My Specialty

Postpartum Nursing, Pascale Middleton, Cedars-Sinai

Teaching expectant parents to care for their babies and themselves

Pascale Middleton, RNC, BSN, a Clinical Nurse III from Cedars-Sinai hospital

Pascale Middleton, RNC, BSN
Clinical Nurse III
Postpartum Unit, Department of Obstetrics
Cedars-Sinai, Los Angeles

Tell us about your nursing background.

When I was young, my mom said, “You should be a nurse.” Not one month later, my high school science teacher reiterated what my mom had said. He thought I would do really well in the nursing program at Adelphi University on Long Island, N.Y., so he submitted his recommendation with my application. I earned my BSN in 1985.

I’ve found that the beauty of a nursing career is that we can always find work when we relocate. My husband was a pastor, so we traveled a lot. Aside from New York, we also lived in Connecticut, New Jersey, and Florida.

While we were in Connecticut, I fell in love with postpartum nursing while working at Yale New Haven Hospital. After we moved to Los Angeles, I applied to Cedars-Sinai as a postpartum nurse. I’ve been here ever since.

What do you especially love about OB and postpartum?

The teaching aspect is especially close to my heart. It honestly gives me an adrenaline rush to watch new parents become more comfortable with their baby and everything that being a parent entails. I get to teach them the meat and potatoes of how to take care of their babies and themselves. This is my joy.

I also teach the “Baby Basics” portion of the prenatal program for expectant parents at Cedars-Sinai. It’s wonderful and inspiring how hungry expectant parents are for information, fishing for everything they can learn, which gives me the opportunity to impart my knowledge to them.

I get to meet many graduates of this program after their birthing experience, and they remember me as their teacher. That’s really gratifying.

What’s changed the most in the years you’ve been working in OB?

I would say that charting has changed the most.  I love that there’s no more paper charting. Pyxis medication management is a change as well, of course, but we still always need to learn medication dosages. Other than that, the birthing process hasn’t changed very much, although we definitely see more and more mothers with medical complications, since so many now have babies when they’re older.

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How has your own experience as a mom impacted your work in postpartum and prenatal education?

Being a mom, I take the support and education of moms and partners very seriously.

The first of my children was a premature baby who was in the NICU for almost a month. Even though I was a professionally trained postpartum nurse, I still had my own emotional reaction and felt inadequate as a mother.

The staff on that postpartum unit made a lot of assumptions about me because I was a postpartum nurse, but I was honestly terrified of taking the child home. In the end, I had postpartum depression.

Having experienced that makes me even more sensitive to moms’ circumstances. I’m a much better listener now — basically, I talk less and listen more. I like them to feel empowered to talk about how they feel. When I’m able to be that present for my patients, it feels so good.

I ended up having three kids (they’re now 33, 29, and 22), and with each one, I felt more and more comfortable. I also felt more natural about giving birth and breastfeeding.

What do you find most challenging about your work?

From the outside, labor and delivery and postpartum can appear easy and laid back, but it can be very emotionally intense and taxing. You have to have a high level of empathy, but also protect your own heart.

How do you navigate communication and personal boundaries in the intimate setting of postpartum nursing?

I’m a very social person, so as soon as I walk into a patient’s room, I’m ready to connect. I use humor as a tool, and I feel them out to see how they’re doing: Do they want space, are they needing to talk, or would laughter be healing in this moment?

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In terms of personal boundaries, I don’t tell patients my deepest secrets, but if we have something in common, I use that as a bridge for connection. For instance, if they’re listening to music I love, or if they mention something that I can authentically identify with, those are moments I use to break the ice, which is so important in this work.

I try to keep in mind the concept of therapeutic use of self. Oversharing is inappropriate — if I share anything about myself or my life, I’m mindful that it’s about the patient and not me.

For instance, with moms with postpartum depression or who have babies over in NICU, I may choose to tell them a little bit of my story, saying, “Your experience is different than mine, but here’s where I can possibly understand what you’re going through.”

I also remind them that they’re working for their baby even as they rest. Their baby is going to need them, and they have to take care of themselves.

Overall, how do you feel about your career and the choices you’ve made?

I love what I do and I love my career so much. Being fully present for patients both as a nurse and a mom is gratifying. I’m very grateful for my nursing career — it allowed me to choose to work nights and be home with my kids during the days when they were younger.

Now that we’re empty nesters, I can work more if I want to. I like that sense of freedom to join committees and get involved. As a working mom, I was always too busy to do that, but now I can commit to anything that piques my interest.

I’m a member of our antidiscrimination perinatal health council, which seeks to understand more about biases and racial inequities. Being part of committees and projects that are important to me and my personal values holds a lot of meaning.

How do you define success, personally or professionally?

It means something different to each individual. For me, it doesn’t mean I have a lot of letters behind my name — I don’t need all that. Success is when I come home and say, “Wow, I made a difference in someone’s life today.”

KEITH CARLSON, RN, BSN, NC-BC, has worked as a nurse since 1996 and offers expert professional coaching at

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