Meet Our Midwife

Welcome to another episode of Season 2 of Womb Stories Project, a series of conversations with people involved in the home birth of our son. This is a really important conversation as part of this series because it is with the incredibly wise and amazingly wonderful Tiffany Skillings, who is a midwife and was my midwife through our fertility journey, throughout my pregnancy, and the primary midwife in the delivery of our son at our home. 

I can't say enough about Tiffany. She is an incredible gift to the birthing community here in Maine, to me and my family, and we really consider her part of our family now. I imagine that after listening to this conversation, you will understand why. 

 

 

Visit www.kitaralove.com for intentionally designed and expertly crafted products for safe and easy yoni steaming at home. 

Connect with Kit on IG @bykitara.

Connect with Tiffany Skillings on IG @tworiverslactation and at www.tworiverslactation.com. 

 

Timestamps

1:38 Tiffany’s Journey to Midwifery

13:59 Midwifery as Holistic Well-Bodied Care

25:07 Expertise in Clinical Midwifery Training

31:20 Midwifery Challenges and Misconceptions

45:47 Elevating Midwifery and Public Education

49:32 Healthcare Costs and Transparency

55:49 Collaboration in Emergency Situations

57:22 Home to Hospital Transfers and C-Section Rates

1:17:11 Importance of Trauma-Informed Care and Debriefing

1:22:28 Intentionality in Client Care and Privacy

1:24:49 Special Moments in Mark's Birth

 

Transcript

Kit:

[1:12] Okay. Tiffany, thank you so much for being here, for being just this incredible, incredible. Yep. I will do this in the intro. But yes. Let me just ground one more second.

 

Kit:

[1:39] Tiffany when I look back on the many years of connecting with you receiving your incredible support something that actually has come through for me as a theme for myself and then what I witness in lots of other women when I share my decision to do a home birth and to work with a midwife for fertility, for the pregnancy, and for the postpartum time, I realized that before I met you, there was so much I didn't know I didn't know. And that's part of my intention with this episode is to really help people just gain more knowledge about what they might not even know they didn't no, because there's a big space there. And what I've seen with myself and with others is that that space makes it seem like we don't have as many options as we actually do.

 

Kit:

[2:32] And so I know we've talked, we don't have any agenda per se to have people do birth in a certain way, but I do have a bit of an attachment to making sure that birthing people do know of all their options so that they can really consider what's right for them. And if we don't know what we don't know, then we can't consider all of our options. So from that point, I just want to honor you for providing me and my family with more options than we ever knew were possible. And really for an experience that I didn't believe or have comprehension could be possible also. So thank Thank you and welcome. It's such an honor to have you here today.

 

Tiffany:

[3:19] My pleasure. Thank you for asking me to be here. It's really wonderful to get to spend time with you, especially inside of the more clinical work that we've been doing together and to be able to talk more and share more with the community about, like you said, just what's within the realm of possible.

 

Kit:

[3:39] Thank you. And so I actually have some questions I've never asked, which I'm really curious about, which is what really brought you to midwifery? And what is that journey for you? Hmm.

 

Tiffany:

[3:52] It's a kind of a long story and kind of a winding spiral or labyrinth of a story. But I grew up with a strong desire to be a lawyer from age eight. That is, you know, like, I'm going to law school. This is what I'm going to do and wasn't willing to consider anything else. despite lots of individuals, adults telling me to have like a broader perspective. I studied at Bates College in the pre-law track with my degree in sociology and focus or concentration in criminology because again, I was going to law school.

 

Tiffany:

[4:32] And then the second semester of senior year, I just needed one more course in the sociology department. I had completed all of the CRIM kind of concentration requirements. And so this kind of forced me to have a broader perspective. And so I chose a course in the sociology of health and illness, and that really just expanded my mind in a really huge way. And I realized like, oh, this is actually what I'm supposed to be doing. Like, this is my focus. I really thought at that time as a senior, year. The first year after graduation from Bates, I really thought that I was going to study sociomedicology. So not involved in hands-on direct care, but trying to figure out what it means to be a patient in the healthcare system. That was really important to me. However, at the time, there were only two programs in the entire country that offered sociomedicology. And so I decided to.

 

Tiffany:

[5:33] I actually applied to work at a retirement community in their kitchen because I had some experience working at a bakery and managing a bakery. And they looked at my application and my resume and said, like, you can't work in a kitchen. You need to go in healthcare. Have you ever considered a career in nursing? And I always knew that nursing wasn't quite the path that I was meant to be on, at least not at that time, though I couldn't really verbalize why. But I did realize this would be a great opportunity to get to learn about the healthcare system from the inside. And so that day, I started working in healthcare and continued to work in healthcare in various entry-level positions, including working as a medical assistant in a primary care outpatient office. I went on to work in an entry-level position for Mercy Hospital, both as CNA or nursing assistant and as a unit coordinator, moved on to work at Maine Medical Center in their float pool, and really, really got to see and learn a lot about healthcare through the lens of nursing more so.

 

Tiffany:

[6:47] I had the wonderful joy and pleasure and privilege of working with one nurse who still wore her white hat on top of her white hair with her white dress and white stockings, white shoes, and white glasses, who did a beautiful job of providing hands-on clinical care. It was really clear that it wasn't just about the hands-on skills or the clinical skills. It was about compassion and connection and finding ways to advocate for those patients in that setting. And at that time, it was an interesting contrast because healthcare was moving in the direction of...

 

Tiffany:

[7:28] Moving to electronic charting, which at that time meant a lot of charting was happening at the centralized nursing station, not at the bedside. We were moving away from having medication carts that rolled down the hallway from room to room and having a centralized PIXA system. You're just all of these systems being developed that were rooted in technology and having really great benefit in allowing multiple people to provide care at the same time, being able to create these added systems that reduce the likelihood of medication errors or other errors in the course of healthcare. So I saw a lot of reason for it, but it was, if I'm honest, kind of a turnoff to me because I really wanted to be more at the bedside and making connections with people.

 

Tiffany:

[8:18] I had one night in the float pool, as is really common, I had moved from unit to unit being reassigned because my job in the float pool was to help mitigate staffing challenges. If there wasn't enough staff to address the needs of that unit, then those of us in the float pool were moved to that unit to help provide that support.

 

Tiffany:

[8:40] And I always loved no matter what time of night because I was a night shift person no matter what time of night I always checked in with my patient assignment and just made sure that everybody was okay and you know their status was exactly as what was reported to me and as I moved down the hallway of this cardiac floor where most of the folks were either about to have open heart surgery or had just had open heart surgery. So I moved through the assignment, checking on everybody. There was only one person sitting up on the edge of the bed at two in the morning.

 

Tiffany:

[9:13] And I stopped in and asked him, you know, hi, how are you? What's going on? You're up in the middle of the night. And at first he grumbled like, what do you want? And I said, well, nothing, actually. You're the only person in my assignment who's awake at this hour. And I just wanted to make sure you were okay. And he said through tears in his eyes that he had been there for 13 days. And I was the first person to just come in and ask if he was okay without it being piggybacked to a care measure, such as, you know, checking his vital signs or his blood sugar, checking his incision. That was the first person to just stop in. And that was a big, a big moment for me that working in the float pool while it just, it gave me such an exceptionally broad base because I was exposed to just about every single department and specialty in this large tertiary care hospital, that what I, one of the things I valued the most is continuity of care. And again, that connection.

 

Tiffany:

[10:11] So I started exploring different things and different ways to, you know, get that continuity of care and still be involved in healthcare. Around the same time, I experienced a really brief pregnancy. I was pregnant and miscarried at about 10 weeks. And in that moment of discovery of pregnancy of realizing like, oh, wow, I'm pregnant. Now what? I started to also So look into my options. And it just seemed like, okay, well, I'm pregnant. So I call an OB, right? And in calling OB offices, the OB offices were not offering prenatal visits before 10 weeks.

 

Tiffany:

[10:50] And so I felt like I was on my own to kind of learn more about what my options are for care and what are other people doing for care. And I was reminded in this research about midwifery and I was reminded in this research about home birth. And I say I'm reminded because it occurred to me while I was looking into these options. My mom has always seen a midwife for well-bodied care. there. My mom is one of eight children born in the Caribbean, and they were all born at home with midwives.

 

Tiffany:

[11:26] I realized that when I worked in the bakery, one of my peers had gone to midwifery school, ultimately the same school that I went to, had gone to midwifery school, had practiced as a midwife, attended home births, and had shared those stories with me, but I had forgotten about that. I knew friends that had had home births, and they had a very distinct, I think, approach to life and their philosophy to living. They were off the grid, did a lot of things on their own, you know, just this whole philosophy where it kind of felt like, oh, well, that's them, you know, that that's their decision and wasn't seeing that reflected in most of my circle. But anyways, there had always been these seeds that had been planted over the years about midwifery and home birth. And then it was the combination of my work in health care and even bigger than that, my own, you know, brief pregnancy experience that ended up being the water for those seeds. And then I didn't plan this, but I literally was enrolled in midwifery school nine months later.

 

Kit:

[12:27] Yeah.

 

Tiffany:

[12:29] From January in miscarrying and then starting midwifery school that September.

 

Kit:

[12:35] That's so beautiful. Thank you. I, oh my gosh, there's so many threads there that I want to pick up on. And how about we start with your mom? I think you just said, which was that your mom accessing midwifery as well-bodied care. And this is the theme that I see and how I talk about my journey in finding you and the various aspects of support that you've offered, starting from a well-bodied visit as the first visit on a fertility journey. And people say to me often, like, I didn't know midwives could do pap smears. I didn't know midwives, certainly I didn't know midwives could do fertility treatments and IUI. And you did that at a midwife's office? Like, what is a midwife's office? And then I get the opportunity to share about your office and to have magical bits, which I'd love to do in a moment as well. But really that well-bodied, like I do have a PCP. It's pretty funny. I think you somehow subconsciously completely kept that from you for a really long time. You're like, wait, you do? And I was like, yeah, I need it for insurance. I have one. I mean, do you need the doctor? I was like, I just go to you for everything.

 

Kit:

[14:00] So actually, if you could just speak more to midwifery as well, body care, I would love to hear your perspective. Oh, yeah.

 

Tiffany:

[14:08] Well, I mean, the lovely thing about midwifery is that we are trained and educated to provide care that is rooted in our reproductive health changes, whether that is beginning menstruation and that well-bodied care can be integrated at that time. Time certainly there's wellness care and preventative care that's offered to people for preconception so the folks who are taking a moment to say like yes i do want i do want to start a family or i do want to become pregnant and i want to do it in a certain way certainly that wellness and preventative care is provided during pregnancy and in the the early postpartum time and can be provided and offered during perimenopause and menopause so i think you're We could do a better job as midwives in providing that education that we're really looking to support people's reproductive wellness throughout various phases of how that's experienced or expressed. rest.

 

Tiffany:

[15:09] Midwives, I think for the most part, people who come to Midwifery have a little bit of a heart, if not their whole heart rooted in education and being a teacher, perhaps not in a classroom setting, but often in a clinic setting or office or in somebody's living room. And so a lot of the The education that I provide is looking at how can we help this individual, this client, this patient establish a foundation of wellness, just starting from where they are, or how can we help them maintain a foundation of wellness? There are certainly things that I consider the foundation of wellness, such as good, healthy nutrition and making good choices within where somebody is at, financial financial resources, access, and so on. How we're moving our bodies, whether that's intentional exercise.

 

Tiffany:

[16:08] Walking, swimming, yoga, you know, all of the choices that we have there. Stress management, looking at sleep, as it turns out, ovaries tend to work better when we have consistent sleep. And so these are sort of like our basics, but because of the way that our lives are today, where we're on the go and we're making connections often through and with the use of technology, the idea of a 40-hour work week has become a myth. A lot of people are working way more than that, that these basic things like eating and hydrating and getting sleep and getting exercise, these are hard things to come by and stay attentive to. And so as a midwife, I love getting to reorient people to these pieces and bringing them back to their bodies. Bodies sometimes that work is hard because not all of us trust our bodies especially when we're talking about in in women or people who grew up as women that we were really taught that we could not trust our body and our body signals or that our processes of our bodies like menstruation were things to be ashamed of or afraid of. The process of ovulation, you know, mysterious to most of us, you know, not taught in our sex ed classes. So it's challenging work to help people come back to their bodies and to connect with their bodies.

 

Tiffany:

[17:37] It's challenging to support people in trusting their bodies. We provide care also to trans individuals, and I believe that that can be an even greater hurdle to overcome when there has been gender dysphoria. How do we really root in the body, and how can we have an embodied experience, whether that's conception, whether that's pregnancy, body feeding? How can we have an embodied experience when oftentimes people feel betrayed by their bodies.

 

Tiffany:

[18:11] A big part of what we do in that wellness care is also coming from a trauma-informed place, which we're hopeful can empower people to be active participants in their wellness care. Because the reality is that the 15 minutes that we might spend in a practitioner's office, or perhaps in the case of my office, the 60 minutes that we spend together, other, that's a mere drop in the bucket. That's a mere fraction of the wellness care that's happening for that individual. Most of the wellness care is happening outside of the office in that person's home, in their day-to-day life. And so wanting to give people the tools needed to make that, make that a priority and to make that sustainable and accessible. Yeah. Yeah.

 

Kit:

[18:57] And I just sort of smirked when you said 15 minutes. I was like, there's never been a time where I've been in your office for just 15 minutes. And that was this huge, huge moment for me. I've mentioned it on this podcast many times, not just in this series about the home birth, but my first experience in meeting you and going for a well visit and having a pap smear. And walking into the first of your two rooms and sitting down and thinking, I mean, I think I booked a one hour and that's like, so I can see it on line. Right. But that didn't land with me as that I had a whole hour with you. I remember sitting down and be like, oh, it's nice. Do I have time to have tea though? It's so nice. She offered it to me, but I want to get through. I want to make sure I have a lot to say and I should, because that's what I knew. That was the only thing I knew with talking with people in the medical space and you just slowing things down and taking so much time and going into my gut issues and my thyroid and just the the my my past with sexual trauma I mean it just was this unbelievable opportunity to share truly holistically what was coming up for me with my health and wellness and then you saying you know are you comfortable going through with having an exam right now and just realizing in a conscious way that this woman is...

 

Kit:

[20:24] Intentionally letting me verbalize my yeses and how profound that was to experience to not just hope for think about or or be frustrated when wasn't happening but to actually be grateful and present with actually experiencing trauma-informed care um and then going into a different room with just as many beautiful pillows and and light and and getting in and just looking at you and being like I'm confused like where do I lie down like where are the stirrups you just looked at me and you're like yeah that's what you said I've never met anybody who likes them I was like good point but how is she gonna do this and then you're just like, bolsters are under me and everything else I'm like propped up like so comfortably.

 

Kit:

[21:17] And then these maybe little, although just like profoundly huge increase of like, here's the temperature of my hands. Can I place my hands first on your arm or on your hands so that you can feel my hands? Now, is it okay with you to touch your tissues? Just everything being up to me to be a participant in, but not just a participant, but being really with you in the decision-making process.

 

Kit:

[21:48] And I think I've shared with you that after that visit, I had to, like, collect myself in the parking lot afterward because I was just crying. And it was this intersection of, like, deep gratitude to have experienced something so beautiful and so different. and real sorrow for the many, many times that I had... Not been treated with that level of care. Really sort of having these flashes of recognition that, no, I wasn't crazy to be upset with how different visits went, or it wasn't me asking for too much to just be treated like a full human being going in to get different reproductive care over the years. And so, yes, from there, I was very, very fortunate to have my mind opened to all these possibilities of being treated so so differently and really again to to live that trauma-informed care um.

 

Tiffany:

[22:49] Which can't happen in a 15-minute visit you know so with all due respect to other practitioners in this field in women's health reproductive health care most most if not all of those practitioners went into this because they really and truly wanted to help people but the systems make that more challenging. For a lot of people, they haven't even warmed up to me as their practitioner, especially if they're meeting me for the first time in 15 minutes. So they kind of give that time and the space to chat about the weather, chat about what's going on outside of their own healthcare and just kind of warm up and figure out how do we communicate before we get into the actual clinicals. And I didn't even talk about the clinicals. Like, Like, yes, we have clinical skills and can do a physical exam. And you're right, we can do pelvic exams and pap smears. We can draw blood or order pelvic ultrasounds, various things that may be supportive to someone's health care and their health care choices by getting added data points because informed choice and informed decision-making is really important.

 

Tiffany:

[24:01] But yeah, some of it is intentionally choosing to practice a little bit outside of the system, not in a radical way, but to say, I'm going to be in private practice so that I can offer a 60 minute visit as opposed to a 15 minute visit. I can't even warm up, you know, not in an obvious way because I do really, really well in one-to-one interactions, but I too am shy. So it takes me a moment to warm up and I couldn't do that in just 15 minutes or less.

 

Kit:

[24:29] Well yes please speak to your clinical care because i i sometimes i'm often asked like well what experience is tiffany having not anymore because of the journey that brought us mark because now everybody knows like not to not to not to question tiffany in my life um and that's from a place of like knowing my deep gratitude and reverence for you but But then also having witnessed your support, and I think in witnessing that, it's just became undeniable the level of expertise

 

Kit:

[25:05] that you bring in addition to the care. So if you could speak to that, that training and the clinical capacity. Yeah.

 

Tiffany:

[25:14] So I chose to go to an accredited midwifery school that focused on providing care in community settings, meaning providing care in a birth center that's not attached to a hospital or providing care in the home. So there in the model was very distinct and different.

 

Tiffany:

[25:33] We, in this school setting, we had both didactic learning, meaning I spent time in the classroom for the first year and a half covering a wide array of topics and starting first with understanding and appreciating what is normal and that there is a wide spectrum or variation of what is normal and then moving into learning about complications. How to identify complications, how to manage complications, because despite all of the processes that I referred to, like menstruation and ovulation and pregnancy and birthing and postpartum body feeding, menopause, they're all normal, but they're also at times vulnerable to complication. And we don't always know when that might happen for somebody. And so wanting to be well first in recognizing it and having the skills to address it. While we are in the classroom, we're also having what we refer to as clinical rotations. And so I spent, for example, seven months in a well-bodied clinic learning with nurse practitioners, not just by observation, but by providing hands-on supervised care with these nurse practitioners. Practitioners and that included conducting physical exams where I might listen to someone's heart, listen to their lungs, feel their neck for lymph nodes or for the size of their thyroid gland as well as its consistency, doing breast or chest exams.

 

Tiffany:

[26:58] Listening with a stethoscope over the abdomen and getting a sense of what is the digestion up to and including the pelvic care that I just mentioned. I also had a clinical rotation that spanned over a year working with midwives who attended births in both a birth center setting and a home setting. And that practice also included some naturopathic doctors. So I was able to learn from them as well in how some primary care issues might be addressed from a more holistic standpoint. And then the next year and a half, I spent 100% in the fields under the wing of certified professional midwives. So midwives that held a credential, the same credential that I was working towards in attending births in the home setting. And that gave me the opportunity to observe and to assist in and also learn how to lead the care while under supervision.

 

Tiffany:

[27:56] For example, during a prenatal visit, I may have been the one to do all of the prenatal education, providing anticipatory guidance, meaning like by the next time I see you, you might be feeling your baby move. Or by the next time I see you, you might not be feeling anything. You may no longer be feeling pregnant because you're not sick and tired anymore, but but you're also not feeling baby move. And that's a weird space. And so providing that anticipatory guidance, talking about all of the standard of care options around testing and treatment and ensuring that people understand what that means and how that relates to them and the way that they're caring for themselves and what the benefits and risks and limitations of those things are, as well as the hands-on exam, right? Checking someone's blood pressure, screening their urine as one more way of collecting data for gestational diabetes or preeclampsia by palpating someone's belly, like literally hands on the belly to get a sense as to what position baby's in, how active a baby is, measuring the belly and make sure that the uterus is growing as expected, listening to baby's heartbeat, whether by fetus scope or by Doppler, like all of these things, getting the experience of practicing them in the hot seat, if you will.

 

Tiffany:

[29:12] But with another midwife who's been training or working for some time and has been credentialed for quite some time, who could be almost like the lifeguard that I'm going to step in if Tiffany misses something, or I'm going to step in if this is getting out of her depth. So I had three years of training with that level of support.

 

Tiffany:

[29:31] On top of my time working in healthcare prior to that, I had already worked in a primary care office where, as a medical assistant, I assisted with colposcopies and endometrial biopsies. I had a lot of context for all of the care that wasn't necessarily inside my scope of practice, but could provide information for those times when it was like, okay, we're outside of what I can offer. Here's your next step, and here's the care that you're looking for outside of this setting. So yeah, it was a fantastic opportunity to train and be mentored as well as to develop critical thinking skills and a strong theoretical foundation.

 

Kit:

[30:12] So wonderful. When you had, when you came over for our home visit, would that have been about a month before Mark was born? Yeah. With everybody who was going to be present for my home birth. So it was Tiffany and her midwife in training, Olivia, and my birth doula, who had just become a certified midwife as well, Hannah, and Carrie, who is a midwife and also my naturopathic practitioner. Practitioner and then I intentionally invited my mom too because I knew that she was feeling a lot of questions and that she would just really love and be reassured um you all and particularly you um who she had heard so much about and you just thought this great line that we we just weave into jokes regularly but yes no we don't come with just a crystal and a bite stick, And then you're supposed to, you're like, not that there's anything wrong with either of those.

 

Kit:

[31:21] But I do think that there is some mythology about midwifery and home births that have people discredit that level of expertise and training that so many of you all have gone through. And there seems to be this focus, what I believe is extremely few or even maybe truly non-existent, but the quote-unquote bad midwives, which has been this trope that has come up occasionally for me, particularly in lieu of this law that was very scary about a year ago, was it? That it seems like it might come through the main house that would severely limit, if not completely eradicate, the ability for midwives to practice home births. And that happened, I believe, within the first year of me having had my home birth. And I just was cognizant that we hoped to have another pregnancy, cognizant that I was so grateful for my experience.

 

Kit:

[32:32] And cognizant that I just, you know, very personally and self-focused wanted to be able to choose that for myself again, but also really wanted to make sure that other people in the state of Maine had that as an option. And that's what I just kept hearing. Well, we need these regulations because you, you were lucky kit. You seem like you had a midwife who actually knew what she was doing. I mean, just these unbelievably condescending misinformed narratives. And thankfully, um, Because of so much work from the midwifery community, that bill wasn't introduced into the legislature. But I wondered if we might speak a little bit about taking a little bit of a turn before we kind of circle back once more, but to some of the biggest challenges that you face as a midwife and as a part of the midwifery community.

 

Tiffany:

[33:28] Yeah. And if I can also just honor that, like one of the things that can be so beautiful about reproductive health care, but also incredibly challenging here in Maine, we have long time held space for and respected choice for provider and choice for place of birth. And what that means is there's a lot of diversity in those choices that when someone chooses a home birth it may not be with a certified professional midwife it may be with someone who is from their community as maybe the case in the Amish community they might choose an Amish midwife that may have a really different level of training also different level of access us to the certain tools and equipment and medications. It could mean that someone has made an informed decision to have a birth keeper or a birth witness, someone who may not be providing any clinical care, but is considered the birth attendant. When I hear people talk about like, you know, a good midwife versus a bad midwife, I first of all have to.

 

Tiffany:

[34:39] Remind myself of where that language and rhetoric came from. And that came from a big shift 100 years ago, more than 100 years ago, as the medical association became organized and started to offer birth in a hospital setting. And part of the language at that time was to put down midwives, put down home birth, and to elevate the services that were being provided in a hospital setting or with doctors and eventually OBGYNs. So I think the public is continuing to repeat some of that rhetoric that has a long time kind of stayed around and it gets passed down generation to generation. And that's why it's so important for us as midwives, particularly certified.

 

Tiffany:

[35:23] Professional midwives, because our work and our profession has rapidly changed even in the last five to 10 years for us to do the work of educating the public and educating providers of who we are and what we do and what we don't do and what we have access to or don't have access to. You want to hear the language of like a good midwife versus a bad midwife, not throwing anybody under the bus, but certainly we can have good OBs and not good OBs, right? Having a license doesn't always guarantee that that practitioner is a safe practitioner or is keeping up with their continuing education or all of the pieces that speak to safety just may not be in place. I think that oftentimes providers like an OBGYN, they are in a system, right? They work for a hospital or a large clinic, especially as we see more and more consolidation of services. And so So there's more support when the birth doesn't go as hoped or as planned. Whereas for us as midwives, we tend to be in private practice. We might be on our own or in groups of two or three. There's less support there. So there is that piece that I just want to recognize and honor. I've already forgotten the question though.

 

Kit:

[36:38] Thank you so much. I'm going to get back to the question, but I'm not going to share. Share but that was that was exactly what I hoped to to glean from you and just the rootedness and choice is really what I tried to focus on when I was having these conversations because it seemed so clear to me that in that language that was being used this good midwife bad wife is your lucky you know this this was within months of the Dobbs decision being made and I was having conversations with progressive elective officials who were introducing this legislation, this anti-midwifery legislation. And I really tried to point out to them that they were not honoring the, to the trust of women, that this idea that we need to be protected by these regulations was actually really rooted in an inherent distrust of us and our ability to make choices for our body.

 

Kit:

[37:38] And that's really certainly how I came to see it. And I was, of course, very glad that they chose not to pursue forward with that legislation. And it comes up in all of us. It's very internalized. You know, and that's why I say so much like this was the right choice for me at that time. And we've talked about this next pregnancy of really being conscious of making the same or having the same awareness and discernment of what's right for me at this time, not falling back into, well, I did this before and it worked because that can be so compelling, but also not necessarily leading to the most aligned choices of the moment. It and that said and i don't think at this point i've actually really felt any big shifts there but just being open to it and putting some attention toward the the reality that things could be different and things could feel different, But when it comes to having not a certified midwife, but a birth keeper or an attendant, a witness, these are all choices that aren't resonant for me, but I am so glad are available to others. And also what I've been trying to say to people just like you I'm not forcing my home birth on you.

 

Kit:

[39:02] Please don't force any sort of birth experience that you might feel aligned and called to on me you know like this is this is what we're trying to talk about this is the way to honor women and birthing people and I know we're trying it is I think I just really wanted to try to explode the myth that this was about protection because it didn't feel that way. It felt like control and it felt wrapped up in some protective wrapping paper, but they were wrapping up some really controlling legislation.

 

Tiffany:

[39:36] That work is still continuing, right? Like the work around LD 1205, it continues happening in a different space instead of the legislative one. It does seem like some of the issues that were brought up with LD-1205 may have been rooted in some misunderstanding, which is why important stakeholders are coming together and having some good conversations. And we'll see, we'll see, you know, where it all lands. But midwives are getting to be a part of that conversation and provide education in that space and some clarification. And it's great to see a team sitting at a table and really trying to work through something that is not coming across as trying to restrict options or choices. But really, I think what we're starting to learn is that we could all benefit from improving the way that certified professional midwives and...

 

Tiffany:

[40:38] Medical providers such as nurses and OBs and neonatologists and you know pediatricians that we could really improve how we all work together but that's going to take understanding issues on on both sides beautiful yeah thank you for so I think I think thankfully it feels like it's dialed down for the moment yeah but again just wanting to make sure like I didn't go I didn't go down this path to become a certified professional midwife, because I think everybody should have a home birth. I just wanted to be one of the options, a safe option in providing home birth. And yeah, there are times when I meet with people for a free meet and greet and say, okay, tell me a little bit about yourselves, what draws you to home birth midwifery. And I get to share a little bit about myself and my approach, but also what I offer. And part of that conversation is about the rules and regulations that govern what I can and can't do. And some people find safety in that, a feeling of safety of like, oh, thank goodness you do know how to put in an IV or thank goodness you bring oxygen to a birth. Thank goodness, as much as I love herbs, I just feel so good knowing that you also have anti-hemorrhagic medications.

 

Tiffany:

[41:53] And then other people, that same exact conversation activates a fight, flight, or freeze, And that really doesn't communicate safety to them at all. And that safety might for them be in the hospital or safety might be at home alone where they can completely protect their birth and their birth space from any providers. So there's quite a spectrum there. But I certainly am not a midwife attending home births because I think this is what everybody should be doing.

 

Kit:

[42:24] Yeah, no, it's so beautiful. I said that whole notion that we all take in information differently. And so the same data can have two different people come up with completely different paths. And I'm just such a stand for that. And you know that my best friend was pregnant at the same time as me. And I said to her something like, yeah, but we have like similar birth plans. And she was like, we do not on any level. Like I'm going to a hospital in DC only work with OB is like, what? But you're doing everything you want and I'm doing everything I want. It's the same. Okay. I was like, no, that's, and I didn't, it was just a good moment for me. I was like, that's truly how I feel. Like, I'm so glad we both have the same experience of feeling like we've chosen the right people to support us through this.

 

Tiffany:

[43:22] Yeah.

 

Kit:

[43:23] So I think there are a few things that I just are really important for me to share. And yeah, One of them is just sort of some clarification around costs, actually, and some clarification around care and hospital transfer and particular C-sections and how those sort of, though they range from community to community, but what sort of the comparison for folks to be aware of if they are considering in an in-between space of hospital birth or home birth. Just I feel like there's also a lot of misconception around both of those.

 

Tiffany:

[44:08] Yeah, so when we're talking about what we might refer to as maternity care billing or billing for providing pregnancy care, labor and birth care, and postpartum care, that's usually done on what's called a global basis, meaning there's just one insurance code that encapsulates all of, again, the pregnancy, the birth, the postpartum, as opposed to breaking it down visit by visit. Typically midwives who provide either care in a birth center or at home are following that same model. And part of my hope and my goal in following that model is that people will feel, empowered to access the whole spectrum of services, as opposed to what sometimes happens is that people are making choices about which visit to go to because they're trying to manage cost, right? And then they end up having really scant prenatal care that may have set them up for a healthier outcome had we done the whole spectrum of 10 to 13 prenatal visits or whatever that looks like for somebody. There's a range here in Maine. I think the range is somewhere between $3,000 to $6,000 for all of that care. And the range is impacted by community or region. The prices may be in Northern Maine, may be different than in Southern Maine. It may be reflective of the services that added services that might be available in that practice.

 

Tiffany:

[45:38] Certainly not reflective of quality. I know the midwives who were providing

 

Tiffany:

[45:43] care at that $3,000 level and the midwives who were providing care at the $6,000 level. And it doesn't mean that you're getting a higher quality of care or lower quality of care if you're choosing one end of the spectrum or the other. Almost all of us have some kind of system in place to make that more financially accessible. And so many midwives are using a sliding scale. Many midwives also have a scholarship fund so that if someone qualifies for financial reasons, including people who are insured by MaineCare, MaineCare will not yet cover a home birth in Maine. And so wanting to make sure that people who have that insurance that has basically identified that they really shouldn't be paying for healthcare out of pocket, that they're not in a position to do that, wanting to make that care accessible by offering these other programs. Like you said, it varies in a hospital what these services may cost. And so some people who have a healthy birth that has very little to no intervention and healthy, meaning like there were no complications and they give birth vaginally, that may cost $8,000 or it could cost $13,000. It really just kind of depends on where you're giving birth, which facility. A C-section could cost as much as $30,000 or may very well cost more because it seems like everything costs more since the pandemic.

 

Tiffany:

[47:08] So there's quite a difference in cost for a lot of people who are insured, including some of the folks who are underinsured. The cost of having a midwife in a birth center or home birth is actually reflective of their deductible. The deductible meaning this is how much, if I was giving birth in the hospital, I would need to pay $3,000 out of my own pocket before my insurance would cover the rest. And so we've heard that time and time again of like, oh, actually, we're not paying any more than we would have had to if we went to the hospital because this is what our deductible is.

 

Tiffany:

[47:42] Some people are able to get reimbursed from their insurance for their birth center birth or their home birth. And there's a wide spectrum from $0 to sometimes like $2,800 or more that people are able to get back in their pockets if they decide to pursue that route. But yeah, there's kind of a range of costs. It's a good conversation to have with any provider. If you are working with someone who is out of network, including if an OB is out of network, the midwife is out of network, the hospital is out of network or otherwise facility, there is something called the No Surprises Act, which I don't think a lot of people know about. But the No Surprises Act requires that any care that is going to be out of network, that you know what that's going to cost ahead of time and have the opportunity to sign off that, yes, I know what this is going to cost. Hospitals are required to list the cost of all of their services on their websites, though that list is often really hard to find. And I believe that some hospitals may not be up to speed with that. it and so I.

 

Kit:

[48:47] Think one of the experiences that two distance that was not I was beside myself because I went in to a GYN appointment I don't know what was going on and that we both agreed that maybe I should do that even though, and it was 15 minutes it was super rushed it cost us a freaking fortune and it was the second time of me going in because the first time I got there they said oh no sorry we did tell you this would be covered by your insurance now we see your card has some different color on it than we thought it would and it's not covered and we will give you no sense of what this visit will cost yeah,

 

Kit:

[49:29] And I was just, and I, yeah, I tried to use my logic. I was like, do you go into any store or any restaurant and just order or buy something and then wait for the bill to come? Like, this is not okay. So I'm so glad to know of that. Okay.

 

Tiffany:

[49:46] Yeah, this is a more recent change or shift and so exciting. I have no idea like what the systems are that keep us all accountable to it to make sure that we really are informing people ahead of time. But just know that as a consumer of healthcare services, you do have the right to know when it's out of network, what it's going to cost ahead of time. And you have the right to know that something's going to be out of network just because you present at the emergency room, which this emergency room department is in network. It doesn't mean that the provider who's taking care of you in said in network emergency room is in network. And so there's still, I think, because this is a newer thing, some things to be kind of worked out, but people have a lot more rights than they might realize. But the No Surprises Act, again, all hospitals are supposed to have a list of what things cost. That's out there. And that tends to be just kind of built into midwifery care, that this is what it is ahead of time, and letting people know at that first meeting, this is what your financial responsibility is, and then sticking with that throughout.

 

Kit:

[50:50] And so just to summarize, we're really looking at generally and we'd have each individual make sure that the specifics was applicable to them but generally it's savings of thousands of dollars actually to do a home birth and you're receiving much more time with your practitioners um both during the pregnancy during the laboring the delivery and postpartum and like i i much more just doesn't even seem to, really qualify just the level of care. And I think it was really, for me, it was my friends and family witnessing the care postpartum that really just had people.

 

Kit:

[51:39] Scratching their heads and rethinking things because you were with us for so many days and then checking in over the phone and in person for many weeks. And I just want to have the opportunity to share, you know, I've now asked about the costs for people to consider. Inevitably, it's important to consider the sort of what if, what if something does go wrong. And so I'd love to look through that lens in general and then also have the opportunity to share my experience of, for me, what, quote unquote, went wrong and how together we navigated that. So just to start, could you share sort of your general answer to folks who say, like, what if I need something that isn't available at home? What happens then? And then we'll go from there.

 

Tiffany:

[52:34] Most of the times this is a conversation that's happening while somebody's in labor or they've just given birth. And so when specialized care is needed that's not available in the home setting, it's the responsibility of the midwife to state that immediately and to state that very clearly and then to activate an emergency care plan. In some cases that may be calling EMS by dialing 911 and then collaborating with the EMS team. The EMS team, meaning paramedics, EMTs, they have a set of skills that we as midwives don't have, but we also have a set of skills that they don't have. They have resources that we don't have, but then we have resources that they don't have. They don't have a means to monitor a baby's heart rate. They don't have anti-hemorrhagic medication that they can use for someone who's just given birth. So...

 

Tiffany:

[53:32] When I say that we collaborate, I really do mean that we collaborate, we work together as a team. Sometimes we make the decision to transfer via ambulance, not because it is an all-out emergency where we wish we were already at the hospital, but because we want to be able to collaborate as a team while en route and continue to provide monitoring or provide care. Usually the midwife leads that effort with the support of the EMTs and paramedics. Sometimes we're choosing to ride by ambulance because there's more room. You know, if somebody is about to give birth, it's really hard to provide good care in the backseat of a car. So just know that there may be different reasons why we're choosing to transport that way. And it doesn't always mean that it is an all-out emergency. Most of the times when we transfer in, we have made that decision based on a pink flag, a warning sign, and not on the red flag. And it's important to be attentive to those pink flags, knowing the limitations of our setting, as well as thinking of other pragmatics or logistics like that it may be, today happens to be a snowstorm and therefore it's going to take us longer to get to the hospital. Or today is, it is currently New Year's Eve and we're getting close to last call. We don't wanna be on the road at last call. So we might make the decision to go sooner rather than later based on a pink flag. bag.

 

Tiffany:

[54:51] When we transport by a private car, we are calling the hospital ahead of time to let them know, but actually no matter how we transport, we call ahead and let the hospital know that we're coming. We let them know what the situation is. We let them know a little background about that individual, whether it's parent or baby that needs to go. We offer our assessment of what's going on as the people who have been hands-on in the situation and also offer some recommendation based on what we're seeing. And the hospital then does the work of preparing to receive that person, preparing a room, preparing staffing, preparing the operating room if that seems that that's highly likely to be needed on arrival.

 

Tiffany:

[55:29] Records are faxed en route so that the providers who are receiving us at the hospital have an opportunity to read those, review those, have a set of clarifying questions if need be. And then the midwife goes in with the client,

 

Tiffany:

[55:44] and continues to be a part of the care team, not where the midwife is making clinical decisions. It may not even be providing hands-on clinical care or medical care, but works as a cultural broker, that in-between person that helps the hospital staff to understand where this client is coming from or the parents are coming from, help the parents to understand where the hospital is coming from so that care can be provided seamlessly. And sometimes a lot of that is is educational work of, okay, the medical team is proposing that they do this. Here's what that needs. Here's what that procedure is. Here are the benefits. Here are the risks so that people can make some decisions around that or even just feel empowered knowing what's happening to their bodies. It's so heartbreaking to hear people who've been cared for by any provider across any setting and they didn't understand what was happening or what was done and don't know what this was called or that was called. That's sad to me.

 

Tiffany:

[56:40] So we continue to remain in situ and make sure that they are stabilized and they have a point of continuity with them. And again, someone who can advocate on their behalf. I do see that ultimately I work for the client, but I do see my responsibility is to support the medical team who does not yet have a rapport, who does not yet have a handle on, you know, the situation. And so I try to be supportive to both so that it really does look and feel and work like a team effort, as opposed to a lot of disjunction and poor communication, bad feelings, you know, that make it hard to work together. I really, really see that as part of my job.

 

Kit:

[57:22] Thank you for that. And how often is it in just your practice, us? Because I know this varies too, but to do, to start at home and end up in the hospital, and then how often does that lead to C-section? Like what are those comparative rates?

 

Tiffany:

[57:40] Yeah. So over the 10 years I've been working in Maine, my transfer rates have been about 26 to 28%. I have had, Three, emergency transports in 10 years. Three, where here's a situation that's presenting itself. It's not resolving in the home setting. We absolutely have to get to the hospital as quickly as possible and have more support. So it's not the thing that's happening every day, despite averaging about 40 births per year. that.

 

Kit:

[58:10] Not sorry to interrupt you i just want to make sure i'm understanding that 26 to 28 percent those the vast majority of those were decided before the person went into labor.

 

Tiffany:

[58:18] The 26 to 28 percent were transfers that happened in labor but were non-emergent transfers got it got it meaning we made the decision to go on a pink flag like non-reassuring fetal heart tones or we seen meconium in the amniotic fluid. And so knowing that that elevates someone's risk status, we made the decision to go into the hospital. And I communicated that I would recommend going to the hospital. And here's why. Here's what we're going to access in that setting. So most of the times it's non-emergent. Most of the times it is someone who is birthing for the first time, knowing that those labors can be longer. They can be more challenging to work through and where the birthing laboring parent is quite tired. And I'm not saying it's taking too long according to like the clock says you're taking too long. Also bearing in mind how someone is coping and working through. When we hit that point of exhaustion, we are working so hard just to hold ourselves together that we actually can't allow our bodies to do the work that it's meant to do during labor. When we've made the decision to transfer because it's been a longer labor and this parent's energy is getting tapped, I'm also holding awareness that if we don't make this decision at some point, we might be increasing the risk of complication, particularly during the pushing phase as well as after the baby is born.

 

Tiffany:

[59:47] It has not been terribly difficult to elicit the participation of the client in that. Usually the client is like, yeah, I just feel like I need to do something different. You know how we say the definition of insanity is doing the same thing over and over, expecting a different result. And so some people are just like, yeah, new tools sound really great. But that's the majority of times when we do a transfer. And again, it's not an emergency. We're able to go buy a private car.

 

Kit:

[1:00:12] And then you were speaking to those three emergency.

 

Tiffany:

[1:00:16] Agency yeah yeah.

 

Kit:

[1:00:18] So rare in that sense and then the c-section comps i'm just curious.

 

Tiffany:

[1:00:23] Yeah so on average it's seven to ten percent in my practice would be the c-section rate and the world health organization has informed us that the healthiest c-section rate for a facility or for a state, for a country would range between 5% and 12%. And I've managed to stay within. If you're less than that, then maybe you're not intervening when you really should. And people are experiencing higher complications, long-term complications as a result of that decision. And certainly, we have some questions to ask if we're doing C-sections at a higher rate than what they've described as healthy.

 

Kit:

[1:01:03] And that is that World Health Organization 5 to 12. That is much lower than my research from a couple of years ago showed hospitals in my area were at. And the national average for hospital births is closer, somewhere between 20 and 30 percent.

 

Tiffany:

[1:01:24] Which is exciting in that that's lower than it used to be. So we are moving in the right direction, but it's still quite high, right? It's more than a couple.

 

Kit:

[1:01:34] That's a good perspective. That's a good perspective. You always get that.

 

Tiffany:

[1:01:38] It used to be more like 33% and some hospitals are in the 40% range, right? And so I see that statistic and I see opportunity and I see improvement and

 

Tiffany:

[1:01:50] it makes me really excited for the continued changes. We have some really great hospitals here that employ midwives, midwives who work only in their hospital. And now some of these hospitals, they are our first line. The midwives are the ones who are receiving our clients who not only have a similar approach to care, but in that approach, like one of their goals is to support vaginal birth where possible and to avoid that primary C-section that sets somebody up for repeated C-sections. And so that I feel really excited by that because I think it's moving in the right direction and hope that it continues to move that.

 

Kit:

[1:02:28] That is wonderful to hear. It does bring me to one additional thing, which is just to remind people that, That birthing in your 30s and 40s does come with different options right now in our system. For me, I didn't have access in my first birth. I imagine it's the same if the policies are the same in this current pregnancy to consider the hospitals with midwives because they have an age limit.

 

Kit:

[1:02:59] And so just in terms of reminding people to ask as many possible questions up front so that those things don't come as a surprise later down the road. But I think we're moving into good places too there, I think, even though maybe my chip on my shoulder about that is, I guess, just dwindling a little. I can find some more humor in it.

 

Kit:

[1:03:21] And I've just had an ultrasound. I haven't even told you, Tiffany, it went really well in a hospital setting that I've had some pretty problematic experiences with before. And I actually was able to have like a real proper giggle and chuckle with the woman who was doing the ultrasound around how I am 42. too.

 

Kit:

[1:03:47] And it was just good to like laugh about the different coding and to have her, a much younger woman, just also reflect back sort of the absurdity of the different protocols that were put through with an indicator that, Tiffany, you have so helped me see that just gets pathologized in these hospital settings and age is something to be in consideration of as a risk factor, but it is not a diagnosis and that is something that I like is a bit of a matcha for me because otherwise it can it can just get definitely exhausting for me to be told over and over again my age because I know it's a report but then also it can get in my first pregnancy in particular it got it got into my psyche as as landing as a bit of fear it just felt like it was such this focal point of everybody else that it made me start to doubt myself or wonder if somehow I am too old or if this is much more of like a diagnosis than it is one factor of consideration around your risk profile.

 

Kit:

[1:04:52] So I think that you mentioned something, Tiffany, when we were talking about the transfers transfers and the more emergency settings. I believe you said understanding, making sure that, the birthing person you're supporting, his understanding of what was happening and what was done. And I will also share that I hear from a lot of folks who feel disempowered and in need of support after a birth that they label as traumatic, that they still, weeks, months, years later, don't understand what was done and certainly don't understand why. And we're not included in that decision-making at all clearly noted by the fact that they still don't know lots of the more fundamental things that were considered by others and done therefore to them and i just want to share in this opportunity some stuff i've been ruminating about in response to, the the sort of the facts of that i had this postpartum hemorrhage and lost a lot of blood.

 

Kit:

[1:06:08] And that that didn't land in my body as trauma. And I'm kind of stunned by it because I feel like in so many other circumstances, if you had told me that five or six years ago, even, I would have been like, no, that sounds like something that would be really hard for me to navigate. Mm-hmm.

 

Kit:

[1:06:32] And similarly, I had a miscarriage in 2021 that absolutely landed for me as deep trauma and kind of knocked me down in a way that I'm just still processing. And just that reminder that it's really not what happens to you, it's how that process happens. And the juxtaposition for me is that in that miscarriage we did choose to go to the hospital and the care I got there in that one setting with those one practitioners, was really disempowering I was not looped in I was told repeatedly they couldn't tell me what was happening that I'd be explained I would I would get an explanation later and that they weren't allowed and my husband at the time wasn't allowed in the room I somehow did have them review that policy and change that um but but then just as i was walking out this younger doctor said to me something like you are sure though you were once pregnant right.

 

Kit:

[1:07:42] And that like to me i just want to say like that level of cruelty even though i know, that his intent was not to be cruel that's how it landed to me it's like here you are having been so effing condescending to me for the last 30 minutes, telling me that you couldn't explain to me what was happening. And then of course, by your question, you just illuminated complete certainty to me as to what's happened. And so that is still something I'm processing through. I've come a long way with, but still processing through and just to see the juxtaposition position of the postpartum hemorrhage and to have those.

 

Kit:

[1:08:25] Those instances in so many ways seem so similar. And my experience of them could not have be further. Just remember so clearly thinking something's not right. And looking up, you were around my womb. And Dr. Carey was up where I could make eye contact with her. And I'm just going to share how I remember it. And I'm so curious if this matches. I've been wanting for over 17 months now and I just I I think I said something to Carrie like I'm bleeding too much and she looked down and looked to you and like conveyed that and you can like confirmed with me I felt like you slowed down time and time slowed and we had a lot of eye contact and you you explained that I was losing a lot of blood and that your recommendation would be to have a shot of Pitocin. And you explained that. And I remember you asking, do you consent to that decision? And me being like, oh my gosh, even in, I mean, I remember thinking even in this moment, like even in this moment, she's letting me consent.

 

Kit:

[1:09:40] And so I said, yes. And then it it continued and you advised me again to have another shot and I consented. And then you let me know that you were advising to go inside and help remove with your own hands, some of these clots. And I consented and yeah, And I felt so cared for and so present to what was happening that it also allowed me to turn to my husband and very slowly and calmly say, you need to take off your shirt. You need to lie down next to me and you need to hold the baby. And he remembers that moment in a totally different way. But he remembers it as like a super empowering way. And the details of which are exactly the same. that even last night when I was speaking to him about talking to you this morning, he was like, I don't think I put together though that you were like bleeding out. I was like, probably not. But just the level of presence in the room was so powerful. And so there was just been no landing of that as trauma in my system. So I would just love to hear your take on that.

 

Tiffany:

[1:10:52] Yeah. Well, I mean, first of all, I'm so sorry that you had those experiences, the experience of a postpartum hemorrhage and the experience of a miscarriage and the way that care was delivered or not delivered during the course of the miscarriage experience. I think that's one of the things that we as certified professional midwives, you know, in really holding that trauma-informed care is really important. Not just thinking about trauma that somebody already might carry into their care experience, but also the trauma that may be happening right in the moment. And I don't know how much I'm allowed to say because like HIPAA.

 

Kit:

[1:11:32] Can I?

 

Tiffany:

[1:11:33] I'll sign anything. I know, sign on, right? Just like in general, when someone is having significant bleeding after the baby is born, one of the goals is to very quickly rally the consent and the participation of the client. It kind of does a couple of things. One, it helps me to have a finger on the pulse, like figuratively of like, are you with it? How is this like physically impacting you or physiologically impacting you? The conversations tend to happen really quickly and sometimes might even sound like.

 

Tiffany:

[1:12:06] I you've got a lot of bleeding i need to give you a shot of pistocin can i get your permission to do that you know as it's already being drawn up and you know it's ready to go but just wanting to make sure that like we are on the same page about things we have a spectrum of options you know available in managing significant bleeding but there are times when the medications are Like that's clearly what's indicated and not some of our like softer, gentler tools. And most of the time we've had a prenatal conversation about it, right? That we sit down at that home visit where you mentioned, you know, that the doula was present, the assisting midwife, your mom was present, your partner was present. You know, we all came together and sat at your dining room table and said, like, okay, let's go over some things. And part of that conversation was, you know, as it is with everybody, right? Standard of care is to do what's called active management of the third stage. That means, you know, do we act preventatively or prophylactically after the baby is born to try to like reduce the possibility of miscarriage or do we watch and wait and only respond to what's happening, you know? And that's a great opportunity for clients to ask more questions or for us to get a feel of like when someone is like, oh, absolutely not. I would rather die than have medications.

 

Tiffany:

[1:13:26] You know, it's like, wow, this is something that we really need to sit with and unpack a little bit more and have conversation about before we're already at the birth, you know? And so I feel like the prenatal conversations are really helpful that we already have rapport and that usually, like almost universally, I feel like I have a trusting relationship with my client where I trust them and they trust me. And that feels like it goes a long way. And that's not always in place, say, in a hospital setting, in part because you just don't know each other, right? It could literally have been shift change 15 minutes before your baby was born and now you're trying to work through an emergency together. And that's not easy to do without having some relationship or some sense of, you know, I've had the pleasure and honor of working with you for quite some time, Kit. And I feel like while I still ask for your permission or still ask like, what are your thoughts here? I sometimes feel like I almost know what you're going to say because I have a sense of like how you make your decisions and what your values and your philosophy is. And I know you've said things to me in visits where you're like, I knew you were going to say that, right? Because you know me when you know how I work. And so I feel like that's best case scenario. If you are going to have a complication for that relationship to be in place and to already know how people work or communicate or how they work in a stressful situation, I know some of my clients shut down.

 

Tiffany:

[1:14:46] And so some of the work that we're doing, like having the assist right there at their head and they're talking to them and keeping them present because they're usually going to freeze, right? Or that somebody else might get really, really aggressive. Like, what do you need? Do you need me to stand up? I'll stand up and birth this placenta. And we're like, actually, you need to lie down. But we already know that about them, right?

 

Tiffany:

[1:15:07] And so I feel like that goes such a long way. And yeah, things can be happening pretty quickly, but it doesn't take a lot for us to have that communication.

 

Tiffany:

[1:15:19] Sometimes if I feel like I'm not in a position to have that conversation, I'll say something to to my midwifery student, or I'll say something to the assisting midwife. And that look that you talked about between Dr. Carey and I, that might've even just been like, I can't talk about it right now. You're gonna have to talk about this with Kit, right? But making sure that somebody, somebody is making those communications. And then we do a lot of debriefing. I feel like, I don't know if this was helpful in your case, but most people who give birth vaginally, they don't have a follow-up visit until six weeks postpartum. That's a lot of time to sit with trauma and confusion. And we're back at the house at one day postpartum. And in some cases, if things aren't stable, we stay for hours, like 12 hours postpartum, right? And then we're back at 24 hours.

 

Kit:

[1:16:06] Another night. Yeah. I don't know. My feeling is like you were there for a couple more days.

 

Tiffany:

[1:16:12] You know, and then we come back at day three and then we see each other at one week, two weeks and six weeks. And that's when things are normal. If things have been complicated and rough, we might be seeing more of each other. Right. And part of that work is not just like, is your uterus shrinking? Is your blood pressure staying healthy? But it's, how are you feeling about the birth? What questions do you have? Do we need to walk through the chart line by line and just talk about what happened? Because even though I may have said like, oh, I'm going to, can I have your permission to use methogen? We're going to try a different drug. Like I might not have explained to you what that was, right. Or why I thought that might be useful. And so we do a lot of debriefing and unpacking and I'm really excited. I'm getting to collaborate with a therapist, a counselor, as well as a doula. And we're, we're working on developing a program about birth trauma for birth attendants, because sometimes these things are traumatic for us as well, or we're impacted by vicarious trauma or witness to your trauma.

 

Tiffany:

[1:17:07] And because we have a relationship, it's kind of hard not to take that on at times. And so, yeah, trauma and the work of it, even when it's happening in real time, is just a really important part of midwifery care. And again, we have the privilege of crafting out the way that we work, including having more time with people or more visits with people to make sure that people feel supported.

 

Kit:

[1:17:28] Thank you so much. That's a piece of the puzzle. I didn't even realize I wasn't cognizant of connecting for myself now, but that level of processing, the space you held for that and the engagement you held with me in processing, so powerful and really helps me further understand how I was able to navigate that in a very neutral, if not empowering way.

 

Tiffany:

[1:17:55] Way, which doesn't always happen in the hospital because not for nothing, the person who caught your baby or delivered your baby, you might not see them in the prenatal space. There are OBs who are known as hospitalists or laborists. They only catch babies. They don't do prenatal visits. They don't do postpartum visits. And while that's important work, and I'm glad that we have coverage for that, you might not ever see that provider again. Talk about what happened in terms of, you know, and sometimes we as midwives are going over records from a hospital based birth with people and just walking them through line by line. But we can only share what's in the document. The pieces that may be captured like that moment, then you gave me a wild look. Like I knew that this was, you know, this for you. And therefore, this is why we responded in that way. Like that's not captured in a medical record, you know. So, yeah, having that access, I think, is really important, but we don't have systems for that in most settings. Yeah.

 

Kit:

[1:18:57] I'll be sitting with all of that. I am so glad to know that you're doing that community work to ensure that you all are supported with your needs around the witnessing that you do and navigating. Navigating, holding space for all of your clients with what we go through takes a lot and would definitely be something that you'd want to have a lot of support around. I know one day I saw you, I think it was maybe, it must have been right before the home visit. And you were like, I'll be right in. And then I like watched you, like just patch of grass and like put your feet into it. And then I was like, oh, I'll give to him in your space. But when you walked back in, you're like, I just needed to ground, like I'm coming from an experience that I needed to clear before coming into your home. And that was just so beautiful to be let in on. And really, I felt so tended to because of that level of care for me, but then that also just like note of like, okay, right, that's the level of care you're offering yourself so that you can show up the way you do for all of us.

 

Tiffany:

[1:20:07] It's so hard sometimes. I think people often when they hear I'm a midwife, they will say things like, oh my gosh, that must be such great work. That's so lovely. That must be so happy. And it's like, most of the time it is. And then sometimes it's really hard. You know, sometimes we are offering a pap smear to someone and they are crumbling on the exam table because of a history of childhood molestation or rape that they're now intimating to us. Or we've just come from, you know, literally attending a miscarriage in someone's home and now we're going to a home visit to plan for a birth. You know, like we, it's not always like happy or you've gone, you know, from this complicated birth and you've barely disinfected and sterilized everything and packed it away and you're getting called to the next one. And so there has to be some, some tools for how to like honor that as its own experience and a teaching experience in a lot of ways. And most importantly, that this is the story of this little love bugs being and coming into being right. And we don't want to erase that. We want to hold that. But also, that can't always be carried or sitting on the midwife's shoulder as they go into the next birth. That's how sometimes fear-based practice, you know, comes into play. And so, yeah, wanting to have those tools so that we can continue to do this work, but make sure that, like, we're not carrying these experiences, our clients' experiences, into someone else's.

 

Kit:

[1:21:29] Yeah, it's so profound. It's something I found myself a little bit surprised and extra delighted and really enjoying the experience of feeling a part of your community of clients and people. And it's not that I've met anybody else who works with you, but it would just be like, Kit, I need to push back. I mean, amazingly to me, truly, like this happens so rarely. I'm like in awe of the management of schedules when there's no predicting when babies come into the world and everything else. On the rare occasion where it was like, I'm running five to 15 minutes late, or we do need to reschedule something or like that. It just felt, it felt really special to be like, of course, like, yeah, because in order to have you offering this level of care to me, I need to be part of the web that steps back at different times,

 

Kit:

[1:22:26] because I trust that that web will do that for me when I need it. And yeah, this has felt extra nourishing and special to me. And we kind of looped into that. So it's really.

 

Tiffany:

[1:22:37] Well, thank you for being receptive. It helps that just about everybody is like trying to have a baby or is having a baby, just had a baby. You know, the empathy and compassion is there. Yeah. Yeah. I mean, I work really hard to try to essentially support people in feeling like when they step into the room or we're in the room together, like they are the only client in the world, you know? And that's where my full focus is. And the reality is that there are, you know, other folks to the point where sometimes I often don't schedule visits back to back, you know, just to give a little more breathing space for clients. It does mean you don't get to see everybody walking in and out, but a lot of my clients have shared community and some of them have not announced their pregnancies yet. So for them to walk by the person that, you know, is that school pickup line that they don't want to know that they are pregnant yet. It's like, I try not to schedule people back to back. You know, I try to give a little breathing room.

 

Kit:

[1:23:31] It's really lovely. Right. I put that together too, but I never worry about bumping into somebody because there's space in between. Yeah.

 

Tiffany:

[1:23:40] Yeah. I'm proud of it about that from happening for people and they can feel like they've got their privacy and they're supported. and yeah wow.

 

Kit:

[1:23:48] Oh my gosh that level of intentionality that you bring to absolutely everything, I just yeah amazed and I'm so grateful to you Tiffany for everything you've done for me and my family and our community and birthing people and.

 

Tiffany:

[1:24:14] Thank you so much for inviting me to be a part of your story and you know for trusting me to continue to to be with you guys and it is really beautiful to get to weave you know like like this ribbon that is my life you know this section of a ribbon in with yours and for yours to also be woven into mine. So thank you so much for allowing me to be a part of it.

 

Kit:

[1:24:40] Thank you. And that actually reminded me that my husband's one question is,

 

Kit:

[1:24:45] what was special about Mark's birth? I'm just curious.

 

Tiffany:

[1:24:50] Oh my goodness. There were so many pieces. I think, I mean, watching you going through your process of, you know, being strong and empowered and going to make this happen. And then also So the moment of like, actually, I have to let it go and let it happen. That's pretty amazing. Because I know you, sometimes I feel like I can read your expressions, right? And those moments of like.

 

Tiffany:

[1:25:18] This doesn't feel like it's happening, right? And then it happens and you go on to do it anyway, right? The space, I mean, you put a lot of intention into the space. And so I have these like really beautiful kind of literal snapshots in my brain of the space and some of the beautiful elements that were a part of that. And so much of a big part of memory, for me anyway, would be smells. And so like certain smells of certain candles and certain moments where you found rhythm with your surges and we're moving you know within that rhythm and it just felt like oh yeah like kit knows what to do now it took a little bit of like having a surge here and a surge there to figure out what's working and then all of a sudden this moment where you were in your bathroom it's like she's found her rhythm she knows what to do so a lot of beautiful moments there's also the like, the deep sigh when everything kind of settled after mark was born and you were stabilized and And we could finally like take a deep breath and I'm going to take a step out and take some more deep breaths and come to center. You know, like, yeah, there's so many beautiful moments. There's just one.

 

Kit:

[1:26:30] We did it just it's funny just to eliminate for the listener. And I was really struggling with getting out of my head and was really, you know, in this kind of trying to make it happen, the labor, and made this decision to stop doing some of the herbal remedies and the other practices to be an act of encouragement and just totally reboot. And knew that there were some risks involved in that. And to me, it's one of, if not the most profound examples of surrender in my life, because I made this really, it felt like such a hard decision to me to just pause or really stop and override my brain that was saying that I was failing or giving up and just trust.

 

Kit:

[1:27:23] My mantra was, I trust my body, I trust my baby, I trust my team. Team and that being the umbrella, I knew that I needed to take this rest. And so you all left the room. Reno lied down with me. I asked him to rub my lower back and like within five minutes, two minutes, a very quick amount of time, I said to Reno, I was like, you actually need to go get Tiffany again and tell her that there is water in my vagina. And he was like, okay. And that kicked kicked things off. And it was really beautiful and profound for me in terms of letting go and really what it means to deepen into that trust. So.

 

Tiffany:

[1:28:04] And then listen to the body, right? Like, I think the feedback that your body was telling you is that the more that we were doing and more that you were doing, the less effective it was. And if we just let it be. It would come together. And so, yeah, again, coming back to the like body trust, which is a hard thing to do to go from like the headspace and the heart space even, you know, into just like full body space. But that's what this is.

 

Kit:

[1:28:33] That's what this is. That's what the big this for me is. That's what Qatar is. That's what steaming is. That's what all of being an embodied soul on the planet at this time is to me. So what a beautiful place for us to close. Thank you for bringing me to that moment. And thank you for all the gifts that you bring to me and my family and the world. You are so special and dear. Thank you.

 

Tiffany:

[1:28:57] Thank you, Kit. Thank you.