Birth, Baby!

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Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Dula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Dula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum adjuvant.

On today's episode, we're talking with Jess and Emily of Moontower Midwifery.

We can't wait to have them share all the information about their new practice and their birth center here in Austin, Texas.

Thank you so much for joining us today, y'all.

Thank you.

We're so excited to be here.

Thanks for having us.

I'm so excited to have you on and to hear more about this new venture.

I'm so excited about it.

I've been just excitedly waiting for updates for the past couple of months, and now it's out there, and it's so exciting.

I've been blindly referring to you guys before you're even open.

I'm so sorry for all of the emails that you're receiving from our clients.

For those listening, I had a little fan girl moment when we found out we were going to have them on the podcast because both of them were midwives of mine, and also Bridget, who's not with us today, but I think she's on call.

They were all my midwives when I was pregnant with my son, so this is so, so cool to have you all here.

I really appreciate it.

So tell us a little bit about how Moontower came into existence and kind of why and how and all those things.

How's about the birth of Moontower?

Yeah, so, I mean, it's probably every midwife's dream to start a practice.

I don't know, I only know the midwives I know, but when we go to midwifery school, there's this dream of creating this perfect place for people to go to have great care and then, you know, throughout our career, as we build on our experience, we have this dream in the back of our mind and we file away all the things we would put in our magical place and we're lucky enough, you know, to be doing it.

So I think our passion as a group of midwives over time, working in lots of different birth settings, inside and outside of the state of Texas, we are really passionate about hospital birth.

You know, we've worked in birth center birth and out of hospital birth, we love it.

There are lots of great options in Austin for that.

We all three met doing birth center birth together at a practice that no longer exists.

And I think that's probably where the dream initially started is when we kind of fell in love with each other and loved working together and had similar dreams, similar thoughts about how to care for people.

And then, you know, that closed down, we moved on and then worked in kind of a higher intervention setting in hospital birth.

So we all worked through and still do for this company that does hospitalist work, which means you're in the hospital doing midwifery care for clientele that don't typically otherwise have access to midwives or those that do are transferring because of a problem or complication in their pregnancy.

And so we gained tons of experience in higher risk care and pushing the scope of our practice in a highly collaborative model.

And so about, I don't know, two years ago when the groundbreaking started at North Austin for creating this new space, new labor and delivery, they started talking to me about these low intervention rooms, these birth center sort of rooms.

And I got to become friends with the CEO of the hospital, his name's Tom Jackson, who, I mean, never would I have thought that myself, I mean, being, you know, I'd love to say like, you know, people in power upstairs, that, you know, but he was a huge advocate of this and really helped bring it forward.

He listened when I told him that he needs to push midwifery forward in this town and that this option is necessary.

And if he doesn't take the opportunity with this option, that someone else will.

He listened to that.

And then, you know, construction continued it.

And I didn't really know what was happening for a long time.

And then he sort of called me back up to his office and was kind of like, okay, well, you know, who's going to run this, this midwifery practice, you know?

That's amazing.

Essentially, you know, someone just like you, that, you know, just is awesome and has lots of experience, you know?

Just little old me?

And I was like, well, not me, no, I don't want to do something like that.

That's too many things, you know?

I'm a mom and I'm trying to do all this stuff and I need to, you know, protect myself.

And I can't, you know, go back into any type of relationship with a practice that's going to be so engulfing that I can't have the balance with family.

Not you, then who, Jess?

If not you, then who?

Well, that's what it turned out.

That's what happened.

So, you know, back and forth, back and forth, meeting after meeting, he just kept talking about it.

I just kept resisting it.

And then finally I was like, so if someone could give me funding, if someone can give me work-life balance where I don't have to work 90 hours a week to make it work, if it could be understood that the midwifery model is the right model and it could be a midwifery run practice and I can be the person along with my midwife sisters that create this model, I'll do it.

And so working with him, as you know, he helped me gain, he helped me get into the room with all these suits of people with money and start this thing.

So I ended up being-

So exciting.

I know, so I got funding through this amazing, larger corporation that starts traditionally OB practices, but this is the first midwifery practice that they're starting.

They're funding it, they're open to letting it be run in the way it needs to be run.

And then in the meantime, all, you know, under all of this, you know, there's this undercurrent of these birthing suites being made.

And, you know, and so now there they are, which is this perfect culmination of starting this practice and having this low intervention space to support women.

The best part about this practice to me is that not only do we have access to that space that allows for your birth to be supported as an unmedicated low intervention kind of birth, but also we have access to more high risk, you know, kind of management.

So we have access to having clients in the normal labor and delivery floor.

If our clients need intervention or need to transfer or want an epidural, but still want midwifery care, they still can see us for their care.

So it allows for this option to be sort of expanded within this continued collaborative model because North Austin's worked with midwives now, us specifically for years.

And so they know and trust us, we know and trust their doctors and are able to work together when needed and still maintain that midwifery presence.

The hybrid model part of that is so cool to me because we do have families who go to a freestanding birth center and it's 37 weeks and they've risked out.

And then they have to not only not have their baby where they thought they were going to have their baby, but they change providers completely.

And just the emotional and hormonal up and down of that.

So that if they quote unquote risk out of care for the birth center rooms, that they can still have you guys in hospital room is just epic.

Yeah, that's my favorite part.

Cause I think that's what drew me to this hospital support that we do as hospitalists, which is how can I bring midwifery care to every person who walks through the door?

Every level, every socioeconomic level, every single person, high risk, low risk.

I've made some of the most longstanding relationships as a midwife with clients that are having babies that are super sick or that they're super sick.

And I feel like everyone deserves a midwife.

And so that's the goal.

The goal is create a space where now everyone can have a space and have an option for a midwife.

You're speaking out of language here.

Yeah, it freaks me out in the best way to think, y'all are the first midwifery practice that they're doing this with, then just what sort of ball y'all just started rolling downhill?

Like, what could happen from this?

So I'm going to ask you the big question and I'm going to ask it right up front because I know people are asking this to us all the time.

When do you expect the center to open and when might y'all start taking patients?

Like, what due dates and beyond?

Well, it's funny that you ask because just yesterday Jess had a big call and she texted all of us with massive exclamation points.

We're opening October 1st, yay!

Woohoo!

Oh my goodness!

So that's right around the corner.

It's official.

We cannot wait.

We have November due dates that are dying to get in with you.

Yes, yes, we know that's true.

And we really do want to accommodate as many mamas as possible.

You know, that's going to, especially in the beginning, take a lot of thoughtfulness in terms of who we take on.

Of course, it's not ideal and not having a relationship that we've built for many months leading up to your birth, but we plan to review your records.

So anyone who's interested in coming to see us, I would recommend contacting us through the website, moontowermidwifery.com or DMing us.

And then really an important piece when you want to transfer is to get ahold of your medical records.

That can take a long time.

I feel like that's the piece that holds everything up when you're wanting to transfer care.

And so one important piece of that is to just request a copy of your records.

Don't say you're transferring out right away until you know you have a home with us, because we want you to be cared for by someone.

So that would be my advice to anyone wanting to see us.

We'll be sending some text messages immediately after this podcast recording.

Yeah, anyone can request their own records.

And so if you have those in hand, I'm keeping a list.

There's a list, a long list of 100 people who are ready to transfer their care now.

And so our goal-

At least five of those are ours.

Yeah.

So our goal, which is so exciting.

I mean, it just fills my heart with joy every single time someone comes.

So I could tear up just thinking about it.

But our goal is to start in the next week and a half, two weeks, to be calling all of those prospective clients individually.

That way we can access those records.

They can send them to us.

We're waiting to get our secure email and fax for them to be sent.

And so we don't want to accept anything via personal email due to HIPAA requirements.

And as soon as we get that, we're actually going to go in order of due dates so that we can try our best to accommodate as many possible people.

That may include some people in October if they are interested and low risk and on top of getting their records to us.

Then we can review those now and get you set up with an appointment as soon as we open the doors.

So would that be for people that are only wanting to use the low risk rooms?

Or could that also be for people that are going to use hospital rooms that are a little bit higher risk?

Either is OK, and really, it'll be individualized.

What we're trying to balance is making sure that we can offer good support.

And in either room, it doesn't matter, but that we have time to create a relationship for that to be trusting, to go over any issues you may have in your pregnancy and form a trusting understanding about what that might mean.

But if you're interested, email us, because we will try our best.

So that brings us to our next question.

How many people will be able to birth in those low-intervention rooms per month?

And is there a cap on how many due dates y'all are taking per month?

So there really isn't a cap on the number of people that we can take on.

I think the most important overarching message that we want to send is that not only can you give birth in the low-intervention unit, but we can also help you and take excellent care of you upstairs in labor and delivery.

So because of that flexibility, we have the ability to take on more mamas.

We have the support of our hospital staff too, which I think it's so important that Jess and I have been at North Austin for many years now.

We've worked with the nurses and they trust us too, so I think that working relationship with everyone, the collaborating physicians, the nurses on the ground, they all know us.

We're part of the family there.

So I think that really will translate into more support that other people can give Moontower.

This is bringing up another question that wasn't on y'all's list, so forgive me.

But let's say those rooms are taken.

I think there's four of them, right?

Okay, so let's say those four birthing suites are taken for the birth center type rooms and low intervention rooms and somebody comes in in labor and they had planned to use that room like that was their plan.

Would they just move over to, they would just use a regular hospital room?

Yes is the short answer.

But of note is that those rooms aren't just labor and delivery rooms that have been converted and can be used as an alternate for a low intervention rooms.

They are on a separate floor in a separate unit and they are set aside.

So it's more of an en suite birth center than it is a part of labor and delivery.

That's intentional.

When you set up this type of unit, you want it to be separate so that one, you don't actually accidentally do intervention on people wanting low intervention birth in a super high risk hospital setting and two, to separate where the epidural is from where you are.

And just that mental change that happens when you come into a birth center versus when you come into a hospital.

So we respect that completely.

Exactly.

That creates a space that feels safe to support you in the ups and downs that is the marathon of labor and birth.

And so we don't expect that those rooms will be anywhere close to capacity for some time.

When birth centers are designed, they're designed, when you take on the amount of patients you can take, the amount of clientele, they average on 10 plus or minus per month per room.

So that would mean if we got to 40 people per month that were all interested in those suites, that yes, we could get to that place.

They're offered to anyone in the hospital that has privileges there, but we have not seen a ton of interest from any other providers.

So we don't expect that to be a problem in the near, near future.

Someday, hopefully, hopefully we'll be asking them to expand it, right?

But there will always be the backup plan that if we were unable to support you there because of capacity that we could move.

I don't expect it to be a problem any time soon.

I do.

You don't know what we're talking about over here.

Well, come on over, you know, come on over.

We're going to make that a goal that you guys need to expand quickly.

Yeah, let's do it.

Let's prove me wrong on that one.

For people that don't know kind of what this looks like, you know, Eugene hasn't seen this.

So what does it look like for care from y'all from beginning to end?

So pregnancy care, what in labor care, follow-up care, postpartum, how is that different from a freestanding birth center?

So it will probably look a lot like a freestanding birth center in many ways as far as pregnancy care.

I mean, one caveat to know is we don't only offer pregnancy care.

Certain birth centers offer wellness care, GYN care and certain don't.

So that's one possible difference.

Outside of that, I mean, really the standard is, and for midwifery type model is longer visits, a closer relationship development with your provider.

We do a collaborative model, which means you meet all of us, not just one of us during your care, so that you will recognize and know that we all practice from the same place.

We all agree upon the same things and that you're getting, if you get one of us, you're getting the same model we've all decided upon together to follow.

You would have your regular prenatal appointments, which are usually every four-ish weeks in the beginning and then closer as your pregnancy goes on.

We do have ultrasound in-house, which may be one difference, which is a nice difference in that we are able to do those, so you don't have to refer out for ultrasound or go to a high-risk pregnancy doctor for those ultrasounds automatically.

We will also have support for things like nutrition and wellness and centering and or group prenatal care.

Those will all be things that are coming, not immediately when we open the doors.

Those will start in the next three to six months, but our space is large and will accommodate many other things in it, and so we're hoping to expand on that by offering lots of different specialties in that area.

It's too bad people can't see our faces because we're smiling here.

Like you said centering classes eventually and my eyes perked up, I don't have Botox, so my forehead wrinkled a lot.

Like, so exciting.

So many awesome things are coming.

I actually just texted Ciarra.

I'm just so excited about this.

I could honestly just cry.

This is just something that Austin has been missing.

And so many of our clients desperately have needed this for so long.

And I'm so excited that this is going to be something that we can offer, that we can suggest now.

So, so excited.

Can I just say, I am so grateful to all the duals in the community for your support.

Already you've sent so much buzz around Moontower.

We love working with you all.

I think everyone needs a midwife, but I think everyone needs a doula too, right?

And so I really look forward to collaborating with all the duals in the community.

And thank you so much for the love.

It's been so awesome to hear from the ladies that we've met in the past, that we've helped have their babies.

And it's just, it's a beautiful kind of full circle moment for Jess and I and Bridget too.

So thank you.

Best.

Yeah, absolutely.

We're just having a love fest over here, everybody.

Sorry, everyone is listening.

I'm not sorry.

I hope you can feel it.

So who is a candidate for using this birth center?

And what type of things might exclude someone from not being able to birth there?

So I think when you're wondering if you would be a candidate for the low-risk unit, it's low-risk.

And so the birthing suites is all about minimal intervention.

There's not any continuous fetal monitoring going on.

We're not giving you any medication to augment your labor.

So that means no inductions, no Pitocin, no cervical ripeners, none of that.

So in order to have a birth like that, it's spontaneous, active labor.

You're coming into the birthing suites.

I think that it's important to recognize that when we admit someone to the low intervention space that they're in super active labor because that means that we are less likely to intervene, right, when we don't need to.

And so I think that our clients will be well prepared for that because of the amount of education that they'll receive and the amount of attention they'll receive during pregnancy and know what to expect, right.

And that's where doulas come in to in a million different ways, but also helping you navigate that early phase when you're at home.

So spontaneous active labor, no intervention.

When you arrive to triage to determine if you're in active labor or not, we'll do a non-stress test, which is a snapshot monitoring for baby.

And once we know that baby's tolerating labor well, then you have the Doppler handheld monitor.

Then you're really just left to labor.

So, you know, anyone who is high risk, they're developing the protocols right now for the birthing suites in terms of who's excluded from that.

But essentially anyone that would need a continuous monitoring for a baby, I wouldn't be able to be in that space.

But, you know, the new labor and delivery units are so amazing.

The showers are so much better.

There's a seat in the shower.

And I can't say enough about the showers, you guys.

So, you know, you're going to get amazing care upstairs, too, if you find yourself high risk.

I just I don't want people to feel like because they don't fit this mold of being in a birthing suite, then they can't have a midwife because that's what Moontower is all about.

Right.

Yeah, that's the best part.

Yeah.

Yeah.

Yeah.

And I think there's two.

Sorry.

I think there's two big ones that stick out that I've gotten a lot of questions about.

One is VBAC because there are many birth centers in the area that offer VBAC support.

I think this is a good place to say, like, we are working within the construct of a hospital system, and that requires policies and procedures that are different than a freestanding birth center, which is why I'm careful about the wording of what the space is called, because I don't want to take away from the out of hospital birth experience, and I don't want it to be confused with being exactly the same.

That means that some of those things will have to grow and change over time, as we are able to show administration and staff and everyone how safe and normal birth can be.

My hope is that this grows over time to accommodate more and more things, right?

But initially, this is a little bit different space in that way.

And so VBACs are one of the big ones that I think people will want to access these rooms that requires continuous monitoring at North Austin Medical Center, as well as hypertensive disorders and multiples.

Those are some big ones to know about.

That doesn't mean that you can't have a supportive birth experience with a midwife.

Multiples is a little bit of a different story, which we're trying to work out now.

But with other of those things, we have this very collaborative working relationship with the hospitalist team there.

And so we are able to take care of you, even if you develop one of those conditions at the end of your pregnancy.

That may mean that it looks different than still what you would have expected if you had been in those low intervention rooms.

As you guys know, some of those things don't develop till the very end, which is hard.

But that being said, our goal is that this becomes a great option and that we're able to expand it to continue to accommodate more and more and more over time.

Absolutely.

So things like gestational diabetes or BMI, sometimes we hear BMI as being a reason you can't deliver out of hospital.

Are there going to be certain restrictions on like those specific things or is it mostly going to be feedback?

Yes.

If you have gestational diabetes and you require medication to manage it, then it is a rule in the hospital that you have continuous monitoring.

There's some risk around term fetal demise related to diabetes.

And so the hospital requires continuous monitoring for that.

If you have, I believe that the BMI they settled on, which, you know, don't get me started on BMI.

I don't believe in BMI.

We don't hold you accountable for what you're about to say.

Not all of these rules are not rules I created, right?

They're rules I set in meetings debating over time.

But there is a BMI cut off currently of 40, I believe.

Once again, these are all things that in a hospital system require baby steps, right?

These are things that require us to sort of push up against the envelope little by little to allow space for the system to see this, and it's new and different.

And so we're careful because we want it to be successful.

And so there are times when even if it's something we think, you know, if you go into spontaneous labor, what does it matter what your BMI is kind of thing?

But those are things.

And so there is a protocol sort of list of certain conditions.

These are some of them.

And then, you know, but those are all things we will definitely talk about one on one in our visits as well.

Like these will be things that you talk through with your provider individually.

Here's all of those things.

How can we support this birth?

That's the huge plus side of this is that even if one of these things happen, just like you said, it can happen at the very end.

That's okay because you can still keep y'all as a provider.

And then you just move into the different room.

And again, like Emily was saying, the rooms are still very nice.

Like there are just a few extra things that you will need.

So I think that this is, this is awesome.

So if someone is like developing, you know, one of these higher risk things like preeclampsia or gestational diabetes, or these things that would basically risk them out of delivering in one of the low intervention rooms, I know they can still keep you as a midwife in labor.

Would they also have to go under the care of an obstetrician as well, or would that be under the hospitalist team?

So we have a relationship with a collaborative physician.

Can I say who it is?

Jess?

Yes.

It's Dr. Piparia.

Everyone loves her.

We're so excited to be working with her that we loved her and worked with her for a long, long time.

So we have a relationship with Dr. Piparia and also with the physicians with OB Hospitalist Group, who are people that we have worked with for about five years now.

And so that trust and respect is mutually there.

So you won't lose us as your provider.

When we are practicing on the edge of our scope, then we need to be very mindful about where our scope is and reach out to the resources that we have and collaborate with people in an appropriate way, right?

And so we take care of a lot of high-risk people right now as our job as hospitalists, collaborating with physicians.

But that physical presence, that midwifery care that you get, that holding space is still there for you, even if things get really high-risk.

Absolutely.

I love that.

I think that it can be hard to imagine that sometimes, but even when you're in an out-of-hospital birth and you transfer in for one of these higher-risk things, like during labor and you get a hospitalist midwife, you still have that benefit of midwifery care, even if you have an OB that's overseeing your care.

I think that will be really valuable for people who are having those complications that sometimes come up.

Even if there's the, let's say, your baby's breech at 37 weeks and we try aversion and that doesn't work, and eventually or whatever, mutually we decide together that a C-section is the best option.

That doesn't mean we won't be there with you and that we won't walk you through that and that we won't take care of you in the hospital still.

We will be there with that OB, making sure your care is still really high quality.

We will sit there next to you during your C-section.

We're here to still support those things.

We also are working on, which I can't say this person's name yet, because she hasn't yet signed her contract, but that will be out soon.

Having another physician that will actually see some clientele in the office.

So she on certain conditions, they require kind of co-management, meaning like we'll see them and a doctor needs to see them.

Diabetes on insulin, for example.

And so we will have that option to get to know her when you have certain conditions that require you to have an appointment with a physician directly throughout the rest of your care.

And we also have a relationship with the maternal fetal medicine group at North Austin, which I think is an important aspect because they also know us and collaborate with us often.

So we feel good about kind of all those levels.

And hopefully, you know, the big dreams here are that this grows into this amazing collaborative model.

And you're able to, you know, move back and forth if you need a physician for a surgery or whatever, and then back to your midwifery care.

You're such a tease.

I'm sitting here going, who isn't?

So once you guys release that, you have to send it to me so I can add it to the show notes.

So we went over a couple of the things that make a difference between the new labor and delivery rooms versus the low intervention birthing suites.

Let's just touch on those real quick so that we can just list them out, so that people can have a quick answer to those.

So things like birthing tubs, required IV placement, fetal monitoring requirements, eating and labor.

Can you go over some of those things so that we know what the rules are in each of the rooms?

Sure.

Well, the first to talk about, which I think is an elephant in my room for sure, which is the tubs currently, HCA has a rule that that water birth, like a planned water birth is not allowed.

And so hydrotherapy will be used for labor support.

And the goal will be to move for birth.

You do not have to deliver on the bed.

And once again, this is another one of those spaces where, you know, our goal is to continue gaining and growing the support for the type of birth that people want in this community.

And so we will continue on that path as we go.

IVs are not required in the low intervention suite area.

Anything, I mean, just of an important note, when we say required, I don't like that word, because none of this, none of anything is really required.

I think these are all things that are communicated.

But as we all know, working in a hospital space, there are things that we will feel required.

Not the policy.

The policy is that you do not have to have an IV.

There you go.

That's a good word.

But also know that your consent should be obtained on everything that we do there.

Then the hospital stay, we're hoping to work and decrease the stay to be more of a model like a birth center.

So that's six to 12 hour postpartum mark.

And we are actually currently working with some groups outside of the hospital pediatrician wise in order to partner with them to kind of give the early care necessary that we all know happens when you deliver in an out of hospital setting.

So we'll have more to come on that.

You don't have to leave at six to 12 hours.

So many clientele that we've had in our out of hospital birth experience want to leave early, but many don't.

And so you can still have the standard postpartum stay in this space as well.

That's so cool.

Yeah.

And then what else?

There's queen sized beds.

They don't break down.

There's no stirrups.

There is nitrous available in those rooms, just like in the normal labor rooms, but not epidural.

So in the normal labor rooms, you have typically IV access.

Typically, you're in a sort of hospital bed.

That doesn't mean you have to deliver in stirrups with us in a hospital bed either though, because we don't do that very often at all.

And then I believe in eating and labor, no matter where you're at or what part you're in.

So that's up to you and your provider to make that decision together.

That's irregardless of the area that you're in.

Oh, love that so much.

As far as IVs go, I know even at a freestanding birth center, sometimes a mom will be really dehydrated or she's just like really tired.

And they're like, maybe if we give her some LR, she'll kind of perk up.

Is that something that will be an option in the low intervention room?

You can absolutely use IV fluids as a tool to perk you up, hydrate you, give you some life so that you can have this baby.

And also, you know, there's the GBS prophylaxis.

So GBS status does not risk you out of that low intervention unit.

And we would offer you those antibiotics in each area.

I didn't even think about the GBS thing.

I'm glad you mentioned that.

Awesome.

So I think we kind of touched on this already, but will other providers have access to those birth center rooms and what provider types are going to be involved in the patient care in both of those rooms?

So the birthing suites do not belong exclusively to Moontower, right?

Even though we wish they did.

Really, those rooms don't belong to us, right?

But we hope to use them the most.

Anyone who is a credentialed provider at North Austin Medical Center can utilize those rooms, and there's enough to go around for everyone, right?

So I hope that anyone who wants to use that space under the care of any physician has that opportunity, right?

And so we've heard just anecdotally, some groups don't have any interest in using those spaces, and that's fine, right?

So we are all about choices for people, and we just want to expand the menu of options as having midwifery care in the hospital space.

Awesome.

And like baby nurses and things like that.

So there are people who we can handpick to train to get good care, one on one care in those low intervention spaces.

That kind of nursing care is not for everyone, but I think that the people who are interested in being down there have a passion for it, and that is just so important to have good nursing support down there too.

It has an understanding of what physiologic birth looks like.

I feel like the nurses who are attracted to that type of birth really are hungry for that.

It gives us life to see just spontaneous labor and low intervention birth.

We see a woman step into her power and do it.

I think that there are enough nurses that look forward to that opportunity.

I know the ribbon cutting was a bit confusing and that the birthing suites are not in operation now because those policies and procedures haven't been approved yet.

We haven't trained the staff up to do that in the right way.

This is such a massive step for this community to have a space like that with tubs in the hospital that we really do want to tread lightly in the beginning so that we can show people how safe this is and how important this is to this community so that it can expand.

Yeah, there's a list of interested nurses on staff, as well as a list that I'm keeping of people who've reached out to me that are interested in supporting this type of birth in the community.

So we're working on designing the training around that for nurses that are interested, but haven't done a ton of this type of birth or have done a lot of support for unmedicated birth, but in the hospital setting only so that we can make sure that that is strongly supported by the people that are on that floor.

And then there will not be a separate nursery nurse that comes in for the delivery.

Though we do have access to the full team if we have a baby that's having trouble.

There's still all the buttons that you see whenever there's an emergency in the hospital room.

There's buttons you can push for whatever emergency that is.

Those exist in the birthing suites area, so we can call extra help.

But in order to preserve this low intervention space and keep it very intimate, like this birth tends to be, you will typically have a nurse and your provider as the only people in those spaces.

Okay, so let's say someone's in labor and mom's exhausted and she's like, all right, y'all, I thought I was going to do this without an epidural, but like it's starting to look like a tool that might be necessary because I'm getting to my point of maternal exhaustion.

If they, I mean, obviously, I know if they need any sort of pain medication like a IV pain meds or an epidural that that would have to be in one of the actual labor and delivery rooms.

So they would have to move floors to go to one of those rooms and transfer.

But what does that look like as far as I know billing is a big issue for people when they're at a freestanding birth center.

They're like, if I get transferred, I'm going to be paying for both places.

Is it as big of a deal to transfer in this situation or is it a little bit more streamlined or do we know yet?

It can't help but be more streamlined in this model, right?

Because if you invest in out of hospital birth, then you pay for those wonderful services in a separate bucket.

And then anytime you step foot in the hospital, you're meeting your deductible.

And so is your baby, right?

And so this is all under one roof of North Austin Medical Center.

So if you're on the third floor and the birthing suites, if you happen to go upstairs to get an epidural, it's all part of your stay.

It's the same facility.

So I don't foresee that being an additional charge or financial hardship to go upstairs and get what you need to meet your baby.

And sorry, another question that we didn't have on the list that just kind of occurred to me.

Are you going to be able to work with like low income Medicaid mothers as well?

Yes.

I mean, it's a huge passion of mine, probably all of ours to be able to take care of everyone.

And that that should not depend on if you have private insurance or not.

The contracts for our insurances, the ones that take the longest.

So typically to make a contract with an insurance, it takes 90 to 120 days.

And the longest ones, guess what?

Surprise, surprise, are Medicare and Medicaid.

So those ones take the longest.

So it is possible that there's a delay from when we open to when that becomes active.

And so, yes, is the baseline answer.

There could be a delay in when we can accept based on when that becomes active.

We have asked for them to make it active by October 1st, but there's no way of knowing when they will make that decision.

We do work with working with Unified Women's, which is this kind of group that's funding us.

They have within their company contracts with all the different insurance companies.

So we don't have to go out individually and negotiate with these companies to create the relationship, which is huge.

Now, this is huge.

So we're able to accept all of those as well as because this is considered, whether you deliver in a labor and delivery room or in those birthing suites, it's considered a hospital birth that you don't have to worry like, my insurance won't cover this because it's a birth center.

I wish for Medicaid to be accepted as soon as we open our doors.

I also don't want to delay the ability of people to come into our doors because of the system that is Medicaid sort of taking longer than the other companies.

So as soon as that becomes active, we will be able to take clients in.

Medicaid is accepted by the hospital.

So there are also other options we can hopefully work around there.

Though, you know, I don't want there, you know, my goal is not to make an economic burden on anyone in order to get this care.

So our goal is to get it active as soon as possible.

We don't have control over when Medicaid makes that active.

That's so awesome, though.

I mean, that's just such a huge gap that we're filling in there.

So many parents don't even have the option of midwifery care because it is such a massive out of pocket fee.

And we have a mom right now.

We've been trying to help navigate that she's due in December and she's had six births.

This will be her seventh birth, but she's on Medicaid and she hadn't lived in this area before.

And only a couple will take those for home birth.

It's really hard.

And she also has a feeling like for some reason, even though she's had a bunch of home births that she's supposed to be in the hospital this time, and she just has this weird sensation about it.

And so this is huge.

I mean, if this comes up, if they approve that before December, we might get you another client.

Yeah, that's, I mean, the hope that's my fingers are crossed about that.

I check in on it once a week with our with our negotiator person.

Yeah, I mean, that's the thing.

It was a that's a personal thing for me when I had my first son, I was in graduate school and I couldn't afford anything other than like ramen noodles, you know, and so I didn't have a choice for out of hospital birth at the time because insurance wasn't accepted and I didn't have the money to pay those fees.

So I sort of felt very stuck and my goal is yeah, let's not let let's not let those kinds of things get us stuck.

Every person deserves this care.

I feel like I'm in church today.

I know.

Anything else that we missed or that has come up for you over this?

We're like, oh my gosh, we've got to have them spread information about this.

Is there anything else that we missed?

I don't know, Emily, can you think of anything?

I think we I think we touched on the concept of midwifery care being more than just that that birthing center birth, right?

I just want to assure everyone that we have so many relationships with people, the system, right?

We've been part of this hospital for a long time.

We've got these collaborating physicians that know us and trust us and will take amazing care of you alongside with us.

We have were funded by this company that has all these insurance contracts that were really set up to cast the widest net possible for you.

And also you don't have to be pregnant.

You don't even have to want to be pregnant to see us.

So there's well woman care that we do.

There's contraception that we can do where Bridget is learning all about menopause all over again for us.

Thanks, Bridget.

She's not here today.

But midwifery care is technically for a woman from the time she goes through puberty all the way through menopause.

And so what a great thing, right?

To have this different model that's not a medical model that allows for more connection, more time spent.

And, you know, if we need to use the resources that we have, our physicians, then we can help you navigate that.

And a quick note on, yeah, and another quick note about inclusivity, I would say, is, you know, we also have the goal of caring for people who may need this type of care and don't identify as women.

Yes.

And we want to be super mindful of that.

We as hugely staunch feminists say the word women a lot and are constantly working on that for ourselves.

And we know that that's a place of learning for us.

And so we but we are also understanding that as a marginalized part of the population, as women, that we want to be inclusive of other parts of the population that don't feel they have a space.

So know that.

I'm so glad you said that because we kept all saying women and moms and we would ask questions saying moms.

And I was thinking, I hope and I'm so glad you're saying this because I definitely want to make sure that people who are listening to this know that whoever you are, this can be a place of care for you.

No matter.

I loved also that you included, you know, just from when they go through puberty, you know, I've had a hysterectomy.

I have no need for OB care, but that's great that that's an option for well, woman care as well or well person care.

I think we should say so.

Thank you for touching on.

Well, it's a trauma informed care to, you know, sadly, so many people have been affected by sexual abuse assault.

So that is such an important piece of this intimate care that we really do work really hard to be trauma informed providers, which is so huge, so absolutely huge.

And also another big gap I felt like in our area.

So I'm really excited that y'all will be able to fill that gap.

We just had a conversation the other day about how important the midwifery model is for trauma informed care, because it does cover all of that in a way that the medical model just really isn't able to, because of policies and time restrictions and all of these different things.

So I'm glad that that will be an option moving forward in our area.

We always tell people it's not because doctors don't want to or aren't willing to, but everything is a business and some businesses are better set up to help different types of people.

And so this is the one that we're really excited about.

So thank you so much for being here with us today, y'all.

You guys, for everyone listening, there are four birth workers that are in the room, well, in their own rooms at the same time, not at birth, which is really huge.

This is our third time.

We had so we're really excited that we got this recorded.

And thank you all so much.

Thank you, guys.

We're excited and we feel super special and a little famous for our first podcast.

You are super special.

Hopefully not your last.

Definitely feel the love of including my dogs barking, the pest guy coming and my husband coming home from work.

Hey, that's just how we all roll.

Well, we can't wait to see y'all in the birthing rooms and we'll chat soon.

Thank you for joining us on Birth, Baby!

Thanks again to Longing for Orpheus for our music.

You can look him up on Spotify.

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See you next week.