#025 - What Does It Really Mean to Feel Seen in the NICU?

Hello friends 👋

What does it take to feel truly seen during one of the most vulnerable moments of your life? In this episode of Beyond the Beeps, host Leah Jayanetti sits down with Val Butler, manager of AIME (the Alliance for Infant Maternal Health) in Miami-Dade County. Val shares her own NICU story, the surprise of learning her nearly ten-pound daughter needed NICU care, and the grace it took to sit with not knowing. She and Leah unpack what made her care team different: representation, transparency, and a refusal to treat patients as anything less than whole people. The conversation widens into Val's work connecting maternal hypertension, climate, housing, and mental health across Miami-Dade's care systems, and closes with her reflections on hope, grace, and what to pack in a NICU bag. A candid, moving conversation for anyone who has ever needed someone else to carry a little of the weight.

Link to episode on youtube: https://youtu.be/BCWoz2VTRdQ

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Short Bio: Val Butler is the manager for the Alliance for Infant and Maternal Health (AIM), a health and well-being initiative launched by The Women’s Fund Miami-Dade. With over a decade of experience in public affairs and advocacy, Val has found her place as a thought leader in the community, promoting the impact of interdisciplinary partnership and cross-sector collaboration. In her current role, she supports the AIM project by fostering a collective impact coalition that brings together key stakeholders to address maternal and infant health care in Miami-Dade County. A proud Miami native and alumna of Florida International University, where she earned a dual bachelor degrees in Business Administration and Health Services Administration, as well as a Master of Business Administration, specializing in Marketing - Val continues a career dedicated to the people of South Florida. As a dedicated public servant, she strives to positively impact each organization and community she encounters with a drive for creating, celebrating, and advocating.

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The transcript of today's episode can be found below 👇

Leah Jayanetti (00:01.909) Welcome back everyone to this next episode of Beyond the Beeps. I am Leah Jayanetti, your host, and I'm so glad to be in your ears, possibly on your computer today, with a very special guest, Val Butler. I have come to know Val over this last year or so, and she's truly been a blessing in my life, and also, as you'll hear today in the conversation, a blessing, a gift, an incredible contributor and energy in the world of infant and maternal health, which is why we're all here. So a little bit about Val before we get into our conversation. She is the manager of something really special called AIME (the Alliance for Infant Maternal Health), which is a health and well-being initiative that was launched here in Miami-Dade County by the Women's Fund of Miami-Dade. She has so much experience in public affairs and advocacy. She now has found her place here as a thought leader, and I love that's her word, but it's absolutely accurate in this community. She is promoting interdisciplinary partnership and cross-sector collaboration here in our county. In this current role, she supports the AIME project by fostering a collective impact coalition that brings together key stakeholders to address maternal and infant care in Miami-Dade County.

She is a proud Miami native and an alumna of Florida International University. She has a dual bachelor's degree in business administration and health service administration, as well as a master's of business administration specializing in marketing, which is crucial when we talk about communication. Marketing is key. She continues her career dedicated to the people of South Florida, all of you included. She is a dedicated public servant for sure. She strives to positively impact each organization and community she encounters with a drive for creating, celebrating, and advocating. It is with great, great pleasure that I introduce the Beyond the Beeps community and the Incubator platform to Val Butler. Val, welcome.

Val Butler (02:10.392) Thank you, Leah, so much, and thank you for always providing support and kindness and warmth, and also leading the way every day, never giving up. So much appreciation for you.

Leah Jayanetti (02:23.436) Thank you, that means a lot. Our guests, Val is also, with the guests that join us, also NICU (Neonatal Intensive Care Unit) parents. And it was in a moment of collaboration for the Alliance for Infant Maternal Health that I discovered that Val is also a NICU mama. She's the mother of two. She has a five-year-old, Sebastian, and a two-year-old, Aurora. Aurora was brought to the NICU. Tell us a little bit about that. What brought Aurora to the NICU?

Val Butler (02:50.84) So Aurora is the five-year-old, the boss of the family right now. But I think for me, just as you were saying now, in conversation, being on-site at a meeting and realizing, "hey, Val is a NICU parent" — when you presented to me the first time, I remember the first time we met, and we were reviewing different initiatives, that was a moment for me, like, wow, I'm a NICU parent. I think that was the first time I really came to terms with it, mainly because my experience was very contrary to a lot of other people's experiences. But that was really when it hit me, like, wow, this was a hugely impactful moment of my life.

I had a completely difficult and unpredictable labor with my daughter, and I remember firstly being alarmed at all the testing that was done. I had read, I did my Googling, I talked to friends and looked at resources. Even then, being in that position when you're recovering yourself, and then having all these people doing all these different evaluations on a child that you've barely gotten to know yourself, it's such an overwhelming experience. Within all those evaluations, her oxygen level was a fraction lower than what is necessary, or what would be considered an approved level. I remember seeing the results, having them explain the results to me, but then them advising me that she needed NICU attention, just because of the level of monitoring that would be needed. I could not process that at all, especially because in our birth plan we had such an emphasis on keeping the infant with us at all times, testing everything being done in the room. We were in a hospital where we were privileged to have those wishes honored, and privileged to be heard and to have our preferences respected, which is firstly not a thing that every parent receives.

So, in that sense, I trusted my physician. I was able to trust the nurses I had been with throughout my time there. We were like, okay, we understand. But even then it was just baffling to try to understand the need for higher care.

Leah Jayanetti (05:43.786) And Aurora, remind me, how many weeks was she when she was born?

Val Butler (05:47.705) 39 weeks, and she was humongous. She was almost ten pounds. So even going to the NICU for the first time and cleaning up and getting a robe on — also, this is in the time of transitioning out of the pandemic, so there's extra scrubbing, extra masking, extra everything. I remember she was crying, and all the nurses would be alarmed because her cry was so loud, and she herself was so big. To walk down that hall — the NICU unit we were in was only eight beds — to walk down that hall and see delicate babies receiving so much care, so much going on, and then to see my giant daughter at the end, mentally it was so confusing. It really made me realize I know nothing of what NICU care is. I know nothing, because I had this generalized idea that NICU means premature, and that's just the only association I ever knew. To see that a NICU stay could look, or have many different outcomes, or look many different ways, was a huge realization for me, for sure.

Leah Jayanetti (07:17.578) It's something we have to regularly remind people, that big babies come to the NICU too. There's an adjustment to life, it's a lot, going from in utero, mom regulating everything, your birthing parent regulating everything for you, to switching all that over. There's a lot that has to happen for a baby to exist successfully ex utero. And I think as parents, when we make it out of the quote-unquote woods of preterm, we think, well, that's it, we did it. So it's an extra kind of wet-rag slap in the face — whoa, we thought we could put that to rest. I don't know if that was something in your pregnancy, or in that period where you were worried about it. Was it something that went through your mind, that once you got to that third trimester, or a certain week, that concern resolved? Or were you a pretty chill pregnant person?

Val Butler (08:27.864) I was not chill. I was far from chill. I actually struggle with anxiety here and there throughout my life, and I've come to a place where I'm able to manage it, and I have the tools and processes in my life to combat it, deal with it, address it. But I was, once again, really fortunate to have a physician who knew my history way before I even considered conception or anything. She knew me. She knows my mental health. She knows what I like. She knows my personality, which alone makes such a huge difference. After a while, I started finding peace in the excitement of it. And then the care providers — my obstetrician's office is a team of three, so you rotate throughout the three. My lead physician is very nurturing, very gentle. And then the leader of the practice is very no games, like, let's get this done, here's all the information you need. I remember she helped a lot, I don't even think she would ever know, I should tell her one day. I remember, probably when I was maybe 36, 37 weeks, that's when I was freaking out. I'm like, my goodness, I don't know what's going to happen, where am I going to be, how am I going to feel, I couldn't process anything. She looked me in my eyes and told me, one way or another, you're going to come out of there with a baby. I couldn't process what she was saying, I was like, that sounds wild, but it was such a simplified way of thinking, because pregnancy in itself, birth in itself, they're such complicated, extraordinary experiences that even the most leading experts cannot really process all of it. It just brought me to a point of acceptance, where it's okay not knowing. It's okay to have an experience not knowing what the outcome is going to be, or to allow yourself to be excited, to allow yourself to have faith, to have hope, to be positive. It's okay to allow yourself those experiences. I think that helped me a lot.

Leah Jayanetti (11:20.396) Do you feel like — I feel like your story is this wonderfully positive opportunity to share what went right in your care, so we'll kind of keep pulling back to that, because that's something I know we've talked about in the past, and I've actually gone to you and said, who are your providers, because I need them for somebody else. And that's incredible — like you've said maybe three or four times already, I was privileged, I was lucky, I had these things, this was what went well, this is how they helped. I want to make sure everybody out there hears that, that it is possible. It is possible for these things to happen. But when you're talking about that time you spent with one of the OBs, and you started to have that acceptance of joy and hope and faith, how did that transition when they said, hey, Aurora has to go to the NICU? What was that like, when you said you were walking down the hall, hearing your big giant baby calling for you at the end? Were you able to apply that same perspective, or to say, wait, I've done this before, I can do it again? How did that shift for you?

Val Butler (12:40.076) It was, again, very similar to the point you just made, where, given the tools and the knowledge that I have, I would have probably thought I would be, okay, I understand what's happening. But no, I was freaking out completely. I was still in pain myself, trying to process my recovery, but then also overwhelmed with that transition and what's happening. Even then, I think about the nursing staff that was there, and the time they took for me. I think we spoke once, about — I think it was based on a presentation you shared, a concept similar to a fight-or-flight type of response, and I was all over the place. But if there was not a dedicated staff present to answer my questions, or to reassure me, or to provide transparency, which I think was really a key factor for me, because when you're able to receive communication, to understand what's happening, and not just be dismissed, or not just have justifications forced on you, but rather have someone listen to you, receive your actual concerns, and provide more concrete, tangible feedback that you can hold on to, and have something substantial to process for yourself — I think that made a huge difference for me, because not only in my time there was I able to learn more about how the NICU works systemically, but I was able to learn community-wise what that means. I was able to learn what a nurse's experience is like, or what individuals who are supporting those in that position, what does that work look like for them. I was really able to get a full perspective of how things come together.

Leah Jayanetti (15:14.37) It sounds like you shifted your mind into kind of a student's perspective — what can I learn from this moment, which is the tools you mentioned coming into practice, saying, okay, this is still happening, I don't want to accept it, but I'm going to work on it. And how do I shift my perspective to see something I can learn here? That feels really productive. And beneficial, because you were in a new experience, completely new. It's a funny thing, even families who maybe have a multiples pregnancy or a high-risk pregnancy, you may even have a tour of the NICU, they may even talk about it, it's still nothing that we can prepare for. I think about what you said, I have all these tools, and if they're similar to the tools I have, I always think about my imaginary toolbox that I bring out. It's like a giant trunk full of breathing techniques and meditations and physical movement and journaling, and I never thought that I would be anxious because I have all these tools. Even now, when I think back on my pregnancy, I'm like, I can't believe I was like that. But when you're in it, you can never know what you're going to be until you're there.

Val Butler (16:44.532) And I think the same thing you just said about, I can't believe it, when you look back — I think there are a lot of cases that we review, and you hear that often when you look back, which, unfortunately, I think on a lot of birthing experiences, people, you're instantly a mother, so you're instantly carrying that load. You don't have time for yourself. In a lot of cases you may not even have time to reflect. But even in the instances when we're forced to reflect, those are the moments where we really see so much. I remember, at that time, the hospital we chose was relatively far from me, anywhere from forty minutes to an hour away. But I selected that because it met all my preferences, for me to feel comfortable, for me to feel represented. That was the price I was willing to pay, the sacrifice I was willing to make. I had no idea that I would be going back and forth to the NICU every day, and then also trying to manage nursing, trying to, as a first-time mother, learn what that is. I cannot even fathom how any of this would have worked without the support, because even at that point in time there was an amazing lactation consultant who said, okay, you're going to be in the NICU, I can come meet with you there. Little things that you're grateful for, but in the reality of it, not every professional is willing to inconvenience themselves just to go above and beyond and provide that extra support. So, like you said, when things are done right, when things go well, it changes every aspect of the experience.

Leah Jayanetti (18:59.49) It's interesting, you used two words there, "inconvenience" — they're not going to inconvenience themselves, or "go above and beyond." So that was a phrase, not a word. But what if that's not an inconvenience? What if that's the standard? Let's talk a little bit about what went right here. It sounds like the people — first, you had the education, you listened to yourself, and you found the people that you felt were going to listen to you, respect you, these are words you said. You made a birth plan with these people, they allowed such a thing. What else went right?

Val Butler (19:51.159) I think the openness and the time — a lot of healthcare systems in general are overwhelmed, so we see the outcomes of that in every facet. But in this case, we see, perhaps the same system of care providers that could be overwhelmed, but an organization that prioritized culture, uplifting patients' needs first, understanding their being as a person first, which, of course, in a lot of care settings, it's prioritizing health, prioritizing, are you good to go, but not necessarily are you okay. I think that difference was felt immediately. So the people. The people.

Leah Jayanetti (20:57.078) The people. And then, were you limited with your OB? Because a NICU experience, as you're beautifully lining up here, the well-being in the NICU doesn't start in the NICU, it's really influenced by what's happening, like you said, preconception. I had these people who were helping lay out my plan for birth, or not, and caring for me, so that I feel more like a whole person. Were you limited by where those care — the OB-GYN would have delivered? Did you have options there? You were limited.

Val Butler (21:33.451) Yes, I had no options. It was, this is the area, this is where we do everything, within a block radius, the private offices, the hospital itself. But then, I think at the time I had a lot of options, a lot of information. I had supported friends through experiences in birthing centers or at home, and was able to really take it all in. I knew for me I wanted to have a hospital birth, but only in a way where I was in community with the people providing care for me. If I couldn't do that, then I would have to go back to the drawing board. But even in conversation with friends, I think a lot of people become limited, just like the options were limited for me, I think a lot of individuals automatically limit themselves when they're considering birth, or maybe limit consideration of other options, maybe because they haven't seen it. Sometimes it's hard to process what we haven't seen, or what we haven't experienced, or what we haven't been exposed to. I think about that a lot as well.

Leah Jayanetti (23:06.882) It's an interesting thing, it's almost a failure to dream that something could be better, and you're right, you just go with what your friends say, or what's here or what's there. But what do you think drove you to say, all right, my backyard OB-GYN, I want to go a little further? What were you looking for there, what were the drivers for that decision?

Val Butler (23:36.685) I think the drivers for me mainly were representation and being seen. When we look at the maternal care crisis, we see a lot of danger in the outcomes from racial and ethnic disparities. For me, as a Black woman, I definitely wanted to make sure my care provider was Black. But then, in reality, when we look at racial and ethnic disparities, and disparities based on discrimination, there's an intersection that's not often spoken about, where for example, just because I'm a Black woman and have a care provider who's also a Black woman, she may not believe in advanced treatment. She may be more holistic. We may have many differences, or maybe she holds other biases. I'm overweight, in a categorical analysis I'm overweight, I have preexisting conditions, I'm high risk just from hereditary concerns, from my age, all of those things — maybe there were other points at which she would discriminate against me, even if we're the same race. So I think it's a thing of finding someone who sees you, and all of what that means. Or even if I wasn't in a hetero relationship, or if my partner was also a woman, how would I be perceived then, how would I be treated then? There's a lot of biases that can come into play, especially when you're providing care in such an intimate setting for a family. I think being able to find someone who sees you for all of who you are was my number one priority. And if I have to drive wherever, and if I'm able to, then that's what I have to do.

Leah Jayanetti (27:07.69) It is in these difficult, or traumatic, challenging times that we know the difference between trauma and traumatization is usually people. It's usually someone else sitting with you, offloading some of that weight, giving you the language to communicate, or to feel more comfortable or confident to understand, to kind of offload a little bit of that, or to even just be in community, as you said, together, so you're not facing it alone. It makes perfect sense to me that it began with the people. It's a very courageous thing that you did in doing that. And I say that because I see so many people, like you said, who sell themselves short, or "it'll be fine," or they don't know to step out, 'cause it requires that much more, it's like seeking help.

Val Butler (28:17.992) Awareness.

Leah Jayanetti (28:26.738) Did you find that same follow-through in the NICU with those providers?

Val Butler (28:32.032) I did. I think the difficulty with the NICU was when I first learned how systemic measures come into play. So even, so many frustrating — I remember you were sharing an experience about how some parents reach the edge and reach their limits, and that was very much us as well. Whereas my daughter was doing way better, but she had to be cleared by a specific physician to be discharged, and this had to be signed off by this and that process, it elongated our stay in the NICU even longer. We were ready to go, we were eager to have our life. But seeing how a hospital system — I know measures are set in place for a reason, to ensure safety and to ensure a more confident discharge for a patient — but I think for me, at the moment, that's not an easy thing to process, and especially if it's not explained to you in a way that translates to something that makes sense. I remember there was one nurse who was so supportive, and she would see me, she could see my face, and just see I was losing it. I remember her just sitting with me, and, do you have any questions, we're waiting for the doctor, but everything is good, do you have any questions. I remember asking her, just at my wits' end, what if I just picked up my baby and left right now? She looked at me and said the police would be waiting for you by the time you got downstairs. I was like, police? For my own child? Then understanding, once again, system guidelines that are set into place. That, yes, as a business, as an organization with a lot of liabilities, it makes sense. But as a parent, some things are not going to make sense at all. That's, I think, to this day, one of the things I'll carry with me, and I'll never fully process. But, just learning those little nuances and having to experience it, it was just mind-blowing. Or then, even in a sense of thinking beyond myself — if this is my experience with a nurse who's communicating to me openly, with someone who's experienced in health services, but what if I had none of this knowledge? What if I had none of this understanding? How would I even understand what's happening to me? How would I not feel threatened by that? So it's just something I carry with me. Even into the work that I do now, I always carry these experiences, and this priority of being able to step outside of myself and my experience to think, in the reality of what our world is today, what would this look like for someone else?

Leah Jayanetti (32:11.766) I think it's Ruth Wilson Gilmore who taught me a long time ago, what are the conditions that result in this behavior? And that feeling you had, of, what if I just take — that's it, I'm at my wits' end, I'm just going to take the baby, I'm just going to go — you're not the only one. We go through this a lot, where people are like, I'm just going to go, I'm just going to go. It's those conditions, it's the systems that are influencing your feeling, your thought, and hopefully not translating into a true behavior where you try to take your baby without permission. Once again it goes back to, without the systems being in place, and I fully appreciate what you say about carrying it forward into your actions, and I do the same, instead of passing judgment on an individual, or even on an individual system — what are the things in play that are resulting in this, what was happening. Even you just gave a whole bunch of grace to a system, well, you're a business, you have your liability, you have these things, and it's easy for us, objectively, with distance, to be able to do that, to say, okay, what's happening for this mother, father, parent, what's happening for the system that they have to do these things. But when you're living it, when you're in that moment, and the fear is driving your days and nights and sleepless everything, without someone explaining to you, it all feels wrong. It all feels scary. It all feels like it doesn't make sense. The puzzle pieces don't even match.

So you've talked a lot in your work, which we didn't really get into too much, so together we do well, you lead and I follow, about infant maternal health, particularly the two main things we're working on right now under your direction: maternal hypertension, or gestational hypertension, and the second one coming, mental health and emotional well-being. What are things now that you've been diving into a lot that you see trend-wise? Is there something that's been surprising to you, or that's just validated how you felt about, or what you know of, the world?

Val Butler (34:57.462) I think, yes, simply from the amount of serving that we do. And also, to speak on the Alliance, it's really an honor, because I don't lead, I facilitate, but we're able to bring together all of these stakeholders from a full scope of care, whether it's physical therapists, or organizational leaders, or midwives, doulas, OBs, community organizers, administrators, everything in between, activists. We're able to put them together to make decisions, to lead together. So that's all I can ask for. But I think trend-wise, or just things that really strike me in the work right now — one, seeing the alignment, because in touching base with all of these care providers, getting their feedback, getting survey results, we see people who care. We see people who are concerned about social drivers of health. We see people who are concerned about the reality of what's happening in our world, what people are dealing with, transportation, housing, climate, health, immigration status, all of these things that are affecting not just an individual's well-being but their birth process, and what that experience looks like to them, even aside from delivery, just the resources they may or may not be able to access, the care they may or may not be able to be provided, and how all of those things are affected. So when we look at things that are having a major effect on maternal mortality, or infant mortality, or maternal morbidity, we see pregnancy-related, or hypertension-related, deaths in pregnancy. And we also zoom out and see the outside factors that come into play. When we look at the intersection of climate, health, and pregnancy, we see how extreme heat affects pregnancy. Especially here in Miami, we see how the same regions that appear as bright red flags showing extreme heat hubs in our city are the same regions that are reflecting the highest-risk areas where we're having pregnancy-related deaths. Or even with maternal health, we see a lot of those intersections of people lacking access to resources on a community level. But then, on the other side of that, we see increases in pregnancy or maternal deaths linked to suicide, homicide, or even increased observations of threats of self-harm.

And I think one of our stakeholders really leads us in keeping our North Star, which is for the Alliance not just to evaluate the systems in place, in a sense where we can find data-driven solutions, but also keep that focus on communicating and bringing awareness to what the reality is. So even in a city like Miami, where we can have so many resources and so many organizations working hard to get funding and moving day in and day out, there are still many aspects in which a safety net is needed when we look at that transition of care. So even in one instance — okay, you're in the NICU, and you know you're not okay, maybe you feel the change in your mental health, but you don't have time to deal with it right now. Maybe you spoke to a social worker, but it's not a priority right now, so you dismiss her. Then you're discharged home. And six months later, four months later, two months later, you're struggling. You're struggling to even find the motivation to do daily tasks every day. But now you're lost, you've fallen through the cracks of a care system, and it's on you, where it should never be just on you. So I think in the Alliance right now, we are working to make sure we do our due diligence in identifying those cracks. And, very much as our Women's Fund Miami-Dade CEO, Marya Meyer, always says, working in the industry of gaps and needs. So if it takes a bit more serving, if it takes a better design to push out focus groups, or a campaign that is more dedicated to a culturally sensitive design where people can be impacted, not just see a picture and keep moving, then in the Alliance, I'm just so grateful that all of these professionals can work together and prioritize intentional care and intentional intervention, not just doing things to do them, but paying attention to what our needs are in our community, what those gaps in transition of care are, what safety nets are missing, and that we can have all these professionals supporting each other, sharing best practices, and providing that peer review, that peer space, because we don't get enough of it. We really don't.

Leah Jayanetti (41:11.382) It's absolutely true. It is providing a great coalition, a collective force of all of us kind of moving in the same direction, for sure. So I know you're a busy lady, so I don't want to take too much more of your time. The things that worked for you are the things it sounds like you wish for everybody, right? And that's whether you intended for it or not, that is the work of the Alliance, and the work that we do, is also elevating the care of everybody, because everybody deserves that kind of care. If you could share with someone who's in the NICU now, maybe a similar journey, maybe different, everybody experiences the same thing differently, what words of wisdom would you share with someone in the NICU?

Val Butler (42:14.422) I think, as cliché as it probably sounds, I would share a reminder to give yourself grace. Because even if you are an expert in the field, even if you are on your eighth, ninth child, or any level of experience you've gained, you're having a new experience. Where you're at right now, with a combination of where you're coming from, comes together to provide a new experience. Give ourselves a bit more grace, because I think even in so many instances, in becoming a mother, in the process of transitioning into motherhood, even just being a woman, a lot of times we're so hard on ourselves, and we're pressuring ourselves. So with pregnancy, with birth, we multiply that sometimes. I think it's okay to allow yourself to have the human experience, or, for me, I'm of Caribbean background, and it's very much a "no worries" type of thing, keep it moving, it's fine, you don't need to cry. But it's okay to sit in that experience, even if it's uncomfortable, if it's scary. I think if we allow ourselves to have a bit more grace in what we're experiencing, it allows us to become better advocates for ourselves, and advocates for others in maternal health, and by prioritizing the human experience of it, we're able to be better care providers, better advocates, better public servants, and, like I said earlier, become the people, the contributing people, to changing that experience and those outcomes.

Leah Jayanetti (44:18.166) And you're definitely one of those people. We're so grateful to have you in our community. The other thing I want to ask you is, if you were to pack a bag for the NICU today, what one item would you put in there?

Val Butler (44:34.836) I'm like, do you want the good answer or the bad answer?

Leah Jayanetti (44:37.846) Both, actually, now I want both. You can get two. You can get two items just because you led into it like that.

Val Butler (44:42.966) I mean, I don't think emotional eating is the thing, but sometimes you need a little — it's amazing how far a healthy distraction would go, because if you're mentally weighing yourself down so much, sometimes you just need a little distraction, something that can bring you joy. And even in my experience, from the infant side, if I were to pack a NICU bag, something I really remember from my NICU experience: they came into the room one day and my daughter had a little funny — it was like a onesie. I had no idea where it came from or anything, but just the visual, the change in visualization from focusing on tubes and whatever else was happening, to seeing the distraction of her and this, whatever she had on, it kind of helped me to disconnect for a minute and to feel a little bit of normalcy for a minute, even if just for a minute. I think I would pack something like that, something to bring normalcy, to bring joy, to bring normalcy to the situation. Because even in that experience, we're worried about bringing the milk, bringing the ice packs, bringing this, bringing that, and we forget the things that fill our hearts and bring joy to our hearts. So I think throwing something like that in there, I would definitely do.

Leah Jayanetti (46:32.148) I love that. A blanket or a little cute outfit that you've been planning to put on your baby, if they can wear clothes, or just the hat if they can't wear whole clothes, or the booties, or something. That's wonderful. Okay, and the last question I have for you — we are in the business of hope. What does that mean to you? What does hope mean to you?

Val Butler (46:58.54) I think hope to me means allowing yourself, or even just as industry leaders, as organizational leaders like yourself, allowing yourself to indulge in what it is to be a futurist, kind of like what you said, envisioning a system where things are going right, where advocacy is prioritized, where compassion, understanding, are held as high values for organizations and for care providers across the board. That gives me a lot of hope. And especially, in my career I've always been oriented in the movement space and the advocacy space, and I think in some fields you can easily end up in this doomsday space. But with maternal health, one thing that always makes me feel so hopeful is even the narratives, the story, storytelling is powerful. So when we're gathering qualitative data from focus groups, even just meeting someone who's sharing your experience, or providing a space where people can hear from others, you're changing lives, you're impacting lives, or even just by showing up. So I think in the space of maternal health, being able to build community has made me so hopeful, because it's one of the spaces where you're so lucky to see the outcomes directly. So all the seeds that you're planting, you see the flowers bloom all around you. No matter how challenging the data may show things to be at the moment, it's still hopeful. It's good to hold on to those things, because you know the impact you can have on people, and you know how you can empower them. So I think that's the hope that I hold on to.

Leah Jayanetti (49:24.17) That's beautiful and really quite true. Thank you for sharing that. How is Aurora? She's five now.

Val Butler (49:33.707) Yes. She's five, and I told you the other day, I am asking everyone for support and prayer, and if I show up like a mad woman, you guys will understand, because — it's funny, having friends and being in community with people, you hear about transitions in parenthood, you hear it, but it's really until you're in it, you're like, wow. And even just to see, you have a child and they have their own life, they have their own goals, their own likes and dislikes, their own preferences. And then also, as a parent, trying to make sure, make the best choices with what you're given, the resources available to you, when we think about education and safety, there's so much to consider always. It's an interesting ride. But I love seeing the person that she is, and even my sister and I joke so much about how our childhood was compared to hers, and I'm like, they could never imagine how carefree they are, or how joyful they are. It's a good show to watch, and I feel like I'm never not entertained.

Leah Jayanetti (51:13.898) I love that. Again, taking that perspective of an observer, or a student, just learning what you can and keep going. It's beautiful. Well, thank you so much, Val. This was just a wonderful conversation, and you provide such a beautiful voice and energy to our community, to the broader audience here. I'm really grateful that you decided to do this with your life. And for all of you who are out there, whether you're walking the halls in the middle of the night, holding a baby new home from the hospital, or pumping, or on your way to the hospital, or sitting at your baby's bedside — Val and I want you to know that you're not alone, and that we look forward to sitting with you again soon. Take gentle care, everyone.