The journey to becoming a midwife was a long (four years long) adventure with so many successes and probably an equal number of challenges. During my training I worked in several different practices; a busy birth center/homebirth practice run by LMs (Licensed Midwives), a couple quiet but steady private homebirth practices run by solo LMs, and a very busy birth center run by CNMs (Certified Nurse Midwives) with integrated care from local LMs. I learned a whole lot about how to be a midwife - the knowledge, skills and wisdom required to midwife, to "be with women." I feel fortunate to have learned from so many different skilled providers, because each one of them has their own unique style and way of practicing. Each with their own favorite "go-to" remedies, and perspectives from different backgrounds which inform the resources and recommendations they use to serve their communities.
The varied approaches and experiences I encountered allowed me the opportunity to learn that there is not one way to be a midwife - there is not one best way to practice. That I can continue to hone a rhythm and practice style that fits who I am as a care provider and the needs of the populations I serve. This revelation was incredible! And once I finally became licensed, I started thinking more mindfully about the care that I'd like to provide for you, as your midwife.
Opening a homebirth midwifery practice is about so much more than getting a license and opening up shop. It's about addressing the needs of the community and the ways in which you need me to show up for you.
Some things I've taken note of in my seven years as a birth worker and supporting women...
Informed choice care has to be the foundation for how care is given - to all people - but especially during pregnancy, birth and postpartum. Reproduction isn't just the exiting of one person from another person's body. Reproduction happens on a physical, mental, emotional and spiritual level, and for everyone involved. It is a transformative process that quite literally shapes human evolution from the cellular level all the way through the structures of society. We must support autonomous decision making in all aspects of care. This means providing folks with all the available options, and all of the risks and benefits of each option, then welcoming their own perspective, desires and preferences so that the decision made is theirs to make. When people are able to make their own informed choices whenever possible, they are empowered to make decisions that resonate with their truth and trauma is reduced.
People need to be truly heard and have their needs addressed when they're experiencing health problems, or if they have any questions or concerns - ever. I can't tell you how many times I've heard people say things like, "I've seen [insert random number] care providers and no one can tell me [what's wrong; how I can feel better; how to get rid of my symptoms; etc]" or "It's probably nothing, but..." or "This might be a dumb question, but..." If what you're feeling in your body feels off to you, your care provider should listen to you and address your concerns. There are so many experiences in our lives - especially as women - that teach or train us to doubt our intuition and instincts. I'm here to affirm that you can trust your intuition and that your concerns will be heard and we will do our best, together, to get to the root of the issue. Part of this equation is having an accessible care provider. You won't have to wait three months to get an appointment. You won't wait for 30 minutes in a waiting room before our appointment. And when our appointment begins, we will spend time together (often 30-60 minutes on average) addressing each one of your concerns. You will leave the appointment with all of your questions answered and feeling empowered to take your health and wellness back into your own hands, with tools, resources and continued support.
Better [aka adequate] postpartum care has to be the norm. According to current research, "the US is the only industrialized nation with a rising maternal mortality rate, and between 2000 and 2014, there was a 26% increase in the maternal mortality rate" [1]. Around 40% of maternal deaths occur on days 1-42 postpartum, and approximately three in five were preventable [2]. This means that these preventable maternal deaths occurred sometime during the first six weeks postpartum. The standard obstetrical care schedule for newly postpartum moms is one office visit at six weeks postpartum, which means if all of those women had been seen regularly during those six weeks, their medical complications and deaths likely would have been prevented. That is a tremendously significant issue that cannot continue to be overlooked. As your midwife, I provide both you and your baby with extensive postpartum care, in the comfort of your own home, to preserve your healing space and the new mom-baby dyad (which are inextricably dependent on one another). I see you at around 24 hours, 72 hours, 1 week, 2 weeks and 4 weeks in your home, then at 6 weeks in my office, and then you have the option for continued support and office visits at 3, 6, 9 and 12 months postpartum. I also remain on-call for you during the first six weeks postpartum, which means you can reach me anytime 24/7 if something is not quite right.
Utilizing wellness and healthful living as a preventative intervention for disease and illness has always been a cornerstone of midwifery care. But let's do more of that. Let's help you feel better by getting to the root of your symptoms instead of masking them. Let's help you stay low-risk, so you can safely birth however you choose, instead of relying on intervention once something "goes wrong." And let me be clear that I have a profound respect and appreciation for medical intervention when it does become necessary - cesareans save lives, antibiotics save lives, inductions save lives... when they are medically indicated. But with a national cesarean rate for first-time parents at around 30%, and the WHO saying 10-15% are actually necessitated, something isn't quite adding up, especially considering these cesareans aren't really improving outcomes and are actually increasing risks to mothers [3, 4]. Let's take an approach of supporting your body in becoming stronger, more balanced and healthy, so that your overall risk remains low. We do this by addressing wellness at all levels; nutrition, movement, counseling, emotional support, informed choice decision making and respectful care. In a recent study on midwifery care and out-of-hospital birth, "results show that among low risk women who intend to give birth at home when labor starts there is no increase in perinatal and neonatal mortality or morbidity compared to similarly low risk women who intend to give birth in a hospital" [5]. Some other recent validations on the efficacy of midwifery care:
Among 16,924 women planning a home birth at the onset of labor, 94% had a vaginal birth, and fewer than 5% required oxytocin augmentation or epidural analgesia.
Nearly 1100 women attempted a vaginal birth after cesarean (VBAC) in this sample, with a total VBAC success rate of 87%.
Low risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes [6]
Humility, compassion and mindfulness set the tone for respectful care. At the end of the day, we're all just people. And a little bit of decency and kindness go a really long way. And as someone who's caring for people, this is always at the forefront of my mind. My primary goal when working with my clients is connection. Because that's where the magic happens. There's so much that people aren't willing or able to share until they feel safe and respected. And that tidbit of information that someone is holding back, just might be the thing that makes a difference in their health, their experience or their life, once it's shared.
It is my intention to integrate these basic principles into the care that I provide to my community. I hear you, I see you and I'm here for you. Thank you for choosing me as your midwife and for your patience with my baby steps as I continue to grow into my midwife self.
If you'd like to learn a little more about who I am outside of midwifery, you can find my bio here.
In Gratitude,
Sources:
1. ACOG
2. CDC
3. WHO
4. NPR, 2019
5. The Lancet, 2019
6. MANA Statistics