Birth, Baby!

Welcome!

This is Birth, Baby.

Your hosts are Sierra Morgan and Samantha Kelly.

Sierra is a Birth Doula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

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

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

On today's episode, we're joined by Leonora, one of the founders of Home Birth Honey.

She's a midwife, mom, and human that believes birthing people should have autonomy in their birthing experiences.

Leonora is joining us today to talk all about out-of-hospital birth.

She's been a midwife in a birth center, as well as a midwife in home births.

So we think she's a perfect person to talk about this topic.

Thank you for being here today.

My pleasure.

Excited to talk to you all.

So let's start this off by, can you tell us a little bit about how you got into birth work and your transition from doing birth center, midwifery to starting a home birth practice?

I definitely availed myself of a super expensive liberal arts degree, and I was three-quarters of the way through that when I was living abroad and started reading about birthing practices in different countries, and got super, super interested in midwifery.

Actually, really adorably, my father bought me spiritual midwifery, the iconic entry point for a lot of midwives by Ina Mae Gaskin.

I read that and I was like, well, I guess I'll finish up my degree and go ahead and become a midwife instead.

So I did that.

I moved from Brooklyn to Austin.

I knew that Austin was a really kind of big birthing community and that there was a lot of availability for preceptorships and learning opportunities here.

So moved here, started apprenticing with a home birth practice and loved home birth.

But then towards the end of my student years, I moved over to the Austin Area Birthing Center, which is a freestanding birthing center.

So that means that it's not connected to a hospital and is run entirely by midwives and nurse midwives.

So it's a little bit different than the type of birthing center that you might know associated with the hospital.

And it was a really, really amazing place to finish up my student years because I was able to have multiple preceptors from different countries.

And some of them were nurse midwives as well, which was really great.

So by the time I got licensed, they were able to offer me a full time job as a staff midwife there.

And again, as a brand new midwife, there's hardly a better place to be catching so many babies, helping so many families, kind of getting muscle memory for all of the types of complications that can pop up that if you are seeing a smaller population, you don't necessarily get that ability to deal with complications on the regular like that with so much support.

So I loved my time there and was able to make a lot of really wonderful connections in the community and catch just literally hundreds and hundreds of babies.

And then there was the pandemic and I was actually doing a little bit of research in preparation for this podcast.

And it's really interesting.

I'm just going to pull up the statistic because I thought it was really cool.

From 2020 to 2021, home births went up 12% reaching the highest level since 1990.

There were 51,642 home births in 2021.

And that is definitely the way the wind was blowing.

My colleague Meg Rodenbush and I were noticing that a lot of our favorite repeat clients at the birthing center were feeling that the idea of going to a facility where tons of people were and birthing in a facility during the midst of a pandemic didn't feel super great.

The idea of birthing at home seemed a lot safer, a lot more organic in that moment, and definitely more intimate.

We were really sadly saying goodbye to client after client who was transferring out to home birth midwives while also dealing with the reality of working as a healthcare provider during a pandemic, which was really difficult.

There was not really any PPE being provided and it was just a really intense time.

We looked at each other and we were like, what if we go help all of these people going off to have home births?

Because both Meg and I had been students with home birth midwives initially in our studies, and we had both actually had home births ourselves.

We were like, gosh, that seems like that would be a really great thing to do.

As it turned out, it was like a skill meets opportunity moment.

Where we had anticipated it was going to be a really slow roll, starting a new practice, starting a new business.

But we definitely hit the ground running because in addition to people that we knew within the community that were planning home births, I think a lot of women were considering home birth that never would have considered home birth.

The policies at the hospital were necessarily super restrictive in terms of the amount of support people that you could have there and then potentially having to wear a mask while you were laboring.

It was a lot for birthing people all around the world.

So taking that experience and just making it smaller and more intimate made sense on so many different levels at that point historically.

So that was the birth of Home Birth Honey and I think both Meg and I feel a little bit like it's our baby because all our kids are getting older now.

So we've put a lot of love and work into the practice just making it as like bespoke and perfect as we can for our clients and it's just been great.

As a little anecdote, I remember when I first met you in person, it was actually at a chiropractor's office down south when we were at a little mixer and it was when people were finally going to be in the same room as each other post pandemic, or not post pandemic, but you know what I mean.

We were all a little careful and I finally got to see you in person.

I was super excited because I hadn't had a birth with you guys yet.

I remember you saying how much you loved being able to do home birth because the volume at the birth center is awesome for being able to learn.

But then you guys were missing out on that piece of that one-on-one interaction with those clients and seeing them from beginning to end and you're like, we would see people and get attached to them through their pregnancy and then we had to miss their birth because we weren't on that day.

So that is also true to who y'all are and what you created and I love that you're getting to do that.

A little question I have for you and not to put you on the spot, but because you mentioned the increase in the number of home births through the pandemic, do you have any idea and it's okay if you don't, if that number stayed steady or if a lot of it reverted back to what the statistics were before?

I wanted to follow up on that because I was curious myself, but they haven't released any significant 2022 statistics, let alone 2023.

So time will tell.

I anecdotally would imagine that the numbers dropped back down a little bit just because I mean, we were seeing people that would have never considered birthing out of hospital that were just like really freaked out by hospital policies and so I feel like the clientele that I'm seeing nowadays is kind of more like typically representative of what I saw before but who knows when the statistics come out and I'm curious to see where those numbers go.

I remember that just as a doula when during the pandemic and having clients that were like, okay, not having a hospital birth anymore, what do we do?

We want out and having to try to navigate that and there were midwives that were just picking up the pieces of just trying to accommodate, trying to accommodate all of these people wanting to have home births and going way over their typical numbers, needing way more backup midwives to help each other but it was so beautiful to see that community come together and to see these people who had never considered it consider it but it sure was a lot of work educationally to help these people understand.

So I kind of wish we had this podcast we're creating with you right now to share with them then which probably leads into Sam's next question for you.

Yeah, definitely.

I remember just thinking about that time that was when I was becoming a doula but at that point we had just like lists of midwives and then I know y'all were on it when you kind of came into the home birth world but lists of midwives who were picking up all those pieces and we were just constantly updating it, oh, so and so has availability for two extra clients in this month and it was just kind of like constantly being updated so that as we were getting these clients who were like, oh my gosh, I don't know if I can deliver in a hospital, who can I go see?

So it was a really emotionally difficult time I think for everybody but also just really beautiful seeing how the whole community came together and that's just one of my very favorite things about the Austin birth community is how much we all come together when we need to.

I love it.

So who would you say is a candidate for an out of hospital birth and are there certain factors that would make someone ineligible?

Great question.

The average person that reaches out to us that's concerned about whether or not they are a good candidate for birthing out of hospital might have thyroid disorder or they might be above the age of 35 or they might have had surgery on their ACL or tonsillitis or something like that in their surgical history.

Maybe they have PCOS, something like that.

These are not going to be factors that necessarily risk you out of midwifery care and birthing out of hospital.

Pre-existing health conditions like type 1 diabetes, hypertension, that's not specific to pregnancy but that is pre-existing.

There are some autoimmune disorders like we're able to care for people with MS because typically that goes into remission during pregnancy.

If somebody were to be dealing with cancer at the time of their pregnancy, that might be somebody who needed the co-management of an oncologist in addition to a doctor.

For us, the typical person that reaches out does not have significant chronic health issues.

For us, age is not necessarily an issue.

Weight or body mass index, which we know is actually a racist way to classify different body types, so we don't even really look at it anymore.

If you are on medications besides supplements, that might be something that we need to look into.

There are some antidepressants that you can take safely while pregnant under midwifery care with co-management from a maternal fetal medicine doctor.

If you wind up developing gestational diabetes during your pregnancy, that does not necessarily risk you out of care.

We need to make sure that we're able to co-manage with a maternal fetal medicine doctor and that your blood glucose levels are staying within a certain range, and that that is controllable with diet and exercise and doesn't require medication.

If you were to develop hypertension during your pregnancy, and it got to a certain level where it wasn't just popping up now and then, it was staying in a higher level, that might require medical intervention.

But I would say for us, the most likely reason to risk out of care prior to labor would be hypertensive disorders and especially something like preeclampsia, which basically is a disorder where you start seeing blood pressure popping up sometimes.

Sometimes that person is spilling protein in their urine.

When it's caught early, it is something that is pretty easily managed in a medical setting, usually with an induction of labor because once you get that baby out, the blood pressures start going back down and the body goes back to normal.

Occasionally, we have had people whose babies were in a breach presentation, and they were not able to, through the different modalities that we offer, for acupuncture, chiropractic, spinningbabies.com, all of those things, external versions, they weren't able to get that baby into a head-down position and have opted for a C-section, although there is some wiggle room in terms of vaginal breach deliveries here in Texas.

There's definitely a lot of different factors when you are considering birthing out of hospital.

But if you are a person who is of moderately good health, does not have any significant chronic health issues, and are somebody who is potentially wanting to avoid unnecessary interventions during your pregnancy and during your birth, it's definitely a good idea to at least look at the out of hospital options.

And if not, if you do have chronic health issues, that doesn't necessarily preclude midwifery care.

There are midwives that are associated with hospital practices.

12% of people in 2021 had midwives at their births, even though only a smaller percentage of those were at home.

But midwifery care statistically is a really, really great way to help decrease the rate of unnecessary interventions and increase the rate of vaginal deliveries.

Yeah, definitely.

So if someone does risk out of care during their pregnancy, what does that look like?

And are you still able to help facilitate their care?

Yeah.

So in those rare cases where we wind up needing to help somebody find a new provider, we typically take as long as is needed to help them find somebody who feels like a really good fit, make sure that we get their records faxed over to that new provider, and make sure that they have continuous care leading up to that transfer of care.

Sometimes people, let's say somebody wound up with a hypertensive disorder and they needed to get on a medication to lower their blood pressure during the remainder of their pregnancy and maybe have an induction to avoid that blood pressure getting much higher.

Sometimes we'll have people opt to come back to us for the postpartum care after they've had their delivery and once they kind of return to that lower risk category.

And we're always really happy to have patients come back and for us to continue care for them whenever possible because it kind of hurts our hearts too.

We have to let people go that we've been caring for since the beginning.

Definitely.

So what does an out-of-hospital birth look like in terms of pregnancy and labor?

I think maybe some people don't really realize that the midwife is like their care provider.

Like you're the one who's going to be managing their pregnancy and that you don't have to see an OB anymore.

Yeah, I definitely get asked that question a lot when people transfer to us from OB care.

Should I retain my OB?

And even if you wanted to, it's a bit of a gray area insurance wise because your insurance definitely wants you to have one primary provider during your pregnancy.

So, you know, the other issue is just the redundancy and then also the fact that like if you were to be seeing an OB and a midwife, you are going to get conflicting advice at different times.

That said, with midwifery care, you see your midwives the same schedule of care that you do for an OB.

Typically, we start care around 10 weeks.

People are seen monthly until the third trimester until they're seen bi-weekly.

Starting at 36 weeks, they're seen weekly and then sometimes even more frequently than that towards the end.

We offer all the same genetic tests, lab work, ultrasounds.

In my practice, we refer out for diagnostic ultrasounds.

If somebody wanted a dating ultrasound or when it's time for that anatomy scan ultrasound, we have different people that we can refer to.

We have self-pay options and insurance pay options.

Then we actually have this janky little laptop ultrasounds that we got at the beginning of our practice because we were really missing being able to do those position checks and those viability checks when needed.

We always tell people it's not diagnostic.

It is quite literally a bovine ultrasound.

We can use it to see if a baby's head down and we can use it to check for that little cardiac flash in the first trimester, which is pretty cool.

I love that.

You're like, guess what?

This isn't real profesh.

It's fine.

We're just going to do this little thing.

Just ignore the cow icon at the bottom of the screen.

It's the same technology.

Regular ultrasounds are like $10,000 on the cheap and this one was $1,000 on Amazon.

It's still kicking.

We have a couple of people with the Birth Center right now that are also seeing MFMs.

I think a lot of times people think that just because you have to see an MFN for something, maternal fetal medicine doctor for something, means that you can't also be under midwifery care.

But that's not true, right?

Absolutely.

We love working hand-in-hand with maternal fetal medicine doctors.

There are some really great ones here in town.

And I'm so grateful to live in a city where that collaboration can be fairly seamless.

I can send a client who found something on an ultrasound that needs follow up, or somebody who's wanting more in-depth genetic testing, or somebody with gestational diabetes, or who wants to stay on their antidepressant during pregnancy, to the maternal fetal medicine doctor.

They're going to get that in-depth, super personalized information that they need about that specific issue that they're dealing with in pregnancy.

They're going to get the ultrasounds and the testing that they need, but they will remain in our care.

So we're able to make sure that our care is continuing to be safe for planning for that out-of-hospital birth.

And that our clients are getting the information that they need from somebody who is really specialized into what they need to know.

You know, I know that in some different communities, it's not as easy a gambit to send a client to a doctor and then maybe not know that your client's not going to hear an earful from the doctor about how midwifery care is unsafe and how dare you plan a home birth.

There definitely are doctors like that in Austin, but obviously we're not referring people to them.

The doctors that we send people to like had home births themselves, you know.

Yes, I know.

I think I know who you're talking about when you say that.

I won't say any names, but it has been so nice to have our out of hospital birth families go and have him even, I even had, we won't name any names again, but we had a midwife say that they thought that someone was risking out of care.

And they went to this maternal fetal medicine doctor, and he was like, no, you're fine.

You're fine to stay home.

Like, I'm not worried about it.

I'm not worried about your baby being big, your 5'11, and your husband 6'2.

Like, this is not a concern to me.

And there are so many other ones that would be, again, like you said, just lecturing them about why are you having home birth?

That's not safe.

And we did actually have one where the ultrasound tech at the place gave somebody an earful about that.

And the doctor was like, you're fine.

I'm sorry she said that.

I had a dollar for every traumatized pregnant person from an ultrasound tech saying something out of hand that they shouldn't have said.

I could buy you a steak.

Yeah, exactly.

Yeah, there's a reason that the doctor is supposed to be the one that gives the information.

So can you explain a little bit about the differences between birth centers and home births?

I can go in depth on that issue.

I spent 10 years at the Austin Area Birthing Center.

Two years previous to that, I was doing home birth, and now I've been doing home birth honey for three and a half years.

So yes, birth centers, freestanding birth centers are amazing for so many things.

I think the thing that Austin Area Birthing Center does the best is community and education.

When I was at ABC, I was, for the last few years I was there, I was sort of in charge of the Centering Program, which is the program that offers group prenatal care slash education.

And Centering is so freaking cool.

It's basically groups of people who are due the same month with their partners.

And they circle up once a month and talk about childbirth, talk about newborn care, talk about postpartum mood disorders, talk about family planning, birth plans, hospital transports, all the different things that you want to learn in your childbirth education.

But it's in a group setting.

And instead of somebody lecturing you for two hours on the subject, the format is more just like people talking to each other about what they know and sharing information.

And you would think in a group of like 10 pregnant people, and there's like some engineers and some social workers and maybe like one health care worker and a few other people that like they wouldn't necessarily know as much as they did.

But as a midwife, like facilitating centering groups, I would literally learn something almost every single centering group.

It was so cool.

And then these people that you come up with, then you have these like built-in postpartum buddies.

And that for me was just so amazing.

I made friends with this woman.

And we would like go to the Alamo Drafthouse on Tuesdays and breastfeed our babies and eat a hot lunch and watch a movie.

Or like go to the mall and walk around and then breastfeed in the Nordstrom changing room.

Go places and breastfeed.

That's all we did.

So that was really amazing for me.

Like even as a midwife, you know, I knew I wanted to do centering.

So I think when it comes to the birthing center, it's a large collaborative group practice.

So there's a lot of great things that go with that.

You've got a lot of different minds, a lot of different methods coming together, just access to tons of information and kind of a machine that's going to take care of you.

What was difficult for me as a midwife about the birthing center was sometimes I would meet somebody in labor for the first time, you know, and instead of having that sort of built-in midwifery model of care where there is that continuity and there is that built-in trust that you already have with one another, you're kind of behind the ball trying to catch up, trying to allow this person to see that you are trustworthy and have their best interests in mind.

And, you know, just the sheer volume of it.

I mean, it was not unusual for me to do two to three deliveries in a shift, in a 24-hour shift.

And is that badass and awesome?

Sure.

Is that ideal for me and for the client?

Not necessarily.

And depleting.

Like, people don't understand that it's not just a length of time that you're there, like, oh, sure, I had a 12-hour shift and then I go home.

But each birth is such an emotional experience.

Even as a doula, I don't care if I get there an hour before their baby is born or 20 hours before their baby is born.

I'm almost just as tired emotionally because you take on everything of that person.

And a midwife is taking on their shoulders the safety of these people and their babies each time.

So you did that two or three times in a shift.

That's a lot.

Yeah.

I just I didn't feel like I was always able to give the best version of myself in those situations.

But no shade.

I mean, the facility itself is beautiful.

Like I said, it's not attached to a hospital.

So the birthing suites are lovely.

The tubs are amazing.

They have nitrous oxide there, which is something really special that not a lot of other places are able to offer.

And again, the sort of like internationality of like different midwives coming together.

I loved that about it.

And Centering Chef's Kiss A+, can't recommend it highly enough.

But like I said, at the beginning of the pandemic, you know, we were just feeling like we really wanted to go in a different direction and be able to offer a different type of care.

And I will say, I myself was really surprised at how it felt to take a step back and spend more time with each client, more time getting to know them, getting to know their family, like literally getting to know their pets and their homes.

You know, I was completely blown away at what Birth was like, going back to my roots of being able to like really provide that super personalized care.

I thought it would be overwhelming to allow our clients to have so much access to us, because, you know, at the Birth Center, if you're on call, it's not just the people that are due that might call, it's all the postpartum people and like 600 other people, you know, that might be like 20 weeks and having a UTI, you know, so you kind of never know what you're going to get.

But for us now, having our lines wide open and like our clients like actually have our cell phone numbers, they're not having to deal with an answering service when they want to talk to us and being able to text us and email us, it feels like, oh my gosh, I'm so glad you reached out.

I wouldn't want you to be waiting until your next appointment to talk about that with me.

So like let's get into that and solve your problems right now so that you're, you know, able to be more comfortable between now and your next visit.

It's just, it feels really different.

And the crazy thing that we noticed was that we were seeing less complications.

And that sounds kind of like pie in the sky, like, oh, it's better over here, you know, our care is better.

But I don't think that that's it.

I don't necessarily think our care is better.

I think that there's a difference between physiologically how our bodies do labor at home versus how our bodies do labor in a facility or in a hospital.

And like, for instance, when I was pregnant, I was sort of like tripping out about like which birth room I was going to choose, which is, I'm sorry, I'm going to use the S word.

That was stupid.

It's so common, too.

No, I know.

They can't visualize themselves.

Yeah.

Yeah.

And I was like, oh, I'm going to go north so that I won't be, you know, south in my home playing field.

But which room?

This tub?

And I was talking to Kat, who used to work with me at the birthing center and now works with us at Home Birth Honey, who's an amazing midwife and yoga instructor.

And she was like, hey, girl, is there a reason that you're not planning a home birth?

I was like the biggest like light bulb moment.

And I was like, oh, there it is.

Okay.

I'm going to be right here in my bed.

That's all done.

Great.

And all I wanted for my birth, like the only thing that, you know, people like manifest their different things.

The word that just kept coming up for me was normal.

I just want a normal birth because, you know, health care providers get weird pregnancy birth health stuff just so that we can learn about it.

And I did have, you know, a fairly miserable pregnancy and like not the easiest postpartum.

But I will say my birth was so normal.

I went into labor and my labor started and it continued and I made it from three to six to eight.

And then I pushed my directly posterior giant headed baby out in my bed and I didn't tear.

Props to Roswita.

I love her.

She's magical.

She's the very best.

So basically, you know, when it comes to home birth, we are touching our own textiles.

We are smelling our home smells.

We are one million percent in control of the temperature, the lights, the smells, the sounds, like everything.

You know, you are the queen of your castle.

And so I think that physiologically, when you go into labor at home and you're not worrying about getting yourself into your car and going to the hospital or calling your midwife and asking if it's OK for you to come to the birth center or not, or if you have to stay home, even though you feel like you would rather be there.

I think there's something very different in just summoning your team to you and everybody quietly assembling around you, because quite specifically, there is a complication that is rudely called failure to progress, but I'll just call it non-progression, because I think that's nicer.

And that would be the most common reason that we needed to go to the hospital.

You know, just it was sort of just not that it was a foregone conclusion, but just that it was always kind of lurking that a labor might not progress, because of course, when we're out of hospital, we can't augment contractions with Pitocin.

We can do things like breast pumping and herbal tinctures and position changes.

And of course, we can eat and drink during labor, but we can't give drugs to make contractions stronger.

So, it was always kind of looming there.

And it was just a very, very normal thing, especially for first time parents to wind up going to the hospital for augmentation or for pain relief to help get some therapeutic rest so that they could keep going and get that vaginal delivery.

And we were just shocked in our first year of practice at how few people needed help during their labor and how much more quickly the labors were going and about how much less we were seeing people bleeding after their deliveries.

And it really blew our minds.

Now, you know, intuitionally, it makes sense just being at home.

I just think that your hormones work better.

But it really blew our mind the first year practice of just like the decrease in complications.

And like, for instance, in 2022, Home Birth Honey, we served 45 families.

And actually, for the last few years, our transfer rate has been around 10%.

That's people transferring who started labor with us and wound up transferring to the hospital.

47% are over the age of 35.

64% labored in the tub, 26% birthed in the tub.

We had three antepartum transfers.

That means people who transferred out of care prior to labor for things like, you know, hypertension.

We had one elective c-section for breach presentation where somebody decided that that was what felt safe to them.

But in 2022, we did not have anybody who started labor with us wind up with a c-section.

And that's not me saying like, oh, we're the best or nobody ever needs a c-section.

Like there are absolutely times when a c-section is the safest, best way to help a baby out.

And I've seen beautiful family centered c-sections and I've taken part in those and, you know, can definitely talk about ways to optimize support and overall well-being with a c-section.

But our story in 2022 was that we didn't need any, which is just kind of bonkers to me.

So I think that when you're looking at where you're going to birth, the number one thing that you need to be asking yourself and of course your partner as well is where do I feel safest?

And for some people, that is unequivocally in the hospital.

And I think that's great.

I think that if you feel safest in the hospital, if that feels like a good, safe place for you, then you need to be with doctors or midwives in the hospital.

You need to have a doula 100 percent.

But that's great.

You know, like that's where you feel good.

That's your safe spot.

And if you go to a birthing center and you're like, oh, my God, I love this facility.

Like, I love these big tubs and I love the energy of just knowing that there's like so many people on staff.

That's amazing.

More power to you.

Go to a birth center.

But if you feel like, OK, when I'm like sick or don't feel great, I just want to be at home in my space.

I want my own bathroom.

I want my own bed.

I want, you know, my essential oils.

I want to listen to Enya, like whatever it is.

Like you can do it all at home.

You know, there are definitely safe ways to go about that if you make sure that you find high quality midwifery care.

So do you think is there in terms of like an emergency situation, if there were an emergency situation, do you feel that there's a difference between birth center and home birth safety?

So is all out of hospitals birth kind of rated the same in terms of the safety of it?

I have my own opinion, but I'm interested to hear what you say for sure.

That's a great question.

And I think a lot of people wind up birthing in the birth center because they see it as a medium in between hospital birth and home birth.

The only aspect that could affect a safe transport when it comes to home birth versus birthing center is your geographical distance from a hospital.

I would say for us at Home Birth Honey, we probably cap it around a 45 minute drive from the nearest hospital.

That would be what feels safe to us and for most of our clients.

When people ask us about transports and about emergencies with our practice, what we tell them is that we very, very much prefer for our transfers to the hospital to be non-emergent.

When we are with somebody in labor and we start noticing some differences in their labor, maybe their contractions are slowing down, or maybe when we're listening to the fetal heart tones, we're noticing some decelerations here and there.

Maybe that person's blood pressure is going up.

These are just a few different things that can come up.

We're definitely not going to just sit on our hands and wait and see.

There are times, I would say, the vast majority of the time, we love to be non-interventive.

We love to sit on our hands and just quietly support what is beautifully unfolding around us.

But when we notice some differences and we want to help, we're going to get right in there and we're going to suggest position changes.

If we're not able to hydrate adequately, we might offer IV fluids.

If contractions are starting to space out, we're probably going to get you up and moving around and more active.

We might put the breast pump on.

We might try some herbal tinctures.

We might do some acupressure.

Then if we notice that despite our best efforts, those complications are continuing to present or worsening, we're going to keep communicating with the client, communicating with the family because communication is key, and making sure that they're aware of what's going on, not trying to scare them, but making sure that they're in control of what's happening and just know why we're trying different things.

Then if we get to a point where the fetal heart tones are concerning and we haven't been able to resolve that or contractions are spaced way out despite our best efforts, that would be a time that we would consider going to the hospital for help.

It's always going to be a conversation.

It's always going to be collaborative care.

If that's something that we think is going to help you, that's what we're going to say.

We're not going to say we're going to the hospital right now.

We're going to say, you know, this is what we've been noticing.

We've tried X, Y, and Z.

We could maybe try one more thing, but, you know, it might be easier if we got there sooner for, you know, for baby to not be stressed out by the time we get there.

The metric is if somebody is really far away from the hospital, we're probably going to have that conversation a little bit sooner.

But for our part, we want those transports to be as smooth, as calm, as uncomplicated as possible.

Because when we show up at the hospital, if we have somebody who is dehydrated, exhausted, their baby's heart rate is super high or super low, or their contractions have completely stopped and have been stopped for hours, their likelihood of having a vaginal delivery and of not having their baby separated from them and taken to the NICU after delivery, that's going to decrease.

For me, the algorithm that's going on in my head is I want to make sure that that person has the best chance at an uncomplicated vaginal delivery and the best chance at being skin-to-skin and breastfeeding after delivery.

So if getting to the hospital a little bit sooner increases those chances, that's definitely something I'm going to bring up in the moment and let them make that choice.

Again, not out of fear tactics, but just making sure that they have access to all of the information that would help them make that decision.

I think that's so important for people to know that it's not that the most, the majority of transfers are emergent.

The majority of them are not emergent because your midwife is going to be paying such close attention and communicating with you so that it's not this crazy, scary, everybody rush, we got to go.

That is the very, very small, small percentage compared to what people see in their brains as to what they think is out of hospital birth looks like.

They're always thinking of that worst case scenario.

So I really appreciate you giving some insight into that from what it looks like as the midwife.

I think for better or for worse, people learn a lot about birth from TV and movies.

And what's going to get the views, get the clicks, get the likes is drama.

So, you know, I think as health care providers, birth workers, birthing people, a lot of our work is unlearning what we have seen about birth and like actually surrounding ourselves with positivity when it comes to that.

Obviously, like evidence-based positivity, not just like blind positivity, but, you know, most birth is so normal and so calm and so quiet and slow compared to what we see in TV and movies.

So, you know, it's so even the way that like waters break on TV, you know, it's always just like, oh, God, get in a taxi.

Yeah, exactly.

And it's like that is so unusual that that happened.

A lot of times people are going, do you think my water broke?

I think it did, you know.

That's mostly it.

Yeah.

And I'm a I think, you know, I'm a HypnoBirthing educator.

And so I'm constantly talking about surrounding yourself with the positivity and that the media drama is what sells and it's funny or whatever.

And that's what makes you watch it.

But that's not generally the norm.

So I love that you said that because I am preaching that all the time when I teach.

Yeah.

I think that's where a lot of partners get their nervousness about out of hospital delivery is like they've seen, you know, 16 emergency C sections on TV, but no like chill home births.

Yeah.

Yeah.

You don't you don't see it a whole lot.

I always tell people, you know, if you want to watch something like go for it, but maybe limit how much you're, you know, ingesting during your pregnancy, because it does.

It just takes root in your brain.

Listen to the positive birth stories and don't worry about the others.

Your brain has had enough training on how to look at things negatively.

It doesn't need more help when you're pregnant.

So what type of postpartum care is included when you have a midwife?

Yeah, I think that postpartum care is going to be one of the big departures in what you can expect from an OB versus what you can expect from a midwife.

You know, I think there are things that OBs do really well, but honestly, postpartum care is not necessarily one of them.

We follow our clients really closely through the postpartum time.

So, you know, including the fact that like we're not just the person who quote unquote delivers the baby, we call it catching the baby because you're the one delivering the baby.

But we're sticking around during that immediate postpartum, and we are checking your vitals and making sure that you're able to use the bathroom and making sure that you're eating and breastfeeding and kind of just hand holding you through all of that early immediate process.

And then when we have tucked you in and turned off the light and we're slowly backing out of the room, it's with this massive dose of education.

We have really prepared you for what, well, nobody can completely prepare you, but we've mostly prepared you for what to expect in that immediate postpartum and how frequently you're going to be breastfeeding and what your baby's bowel movements are going to look like and what to do if your nipples are getting sore and also that you can continue to call and text us through that postpartum time.

We're going to be calling it 24 hours to make sure, you know, we go through a really long list of questions to make sure that things are staying on track.

And if things are not on track, then we're coming back out and we're checking you out.

More typically, though, we're going to see you at that two-day mark, and that's going to be a home visit.

So you guys stay in bed, you're breastfeeding, you are staying alive, and that midwife is going to come back and weigh the baby and check on your perineum to make sure things are healing well and feel your fundus and check on bleeding and bring your placenta capsules if you're getting your placenta encapsulated, talk to you about nutrition, and definitely just a ton of breastfeeding education.

Between that two-day visit, then there's a gap until the two-week visit, but it's really unusual for us to not talk to somebody between that two-day visit and the two-week visit.

Typically, we've got a text thread going and any concerns that are coming up, we're just dealing with them as we go and coming out to offer weight checks as needed.

If the baby is showing any signs of jaundice, we can do a little heel poke test.

We can also offer the newborn screens, all of that care.

You don't need to drag yourself into a pediatrician's office with a bunch of sick kids at two days postpartum.

You don't need to go back to your doctor's office.

It's all coming to you.

Then at the two-week and the six-week postpartum and newborn office visit, it is also just a ton of follow-up on breastfeeding, on your perineum, on especially postpartum mood disorders.

We don't just call it postpartum depression because there is a whole rainbow of different postpartum mood disorders that can come up.

We actually did that.

Did you do that?

Yeah, we did.

We had a therapist come on and do a whole episode about it.

It's so important.

I'm so glad you guys go over that with them because I feel like you can't talk about it enough because if people don't know about it, they don't know to be on guard or aware that that might be happening to them.

Absolutely.

And we really love for partners to come to those visits because they're able to offer perspective and then also sometimes learn about the newborn care and breastfeeding and how they can be helpful.

And then we are also making plans for the future because family planning is a really important part of your overall well-being during the childbearing years.

We want to make sure we would love to see you again, but we want to make sure that that's on your timetable and that you're not coming to see us any sooner than is safe and desired.

So we're going to be talking about birth control and all of its different permutations and what works best for the family.

It's very rare that we leave on that six-week visit without a solid plan in place.

And if we do, we know that we'll be seeing that family sooner rather than later, which, you know, is all good.

But yeah, it's a ton of follow-up.

And I'm just always completely shocked when I hear about people whose experience was, you know, having their baby born in the hospital and then not seeing their doctor until six weeks postpartum because I can't imagine a more turbulent, vital time to be talking to your health care providers.

Yeah, it's so important.

I remember just being able to like text my midwife and my second postpartum experience and be like, hey, this just happened.

Is that something I should be concerned about?

Because, you know, it's something I'm thinking about and worrying about and spending all this time on.

She's like, no, that's totally fine.

That's totally, you know, that's just part of this.

If you see this, this or that happening, then, you know, then we can talk.

But right now everything's fine.

And if, you know, having to call an OB's office and sit in the on call, you know, answering service and wait for a call back and all these different things, it's stressful.

And having, you know, we get a lot of questions like that from our clients that are with OB.

So like, hey, this just happened.

And, you know, I just I don't know.

And we're like, well, I mean, unfortunately, you're just going to have to call and wait for them to call you back.

And that really sucks sometimes to have that anxiety just for them to, you know, get the phone call back.

Like, no, it's fine.

See you at six weeks.

So it makes me crazy.

It's so easy to communicate.

I mean, of course, I understand that when you are in a larger practice and you're dealing with more people, you know, it can pile up.

But it's like you might as well answer somebody's question closer to when it happens versus waiting for it to become a larger issue later on.

Yeah, yeah, definitely.

So I remember I don't know if you remember this when I was looking at delivering at Austin Area after having a hospital delivery.

You were the one that actually did my tour.

And I think that for me, my biggest fear was the safety of delivering, you know, out of hospital.

Like, well, what if this happened?

What if that happened?

I had had a prior experience with a hemorrhage and a BB with a NICU stay.

So for me, I was thinking about, OK, well, what if all of these things happen?

I need to know kind of what the game plan is.

And you were able to really talk me very clearly through that in my tour.

And it just made me feel so much more comfortable to be able to deliver out of hospital.

You also had a Harry Potter sticker on your laptop, which pretty much sold me from the get go.

I can't believe you still remember that.

It's a very clear memory, OK?

The things that are important to Samantha.

That's it.

Harry Potter and safety of my kid.

How do you educate people when they're worrying about the safety of out of hospital birth?

What does that look like for you?

For sure.

We do consultations.

We call them tours because that's what they call them at the birth center.

When people reach out to us and they're interested in using our services, we typically schedule a Zoom as soon as possible so that we can get right to their questions.

Sometimes people do their research and they have very specific questions.

What about this complication?

My sister had this happen to her.

What about that?

Sometimes they're just like, what do you do in case of emergency?

Similarly to what we were saying before, we are super big on non-emergent transfers or prioritizing non-emergent when we can.

But once in a while, something will come up that is time sensitive, that does require immediate care in the hospital.

We are not shy with calling EMS when needed.

Typically, there's a station really close by and if we need that extra help, if we were to be dealing with something like an umbilical cord prolapse or bleeding during the postpartum period that we weren't able to control with the anti-hemorrhagic meds that we carry with our kit and with the hands-on skills that we have.

We would use an ambulance to go immediately to the nearest hospital to get some extra help.

Have I called an ambulance in the last few years?

No, I have not.

Would I hesitate to do so if I needed it?

Absolutely not.

I think that when it's needed, it's a great way to ensure that if lights are needed, if we need to get someplace quick, that that's going to happen safely.

But like I said before, typically these issues that come up are just not that time-sensitive.

We have time to, again, try to work it out at home, to go through our little bag of tricks, and to have a very thoughtful discussion about what's going to happen and where we're going to go.

I'm going to tell you about a transport that I had two years back with a first-time mom that I just loved.

She was so cool.

She was just a powerhouse in labor.

She was so strong.

She was just doing all these squats in different positions and really working through it.

And her labor had kind of slowed down.

And then we were just really having to work to get each contraction to come.

And I was like, I think that you could still have a gorgeous vaginal delivery and a much easier postpartum time if we were to go get some help right now and get your labor pattern kind of back on track.

And she was very amenable because she had been laboring through the night.

She was pretty pooped out at that point, wanted a little rest.

And she was in Buda or Kyle, I can't remember.

So of course I called St.

David's South because it was, you know, kind of rush hour-ish times.

And I spoke to an OB and he said, OK, well, is she ready for a C-section?

And I said, well, she is in that she knows that could be a potential outcome, but not in that she thinks that that's what's going to happen.

And he said, well, if she comes in, I'm going to give her a C-section because she's got a big baby.

This being somebody who has never met or laid hands on this person before.

And I hadn't told him that I thought she had a big baby.

He asked me an estimated fetal weight and I said, I thought maybe eight and a half pounds.

And she was just a normal size person.

And I was like, OK, cool.

Thank you so much for your time.

Goodbye forever.

Goodbye forever.

Goodbye forever.

Called St.

David's, Maine.

And they were like, yeah, we're kind of busy.

But I was like, cool.

Thank you.

Bye.

On our way.

And so we drove the extra 15 minutes to get from St.

David's, to get from Buda all the way up to St.

David's, Maine.

And this woman had such a freaking awesome vaginal delivery with midwives at St.

David's, Maine, with us in attendance.

Just rocked it.

She got there.

She got a little pain relief, got some rest.

And then she just rocked that birth.

Meanwhile, a few hours later, I get a call from St.

David's Health and they're like, hey, are you still bringing that patient to us?

And I was like, LOL, no, 100% not.

And they were like, oh, what happened?

And so I told them what had happened.

And they were like, would you like to file a complaint?

And I was like, oh, don't mind if I do.

And so I did.

And it turns out that that was not an OB that typically is a hospitalist at St.

David's Health.

And he I feel like I know exactly who you're talking about.

You probably do.

I think he moved to like Minnesota or something.

Bye bye.

Don't let the door hit you.

But it was great.

You know, it was like it was such a well-oiled machine.

And I was so pleased that I was in my whatever, like 12th year of practice versus first year of practice, because I just don't know that I would have had the wherewithal to not just be like, OK, well, if you think that that's what's best, I guess we'll come in.

So anywho, you know, when it comes to transport, it's really important that A, the people that you are working with have good working relationships with the hospitals around them, that they are not hesitant to go in when help is needed.

And B, that they know the different facilities and know the different providers and again have that wherewithal to know what's normal, what's not normal.

And, you know, there is a fine line when you get to the hospital.

You know, if transport is needed, one of us is going to go with you to the hospital.

We don't have hospital privileges, so we can't practice there, but we can act as an advocate and, you know, kind of doula adjacent, but more advocacy than anything else.

And it's really important that the people who are with you, supporting you at the hospital are advocating for you and helping you in that way, but not fighting your medical team at the hospital.

I know you guys know that it's a really delicate dance because you want to make sure that that person is getting the best care possible and not having unnecessary interventions pile up.

But if you become combative with the doctors and nurses at the hospital, that is not in anybody's best interest.

You can always file complaints afterwards, but definitely important to not fight them in the moment.

So anyway, you know, you want to make sure that the person going with you, helping you in that moment has your best interest in need and not, you know, their own like Don Quixote, like kind of trying to fight the system from within.

Because even though that's cool, it's not cool for you.

Yeah, we're support people, not cowboys.

That's a really important line, I think, for people to be mindful of.

So on that same note, do you feel like doula care is still beneficial in out-of-hospital births?

I'm going to give you a hell yeah on that one.

I think so many people don't recognize that.

Like we hear it all the time.

Like, oh, I'm having a home birth, so I don't need a doula.

And it's like, our role might look different.

But, you know, we obviously have an opinion on it.

But I'm curious, how do you feel about doulas in your practice?

What does that look like with y'all?

Yeah, I know, I do know of midwives in the community who either weirdly don't want doulas at the birth or who just like don't encourage their clients to seek out that doula care.

I would say, you know, if I could make a rule, I would say that no first time birthing person should ever birth without a doula.

Like if I could just like wave my wand and make that be a thing, I would really like to do that because doulas like midwives create better health outcomes, especially when you're looking at the health outcomes of women of color.

You know, in doing a little research for this podcast, I was looking at some stats and let's see, between 1987 and 2017, pregnancy-related deaths in the United States more than doubled, 17.3 deaths per 100,000 live births.

In communities of color, the crisis is far greater compared to white, non-Hispanic women.

Black women are more than three times as likely and Native women are more than twice as likely to experience pregnancy-related deaths.

In creating better outcomes, doula care is essential.

Access to midwives is essential.

This is just a really overlooked aspect of health care in the United States.

I'm going to get off of my soapbox now and go back to doulas in particular and just say that especially when you're a first-time birthing person, you are not going to have any freaking idea of what to expect with labor.

You can read every book.

You can watch every YouTube channel.

You can even attend births.

I mean, when I had my baby, I had been a midwife, I think, for like, I don't know, eight years or something.

And my mind was bending during labor.

It was so crazy.

And again, I had a totally normal birth.

So I would have never in a million years considered not birthing with somebody who was specifically dedicated to my emotional and physical comfort and well-being.

For me, that was Brittany Smith, who is now my student midwife, but who is like literally minutes away from becoming licensed herself.

So she was the medical assistant at the Austin Area Birthing Center, and she came over to our practice as soon as we started and has been amazing.

But for me, she was somebody in the room who knew when to shush my husband, when to pull the sheet off of me when I got hot or put it back on when I got cold, who was just present and there for me when I was saying, you guys, over and over.

And so what I see with doulas, how they bring so much to a birth is just their presence.

They're this person in the room who is never going to step away when the person in labor is asking for a hip squeeze or counter pressure, who is never going to forget to refill their water cup, who after the baby is born, especially in a hospital setting, is going to be rushing that baby to the mom's breast and really trying to maybe not fight, but make sure that the L&D nurses know that this mom does not want her baby bathed, does not want the baby whisked off to the nursery, wants to be skin to skin, wants to be breastfeeding, wants to delay all of the newborn stuff that needs to happen.

We just see people who are supported by doulas have more satisfaction with their birthing process, regardless of whether or not they birth at home or birth at the hospital or even wind up with a C-section, because when a doula is with you, you are being listened to, you are being heard, you are being seen, and that's really, really important.

And it's different than what the midwife does.

There's some overlap there, but there's a difference, because when I'm coming to your birth, I want to make sure that you are as safe as you can be and that your birth is progressing as perfectly and normally as it can.

And I'm going to be doing little micro adjustments here and there to make sure that everything stays on course.

And because that's where my head is, I can't be with you with every contraction, breathing with you.

I can't be reminding you to drop your shoulders.

Of course, I'm going to be, you know, touching your body during that process and trying to provide relief in any way possible.

But if there's somebody there who is already squeezing on your hips and doing counter pressure and, you know, putting chapstick on you and all that stuff, I can really get into my midwife brain and just do my job even better than I could than if I was having to also do all that other stuff.

Yeah, I think that that's what we try to tell people.

Like, if you have to choose between, you know, doing a fetal heart rate, you know, doing the little Doppler real quick or squeezing her hips, you're going to have to check on the baby.

So we try to explain that and I think you did a perfect job at that.

I think this has been completely invaluable for the people who are going to get to listen.

I'm so excited to be able to have this to offer to people.

And if you wouldn't mind just telling people how they can find you, we would love to just have you plug whatever it is that you want to plug.

Thank you.

We, our website is homebirthhoney.com.

Our Instagram handle is homebirthhoneyatx and our Facebook is homebirthhoney.

And we, we are a practice of three, about to be four midwives, and also an amazing other student, Nicole.

And one thing that I think is really cool about our practice is that we, A, we offer free prenatal yoga with Kat, who's the bomb, and B, as a small group practice, we offer pretty much 100% continuity.

So at your birth, there's always going to be two midwives, and you will always have met both of those midwives a bunch during your visits.

So we love being able to provide that quality of care and also quality of life for us, because we're able, I just went on my honeymoon to Spain and Greece.

It was epic.

And so it's a group practice, but it's really small and intimate.

And yeah, we'd love to see more of y'all.

We're so thankful to have you in this community to be able to refer to, and we really hope to work with you more in the future.

And we just thank you so much for being here today.

My pleasure.

Thanks, guys.

Thank you so much for joining us on Birth, Baby!

Be sure to tune in next week as we chat with Cheryl Reilly, who's a pelvic floor therapist.

Thank you again to Longing for Orpheus for our music.

You can look them up on Spotify.

Remember to leave a review, share and follow wherever you get your podcasts.

See you next week.

Bye-bye.