National Midwifery Week Celebration #019

We celebrated National Midwifery Week with this live podcast!
Our midwifery panel (Meredith Strayhorn, M.Ed, CD, CPM-Student, Ray Rachlin, LM, CPM, CLC, Dr Angela Mike, DNP, CNM) shared with us their answers to what midwifery means to them, what they wish they'd learned in school, but didn't, what they love to do as midwives outside of catching babies, how they process difficult birth outcomes, and how they are living out this year's slogan "Midwives for Equity."

Transcript

Copy Transcript Copied

Maggie, RNC-OB  0:05  
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 are celebrating National Midwifery Week, we had the chance to bring together some of the wonderful midwives who work here with Your BIRTH Partners, to spread more information, more awareness and to share their experiences about what it means to be a midwife now in the year 2020, in the US.  So you'll learn a little bit more about their experiences, how they chose their path into midwifery, what they wish they learned in school, and they didn't, what their ways are to cope with difficult births, and they're going to touch on the ways that they really embody the slogan for this year's National Midwifery Week is "midwives for equity." And I am so honored to share this conversation with you because it reflects so much of what we hope to see in the future, as midwifery continues to grow to be more inclusive, more accepting of all people, regardless of gender, of race, of socioeconomic status of any of the things that have held us back, and that have stopped people from having equity, in their health care, and in their birth care; everyone deserves a midwife.  We hope you gain greater understanding about what's brought them into this work, and that you feel inspired as you go on in your own.  Onto the show!

So yay. So I am just so excited to have some of my favorite midwives here to chat about just everything that is going on for you all and then you know, I feel like I'm always celebrating national midwifery time, but especially here during the national midwifery week, just to kind of check in with you all and talk about midwifery, we had a couple questions that came in earlier in the week that we wanted to kind of address and then whatever else you guys want to kind of throw out there and we'll see if anyone else who joins us has any other questions. So welcome, welcome. If you guys just want to go around and say who you are, what your shtick is for anyone who's listening who doesn't know.

Angela, CNM  2:25  
I am Angela Mike. I am a Certified Nurse Midwife. I also hold a doctorate in nursing practice. I have been in women's health for almost 15 years. And I am currently here in the Las Vegas area, working in a private practice where I do outpatient only women's health care right now. I have four children and a husband and yeah, that's about it.

Meredith, Doula, CPM-student  2:54  
I'll go next; I'm Meredith Strayhorn.  I am a student midwife and a birth doula. I just started school in August and so newer to the game, but I absolutely have been loving my experience so far. I am in Northern Kentucky, right near Cincinnati. I have been in birth work for about three years now. But I have loved all things birth for as long as I can remember. So really glad to be here.

Ray, CPM  3:23  
I'm Ray Rachlin, I'm a Certified Professional Midwife, Licensed Midwife, and Lactation Counselor. Based in Philadelphia, Pennsylvania, I have my own home birth practice refuge when we're free, and I kind of serve Billy, South Jersey, Southeast Pennsylvania suburbs. And I also do IUI and queer Fertility Care. and educating providers is also a really big part of my practice. And my pronouns are she and they. 

Maggie, RNC-OB  3:50  
Thank you. So we'll kick off with the first question is just kind of what does midwifery mean to you? And you can answer that in any way that it kind of fits for you. And I think there's a couple of different kind of like the definitions we all like here and think of all the time but I've seen a lot of posts this week that people have really been diving into like, you know, obviously midwifery is more than like, just, you know, birth and all these things. So I'd love for you to share with us what what midwifery means to you.

Angela, CNM  4:17  
Midwifery is about being present, listening to women, listening to families, it's about choice. It is about validation, and it is about support and empowerment. My primary purpose for going into midwifery was because I wanted to protect and serve women in a way that empowered them enough to take charge over their personal health care.

Ray, CPM  4:51  
Ditto. For me, midwifery is about the restoration of choice. And it's the restoration of choice through slower care, through relationship based care, through building trust with the families that we serve, listening to them, believing them, and then working in partnership to help have healthy outcomes and also to guide people through unexpected scenarios and their reproductive lifetimes. And I started attending births 11 years ago as a doula and ultimately decided I needed to become a midwife. And I needed to become a home birth midwife, because what I saw in the hospitals, I was attending person in New York City was the absence of choice and agency. And when I first saw my first home birth, and I saw what was possible, and what birth could look like when pregnant people weren't fussed with and didn't have to comply to arbitrary rules and systems was that it looks really different. And I wanted to create competition, so hospitals could have to behave better, that if they were that if home birth and community midwifery was a viable, robust option in this country, hospitals would treat people better, and then we would have better outcomes across the board. 

Meredith, Doula, CPM-student  6:03  
I love that. Both ditto to both of you, you know, for me, midwifery is also about advocacy. So ensuring that they have choice that they that they're they are empowered to, to really truly choose the experience that they wish to have and not be forced, or, you know, we there's so many times that we hear that word allow in the maternity care system, and I absolutely hate that. I agree. It's about listening, it's about choice, it's about supporting and offering that guidance and education, and I'm really big on education, I'm trained as an educator as well. So making sure that not only do they know what choices they have, but also understanding those choices, and then being able to impact the entire system, my goal is to turn it on its on its side and, and change these negative outcomes that we have. And for me, especially in the black community,

Maggie, RNC-OB  7:01  
Absolutely, there is certainly a lot of change that needs to happen. And midwives have always been really pushing and leading for that change. And, you know, to your point, Meredith, obviously, the Black midwifery community is really, you know, pulling forward and, and claiming that very loudly that we need to, we need to make a change, and that we need to have to have more equity, and we need to have better representation so that everyone is receiving care that resonates with them, that comes from people who share their life experiences. And you know, and I say this as like a straight white woman, a lot of our perinatal health care system has been set up to support people like me, but I do not represent all of the people who come in to birth. And so many of our hospital systems are really set up by very, very narrow minded people. And for people who, who aren't straight, who aren't White, who aren't having a super planned pregnancy, for all sorts of different factors that come into our lives, we need to we just need to do better in terms of supporting everyone and providing what they actually want and need. So another question we had was, What do you wish you had learned in school, but didn't? Like, is there something when you are going through midwifery school that you realize now like that would have been the difference maker?

Meredith, Doula, CPM-student  8:32  
I'm just gonna say I'm all ears for this one. Since I'm still in school, I would love to know, what are some things that y'all did not learn that I can maybe, you know, push for, and figure out how we can get it into these programs?

Ray, CPM  8:46  
I think the short answer is how to care for people that aren't straight white women. You know, I thought training as a Certified Professional Midwife and training outside the larger healthcare system that I would learn how to do better care for people who are not being served by our current, you know, patriarchal system. And that wasn't true. I just learned different ways to care for straight white women. And my, you know, majority white women midwifery class was not adequately given you know training on like cultural competency, or humility.  I was not trained to care for my community of like queer and transgender people. It took a lot of work and a lot like searching outside of my program to start learning the skills to serve people that are, to serve, like women of color, to serve queer people, to serve transgender families. And I mean, it's still a lifelong learning process. Like I'm never never going to get good at it. But yeah, obstetrics and midwifery center, straight white bodies, and as long as that's the basis of normal, you know, like, women of color are going to continue to die like they needs to be a huge shift about what bodies are normal, what bodies are centered in our training.

Meredith, Doula, CPM-student  10:01  
So something that I have heard, I haven't experienced it yet, but I have also heard that the NARM exam is written that way, it is centered around serving white women. And that was like the trick, if you will, that I've been told when I'm ready for my norm, just pretend like I'm answering it as a white woman, which isn't fair, because I'm not and my clients are probably not going to be either. So.

Ray, CPM  10:30  
Yeah, I think that's true, I think. Yeah...

Angela, CNM  10:32  
Yeah. You know, it's so interesting that you guys have, you know, pointed out the lack of culture diversity in your training, I think what stands out to me most is, you know, certainly, being a black woman, this is my baseline, you know, this is my norm, I am adjusted to nothing being, the standard not being created based on me. So, it's interesting, like, when I think about, you know, like, "Oh, did I get that sort of training and midwifery school or nursing school?" or, you know, and I remember having cultural diversity classes. But for me, it did not stand out. Because I already knew that these are things that I needed to do. So I don't know that I felt like I was lacking that stuff. Um, I was always grateful for those cultural diversity classes, because I would be like, yes, people who don't look like me need to hear this. Yes, I hope they are taking this and I hope they are absorbing it. But it is more than just taking a class or two, it is more than just, you know, I'm talking about how we impact change to decrease the gap in health when it comes to race disparities. It is about social change is about things that have been ingrained in our system. Since the beginning of time, it is about forcing people to recognize their privilege, and forcing people somehow to see things that they take for granted, are the things that Black and Brown people are dealing with on a regular basis. So as far as like, you know, lacking you know, that aspect of my education, I would say, I probably wasn't as present as it should have been. But in general, like, oh, gosh, man, y'all I went to Frontier Nursing University. They have a phenomenal midwifery program like I did not, I felt so complete there. I felt so whole and I felt so validated. And it was like I suddenly was not alone in the way that I thought women should be treated in the way out thought births should happen. It was no longer this crazy nurse I was no, that is you are smart. And that is what we shouldn't be doing person. 

Margaret Runyon  13:10  
So as a nurse, obviously, there is like, especially working in mostly hospital systems, there is that that kind of that othering thing that happens if you're working outside of that system? And so it's interesting how you know, within midwifery, then that started to feel like that was that there's a shift happening that that is more normal, that what the expectations around birth, that they are, you know, they are different than obviously the medical model. I wonder, so Mere, you just have started, you know, your CPM program, what led you to choose that route? What led you choose the school you're going with? 

Meredith, Doula, CPM-student  13:45  
So that's a that's a really great question. My original plan was to become a CNM. Then I had some conversations with some friends, some other birth worker, friend, one in particular, who is planning to become a CPM, she and I just kind of talked through some different things, and I had to I just the track that I'm on and kind of what I think I really want to do is homebirth as well. And so I felt like if I were to go the CNM route, that I may have to do some training, and that I just I wanted to kind of get into practicing and not really have to untrain my brain with the medical model. And that may not be true. This was just where I was in my thinking, but I really wanted to just go straight into the like community based midwife homebirth mid midwifery care. And that's, I don't know, I guess that's just sort of the it felt more right for me. But I can also say that I absolutely love and appreciate our nurse midwives as well, because I've worked with several in the hospital as as a doula and you know, there is a need for every type of midwife. And so I'm grateful that you know that that path is available for people to choose what's going to fit best with how they want to practice And the clientele that they want to serve? Absolutely. So, you know, my hope is that as a home birth midwife, if we do have to transfer then I can find somebody to transfer to that appreciates midwifery care that understands midwifery care, and is operating out of that model as well. That was, I guess that's probably the best way to describe my path to it is just doing the research and then seeing what felt right for me. 

Maggie, RNC-OB  15:25  
Yeah, I know, for a lot of people, and I know a couple of nurses who chose not to go CNM path, even though they already had a nursing degree, and they chose to be CPMs. Because they wanted to have that kind of that experience of providing more community based, you know, home birth care, which can certainly happen, and there are, you know, nurse midwives who do that as well, just the different, you know, training piece of it that goes into it. And I love it for obviously, collaboration like that is, you know, that's our whole game. That's what we want to see more of. So absolutely. We need more, we need more midwives going down any path to be all over the healthcare system. 

Meredith, Doula, CPM-student  15:56  
Yeah. So that they're not to say, that's not to say that at some point in time in the future, that I don't end up with a nursing degree or, you know, advanced practice, depending on what, you know, what depends on what the future holds. I don't know what that is. And so I have some really big goals and big plans. And so they open up different avenues for me, but to legally be able to do the things that I'm trying to do. So we'll just have to see.

Maggie, RNC-OB  16:22  
Yeah, the legalities certainly keep getting getting in the way. And that's, uh, hopefully we're gonna keep pushing through on that issue as well. I don't know if you want to speak to that a little bit, just while we're mentioning it like so in terms of pandemic changes. So one thing I've seen is obviously a bigger push for midwives to have access and for CPMs, to be able to practice.  Ray, an you speak to that? Or any of you all about kind of, like, have you actually seen much traction really happened with any of that kind of permanent changes? 

Ray, CPM  16:53  
Yeah, so the there is a number of so maybe a little bit of context. So Certified Professional Midwives are currently licensed in 33 states, right, Meredith? That might be 35. Right now, it's a qualification that's existed since the early 90s. And it's direct entry midwives. And there are other states like Pennsylvania, where I practice, where there's like a statute saying that we should be regulated and regulated us, there's places that it's illegal and midwives get prosecuted. And at the beginning of the pandemic, there was this very intense and profound surge towards folks wanting to leave the hospital and have a home birth, whether it is because of fear of COVID, or new hospital restrictions or the risk benefit between home and hospital changing. And you know, like, myself, and every other midwife, I know, those phones are like ringing off the hook, and I was on the phone for like hours a day. And yeah, had more interviews in like a two week period than I had like that year. And we tried to manage the volume. And also we're trying to figure out how we can just create better access. So New York is the only place that actually got a bill through. So there was an emergency order that CPMs who had licenses in other states could practice in New York, and then it got extended. And that's currently in place. And Pennsylvania, we also tried to do the same thing, but it did not go through. So we are still the same legal stature that we are, which means we can't bill Medicaid, which means the ability to leave the hospital system has been yet is limited to people who have the funds to cover the cost of a home birth. So what then ended up happening in Pennsylvania is that myself, Asasiya Muhammad, and a few other midwives decided to organize a birth fund to just do births of at our cost, and then give grants to people who are black women on Medicaid to be able to access homebirth. And our fund was really successful. We raised $50,000 in from you know, the last like four months, we're able to give 22 people grants for home birth. And this also got other funds started. So there's at least 12 funds now that I know of throughout the country that are also granting, like black women on Medicaid the funds to partially or fully cover the cost of a home birth care so they can leave the hospital during the pandemic. So that's been a really interesting, cool community response to have that like and also like, a band aid, it's not systemic change that increases access. 

Maggie, RNC-OB  19:17  
So cool.  Here's a next good one. So what's your favorite thing to help folks with other than birth?

Meredith, Doula, CPM-student  19:24  
For me, it's education. It doesn't matter. It doesn't have to be about birth. It's just like I said, I'm an educator at heart. And so I just like to learn new things. And so anything that anybody wants to learn about, I'm like, Yeah, let's go find out more information about that. I'm all for it. So just helping figure things out whether that's, you know, something that's just personal or if it is, you know, more on like that like business level or within their profession, or even just like fun, fun facts just exploring different topics.

Maggie, RNC-OB  20:00  
That's great.

Angela, CNM  20:01  
My 100% most favorite thing is girl talk in the clinic. Let me tell you hands down those GYN or antepartum visits like I love having women come into the office, and chit chat about whatever it is like whether she is concerned about this weird discharge, or her itchy vagina, something on her boob, her period being all over the place, or I haven't had a period in a year or two or three or five, I've seen that. Um, I love it. I love when I get, you know, my eighty year old patients coming in who want to have sex talk with me. I like it just brings me complete joy. And it is one of those things where, because I love birth so much. You know, I started off as an l&d nurse, and I love birth so much. I just thought how am I ever going to do this thing in the clinic, but I'm a talker. And so women talk and they come in and we have girl talk for nine hours pretty much. And so that is the most most favorite thing that I love to do. I love it so much. And I also love being able to tell women, that their bodies are normal, and to not be ashamed of their bodies. And I love being able to counsel them about ways to make themselves better, whatever that means for them, you know, and by better I mean, health wise, you know, that? Yeah, it's the girl talk in the clinic. That's my favorite. Where you get to know people, you know, and establish those relationships and that trust.

Maggie, RNC-OB  21:48  
Yeah, that relational piece is awesome. 

Ray, CPM  21:51  
I think my non baby catching favorite thing is helping people get pregnant. I do IUI, intrauterine inseminations in people's homes, and it's like this really sweet, nervous, intimate experience. And, you know, I love that I can help queer families and single parents by choice, like get pregnant in their own bed. And that feels really important. And then also, like, really cool to like, get texts and photos of like, babies that Yeah, I like I was I was a part of helping. Yeah, great. Yeah. 

Maggie, RNC-OB  22:25  
That's beautiful. I love that that is, can you speak to you a little bit not to get like too into details, but you know, how many, it's not that it has a quantity but like, do you see pushes towards that in terms of more like home based outside of the fertility clinics? Like I know you do that work, I don't know that many other people who do that, who offer that it is that growing more? 

Ray, CPM  22:48  
I think it's kind of growing as a movement with like home birth midwives or midwives or small practices that are doing this for folks. You know, IUI is a very simple procedure. And the thing that we're doing to help facilitate home IUI is fertility awareness counseling. And it's just like, an extra level of doing fertility awareness counseling, because you need really good timing, because sperm is really expensive. But yeah, I think it's like happening and more and more cities, but like, my practice is the only one who's doing it kind of like in you know, like, 100 mile radius, at least if not over, which is Yeah, not okay. There's just not enough options and fertility clinics are designed around the needs of straight people. And so, where people often are single parents wind up getting like more tests and more intervention than they necessarily need or desire. Because if the system is not set up for our bodies and our families and so it's like nice to provide an alternative for folks that want a less medicalized experience to conception. 

Maggie, RNC-OB  23:46  
Just thinking in my head about like, what are the, you know, like, what are the steps that can get put into place like do you, is that something did you train like specifically for that? Like, is that something that any, you know, any CPM or any, you know, nurse, midwife homecare provider could could step into? 

Ray, CPM  24:01  
I think so. I mean, I think queer competency is like, first and foremost. And if you're not a part of the community, or being a part of the queer community is not competency. There's still more to learn. And then, you know, the actual actual logistics of IUI are incredibly simple. I was so fortunate to train in a birth center that had a queer midwife who started an IUI program and to also do an apprenticeship with a transgender midwife, who's also a naturopath who's doing some work and that kind of gave me the foundation I needed to be able to start this part of my practice. But preconception is absolutely in the midwife scope of practice, you know, and if you can do a pap smear, you can do an IU. I just, I think 90% of yeah, fertility and IUI care is being really good at fertility awareness and answering questions about sperm.

Maggie, RNC-OB  24:54  
Yeah, awesome.

Angela, CNM  24:56  
I'm a little bit jealous. I want to do that.

Ray, CPM  25:01  
Before the pandemic, I was working on creating an IUI for midwives class, and then the pandemic happened. And that plan kind of went somewhere and it's like in the background, I'm like, I'm gonna come back and do this and make this happen. So like, everyone can have a midwife who can like get them pregnant in their home, or just have access to like the midwifery model of care for this intimate life experience.

Meredith, Doula, CPM-student  25:22  
So that leads to one of those things like the legalities in Kentucky, that's not something that we have in our scope of practice right now. So there's still more work to be done to be able to really broaden what we can do as far as well woman care, and then, you know, being able to offer a service like that is amazing.

Angela, CNM  25:47  
Incredible.  I did want to just kind of backtrack a little bit, because I wanted to put a spotlight on something Meredith said when she was talking about reflecting about which route to take in midwifery, and being concerned about man, the possibility of becoming over medicalized as a midwife. And what I want to say to you and hopefully to any other woman who is out there listening, is that midwifery is in your heart. It is, it's who you are, it is in your heart, and you will 100% be able to make the distinction between when I need to intervene. And when I do not, it will tell you, I never had those thoughts and those challenges or those concerns. And I know plenty of nurse midwives who do homebirths, I am a crunchy hippie midwife, oh my goodness. But if I need to practice medicine, I am serious about it. Like I had my last baby at home with a CPM. Like because I love and believe in what we do. I love it so much. And I trust birth, I trust birth. And so I think a lot of the physicians that I've worked with even midwives that I work with, when they find out that I had a home birth with a CP and they're like, like, what? That does not determine competency. I know so many Certified Nurse Midwives and physicians who should not be practicing medicine at all. And it is about what you know, it's about what you trust, it's about your heart. And it's about what your intentions are. So if at any time in your life, you decide, you know what, I want to become a nurse midwife, I want to get my doctor's, whatever it is, it doesn't mean that you have to let go of the core at all, it does not mean that I would probably say even in my clinical practice 90% of what I do to treat people or intervene is counseling and education. It is rare that I am writing a prescription for anything. It is even rare that I am writing referrals because I meant it. And most of the time, it's just really going through their history and saying, "Hey, you know what, these are all the things that are probably contributed to that. So let's try this first, you know." So yeah, what's in here will never change. Doesn't matter how many letters behind your name.

Meredith, Doula, CPM-student  28:25  
Thank you so much for that. And I hope there are others listening because that's I think that's really key. Yeah, absolutely. Thank you.

Maggie, RNC-OB  28:34  
All right. So I have another question for you kind of switching gears. So do you have a routine/practice something you do after a birth? That helps you kind of like process or review it? And does that change if you're dealing with like a difficult birth or difficult outcome? 

Ray, CPM  28:52  
I mean, I now have all these COVID protocols. You know, like when I'm leaving a birth, I have to like, wipe down everything. I like I touch, like, yeah, like every alcohol swab gets wiped down before it goes in my bag. Then I have to wipe down all my bags, like right as I leave the house, I'm putting them in my car, and I'm like sitting on a towel in my car that like now is my car. So then I can get home, take off everything that I've been wearing sani-wipe my phone and my keys and immediately take a hot shower. And then I get to touch things in my house or eat something. And so that's a new, that's a new routine. Yeah, I think before this, you know, like, try I yeah, I think there are times that I'd like just kind of, you know, go to a birth and be like, okay, it's 11am like go to your appointments and then you get to go take care of yourself and other times where I got to be like slow and sleepy and just let the experience degrade a little Yes. Which is, you know, a solo practice and sometimes, you know, you just have to work until you're done. Yeah, and I think with like harder challenging births, I'm really feel so fortunate to have a bit of free community both close and far, you know, I, you know, call midwives all of the time, I'm on the phone with midwives and processing my experiences and learning from theirs. And you know, in our midwifery community peer review is a part of the standard of care, which means like I, when I have a complication or someone transfers out of care, I go through the chart with like a group of midwives, where we've all signed, you know, a confidentiality agreement and like, go through my chart from start to finish on what I did, and then learn from others, I can get feedback about what I could have done better or experiences other people have had. And so yeah, every challenging experience can also be an opportunity to learn and be a better midwife.

Angela, CNM  30:46  
Probably one thing that I do, excuse me is reflect Frontier University, let me tell you guys for four and a half years, all they made us do is reflect I was reflected out, we it was just in, they had to be deep, thoughtful reflections. And I now realize that the purpose behind that was to ensure that I stayed honest, to increase my self awareness. And to grow and learn from it's easy to reflect on those beautiful experiences, it's so easy, we just want to bask in that glow, that energy because it feels you it is what feeds your soul to keep you going to the next birth and the next experience. It's the ones that are really traumatic, that we don't want to think about, we try to put out of our minds. So after every, every birth experience, I always reflect and certainly on the ones were that were traumatic, and there's lots of crying, lots of self doubt, lots of regrets, all the what ifs, maybe I should have done this, maybe if I had done that. And we also go through a very intensive peer review process. We did something called morbidity and mortality meetings, once a month, and during those meetings, whatever, if you there are certain criteria for things that had to be discussed. And so whenever your, you had an experience that met those criteria, you had to present the case in front of a group of your peers, this would be midwives, PA students, Family Medicine physicians, Obstetricians, and then you review the literature on it, you reflect on the things that did not go well, how those things could have been dealt with better. And if it is a sentinel event, then it goes to a medical panel review board to determine whether or not you met the standard of care, and you practice within evidence, and if those things that you did, contributed directly to that or could have been prevented at all. And so it is definitely a humbling experience. I've had to present one really serious case on my behalf and it still haunts me, even though I was found not to be negligent, I did all the things, right. But it is a reminder that you are not in control. And you do not have the power to make everything right. But you have to be you have to be watchful, you have to be watchful, and you have to be confident and competent enough to know that this is no longer normal. This is becoming a-typical, even though we're still safe, this isn't right anymore. Now you need to be medically managed. Because when a mom loses her life, when a baby loses its life, you can't come back from that. Like it stays with you forever. It stays with you forever and ever and ever. Even if you did everything right.

Meredith, Doula, CPM-student  34:08  
So for me, just having that safe group to be able to talk things through. And just really being able to process is really helpful. And then outside of that something that I do for my own self care is just finding a nice place to hike I love nature I love finding different views and in being able to just really experience everything that God has created. And so that is another way that helps me process so if there's something that is pretty challenging or difficult that I've experienced then trying to use nature therapy to cleanse my my mind. 

Maggie, RNC-OB  34:51  
Yeah, those are all good idea. I think obviously having that, that community that support that you can let you look in and reflect and like you did to learn and to grow, because none of us ever, we've never arrived, you know, we're always keep learning and thinking of different ways that we can just keep pushing forward. And then so the last question, and we've had a chance to touch on this a little bit. So for National Midwifery Week, the slogan for this year is "midwives for equity." And so I just kind of wanted to see like, you know, what does that that mean for you? How do you feel like you're, you're going to kind of living that out as you kind of work through your day to day and as you're kind of doing your, your bigger kind of planning for what comes next? 

Ray, CPM  35:37  
I definitely think a lot about how, you know, while home birth has traditionally been in the hands of midwives of color, the modern home birth movement in the United States has been white, or majority white, and if I'm not challenging, the kind of current paradigm of how care is delivered, and who gets to access these like sweet, lovely waterbirth and creating other avenues to access midwifery care whether it's financial or social or otherwise, then I'm reinforcing the same systems of oppression. And yeah, it's, it's not easy. And I don't think I necessarily, you know, do a great job every day. But I think I'm really excited to be in a midwifery community that like prioritizes, lifting up Black and Brown birthing people and lifting up queer birthing people and transgender people, and trying to like, find a way forward. And I think those are kind of the voices I want to continue to listen to and like, work towards.

Meredith, Doula, CPM-student  36:47  
That's awesome. For me, part of me being in midwifery school, and becoming a midwife, I think, is part of that contribution. For me, I not only want to be a part of this community, but then, you know, once I have more experience, and I feel confident in doing so, being able to educate others, and kind of, you know, being a preceptor being an educator, and, and being able to train up the future generations of midwives and being able to bring awareness back to the roots of midwifery, I think is really important. You know, like you said, it's right now home birth is pretty typically white. And that's, that's not where history comes from. So just getting back in touch and bringing awareness so that again, when we talk about equity, that everyone who seeks out this system of care has access, I think access is extremely important. It's crucial that no matter your socioeconomic status, your race, your you know, how you identify, none of those things should matter. We are all people, and we deserve to be treated as such. And we deserve the kind of quality care that we're seeking.

Angela, CNM  38:07  
For me, this year has been so pivotal in regards to decreasing disparity, and improving equity amongst all individuals. And for me, it is ensuring that I am vocal when I need to be, and silent when I need to be. And I make it a point in my practice to always tell women when we open the space and I introduce myself, I tell every last one of them, this is a safe space. I'm so glad that you are here. Thank you for letting me offer to serve you. You can tell me and share anything with me there is absolutely zero judgment in this space. And I flat out say depending on what it is that therefore I'm like, I don't care who you're sleeping with, I don't care what STI you have, I am not here to judge you at all. This is girl talk, I am here to serve you. And I want you to be honest so that I can protect you and help you. And so that is that is you know, that is how I ensure equity. You know, I put my families know that do not care where you come from. None of those things matter. What matters is my ability to serve you in a way that is respectful and that is meaningful, and in a way that you feel empowered and validated. Period. And I have zero tolerance for it when it comes to other people misbehaving. So those are the times where I talk about speaking up. I have zero tolerance for people who treat other people poorly and I will call you out directly Not mean about it, but I will be direct, and let you know, that's not acceptable, I'm not comfortable with you speaking that way, in my presence or around the people that are in my space.

Maggie, RNC-OB  40:12  
Mmm. That's all so good. Oh, I just I am just, there is obviously there's just so much inequity in our system right now. And I am so excited for everything that is happening in terms of just the the greater awareness that is coming. Obviously, this is not like a new issue. But I'm glad that it's receiving at least more, more play in the the bigger world out there, I'm glad the bigger institutions are talking about it, that it's that, you know, equity is getting onto the hashtag scene, and that it's, you know, at least there is more discourse happening around that as we work on the, you know, both individual issues that we all can address, you know, in our lives, in our communities, and then obviously, these bigger systemic structural issues that, you know, are behind so much of it. And, you know, midwives are, they're there to be with people, whatever they need, whatever, you know, whatever their background is, whatever their gender is, whatever their race is, in all the ways that you know, all the ways we identify as these complex human beings that cannot be just put into a little box. And so I am, I'm really excited to see what, what keeps pushing forward for. And I'm really grateful for the work that all of you do every day to keep pushing for that and striving to do better in your own practice and helping everyone else in theirs to also grow and keep making birth better. So thank you all so much for like sharing your time with us today and sharing of yourselves. Is there anything else you guys wanted to add before we close out?

Meredith, Doula, CPM-student  41:52  
I would just like to say I would love to stay connected with both of you. I would love to learn from each of you. You are phenomenal people and I know that I could benefit greatly and that can impact those that I serve as well.

Angela, CNM  42:06  
All about collaboration, Ray said earlier how she talks with midwives every single day. Literally every single day, y'all I just got a text from one of my girlfriends, she's actually a family nurse practitioner, she's like, I need to do a phone consult with you about you know, an OB patient. And like, this is what it is like we are so much better when we are together. And we can learn so much from each other because we all offer something that is so important, so powerful. And I am an advocate for all midwives and advocate for anybody who is practicing medicine, practicing safely, offering incredible support to women and families. Like that is what I love. And so to be surrounded by women who all heightened for that same thing. It's magic. It's just magic.

Ray, CPM  43:03  
Yeah. And Meredith, I'm so excited that you're joining the CPM community, like we need you as a midwife, we need more black midwives, we need more black cpms who are like leading the home birth movement, where it should go. And you know, like we cannot do this work without nurse midwives and awesome labor and delivery nurses. You know, if I didn't have nurse midwives in the hospital that I could text and consult with and really trust that when I transfer my clients, I'm transferring them into good hands like I couldn't do my job and or even just the times where I've gotten to the hospital after a super long birth and I see a nurse friend that I know who like greets me and my client and like gives us the energy to like get through it it. You know this? Yeah, this work should happen and community and collaboration and that's what leads to good outcomes. And I'm so excited to get be here with all of you celebrating National Midwifery Week and for everything that's going to come in the future as we work to change birth in the US.

Angela, CNM  44:05  
I just want to say one more thing. I'm sorry, I like start talking about birth and midwifery and I just get all in my feelings that I remember like when I was when I was planning my home birth, it was a few CNMs I worked with and they all referred me to the CPM practice because that is the home birth practice that all of the midwives used in Atlanta. And I will tell you, I learned so much more. Because I thought I was granola. I had some issues. And I learned so much more about practice, and the pause, and being still, and being patient and just listening. My appointments were an hour long and probably we spent 45 minutes with me just laying on the couch and her talking to me, and humanizing me and she made me feel feel so empowered about my ability? Like I, it was all the things that I want it but I did not have birth fear. Like I was not afraid to birth my fourth baby at home, without an IV, GPS positive, no antibiotics. No, you know no pitocin I was not afraid of any of that, you know, she just reminded me, it was just like "Angela, look at the evidence, think about it, look at the evidence, you decide." And I was like I trust you. And that was it. And I had a beautiful birth with no issues. And it was everything that I wanted. And she reminded me to always be that way in birth, even in the hospital.  Okay, I'm done. [laughter]

Margaret Runyon  45:50  
Well, I could sit here and talk to y'all all day because I do I value so much of the just the spirit and a passion that you bring to to all of this and the way that we connect with each other and connect with those in our care. So I really appreciate you all. Thank you Happy National Midwifery Week. Enjoy your celebration with whatever would feel good!

Meredith, Doula, CPM-student  46:12  
Bye. Bye. Thank you so much.

Margaret Runyon  46:20  
Thanks for tuning in. 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. You can check out our show notes this week for information if you're interested in becoming a midwife and wanting to understand education pathways, we'll be sharing some resources about finding a midwife in your area that meets your needs. And we'd really love to hear from you what struck you during this conversation? What was something that you learned or that made you think a little bit harder. We'd love to hear about your experiences as a midwife for accessing midwifery care, as we all work to grow and make birth better. Till next time