Your BIRTH Partners

Certified Professional Midwife Role with Ray

February 17, 2020 Your BIRTH Partners Season 1 Episode 4
Your BIRTH Partners
Certified Professional Midwife Role with Ray
Chapters
Your BIRTH Partners
Certified Professional Midwife Role with Ray
Feb 17, 2020 Season 1 Episode 4
Your BIRTH Partners

This week we dive more into midwives; discussing the Certified Professional Midwife role with Ray Rachlin, CPM.  We'll discuss what drew Ray to this work, the niche they've carved for themselves in the homebirth world in Philadelphia, and the challenges and hopes for the future for CPMs.

Support the show (https://www.paypal.me/yourbirthpartners)

Show Notes Transcript

This week we dive more into midwives; discussing the Certified Professional Midwife role with Ray Rachlin, CPM.  We'll discuss what drew Ray to this work, the niche they've carved for themselves in the homebirth world in Philadelphia, and the challenges and hopes for the future for CPMs.

Support the show (https://www.paypal.me/yourbirthpartners)

Maggie, RNC-OB:

Hello, welcome to Your BIRTH Partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth, and postpartum. We welcome you no matter what your background is, and are so excited to learn together. Today we have our very own R ay Rachlin, certified professional midwife. You'll learn more about their background, what brought them into pursuing birth as a career, and also you'll gain a greater understanding about the roles that CPMs play in birth, how they are integrated, or not, into our healthcare system, and a little bit more about what we see as their future. On to the show! Alright, so welcome. So Maggie here, I am interviewing Ray today to talk about what it means to her to be a midwife and her profession and learn a little bit more about her. Welcome, Ray!

Ray, CPM:

Thanks for having me!

Maggie, RNC-OB:

Yay. I'm so excited to be working on this with you.

Ray, CPM:

Me too. I'm really excited to be doing this.

Maggie, RNC-OB:

Great. Alright, so we'll talk about just yourself a little bit. So tell us about yourself. What are your qualifications? What do they mean? Kind of how are you as a person?

Ray, CPM:

Sure. So my name is Ray Rachlin . I use the pronouns she and they, I'm a certified professional midwife, a licensed midwife, and also a certified lactation counselor. And what does that all mean? So I trained as a certified professional midwife out in Oregon a few years ago. There are a couple of routes to becoming a midwife and I was a doula in New York city hospitals before this and I really kinda came to the conclusion with myself that I needed to train with normal birth. I needed to train with autonomy and, you know, I knew I was going to do home birth. So after a lot of research and talking to midwives and an internship, I decided that I needed to do all of my training out of hospital and also train outside the system. When I decided to become a midwife, it was before the ACA, so a lot of people were uninsured and I was curious about what, you know, midwifery would look outside the insurance system. On the other side of that, it's definitely more complicated, but it does provide a lot more autonomy. So , um, in 2013, I moved across the country from New York City to Portland, Oregon to train at Birthingway College of Midwifery. There's a couple of routes to becoming a CPM and I chose to attend a MEAC-accredited school. So I went to a three year program of like kind of butt in the chair coursework and then did my clinical training or apprenticeship at a busy birth center attending birth center and home birth. And I think one of the main differences with CPMs and CNMs is that we train with complete continuity of care. So I was training for, you know , seeing people from their first prenatal to, you know, their birth and all the way through six weeks postpartum. We also do a lot of postpartum care in our training as well as are trained to be primary care providers for well newborns. And you know, the birth center I was at also had an insemination program. So I got trained in that as well. And that's been a lovely part of my practice. So it took me about three and a half years to become a midwife.

Maggie, RNC-OB:

Okay. And did you work as a doula during that time or were you focused just on school and then apprenticeship?

Ray, CPM:

I thought I was going to work as a doula, but there was no time, you know. And I remember at one point in my apprenticeship I like looked at my calendar and there was like, it was like this January and I was like, there is one day this month that I'm not going to be at school or work or my apprenticeship and I also will be on call for six births . So like, you know...

Maggie, RNC-OB:

[laughter] there was not really a day off!

Ray, CPM:

I did a lot of weird things in midwifery school, like I worked as a placenta courier. I nannied, I did tailoring , just a lot of odd jobs to get by. I was on call for like four to six births a month and was attending them from start to finish, in addition to a full clinic schedule, and like lots of postpartum home visits and you know, like eight to 15 hours of classes.

Maggie, RNC-OB:

A very full schedule. I think the on-call lifestyle, you know, we'll talk more about this, but I mean the on-call lifestyle, it, it takes a lot out of you to be able to, you know, balance everything else in your life along with supporting birth .

Ray, CPM:

It's, yeah, it's intense. When I was done with my training, like my body just like fell apart was like, you can't do that again. Um, but yeah, after like three and a half years I was able to sit for NARM, which is the certifying exam for a certified professional midwives. And that gives me the ability to get a license. I believe in now 33 States , uh , in the U S where we can practice, you know, independently. In New Jersey where I'm licensed, I can only attend home births, and in some States I also can work in birth centers. And then I also practice in Pennsylvania, which is really interesting. There's a statute from 1929 that says that direct-entry midwives, you know, are a part of health care and that we should exist and we should be regulated. And then they've never written regulations . So we practice in a weird legal gray area, but also can do all the things midwives need to do, like filing birth certificates and newborn screening and you know, congenital heart defect screenings . So we're like somewhat integrated, but pretty poorly.

Maggie, RNC-OB:

Okay. All right . Obviously plenty of work to do. Yes. So what, like what brought you, you were a doula at first in New York, What brought you to the birth field?

Ray, CPM:

I started off in politics. Um, I worked, you know, in the labor movement, or the other labor movement, and was really, you know, looking to like I guess change the world through community organizing and just felt this like real gap in between, you know, maybe ideals and you know, tangible like how people live and the support they needed. And you know, I was kind of having maybe like a little bit of a crisis of faith with what I had chosen to do. And a friend of mine had suggested, becoming a doula and I spent a couple months ruminating on it and I was like, you know, if I took money off the table, I want to learn how to support people. I knew nothing about childbirth. I was like 21. Um, but I was like, I want to learn how to support people and see where that goes. And I didn't think I was going to change fields, I didn't know birth work was a job, but it all kind of unfolded really incredibly. Like a week before the doula training I signed up for, I found out I was going to get laid off from my job, which, and then I went to this training and was like blown away where I'm like, 'Oh, this amazing thing happens to our bodies and it's designed to work. And then you provide this arc of support and it really changes things and it's a job.' So I, yeah . So I had the opportunity to like build a doula practice while collecting unemployment, which was really amazing. And I then became a postpartum doula, and then I was doing placenta encapsulation, all the things that start unfolding when you're doing birth work and, but you know, I was attending really intense, rough, violent births in New York city hospitals and, you know, I didn't know it could be different until I attended my first home birth. SO it was probably about a year into doula-ing, and it was the absence of intervention that was really startling to me. And it's not that, you know, the midwife was providing the same safety that we do and they can provide in a hospital setting, like monitoring the baby, monitoring the parent's vitals, but the person in labor wasn't having to work around the hospital systems. They weren't being like, "Oh, we lost the baby, come back to the bed and get on the monitor." Um, it was, you know, just leaning over, you know, or under or through just all these ways that like midwives work around people and labor, and birth looked completely different. Like, I didn't know birth could look like that. I didn't know people could have that kind of, I mean all birth is beautiful and amazing and like meeting your child is incredible, but what it looks like to be treated with respect and have autonomy in that process really was mind blowing. It was unlike anything I'd ever saw and by the time I left, you know, this birth in this basement apartment in Brooklyn, you know, the next morning I was like, that's what I need to do. I'm doing the wrong thing. Like I need to be a midwife because I want to help people have this experience. I think this experience changes things. And also if hospitals have to compete with what I'm doing, they're going to have to behave better. You know? Cause like 1.36% of births happen at home in the U S, like, that's probably not going to change dramatically. But when I trained in Oregon, what I was really startled by was how Portland had a 4.5% out of hospital birth rate and hospitals behave differently. They behave better. They have to compete. Midwives, they're more patient, they're more kind. They asked for consent, NICUs have rooming in. Like it's, you know, I think this model of care emanates. And so I am really excited about this podcast because I think helping this model of care like is gonna not that like I'm , I don't need to convince people to have home births or whatever, but making this like more accessible and also more mainstream is going to change how hospitals provide care and that's going to help everyone .

Maggie, RNC-OB:

Absolutely. I don't think, I think a lot of people who search out home birth are not necessarily hooked on the idea of having their baby in, in their actual home, in their domicile. What they want is the type of care that goes along with that kind of focused , you know, delivery. And so I definitely think there's, you know, there's definitely work to be done with that. And I think so much of it is seeing, I love how that's like that exposure shaped your professional journey. And I agree that through, you know , the podcast and as we talk about these topics and get into options out there that both, you know, birth workers and providers and also consumers just get more exposure to what what is possible and how birth can look so that they can line it up with their own values and what their goals are, you know, from the experience. And so I love that. Yeah. How do you feel like, you know, we talked about your professional qualifications. How do you feel like personal experience and intuition kind of play into your practice?

Ray, CPM:

What a good question. Let's see. Yeah , I think they're probably the unique thing about being a home birth midwife or a certified professional midwife is, is how much relationship based care I get to provide. And you know, it's like we have the like clinical training. I'm screening for the same things the hospital-based providers do, but I really get to know how someone looks, what, how they operate, what they're like, the quality of their baby's heart tones. Um , and it really, it really allows to like notice more subtle shifts that I think is really unique. Um, I think there's , you know, like I've, I've talked to folks before about how, you know, oftentimes when my clientele, when someone's developing preeclampsia, you can see it in their face before you see it in their blood pressure. And that only comes from like seeing someone for like an hour every month and then every two weeks and then every week. And when we can detect things earlier, we can help do more preventative things to help maintain their blood pressure and get their baby to term.

Maggie, RNC-OB:

I love that. That's awesome.

Ray, CPM:

Yeah. And then it also allows for like that kind of, you know, just having a relationship and connection and labor. So if someone starts sounding their quality, their sounds are different. Like I notice that there's a shift. I can notice that there's a shift towards birth or also that there's a shift that like something is stuck and maybe what we're doing isn't working. And it's like time for a change either in what's happening at a home birth or in environment to a hospital, ,where there's, you know, bigger tools.

Maggie, RNC-OB:

Right.

Ray, CPM:

And you know, I think there's an aspect of like midwifery that has like a very spiritual component that, you know, I don't know if I can articulate very well, but also I really, the longer I do this, the more I'm able to like kind of tap into of like, you know, it's not my job to like make people have this experience or that experience. It's just like I'm holding space and like going as deep as, as needed to like to see people through. And yeah, there's like, maybe it's like this is a really long tradition that people have been doing for, you know, birthing folks for as long as humans have existed and like, and I dunno, maybe the longer I do this I get to like kind of tap into that lineage. Yeah. I don't know . I feel like I'm pretty protocol-based as a midwife, you know, it's just like this is what I do. And there's like , this is where I can provide safety and this is when you know, when that situation has changed. And I think a hospital transfer or hospital birth is safer and I'm always really clear with folks about that. But then there's all the things I can hold that are really like unique and special. And I think so much of it comes from just really knowing the families that I work with.

Maggie, RNC-OB:

That's beautiful. I love it. So, future visioning here, where do you see yourself in 10 years?

Ray, CPM:

Ah, I don't know. I think, I think midwifery is going to continue to change in the U S like it's not a given. The system is a mess. It's really poorly integrated and we see that because we don't have good outcomes in the U S.

Maggie, RNC-OB:

Right.

Ray, CPM:

I would like to see midwifery change, and also there's a lot of barriers to getting there. But you know, I, I have a lovely solo home birth practice in Philadelphia. You know, I get to serve my neighbors as well as, you know, families, you know , far out in like this County or that County. Yeah, I did like two home visits an hour away yesterday. And, and I really, I really love the care that I get to provide and the community I can build from having a solo practice where like, you know, I have like potlucks for like my clients and like , um, I organize get togethers for queer families that are trying to conceive just because a lot of them have a lot of isolation in this process. And I want to , I'm so curious of like what we can do to like bring the community building around birth and families forward as well as how do we move this profession forward to where everyone has a midwife and can access the care that they want and need.

Maggie, RNC-OB:

I love it. I can't wait to see all of that come to fruition. So kind of pivot a little bit to talk just a little bit more about your role and your profession. So you talked about your schooling. So what kind of the professional organizations that back up being a CPM, being a licensed midwife, how does that work?

Ray, CPM:

Yeah, so our accrediting body is the North American Registry of Midwives and so I just had to renew my certification and that was, you know, expensive like paperwork, CEU-filled process. And so probably much like other providers, I had to take a bunch of classes and renew my CPR and NRP, which is neonatal resuscitation and update all my protocols because I could get audited. So you know, in the CPM world we have like a scope of practice, but we also get to like have a lot of independence and practice. So it just being like "this is how I manage anemia, this is how I manage gestational diabetes ."

Maggie, RNC-OB:

Okay.

Ray, CPM:

There are some places, like in New Jersey, where I have criteria that are my risk out criteria, which is great. And then in Pennsylvania I don't, so I use my Jersey criteria, things like that. And then there's also a couple of professional organizations. So we have MEAC or Midwifery Education Accreditation Council that accredits our education programs. There is, I believe only like nine CPM programs right now that are accredited. Don't take my word for it. It could be 10, it could be eight. Um, some are distance , and some are kind of button butt-in-the-chair, which is what I did. And then there's also a couple of professional organizations. So MANA which is the Midwife Alliance of North America has been around for a really long time and it holds space both for like CPMs, nurse midwives and traditional midwives. So people who've chosen maybe not to get a credential and have only trained through apprenticeship in one form or another. And I don't participate in MANA. I felt kind of complicated about some of their politics or lack thereof in the last few years. But I do participate in uh , the National Association of Certified Professional Midwives or NACPM and a , it's an organization that has taken the CPM credentials like, yeah, like how do we make this, you know, like midwifery care, like, you know, evidence-based, like justice-based and accessible. And part of that has been through supporting licensure campaigns so we can get Medicaid , um , or you know, and also be better integrated into health systems. So, you know, my state has a state chapter of NACPM, which is the Pennsylvania Association of Certified Professional Midwives and I am our chapter's president. So I am pretty involved in just yeah, organizing midwives throughout the state of Pennsylvania to , you know, be connected to larger midwifery efforts and also have opportunities to organize for our own licensure when they arise.

Maggie, RNC-OB:

That's great. I think that having that community piece, it's, you can't beat it. You really need to be able to have, you know, people that draw from and learn from each other and what you're experiencing. And I think it's interesting how you were talking about the different, you know, you have kind of criteria in New Jersey but not in Pennsylvania. And I think being able to discuss that amongst, you know, midwives who are working in so many different States every year , there are so many different layers and how they're able to provide care, what they're allowed to do legally. And I think as we keep working on legislation to kind of, yeah , level the playing field a little bit, there's going to be a ton of growth there.

Ray, CPM:

Yeah. The scope questions are, yeah , really crazy. You know, like what I can do in Maryland as a CPM is different than what I can do in Delaware, which is different than I could do in Jersey, which is different than what I can do in Pennsylvania. Yeah. Like we all have the same trading and like, you know, there's a BMI cutoff here and there's like, no breeches here or, and yes to twins here, but you can't carry oxygen like it's all over the place. Yeah.

Maggie, RNC-OB:

And so what do you, what do you feel like the most challenging pieces for the role for being a CPM right now in the U S?

Ray, CPM:

The lack of understanding of my profession and integration. You know, I think the ability to consult and transfer with hospital-based providers is essential to me providing safety, and it is a fight every step of the way. Um, and it can be simple things like it took me seven weeks to get an ultrasound from a patient in New Jersey that I ordered, where I'm legally able to practice, you know, and I just like want to be able to counsel my client on her anatomy scan...to, you know, misunderstanding or mistrust when you know, greeted at a hospital, if during the labor transfer. I think, yeah, better understanding and ability to work together will elevate our profession, make home birth safe. You know, I think the data is really clear that like home birth is safe in well -integrated health settings where you know, providers can collaborate and transfer well. And so as a CPM and someone providing home birth , it's my responsibility to seek out those relationships. But it's really individual and based on like, you know, this midwife I know here or this person I know there versus it just being system-wide and like why , you know, when I have a client who's giving birth like in the suburbs or rural area that the best way I can transport her is to bring her to the city. It's just not, it's not acceptable like right.

Maggie, RNC-OB:

Yeah. That's not that. It doesn't help the safety piece. And I think like you said, that integration in the system, that's, that's what we see as crucial. It's not about home birth in and of itself. It's about how it works within, you know, the rest of the system and how we're able to transition care, you know, back and forth when needed.

Ray, CPM:

Yeah. And then it's like I'm not scared of the hospital. Like I really, you know, I have a transfer rate of 20% I feel really good about that because like I'm having like safe normal births at home and when, when the situation changes, I don't, I don't hesitate to go in. And that's what makes home birth safe. But what is the next step, right. No to like making, you know, our welcome like us to be well received for me to easily be able to get a non-stress tests for me to not have to like fight with my client's insurance companies to cover labs that I drew because I can't be in-network because of our licensure or lack thereof.

Maggie, RNC-OB:

It's incredibly frustrating.

Ray, CPM:

And then even in NJ though I have a license or, and I can't take Medicaid, there's just all these places that, you know, I think the CPM movement really started from a place of "let's create our own credential before we're regulated upon." It was, you know, the 1970s like white people starting to attend each other's birth because they didn't like what was happening in the hospital. And while black midwifery was kind of being pushed out, there are like a lot of, you know , awesome black midwives in this movement as well. But this has definitely been like, a white-dominated process.

Maggie, RNC-OB:

Yes, absolutely.

Ray, CPM:

And you know, we created this credential, we've created our own, you know, we've self regulated, which I feel so excited and proud about. And also we're not integrated, you know, and I think there's a lot that's really gained in being independent healthcare providers that are more outside of this system. And also it makes, because of the resistance to us, and like assessing as incompetent or whatever kind of prejudices that come about. It makes it a lot harder to do my job well.

Maggie, RNC-OB:

Absolutely. So I think the last question I have for you is just, we've touched on this a little bit, but like what is the one thing, because I think there's just a lot of misunderstanding about all these roles. Um, you know, what do you wish the birth community knew about your role? What is, like, the one, the nugget of knowledge you can give them that would help them to have better awareness of what you really do and provide for birth?

Ray, CPM:

I think I want to say like the words of Christy Santuro who's an amazing CPM here in Philadelphia has been practicing for like 20 years, is that this is not, "this is a model of care. It's not a place of birth." You know, it's a model of care that's like deep relationship building. Really learning about our client's needs, providing informed choice in really unique ways. Like going beyond like this is... I think a doctor once asked me what the difference between informed consent and informed choice is and that we're giving people the information for them to make their medical decisions, not consenting them to do what I want.

Maggie, RNC-OB:

Absolutely.

Ray, CPM:

What it means to like really trust the families I work with to make the right medical decisions for their pregnancy and their family and how I'm doing that to translate into empowered parenthood and you know, and then I provide, I mean, you know, awesome attentive care during birth but more importantly a come to their house, you know, at one day and then three days and then seven days and then two weeks I check on them and their baby, I am sent pictures of people's belly buttons or baby's belly buttons even be like, "is this normal? What do I do? This just came out of me!" Like every body part and fluid that can be attached to that . I've gotten a text picture of and it's about that kind of care and seeing people through, so they're confident, comfortable and supported and empowered parents. On the other side of this, you know, a big part of like postpartum mood disorders is the lack of support. And this is about, I'm building a relationship prenatally, having a birth experience where someone is like respected and heard and then having the support afterwards to prevent mood disorders and ultimately like help people have healthier parenting. So that's, that's why I do this. It's to prevent and reduce trauma and heal the next generation of kids.

Maggie, RNC-OB:

I love it. I think that is so important. I think the idea of that support that it's lasting all the way through, that's a huge thing. Uh , I'm working on a project, the hospital that I work at right now to do that as well because it's something that is really sorely missed in typical hospital settings just because of the way care is, you know, arranged. And I love that in community birth it's just, it is such a strong current all throughout so people know where to turn at any point during, you know, pregnancy, birth and then postpartum and I'm sure much beyond that typical, you know, six weeks to a year of postpartum time. I'm sure you hear from clients past that as well.

:

Oh yeah. People texting me about their toddlers and I'm like, I am not an expert, but that's what it's like to be trusted with this time.

Maggie, RNC-OB:

I love it . That's wonderful. Well, thank you so much Ray, for sharing about yourself and about CPMs and I am very excited to see where the profession is going to grow.

Ray, CPM:

I'm so excited to be a part of this podcast. Thanks for including me .

Maggie, RNC-OB:

Thank you, Ray, talk soon.

Ray, CPM:

Talk soon.

Maggie, RNC-OB:

Thanks for tuning in to Your BIRTH Partners. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, we're Your BIRTH Partners on all platforms, or comment on our show notes blog yourbirthpartners.org. In particular, we would love to hear any questions you have about CPMs and the roles they play during birth, and from our CPM colleagues. Please tune in with your experiences, and challenges you're facing, and the path you're paving to take care of people during birth. Till next time.