- [Announcer] Funding for this program is provided in part by the Minnesota Arts and Cultural Heritage Fund and the citizens of Minnesota.

(bright music) - [Announcer] Coming up on the next "Off 90," we visit Wells, Rochester, and Pine Island to learn about the growing practice of midwifery and its impact on Southeastern Minnesota.

It's all just ahead on the next "Off 90."

(lighthearted music) (lighthearted music continues) (bright music) (gentle music) - In essence, women have been having their babies at home since the beginning of time.

Midwifery looks really different across different countries, so it's got a long history in the US, really started with Black midwives in the South, and then got pushed out of really mainstream society for a while.

And lately, it's been making a resurgence, which I love.

- Midwifery is the oldest form of care for pregnancy and birth, so it's been around.

Everybody used to be born at home with midwives.

That has shifted, of course, but we did see a little bit of a resurgence in interest in home birth when it came to the pandemic in 2020.

Because people started to realize perhaps going to a hospital full of sick people to have a healthy baby didn't quite make sense.

So we're still a low percentage of total births, but that has increased in recent years.

I think we're at 1 to 3% of births, - A midwife, so I am responsible for the overall wellbeing of Mom and Baby.

So I'm seeing people for routine prenatal appointments throughout their pregnancy.

I'm there doing the monitoring of Mom and Baby in labor, so making sure everyone is stable, managing any complications that come up, and then doing postpartum care as well.

- I became a midwife 'cause I was interested in more like the medical field for a little bit, and then one of my friends had said that we should be midwives in the Philippines, at this school in the Philippines.

We ended up looking into it together, and then just the more I looked into it, the more I realized that there's quite, quite an issue with maternal health.

And I was excited to help that process and to help people's experiences be better.

- I saw my first birth when I was in high school, and I kind of fell in love at that point.

So I worked seven years as a labor and delivery nurse.

And I kind of had this secret desire, maybe not-so-secret desire, to eventually, one day go back to school to become a midwife.

When I was pregnant for the second time, a coworker of mine actually had a home birth of her own.

And I just could not get enough of her birth story.

She was like, "You know, Melissa, you could do that for yourself."

I went and I interviewed a home birth midwife, and she shocked me in that she was able to answer every single safety concern that I had.

We get into care with her.

I was a late transfer at 32 weeks, transferred to this home birth midwife, and I remember just thinking, okay, not only did she answer my questions in a consult, but she delivered, and she stood by her answers.

And at that point, I was sold for home birth midwifery care.

I ended up training under two different midwives here in Rochester, and just last year, I officially became a certified professional midwife.

- We kind of accidentally fell into home birth, got pregnant in between switching insurance plans and learned that there was a midwife at our church, and she was a lot cheaper than going to the hospital.

And we said, great, let's try this home birth thing.

And that really kickstarted my journey toward becoming a midwife.

Along the way, a friend invited me to go to her birth, and I was hooked.

And so I became a doula.

And I went to one birth as the doula.

And when it's time for the mom to actually have Baby, the doula kind of steps out, and the midwife kind of steps in.

And I went, oh, that's the seat I actually wanna be in.

- I became a midwife through a little bit of a circuitous route.

I found myself volunteering at women's clinics.

And it was finally a conversation with my husband that I clearly wanted to be doing something with women's health.

And it was when I was working as a volunteer at a homeless youth clinic in Seattle that one of the teens was pregnant, and she was working with a doula.

I was just amazed that there was this role that existed that I could be in a birth room with someone and not be a medical provider.

And so I trained to become a doula.

And I was working as a doula on a military base in Washington.

But it became very clear to me that I wanted more.

I didn't wanna be just the support person, even though I love that.

I wanted to be the leader in the room.

And I wanted to be part of keeping that mom safe.

So it was from that experience that I decided to become a midwife.

And so I found a school and got my master's degree in midwifery.

- There are midwives like myself who do a home birth, and then we also have some birth centers in the area.

I think it's important to think about where feels good to you; is that at home?

For some people that's leaving home.

But then knowing what kind of midwife you wanna hire.

Minnesota recognizes a lot of different types of midwives.

So you can have, I'll say kind of highest level is your nurse midwife.

So that's someone who got a nursing degree.

They have that background first.

And then they got a master's in midwifery.

So they work in a hospital.

We also just licensed another kind of midwife called a certified midwife.

And then Minnesota also allows for traditional midwives.

So anyone can call themself a midwife.

You can be traditionally trained with no degree, and you can be a midwife as well.

We're all a little bit different.

We all have areas that we're really passionate about.

So I think just getting a sense of, who is this provider?

Do I feel like we're gonna be a good fit for each other?

And then knowing what your concerns are in pregnancy, do you think that they're gonna address those appropriately?

- To me, birth is very personal.

It's very sacred.

It's very family centered.

I really value knowing exactly who my team is going to be.

I love them having a very, very thorough medical history.

I love them knowing who I am and who my family is.

And I feel that birth, when it is low risk and when it is healthy, it tends to unfold safest and best at home.

- Almost anyone experiencing a healthy, normal pregnancy with a full-term baby can qualify for a home birth.

But it's also really about, what are we anticipating in terms of support for Baby?

If we know Baby will need additional care at at birth, that is not necessarily the best plan to be at home.

But typically, if you're not managing any long-term, what we would say, comorbidities, like diabetes or liver disease, then you're safe to be at home.

- If you are one who cares about your health and is in a low-risk category for birth, and you are striving for a physiologic natural birth, you are best suited at home with a midwife.

I know normal physiological birth.

And because I know normal so well, I can spot abnormal very quickly.

And so when it comes to abnormal, then we'll be going for higher care.

But when you're at home with a midwife following a physiological path of birth, then the body is designed to do that and to do it well.

And so when its best supported like that, we have better outcomes, versus maybe an obstetric view would be looking at birth as like a pathological disease, that this is something that's wrong with you and that it needs to be managed always, and there's always gonna be a problem.

And that's kind of their view.

And so if we're looking at it like that, then we're introducing a lot of interventions into this normal physiological birth process.

And that's when kind of the issues arise for a low-risk demographic.

- For me, it's really, really important to have time for what we call informed consent.

So I'm a really big believer that the person who primarily has to live with your healthcare choices is you, so you should be the one making them.

So I do lots of education, what are my requirements around gestational diabetes testing, what are my requirements around group B strep testing.

And so I make sure that I talk about those things, at least a couple of appointments ahead of when you would actually wanna make a decision about that.

I start talking about things like postpartum before we're even halfway through our pregnancy.

I find that if we start talking about those things early on in pregnancy, we're able to make changes so that they don't become an issue afterwards.

- Everything in my care is the same as what maybe an OB practice would offer.

So we talk about routine labs that they offer at, like, an initial visit.

And then at 28 weeks, we talk about gestational diabetes screening.

And then at 36 weeks, we talk about GBS screening.

We offer ultrasounds, things like that.

Everything's offered, but nothing is required.

And so anything is declinable.

We would talk about all of the pros and cons, all of your individual risk factors, what do you prioritize as a client, and what ultimately do you wanna choose for your care.

- I offer some additional things, too.

So I like to do more than just the standard labs.

I offer some of those things, you know, help people look at their thyroid, if they're interested in that, or their vitamin D levels, or an A1C, like, let's see how your blood sugar's been doing.

So I like to at least offer moms those things as well.

- I think the best thing that I can offer as a midwife is individualized care, right?

So I'm only taking maybe four or five clients a month.

And so that, instead of an obstetric hospital, they're taking on this huge client load, and so to be individualized in their care is just impossible.

So for my care, even prenatally, we're talking an hour appointment versus a 10-minute appointment with the obstetrician.

So we're gonna talk about any topic that we can so that by the time we're in the birth setting, we already know each other, (chuckles) we already know each other so well.

And so it's this individualized care.

And then even when it comes to birth, I already know all of your preferences, all of your wants and desires.

And so we shouldn't be, we shouldn't be in a rift with each other at all during birth.

- A typical birth at home is usually a very peaceful, calm, quiet, unhurried event.

We are typically joining a family in their home in active labor.

So you can think of that as the typical time you'd go to the hospital.

But we're joining them when contractions are consistent and strong.

And we're with them continuously until the baby is born.

And so it's usually monitoring Mom and Baby to make sure that they're safe, but also a lot of encouragement, both in physical positions of Mom to encourage labor forward, encouraging to nourish and hydrate.

And there's also a lot of mental, emotional, and spiritual support that we provide as well.

And whether I'm catching that baby, helping Dad catch Baby, helping Mom catch her own baby, as soon as that baby's into the world, the focus is on skin-to-skin and falling in love.

And my team and I are always very consistently, carefully watching Mom and Baby to see how they transition through that initial postpartum period.

But it's hands-off.

And the less we do, kind of the better the flow of those hormones and the process, and the fewer hiccups we have along the way.

But we're always there monitoring closely.

But that first hour is just falling in love.

And then when they're ready, we move them into bed.

We make sure that Baby is able to latch and nurse well with comfort for Mom.

We feed Mom.

We do her laundry, her dishes.

We clean up.

There's no sign that a birth has taken place.

And we make sure everybody's comfortably tucked into bed before we leave.

- I always like to have a good safety plan in place.

So we always talk about, in pregnancy, if we need to go in, what's that gonna look like?

So we have identified, if we have an emergency, where's the ambulance gonna take us to?

And then we identify, if we need to go in for some reason, and it's not an emergency, where would we like to go?

So I try hard to have relationships with area hospital providers.

There is a time and a place that we need them, and I'm so grateful for them.

So typically, I'm going to go with the parents if it's via ambulance because we need to get somewhere quick.

I'm gonna do my darndest to get on that ambulance.

If we're going by private vehicle, I'm going to call ahead.

I'm gonna let the provider know what's going on.

We're gonna try and pick the best location based on what we need, whether that's something for Mom or something for Baby.

And then I'm gonna go with and at a minimum make sure that you're settled, otherwise, stay with you, you know, until we have baby or until everyone's safe and stable, and you feel good about me saying, I'll see you again soon.

- I am very, very grateful for hospital-level care when we need it.

But I think, sometimes, at the hospital level, we're given a one size fits all.

And at the midwifery model of care, there's a lot more individualizing for that care.

There's a lot more full-informed consent.

- People who choose home birth have to be willing to accept the responsibility of risk.

And for most pregnancies, healthy, normal pregnancies with a full-grown term baby are perfectly safe to be at home.

However, there are always risks, regardless of location of birth.

And so that's a deep conversation that we have of preparing for birth.

The goal is always safe and healthy moms and babies at home.

We're never gonna compromise safety.

However, there are times and reasons that we want to elevate to a higher level of care.

And so that's why I'm there is to be that voice of reason and say, we have done the things that we can offer, and now is an appropriate time to use the higher base level of care in the hospital.

And so I never want what I would say is a red flag event to happen at home.

And those very rarely come out of the blue.

And so I'm there to monitor pink flags before red flags.

- We are fortunate.

We have some really great birth workers just kind of in the region, so a great collection of home birth midwives, a couple of birth centers, some phenomenal doulas and lactation consultants, and really great hospital-based providers, too.

So what's nice is when we're able to work together in collaborative relationships.

So for example, you know, if I have a client, especially if it's a first time mom, I'm always gonna recommend they at least interview a doula because I think they're fabulous support people.

But then sometimes after birth, the majority of my clients wanna breastfeed, which is absolutely natural and normal, but it's not always easy.

And so that's when we say, hey, I know a great lactation consultant.

Let's get you connected with them.

Other times, things come up in pregnancy or maybe during labor, where it's like, you know what?

We really need a second opinion from someone who works in a hospital.

We might end up needing to call on them.

So then I have providers where I can call them up and say, hey, here's what's going on.

Give me some input on this.

What do you think?

And that just makes it such a nice process for moms.

For those times that we do need to access a higher level of care, to know that we already have a relationship in place, we already know what expectations are probably going to look like going in, it really helps provide safe, appropriate care for moms who are desiring home birth but sometimes maybe need something else.

- Certainly, it's my goal in my practice to make midwifery a more common part of the community, that more people understand and are willing to entertain the idea of birth at home.

But for me, really, the goal is an equitable distribution of resources.

I want the hospitals in my back pocket when we need them, but I also want them to be able to better utilize their team and their resources for the pregnancies and the babies who are high risk, who need their time and attention.

And so I would love to see midwifery be able to come in and support a community-wide, you know, baseline of healthy pregnancy, healthy birth, and be able to work equitably with hospitals to elevate those who need it, and then have the hospital have the time, that they're not serving everybody, but can more dedicate their resources to high risk.

So I want that equitable distribution of resources in the long run.

- I would hope that it would continue to grow, and I think we would continue to train up good midwives to support women.

And hopefully, there would continue to be this understanding between, like, an obstetric model and a midwifery model, and that they would cohesively work together.

'Cause I think there's a lot of misunderstanding of what midwives are even capable of and what they're doing safely.

And I think just the fact that most people are starting to think about their overall health and taking it into their own responsibility lately, I think that is really increasing home birth rates as well of just starting to take responsibility of their own health.

- Because we're seeing a growth in interest, we're seeing more midwives.

So for example, when I was a student, we had a huge influx of students in the cohort that I was in.

And so when you're a student, you need midwives to work under.

And there were a lot of us students trying to get in with not very many midwives.

Well, now all of those students have become midwives.

And so we've got that many more preceptors available for new student midwives.

So I see schools are recruiting students.

A new midwifery school just opened up.

The access and availability to midwifery is really growing.

And I think that that's really exciting.

- I think it's a growing interest for people.

I think that people, it piques their interest to talk about what it looks like to have full autonomy over their pregnancies and their births and their decisions.

I think it piques people's interest to think about what would that look like for me to give birth in the comfort of my home with my friends and my family, and my terms, on my territory.

I think that personalized approach is really drawing people in.

And I think that people are talking more about birth as a physiological natural event rather than maybe a medicalized event.

And I'm excited at the potential.

And I hope that I can be a part in seeing that growth happen.

My hope is that it's something that brings people together.

I love the idea of midwifery being something that brings community closer.

I think that birth can often be taken as a very medicalized event that's owned by a system.

And I think birth is more of a family event owned by the community.

I would hope and think that home birth is gonna continue to grow and continue to flourish as we pour ourselves into it, and people learn more about it.

- My favorite part of being a midwife is getting to work with families that I would not otherwise ever come in contact with.

We can always find a way to respect and love each other through this shared goal and shared teamwork of having a healthy, beautiful birth at home.

I would say one of the greatest joys of midwifery and home birth is being able to celebrate the joy and the sacredness of birth.

It's a very normal human process that has tended to be medicalized and can be feared because we're looking out for all the things that could go wrong.

But if we come from a place of safety and making that definition of safety more broad and colorful, safety in your emotional state, in your nutritional state, in your physical state, in your home state, in your relational states, all of those contribute to safety.

And so I think if we dive into those pieces and support our families in a more well-rounded way, we can celebrate the joy and the miracle of birth instead of fearing it and medicalizing it for everyone.

- I would have to say that the part that still can make me cry after attending hundreds of births is that part when a mom is just having that baby who's come on her chest, and it might be in the first few seconds, or it might be an hour later, but she has this realization, this aha moment of, I did it.

Oh my gosh, I did it.

And I think that seeing women find their power and being able to walk that journey of empowerment and helping them to find that power is probably my favorite part of what I do.

- My favorite part actually is my clients 'cause we get to know each other so well over, you know, a nine-month course of pregnancy, birth, and then postpartum.

So I might be with somebody for a good 10 months out of a year to get to know them so well and integrate into their family.

And so the bond I have with my clients is quite amazing.

And I don't think any profession really nails it.

Just because I'm seeing somebody who might be pregnant for their first time, so going through all of these first-time questions with them, and then at their birth specifically, I'm seeing them in their hardest, most physically, emotionally, spiritually state, and then to see them on the other side of that and who they've transitioned to.

They call it, like, transitioning from a maid into a mother.

To see that whole process really is something special that nobody understands but midwives.

I just saw it the other day with one of my moms.

It was her fifth baby, and she's going through transition, meaning it's the hardest part of her labor.

And so she's in the depths, saying these things of, "I don't think I can do it."

This is her fifth baby.

She's done this before.

"I don't think I can do it.

I don't wanna do this again."

Looking at her husband, "We're not having any more kids."

And then immediately when she has her baby, she's on the mountain.

"That was amazing.

It was so good.

I loved that birth."

And these are like two minutes (chuckles) apart from each other, right?

You're in the worst, and then you're on the high, and then you get to sail.

And that's why I think, actually, physiological natural birth is, there's purpose through the pain, is that there's a purpose of going through that.

And I really think it makes us better moms.

'Cause if I can do that, then I can do the 2:00 AMs, rocking my baby at night, and I can do the the thing that I have to do to show up for my kid again and again and again.

And so I think it's part of the process is to go through that pain.

- The part that I actually really, really love is caring for moms.

I just find that when we take the time to address things prenatally and to really look at their whole health picture, we're able to avoid a lot of the challenges that moms face.

Postpartum mood disorder is so much more common than we recognize as a society.

And people don't realize that it can be anywhere in that first year after you have a baby.

I think the other thing is that we tend to think of it as like, you know, being really sad.

We think postpartum depression, whereas the majority of moms that I see struggle with anxiety, or else rage is another one that we don't talk about very often.

And that's something I see a lot of moms come to me, they're like, "I had a really rough postpartum last time.

I don't wanna do that again.

What can we do differently?"

And we make changes in pregnancy.

And they have very different experiences postpartum.

So I really love getting to serve moms in that capacity and just help them to be, to feel more empowered to deal with life.

Pregnancy is great, and it's beautiful.

But at the end of the day, it's nine months of your life, and you're a mom forever.

So I wanna help people feel good as moms forever.

(lighthearted music) (lighthearted music continues) (bright music) - [Announcer] Funding for this program is provided in part by the Minnesota Arts and Cultural Heritage Fund and the citizens of Minnesota.