present and how well they work together. It starts with the patient and the level of confidence she has in herself, the team, and the process. When they have an idea of what to expect, the options available, and have a flexible plan to navigate labor that aligns with their personal values, they feel more in control. In addition to preparation, practice builds confidence. That is why patients who have given birth before are more confident than those who have not. That being said, I’ll always remember a 16-year-old patient I cared for who impressed me with her knowledge of the birth process and techniques to help cope with contractions. When I asked her how she prepared, she said ‘I didn’t take classes, but I watched ‘A Baby Story’ every day for the last nine months.’ Even though she hadn’t taken formal classes, she gained confidence by learning from others’ experiences.
Secondly, having the right support system is crucial. Labor is a time of high vulnerability. When a patient is surrounded by people she knows and trusts, she can relax, knowing they will respond to her needs and advocate for her preferences. Support from the healthcare team is also important. Research shows that a patient’s perception of support from the care team is one of the strongest predictors of a positive birth experience.
The third key element is the competence of the healthcare team. They need the skills and experience to handle any medical situation safely, while keeping the mother’s preferences at heart. Competence consists of individual skills and the synergy of the team, and both are cultivated over time. I’m blessed to work with a team of highly skilled clinician’s and we’ve been together so many years that now we are able to respond in any situation calmly and confidently.
Finally, there needs to be collaboration between the patient, her support system, and the healthcare team, and alignment towards a shared vision. When everyone is aligned, there is ease and flow. This requires open communication, shared decision-making, and ensuring the patient has choice and a voice throughout the process.
Can you tell us about a birthing experience you were a part of as a professional that you actually wish had gone differently? Do you know exactly where it took a wrong turn? Do you think or know there is something someone, even you, could have done to improve this situation? Can you please explain what you mean?
In every birth experience I am a part of, I strive to help my patient achieve the birth of their dreams. Even in the most difficult situations, I have found ways to build trust and connection with my patients and create a positive experience. The toughest days are when I am not able to make that happen.
I remember caring for a mother who had a beautiful plan for an intervention-free birth. She imagined laboring in the tub with no IV and minimal monitoring. Unfortunately, early in labor we had concerns about the baby’s heart rate. As her labor progressed, medical interventions were necessary to try and correct it. Each intervention took us further from her original plan, and I could sense her frustration in this uncontrollable situation. When we ultimately needed to recommend a c-section for her baby’s safety, she was angry and upset. She said she had heard stories of women who had unnecessary c-sections and was afraid of that happening to her.
Though we tried our best to be transparent in our concerns and validate her feelings, healthcare mistrust can’t be undone in a few hours. It was heartbreaking to realize that despite our efforts to provide safe care, informed consent, and holistic support, her birth experience was disappointing.
Which of these do you feel most in contention with, if at all: lack of time, lack of resources, lack of information regarding a patient’s specific case, healthcare worker burnout, compassion fatigue, or something else entirely? Can you please explain what you mean?
The challenge I feel most in contention with is lack of time and resources. However, lack of time and resources is directly tied to burnout and to patient dissatisfaction. Nurses have so much to do for patients and so little time, especially in postpartum.
I think back to when I started my career. Patients stayed in the hospital for 3 days after a vaginal delivery and 5 days after a cesarean. This allowed them time to physically recover, to bond as a family, and have breastfeeding support. We offered a class on the unit about postpartum and newborn care. Nurses had time to sit with patients, listen to their concerns, provide education, and build their confidence. They even received a follow up home visit by a nurse! Now a patient typically goes home 24–36 hours after a vaginal delivery and 48–72 hours after a cesarean, with no in home follow up. We have the same things to teach them, but less than half the time we used to. Not only that, we have a patient who likely had a long labor and hasn’t slept in days. If she has a medical complication, that can further impact her capacity to learn. Even with a normal patient load, it can be overwhelming to complete the basic care tasks and the psychological support is what gets lost. When nurses have the time and resources they need, they can provide more attentive, compassionate care, and create better outcomes for everyone involved.
In your dream world, what would a perfect shift at work be like for you? If you had a shift with back-to-back births, what else would be in place structurally that would make you feel as if you are fulfilling your dream for birthing parents? Now, how can we take this out of your dream world and root it in reality?
It sounds cliche, but nearly every shift is perfect for me because I’m doing what I love. For me, a perfect shift consists of having the time and resources I need to give my absolute best care. That means enough staff so I can spend quality time with my patients and take my breaks. It means not getting pulled to cover other units, having all our equipment working properly, and never running out of supplies. When a patient needs an interpreter or any other resource, it would be available right away. I’d be working with my current team of providers and nurses because they are incredible! And if I’m having multiple births in one shift, I’d be able to help one family through their birth and recovery and get them settled in postpartum, before taking on my next patient. While no place is perfect, the reality is that I work in a place where I have what I need to provide excellent care and I’m so grateful for that.
Are there any innovative practices, technologies, or policies that you believe can significantly enhance the safety and comfort of the birthing process?
One practice that promotes safety in the hospital is called a debrief. In certain scenarios, we come together as a team to review the case and provide feedback on what went well and what we can do to improve. It’s a way to identify changes that we can make to improve safe patient care.
Safety is also built into our policies. I’m part of a multidisciplinary team that reviews and updates our perinatal policies. There is so much work that goes on behind the scenes to ensure each policy reflects the current evidence-based practice, and that all stakeholders contribute their perspective.
As far as comfort, we have lots of toys to use for positioning. But they aren’t just for comfort, they can help labor progress too! Birthing balls, peanut balls, birthing stools and inflatable half circle positioners called “cubs” can be used to intentionally change a mother’s body shape to facilitate labor progress and delivery. In fact, anything we can do to promote physiologic birth will enhance safety and comfort.
Let’s move on to the heart of the discussion. Can you please share “5 Things That We Can Do to Improve the Birthing Experience for Mothers”?
1 . Empower Patients Through Choice and control
Birth is a deeply personal experience, and every birthing person deserves to feel empowered and supported in their choices and decisions. There are countless choices that are made in labor, and it’s easy to forget that even small choices can make a meaningful difference. I remember a patient who assumed hospital rules meant she had to wear a hospital gown during labor. When she learned she could wear her own comfortable pajama pants and t-shirt, it helped her feel more relaxed and in control. This is why we use tools like Team Birth to promote open communication and shared decision-making. When we take time to explain all options and support their choices, they feel more confident navigating their birth experience.
2 . Rebuild Trust in the Healthcare Team
Trust is fundamental to healthcare, yet many patients come to us with that trust already damaged by past experiences. When trust is broken, it takes time and effort to rebuild. This is especially important in the highly vulnerable time of labor and birth. One way we can rebuild trust is providing trauma-informed care (TIC). During my own TIC training, I learned that even when assisting patients with breastfeeding, we need to ask for consent. For me, I was just doing my job. I didn’t realize this could be triggering for a patient. I’ve since changed my practice, and I have had patients say they appreciate being asked.
3 . Acknowledge Implicit Bias
Maternal statistics show that marginalized groups face higher rates of pregnancy complications and poor birth outcomes. Implicit bias is a major contributing factor, yet it’s hard for us to identify when our own subconscious bias is present. By increasing awareness through education and interactive training we can help create a space where all birthing people receive respectful care.
4 . Improve nurse training and mentorship
When patients come to the hospital in labor, they expect and deserve to be cared for by skilled, experienced nurses. The challenge today is that many seasoned nurses are leaving the profession, and new nurses often aren’t getting the comprehensive training and ongoing support they need. Labor nursing is not something to be learned in a book, it’s learned over time, one patient at a time. Hospitals need to step up with strong training programs and mentorship for new nurses. A large portion of my coaching clientele is nurses with less than a year of experience. Many of them feel unprepared, even after formal training. Having an experienced nurse mentor by their side improves confidence and improves safe patient care.
5 . Prioritize Access to Mental Health Support Before, During, and After Birth
According to the Maternal Mental Health Leadership Alliance,
- 1/3 of birthing people report feeling traumatized by their childbirth experience
- 1 in 5 mothers are impacted by mental health conditions,
- Suicide and overdose are the leading cause of death for women in the first years following pregnancy, and
- 75% of women with maternal mental health conditions remain untreated.
These staggering statistics are a call to action for us to reduce the stigma associated with maternal mental health conditions and increase access to qualified providers. It’s important to remember that a delivery can be traumatic for the birthing person even if it appears that everything went well. I have a friend who planned to have an epidural, but she arrived at the hospital fully dilated and delivered within 15 minutes. She and the baby were both healthy, and everyone around her (including me) thought it was a “perfect” birth because she delivered so quickly and without medication. A month later I was surprised when she asked me to help her find a therapist because the birth was extremely traumatic for her and she was experiencing postpartum depression and other negative effects. It took several weeks for us to be able to find a practitioner and get her the help she needed.
How do you ensure that there is effective communication between healthcare teams and expectant mothers to reduce anxiety and build trust during labor and delivery?
I’m proud to be a part of the group that implemented Team Birth at the hospital I work in. “Team Birth is an industry-standard process to improve communication, teamwork, and shared decision-making throughout the birthing process, giving every person a chance at a safe, dignified childbirth experience.” In the Team Birth process, the patient, her support persons and the healthcare providers “huddle” to review labor progress, discuss options, and make decisions together about the plan of care. The information discussed is written out on a whiteboard that hangs in the room. During postpartum rounds, I ask the patient for feedback on the Team Birth. Every patient I’ve spoken with reports feeling more involved in their care and their decisions were respected.
If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
If I could start a movement to create the most positive impact, it would be to ensure that every birthing person has access to comprehensive, holistic care throughout pregnancy, birth, and postpartum. Many countries have models that prioritize the whole experience, from physical well-being to emotional support, and I believe we could benefit tremendously by adopting similar practices. Imagine having access to a dedicated healthcare team, including doctors, midwives, and mental health professionals, along with childbirth and newborn care classes, support groups, and around-the-clock access to a healthcare provider.
This movement would also focus on mental and physical preparation for birth through mindfulness, hypnotherapy, prenatal yoga, and massage. I envision family-centered birthing spaces that are designed more like a home. We would provide meals, lactation support, and a longer postpartum stay for those who want it, allowing families to bond and recover in a nurturing environment.
Children are our future, and we can set them up for success from the very beginning by providing a safe, supportive birth environment and compassionate care for both parents and babies. Ideally, birthing centers attached to hospitals would offer low-intervention, physiological birth as the standard, with advanced medical support readily available if needed. This vision of holistic care could transform the birthing experience, creating a foundation of health and improving the birth experience for every family.
How can our readers follow your work online?
Follow me on Instagram @angelagenzale_coaching on LinkedIn linkedin.com/in/angela-genzale/ or visit my website angelagenzale.com
Thank you so much for joining us. This was very inspirational.
About the Interviewer: After becoming her father’s sole caregiver at a young age, Lucinda Koza founded I-Ally, a community-based app that provides access to services and support for millennial family caregivers. Mrs. Koza has had essays published in Thought Catalog, Medium Women, Caregiving.com and Hackernoon.com. She was featured in ‘Founded by Women: Inspiration and Advice from over 100 Female Founders’ by Sydney Horton. A filmmaker, Mrs. Koza premiered short film ‘Laura Point’ at the 2015 Cannes Film Festival and recently co-directed ‘Caregivers: A Story About Them’ with Egyptian filmmaker Roshdy Ahmed. Her most notable achievement, however, has been becoming a mother to fraternal twins in 2023. Reach out to Lucinda via social media or directly by email: lucinda@i-ally.com.
