I'm here for another rant of sorts.  I've written about what a bargain a home birth midwife is, but I feel it's time to go a bit deeper into my perspective as a midwife.

When you hire a home birth midwife, you are getting so much more than just a care provider.  You are getting direct access to me to ask questions or share concerns.  My clients have my direct phone number so they get me instead of an answering service or voicemail system. When you hire a home birth midwife, that midwife alters her life during the time she is on call. I don't travel more than an hour away from my home, and if it appears labor may happen soon, I often will limit my travel radius to only around town. I will change plans at the last minute, break commitments and sometimes miss family events and celebrations.

Being a midwife costs me personally. There are the tangible costs such as equipment, supplies, education, maintaining certifications, maintaining a reliable car, having a cell phone, computer, internet etc. There are also intangible costs such as my time, ability to commit to events with family and friends, hoping I don't have to miss or reschedule doctor appointments that can't wait and scheduling all my regular health care appointments during my planned time off, as well as not being able to travel outside the area. There is behind the scenes time spent researching the answer to a client's question, keeping up with the latest recommendations and research, filing required documentation with the state, maintaining my equipment so it is ready for a birth, and much more.

Being a midwife has value which can be seen in the tangible aspects, but the biggest value in my opinion is in the intangible aspects. What is it worth to have 24/7 access to your provider, to know your provider will be close by and ready to drop everything and come at a moment's notice regardless of what they are doing?

I value myself as a midwife and I love serving clients who recognize my value as a midwife.

The maternal mortality rate in the USA has made the news again, and for the usual reason.  It has continued to increase significantly during 2021. This really bothers me. The rate was double that of some European countries, and triple that of other European and Asian nations. We can wring our hands, finger point and blame it on Covid among other things but the sad fact is that the US has been and continues to do something wrong.

I've written about almost losing my sister after the birth of her son, and how that prompted me to become a midwife. The fact that nothing has changed, and has only gotten worse just breaks my heart.  The CDC has said up to 80% of maternal deaths could have been prevented. When Serena Williams had her baby, she had issues that would have been fatal if she had not been able to advocate strongly for herself, and what makes her story even more concerning is that she had a known history of blood clotting issues and she still wasn't taken seriously when she began experiencing symptoms.

There are many components to the maternal morbidity crisis. I have some ideas to reduce the impact of some of those components and in turn reduce the maternal morbidity rate.

• Listen to mothers, after all they are the ones who know their bodies the best.
• Take mothers' complaints seriously and don't ignore them.
• Have more frequent postpartum checkups.
• Give all postpartum parents paid time off with no exceptions.
• Provide postpartum doulas to help mothers in the first feew weeks after birth.
• Have more midwives. In states such as Kansas with large rural areas, having providers close by instead of expecting women to drive over an hour for care will make a huge difference in outcomes.
• CPM, CNM, MFM and OBs working together as a team so care can be provided by the appropriate provider and smoothly transitioned if something changes.
• Train and equip EMS to handle birth and newborn emergencies instead of hoping the emergency happens close enough to a children's hospital that they can send the ambulance.

These are things that need to be done at the local level and nationwide.  Some of these suggestions will take time to implement such as training more midwives. Some have already been recommended like more frequent postpartum checkups but have yet to be common practice at the local level, and in many areas across the country.  Some can be implemented pretty quickly such as training and equipping EMS and other emergency services for birth and newborn emergencies.  Even addressing one thing on my list will improve outcomes and change the maternal mortality trajectory. It's time to take action instead of sitting around bemoaning the fact that maternal deaths continue to rise in the USA.