Torie Bowie was an athlete. She wasn't just any athlete, she won multiple medals including the gold medal at the 2016 Olympics. This was a woman who was incredibly fit. She was found dead at 8 months pregnant due to eclampsia. The takeaway is that even the healthiest of mothers can have health issues that are a direct result of pregnancy, and that maternity care providers must do better for mothers in their care.

It grieves me to learn of stories where normal maternity care should have caught something.  It grieves me to hear of mothers who aren't listened to, whose concerns are dismissed and who do not feel heard and respected. It appalls me that mothers aren't educated about nutrition, appropriate weight gain and normal changes in pregnancy. It scares me that mothers aren't educated about symptoms of concerning health conditions during pregnancy.

In my midwifery practice, I partner with my clients in providing care. I want my clients to understand what is normal and what may be concerning. I want my clients to know what symptoms to watch for that means we need to do some testing, or additional checks. I want my clients to know that I hear them and I take what they say seriously. I want my clients to know I will not dismiss their concerns, observations and complaints. I want my clients to know I care!

It's so hard for me to wrap my mind around how this nation can spend so much money on health care and yet have higher percentages of poor outcomes compared to other countries, including those we consider developing. I don't think more interventions, medications or treatments are going to solve the maternity crisis in America. Listening to women, and trusting them are the things we can do to improve care dramatically and quickly in my opinion. We can't continue doing the same old things and hoping for different results.  We must make big changes, and make them now. Increasing access to midwifery care is a simple, effective way to reduce maternal mortality. I'm proud to be a midwife who is making a difference one birth at a time!
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Since I became a CPM, I have discovered the  "just a CPM" world. It's on social media, and sometimes in personal interactions I've had. I personally find "just a CPM" demeaning of my education, skills and what I do.

There are differences between a CPM, a CNM, and an OB-GYN. Those differences include the education required, the philosophy of practice, and the clients we each serve. I know I'm not trained, or equipped to handle the situations an OB-GYN does, and the same goes for CNMs. I value the skills and education they have, and am thankful they are able to help clients when they need more than I can offer.  Each provider has their own skill set, and is best suited to serve particular needs.

OB-GYNs are absolutely the experts to go to when a mother has conditions or indications of a condition that puts her life or baby's life at risk. A mother who is a smoker, who has high blood pressure, who has a history of blood clotting issues; a baby who is not growing, whose ultrasound shows a possible congenital issue, who isn't tolerating labor well will benefit from the care an OB-GYN can provide.  A mother who wants the care of a midwife as well as the options a hospital has such as an epidural will benefit from the care of a CNM. For the mother who is healthy, and having a low risk pregnancy that wants to have baby in the comfort and security of her home, a CPM has the skills and training to support her well. Each type of provider has a niche, or particular women they would serve well.  

There are differences in skills, training and expertise among types of providers. Since I support births at home, that is what my training emphasized. That is why I was required to attend at least 55 births (I attended a lot more), with 45 of those in the home setting. OB-GYNs and CNMs are not required to attend any home births but they do have to attend hospital births as part of their training since they will be working in the hospital. With the differences in training and skills, if all the providers can work together when different skills are needed, both babies and mothers will benefit from the wide range of expertise.

To refer to me as "just a CPM" is belittling, in the same way as saying "she's just a stay at home mom". It implies that there is less value in being a CPM instead of recognizing that each type of provider has unique skills and understanding that makes them valuable in their own right.

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When should we let people know labor has begun? I get this question a lot from clients, especially if this is the first baby, AND I have some strong opinions to share.

​I personally don't think announcing labor has begun is a wise idea at all. I have many reasons, backed up by experience.
 

• There are a lot of preconceived notions out there about labor. There's the idea that labor shouldn't take a long time, and that it never slows down or stops. So, if labor doesn't match these preconceived ideas, expect to be fielding a lot of texts and phone calls from friends and family who are concerned that something is seriously wrong.
• Announcing labor has begun and then not answering calls or texts may just bring unexpected and/or unwanted visitors to your door because they are concerned and want to make sure everything is ok.
• Announcing labor has begun might get shared with people you had preferred not know.  
• Announcing labor has begun may end up on social media for all the world to see, which might not be the way you wanted to announce your baby will be arriving soon.
• Instead of being able to focus on labor and birth, you may find you are so busy answering texts and calls that labor stops and we get to try again another day, or Dad may not be able to give Mom the support she was expecting and counting on
• The blue light emitted by electronic devices may interrupt oxytocin flow, not to mention the stress hormones produced as a result of having inquiries about how labor is going. Interrupting oxytocin is a guaranteed way to have a longer, less efficient labor.
• Expect to be contacted at all hours of the day and night. People seem to forget basic manners about when it is appropriate to make a phone call or send a text when they know someone is in labor. Just like being pregnant seems to invite public comment from total strangers, knowing labor has begun seems to give people the expectation that everyone has the right to know what is going on.

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I have been at a birth where Grandma shared online that labor had begun. After 24 hours with no baby, she was getting quite irritated by all the inquiries she was getting. I have attended a birth where it was announced to the extended family that labor had begun. When the parents decided to turn off the phones, the family decided to drive to the house to check on things. Neighbors who see on social media that labor has begun will ask me for updates if I step outside to get some fresh air, or they see me going to my car.  

Labor and birth are hard work, and there's no reason to make it any harder than it needs to be. I honestly think the best plan is to wait to announce anything until your baby is here, and you are ready to take phone calls and have visitors.

I opened an email to see that "giving birth is more risky than skydiving". This email also goes on to state that "it's one of the most dangerous things our patients will ever experience." I realize the sender is trying to get me to sign up for a class on obstetric emergencies, but really?!!

Let's put this in perspective. Women have been giving birth for a heck of a lot longer than humans have been skydiving. So, just from a risk over time consideration, there isn't a correlation. The percentage of the US population who has done at least one skydive is significantly lower than the percentage of the US population who has given birth at least once. Why would someone compare birth with skydiving? That's like telling you not to eat broccoli because you might be in a car accident.

There is an element of risk to pregnancy. There is risk when you walk outside your front door. There is risk every time you get behind the steering wheel of a car. Risks can be reduced but not eliminated entirely. If you are a human being, risk of part of the package. If birth is so "dangerous" then why have humans proliferated so successfully?  

For the majority of women, birth is not an emergency. Yes, there can be truly serious situations that can be an emergency but they are not the majority of births. Playing on fears of the minority of cases that are emergencies to get my money for a training course doesn't impress me and it actually ticks me off. As a midwfe, I truly believe pregnancy and birth are not medical conditions to be managed. I feel birth works best when we trust the process and do not try to manipulate or manage it.  

Using dramatic, scary wording does not impress me. It actually makes me wonder what kind of care is being provided that would make birth more risky than skydiving. Needless to say, I will continue to educate myself so I am prepared for the times when birth needs help.  I will not add drama or fear to birth, especially in the times it does need help.

There seems to be a myth floating around that if you have hired a midwife and are going to have a home birth, you don't need a doula. As a home birth midwife, I strongly disagree. I think hiring a doula when you are planning a homebirth is just as important as when you are planning to have a hospital birth. A lot of the reasons are the same, but I have a few more reasons when someone is planning a home birth.

​Reasons I recommend a doula include:

• You have not done this before so it is helpful to have someone familiar with labor and birth right by your side once it starts getting big enough you can't ignore it.
• Doulas have skills and tools to help you navigate the challenges of labor well. These include comfort techniques, positions to help baby navigate the pelvis and so on
• Dads like to fix things, but labor isn't something they can fix. It can be challenging to see Mom in pain and not be able to take it away. A doula can support Dad as he supports you, and can show him ways to support you if he's unsure of what he can do that will be helpful.
• If labor is long, a doula can spell Dad so he can get some rest and then come back rested and ready to support you.
• A doula is a calm, reassuring presence. Having that presence can help Moms navigate labor with less stress, which can lead labor to progress faster and more efficiently.
• A doula is there just to support you and Dad, they are there for you in the moment without being distracted by needing to make clinical assessments, listen to baby, set up for the birth and other things.

If the concern or hesitation about hiring a doula is that the doula is going to take the place of Dad, or keep Dad from supporting Mom, I think this video by David Arrell explains how doulas can actually help Dad step up even better than without a doula to support Mom.

Being a doula is hard work. It is physically and emotionally demanding. If I have to doula a client, I am afraid it will be at the expense of my midwifery skills. I want to bring my A game to the moments of birth when it is vital, but if I've had to do the work of a doula as well as a midwife up to birth, I'm going to be tired, and not as fresh as I want to be to be my best.  ​

To paraphrase Forrest Gump Labor and birth is like a box of chocolates, you never know what you are going to get!  You can have a great understanding of the process, but until you are in it, you truly don't know what it will be like for you. Having someone who will come alongside you and support you will help you navigate labor easier. Labor can be compared to hiking the Grand Canyon. If you want to hike to the bottom and  back up, doing it by yourself is way more challenging than having a trail guide to lead you. A doula is very much a trail guide for labor and birth.

In my years doing birth work as a doula, as a midwife's assistant, as a midwifery apprentice and now as a midwife, I have never once heard someone say they regret hiring a doula. I HAVE heard plenty of people say how much they wish they had hired a doula.