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Is home birth safe? With Michele Liot, CNM
97 Plays2 months ago
Is home birth safe? That's the biggest question we face when considering giving birth at home. In this episode Michele Liot gives an answer backed by data, science, and intuition. Learn about the current state of birth in our country, about how safe birth is in hospitals, and how your home birth midwife keeps you safe throughout your pregnancy and birth.
This is part 1 of a 2 part conversation. Subscribe to The BeHerVillage Podcast and never miss an episode!
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Want to be in touch with Michele? Visit East End Midwifery
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Transcript
Introduction to Be Her Village
00:00:00
Speaker
Welcome back to the Be Her Village podcast. I'm your host, Caitlin Magraeus. I'm a mother of three, I'm a doula, and I'm the founder of Be Her Village.
The Need for Support Over Material Gifts
00:00:09
Speaker
When I had my babies, I spent so much time preparing my nursery and worrying about you know the design and decor and all the things that my baby needed.
00:00:19
Speaker
And I was completely caught off guard when I had my baby and realized, oh, I didn't need all these things. I actually needed people to help me figure this out. I was a little lost and a lot alone. And I realized that we could be doing better when we give to
Safety and Practices in Home Births
00:00:36
Speaker
new parents. So I created a brand new kind of gift registry, one where instead of products on a shelf, you can find doulas and help and hands-on care and people that make up your village and you can get funds to pay for them as your baby shower gift. Check it out at BeHerVillage.com. My guest today is Michelle Leo, a home birth midwife and owner of East End Midwifery. And what we talked about today is probably the number one question that people have about home birth. Is it safe?
00:01:09
Speaker
Her answers and her in-depth discussion of not only ah the data and the statistics behind home birth safety, but also what actually happens and how home birth midwives keep their patients safe throughout the entire pregnancy and birth.
00:01:25
Speaker
And what happens when emergencies arise was an absolutely wonderful discussion that every single person who is thinking about or even curious about home birth should be listening to. So we're going to jump right into it. I want to talk about some of the myths around home birth because I think that, and we were just sort of talking about this before we started recording, I think that there's, home birth is still niche.
ACOG Guidelines and Midwifery
00:01:54
Speaker
Home birth is still the 1%. I mean, maybe with the COVID bump, it went to like 1.5%, but it is still, most people are not having home births. And I have a really distinct memory of me and my doula partner um speaking to a couple.
00:02:11
Speaker
who and were like, okay, so here's our birth plan. They literally printed out their birth plan. And it was like, I don't want an IV. I don't want to check. I don't want this. I don't want that. I don't want, like literally they wanted nothing that the hospital was offering them. And my, two right. And my much wiser and much more experienced stool, a partner, Kathy Shamoon, who I love said to them with so much love and grace as Kathy does things,
00:02:38
Speaker
So I'm wondering if it makes sense for you to be planning a hospital birth if everything you want is a no for what they're offering. And it really opened up this beautiful discussion about, well, what's what are the alternatives? And home birth on Long Island is the alternative. There's no birth centers on Long Island. And what the obstacles were. And the obstacles for this couple in particular were all mental. They were mental blocks. they were You know, we're not sure the partner wasn't bought in. What about the family? Do we have the right space? There was just all these questions. So I would love to sort of open up a discussion of the major myths that we um and maybe even myth isn't the right word, but like the major blocks between.
00:03:22
Speaker
people who are considering, quote unquote, natural birth, unmedicated birth, ah midwife supported birth, and what might be stopping them from doing it in the home versus the hospital. So my first question for you, which is probably the number one question people have about home birth is, is it safe? Is it actually safe to have a home birth?
00:03:46
Speaker
So I was dropping into reviewing sort of the stats. I mean, again, it's something that sort of lives in the back of my brain anyways, because I do have to answer this question somewhat frequently and it's relative, right? So is home birth considered safe in the United States of America, okay? Because we have a very different healthcare system than other developed countries who have a highly integrated midwifery led obstetrical model, right? So our country,
00:04:13
Speaker
10% of home birth midwives, that's it. 10% of all midwives are ah operating in the out of hospital setting. So 90% of certified nurse midwives and certified midwives, that is who I'm speaking to in terms of licensure because I hold the certified nurse midwifery license, okay, here in the state of New York. So 90% of these births across the country are being supported midwifery led, supported in the hospital setting, right?
00:04:42
Speaker
Okay, so let's bring it to out of hospital and how so data collection in a hospital setting is very different right it's a controlled environment, people can participate in research studies.
00:04:53
Speaker
They can have their options, do they want augmentation versus not, et cetera, et cetera. In the home setting, we're doing pure physiology, but the way the data is collected, it's it's very challenging to do so because you're relying on the various midwives across the board submitting standardized data, which is not necessarily easy to collect because of how the various families is and the variation in within these families um race, demographics, socioeconomics, all of these things factor in. So data is really hard to collect. So is home birth safe?
Hospital Birth Risks and Misconceptions
00:05:28
Speaker
Let's take it to ACOG. The American College of Obstetrics and Gynecology puts forth that home birth should be an option for low risk pregnancies. So this huge organization does say home birth is a reasonable option. What they put forth as supporting that is having a
00:05:48
Speaker
well trained, experienced clinician present and they support the certified nurse midwife and certified midwife licensure. That is what they define for themselves as an experienced clinician. Okay, I don't want to discount my CPM colleagues by any stretch of the imagination, but we're going to leave that aside because New York State is where we live and they're not currently licensed, eligible for licensure in the state of New York.
00:06:12
Speaker
Okay, so is it safe? Many women, the the majority of women in the country are low risk. We have a rise of diabetes. We have a rise of hypertension that are changing the risk strata for many people because it's on the rise in this country. But again, predominantly,
00:06:32
Speaker
women, birthing people are falling into the low risk category. And low risk is the scope of the out of hospital midwife. It's also the scope for in hospital, but because of the support they have in the background, they can step into a slightly higher risk stratus because their resources are are available differently.
00:06:50
Speaker
Right. That makes sense. It makes perfect sense. Yeah. Well, is it safe? It is safe if your clinician is navigating your risk strata throughout the process of your pregnancy. You're starting with your health history, starting with prior births, starting with so many factors to determine if you're even a candidate now, and then continuing to monitor throughout the pregnancy to maintain that candidacy for an out of hospital birth. least You have to maintain in that low risk setting, although I wouldn't say it's small, I would say it's wide, right? But there's a lack of sort of comprehension because our society says birth is dangerous. Birth is dangerous, birth is dangerous, birth is dangerous. Now, is there inherent risk with birth? Yes, there is.
00:07:38
Speaker
but we also have an increased maternal morbidity and mortality rate and it is not a mutually exclusive from the hospital setting. With the rise of cesarean birth and that maintenance at that high level, the ah rise of interventions, inductions, augmentations, we are seeing mority morbidity and mortality increasing because these interventions interventions were lead to or can lead to and it is indisputable, yeah right? And so why aren't we engaging in that conversation with our hospital-based providers? Why aren't we saying, what's what's your standard of care? What's your wait time? Do you go off call? Are you trying, like, people don't understand. People are like, oh, I i don't want i want a private practice so I can guarantee who's gonna be at my birth.
00:08:29
Speaker
in In what universe? In what universe? Part of the issue is that people don't even know the questions to ask, right? is Is like, how do you ask about call when your doctor is telling you, I'll be there. They mean they'll be there because they're gonna induce you. That's how they're ensuring they're gonna be there. Like if they're saying, I will be at your birth. Right. the There's some underlying stuff going on in the background. Right. right Because then all of a sudden, oh, but you know, your advanced maternal age, the 36.
00:09:03
Speaker
Lord have mercy. we're gonna We're probably gonna induce you at 39 weeks. That's the recommendation. Ooh, your baby's big. Mm, you're fluid. It's not high, but it's high-ish. And so we we create, the system creates pathology to then, I call it coercive counseling. You are directing someone towards something that then they integrate as like, well, I had to do this. It saved my it saved my baby and it saved me.
00:09:32
Speaker
And while that, in some circumstances, is absolutely true and valid, in many circumstances, it is not. This is why we're seeing the rise of cesarean birth that is not necessary. And how many times, Caitlin, you've heard it too, and and this is not to diminish the women out there who have had genuine emergent surgical births.
00:09:47
Speaker
but there are a million times in a row where I have heard I had an emergency C-section. And then I inquire, tell me more about that experience. Tell me how you ended up in the operating room. Tell me the rapidity of how you ended up in the operating room. Were you flown through hallways and put under general anesthesia? What are we talking about here? Or was it a conversation with your practitioner? If you had a lengthy conversation with your practitioner in a hospital room, you did not have an emergency cesarean birth.
00:10:15
Speaker
And that is not to diminish what you were told, that is not to diminish your experience, but it is to qualify it in real life. Because now you are living with this with the with the ideology that this provider saved you, that this setting saved your life. When in truth, midwifery led birth decreased cesarean rates, decreased use of epidural, decreased intervention, decreased augmentation, and the cascade of interventions is real.
Personal Experience with Home Births
00:10:45
Speaker
It is so real. So I want a hospital bird. You have less augmentation, almost none. And augmentation is what, with herbs, with homeopathy, we're not giving medications in the alpha hospital setting. We are having less induction. We are having more spontaneous labor, which leads to more spontaneous natural natural vaginal births, right? So we're so safety,
00:11:09
Speaker
is such that there are there are positive outcomes for the out of hospital setting because you are negating some of the risks associated as a low risk individual that can then become high risk because of the iatrogenic causes. We're putting this stuff on you and we are changing the trajectory of your birth and actually changing the safety. So I want to speak to this specifically. Iatrogenic i what did say iorogenic causes I want to just underline that and define it because when I was a new mom, and honestly, like when I was a second time mom too, I didn't know what that word meant. And when people ask me about home birth safety, I tell my home birth story, which I don't know if you know this about me, Michelle, but I became a doula after my second and my second birth.
00:11:58
Speaker
And when I became a doula, I did not, quote unquote, believe in home birth. You've told me this before and I love it because they had one. Because then I had one less than two years later, like maybe a year and a half later. But I was the person who just didn't think it was responsible. I didn't think it was responsible. um This was like a very like a pre, you know, when you're not a mom and you just judge everybody else, like who am I like believe or not believe? But my stance was it doesn't make sense that we have taken all of these decades and centuries of information and advancements. Oh, we are so advanced. Who are we as mothers trying to protect our children to reject that?
00:12:42
Speaker
Who are we to say no to the modern medical miracles that are happening in hospitals? I'm like, I don't want to throw up my mouth a little bit just saying that, but that was who I was. I was like, it does not make sense. And what it took for me was, first of all, experiencing the hospital caused interventions that create problems that need more interventions that cycle that cascade of interventions. Everything you're describing about that non-emergent cesarean is my entire first first birth. It's just like you start with a little bit of, you know, cytotec and then a little of that a little epidural and a little ah damage low blood pressure drop, lots of beeping and machines and people and no emergencies to be found. Um, and I just, I think part of it for me is there was this like,
00:13:30
Speaker
and not spiritual, but it's like, it's like a paradigm shift in my brain from the hospital is this advanced place where I can get top-notch care for my baby. Because the truth is all of us want the very best for our babies and ourselves. That's the universal. It's just what that is. And it took becoming a doula, first of all, going through it, but then becoming a doula and watching with my own eyes that cascade of interventions happening again and again and again, just as you're describing,
00:14:00
Speaker
that I started to realize that a lot of these issues that are so-called emergencies are actually caused by the medical interventions themselves. And that was when I started to shift into this place of like, it's not necessarily a perfect choice. It's not like, you know, I can go to the hospital and have zero risk, right? That's the other piece of this. The hospital has zero risk and home has lots of risk. That's sort of like how it's presented to us. Home birth is risky and hospital birth is not, but actually it's, do you want- Walking from the door to the hospital, you increase your risk of surgical birth. Period. Like that's it. You increase your risk of bleeding. You increase your risk of infection. You increase your risk of of sequelae from that. You increase,
00:14:44
Speaker
risk of respiratory distress in your infant. We know that there is an increased incidence of those things. And so again, it's not to say that home birth negates that risk. That's not- That's not what we're saying. You cannot minimize that there is also associated risk by walking through the doors very specifically if you are a low risk individual. Yes.
00:15:03
Speaker
Yes. And I think that that is such a big part
Midwife Assessment and Safety Models
00:15:06
Speaker
of it. It's like, is it safe? And it's like, well, first of all, is it safe in comparison to my other choices? But also what I heard you saying is, is it safe for me? Because it's so individualized and it sounds like your job as a midwife mainly is to create this relationship and this monitoring and this connection with your clients so that at every step of the way,
00:15:28
Speaker
you're making sure that it is continuing to be safe for them through pregnancy. And I would imagine in the laboring time, in the birth time, that that is your main role. Is this safe? Is this continuing to be safe? And how can I assist in that?
00:15:42
Speaker
So I think that lends itself to a conversation that I have with potential clientele frequently. It's a model that I adhere to um um specifically as a midwife, but it speaks to safety overall. and And generally speaking, this is how a lot of home birth midwives operate. So I go by the stop sign, stoplight model, okay? So green is go, right? It's just go, we're good. We're low risk, we're healthy, we're keeping it moving, blood pressure is good, bubble, you name it, we're good, babies move at heart rates. but Yellow, some people wanna drive through that yellow light and occasionally I do, I'm gonna be honest with you because it's Long Island and if I'm headed to a birth, I'm speeding through it. um But what does yellow mean? It means caution, it means slow down, it means stop and think. So let's say I have a client who gets a sonogram and we have some small measurements on the baby. Okay, how do we feel about this? Let's get some data. I always want data, I want data points, I wanna compare things, right? i'm i'm a
00:16:38
Speaker
I, my brain, I'm a total nerd. So I'm like, okay, what are the recommendations of the, the physician who reviewed the sonogram? Okay. Follow up in four to six weeks for our growth scan.
00:16:49
Speaker
Great, we follow up in four to six weeks. Growth is normal. We keep it moving. We follow up in four to six weeks. Growth is on par where it's been. Let's have a consult with a physician, okay? let Then we take it from there. This is a model, okay? You have some hypertension today. Your borderline, let's see. Let's test your urine. Let's maybe do some blood work. See what's going on. And then if we return back to green, we keep it moving.
00:17:18
Speaker
if we If we don't, and then we follow through with our consultations, collaborations, lab work, et cetera, and we hit red, you risk out. That's And that same model is when you're in your laboring time. I have different measurements and sort of bench ah benchmarks, baselines, et cetera, that I need to maintain for the low risk labor experience. And again, it's the same. Yellow, we're gonna see what's the what. I'm gonna tell you what I'm comfortable with. I have no poker face. I discuss everything with the parents straight up and down. If I'm thinking it, you know it. And if we hit no, we're red and we transfer.
00:17:56
Speaker
This is how this goes. So again, we are, like you said, like out of hospital midwifery, like we're not trying to mess around with your safety. I'm not more invested in the location of your birth than your safety. I always say, mom first, baby second, cause mom's already here. She exists. Baby second, they exist, but they aren't outside yet. Location third, your location is not my priority because I'm a home birth, your safety is.
00:18:22
Speaker
I love that. That's amazing. Excellent. Well, I feel like that was, that's a really hard question. Is home birth safe? And I feel like you just hit on so many layers and levels of that. And I really appreciate the well thought out like statistical answer and also the real answer, which is like, is it safe? Yes. And here are all the things to consider for yourself. And as you're selecting a midwife, you know, like what is their, what is their process of,
00:18:50
Speaker
um of assessing that risk. And also the other thing I just want to point out before we move on to the next sort of block that happens for people is what you mentioned in that risk assessment is consulting with a physician, is using those tools of quote unquote modern medicine, right? The sonograms, the tests, the labs, the consults. And I feel like that's an important piece of this because There is this idea that midwives are like, and actually this is, let's just move right into it, right? There's this idea that midwives are like almost like witches, like midwifery, like witchery. And listen, we might also be witches. We're not going to dispel that completely, but there's this idea. I love it. I love it so much. but Let this be known.
00:19:39
Speaker
But I am a clinician, and I am a proud clinician, and I am a licensed clinician, and I've done a training, and et cetera, and I have skills, and I can prescribe medications, and I can do lab work, and you're right. Like, it's like, I i feel like midwives are constantly sort of defending who they are, that we're just like in the backwoods, you know, cutting umbilical cords with our teeth, and I'm like, this isn't like, I'm like, and then I'll just, sometimes I'll just be, you know, completely facetious and be like, yes, the deer were present for the birth.
00:20:09
Speaker
And like, listen, so it's funny, like I've seen umbilical cords cut by candle, right? At a home birth, the candle ritual, like you can have all of those witchcraft, wonderful ritualistic types of things. Like that is sometimes what people are inviting into their home birth. But I wanted to spell this myth.
00:20:28
Speaker
that midwives are untrained, that they're walking into your house without tools, without medication, that they don't have skills, that they are not trained clinicians. So can we talk a little bit about what do midwives bring What are they allowed to do? Do you need a doctor for some parts of your pregnancy or some parts of your birth? Like where does that all fit in? And cause I, and I think also one of the big myths is like midwives and doulas are on the same level of training and just doulas go to like a three-day dream. At least I did a three-day training, some reading and some follow-up. It's a great training. It's very in depth, but it is not disparaging doulas. We love them. I love, I am a doula. I love doulas. They're vital part of the maternal health care system. Um, and you should have one and get one, but you need one in addition to your medical team because your mid, your dual is not part of the medical team that's going to be giving
Integrating Midwifery into Healthcare
00:21:24
Speaker
care. So what does it take to become a midwife? Um, what's your background? If you want to share your background, but what is it, how are you prepared in a birth for just birds, but also for like, if an emergency happens, how are you showing up?
00:21:40
Speaker
So, it's interesting. this is a This is like a multifaceted question. um So, technically midwifery training, you, ah CNM, certified nurse midwife, CM, certified midwife, slightly different paths to the education. The CNM clearly is a nurse prior. I was a nurse for I've been a nurse for 16 years and I've been a midwife for fours. I was a nurse for 12 years prior to the predominant timeframe spent in labor and delivery. And I do think that my nursing background is really, has informed my um experience and and developing expertise. I have imposter syndrome. So I'll never say that I'm an expert on anything. um If you think you're an expert, you got to keep, you got to keep it moving and keep learning.
00:22:22
Speaker
um But so i yeah so that was my specific training. I then went on to get my master's in um midwifery at Stony Brook University. There's a ah high number of clinical hours that you have to complete in different components of the midwifery scope of care from gynecology. We don't only catch babies, midwives provide reproductive care from adolescents through the lifespan of uterus owners, right?
00:22:52
Speaker
um We can provide comprehensive GYN care, including gender affirming care, right? Moving towards birth, because this is the predominant conversation we're having. We then are also trained in intrapartum, that's labor and delivery. We are trained in, and then we do an integration component as well. So we're catching a bunch of babies while we're in midwifery school. We're training on sutures. Yes, we can put together lacerations. Yes, in the home birth setting, you do not have to do that without pain medication. We use lidocaine.
00:23:21
Speaker
Okay, I think that's another myth. People are like, can you put me back together? Yes. Am I going to just have to be screaming and biting a leather belt? No. Thank goodness. I know. God. um So that is a component of the training. And then um we don't necessarily have a like a residency, although there is often a lengthy orientation in terms of whatever practice you join up with.
00:23:48
Speaker
um and where you're rendering care. So bringing it now to collaborative relationships, I feel very privileged, um and I use that term very specifically, I am privileged in that my experience at Stony Brook University, I developed an enormous amount of collaborative relationships. I had you know, experience with these, the in-hospital midwives, I had experience with the physicians, the um standard OBs, the generalists, as well as the maternal fetal medicine specialists. And so I already had these relationships built because one of the hallmarks, according to the research data, as well as ACOG, which I referenced earlier, is having integrated collaborative systems as well as transfer protocols established. Does that exist in the United States?
00:24:35
Speaker
Barely. Does that exist in the other developed countries where free led obstetrical care is integrated fully? Yes, it does. This is why their home birth outcomes, they have better research, they have more data, and they have really positive, different outcomes than what sta data we have collected on home birth. Because one thing you have to remember is that, because if you're Googling data, which people love Googling, Lord have mercy,
00:25:00
Speaker
um You're getting stats for people who had unplanned out of hospital births as well. The accidental, I had a baby dropped out of my house. It was a 28 week kid. It was a poor outcome. We called the ambulance. So that's collected as home birth data. So are you kidding?
00:25:16
Speaker
No, that's not the same thing at all. the plan I always say it's so funny just in conversation. Whenever I tell people I have a home birth, I always say planned home birth because I think it's so important. or it It's different. Yeah. but um Because again, who is in attendance? Do you have a skilled provider in attendance or not? Right. But because that data is all just consumed by birth certificate data, there's no way to differentiate that because there are those at home birth who may not be attended and then they're filling out their birth certificate information that's being submitted, but it's it's under the umbrella of home birth. Okay, so that's an aside. We do not have a well integrated system here. um There is adversarial relationships predominantly across the country with physicians. um
00:26:03
Speaker
and out of hospital midwives as well as even hospital-based midwives. There can be an adversarial relationship and um and transfers occur and the receptivity can be very negative. And what an integrated system is, is wherein there is meaningful transfer protocols that you have receiving practitioners who are um amenable to receiving and supporting this and then engaging in a safe progression of the labor if it's possible or or engaging in a safe surgical birth. if that is what it's indicated at the time. right Respecting the the midwife providing full comprehensive report, recognizing their role as a clinician and a provider that we are not, again, some witch in the woods that they don't need information from.
00:26:48
Speaker
We have comprehensive information to give that meaningful transfer. I have had very good experiences to date with my transfers, but it is not always met without challenges. oh And that can be hard.
00:27:05
Speaker
um So that's what an integrated system sort of would look like. There are inroads trying to be made specifically at Stony Brook. They are a little bit more amenable. They recognize that an integrated system is safer overall. They're not pro-home birth, but they know it's happening on Long Island and they are respectful from a nursing standpoint all the way through to the MFMs.
00:27:30
Speaker
they know what's happening. They're predominantly the institution that's doing our sonograms. So they know what's happening. And it's, it's meaningful. So Stony Brook is always my place. It's not to plug Stony Brook so high, but, but they have generalists, which means generalists are going to have a longer, um,
00:27:53
Speaker
they're gonna be more capable of allowing the labor to continue in its normal way. They're not trying to speed it up. Why? They go home, next person comes on. They don't have to get home. They don't have a person at home that's like, you've missed dinner four times this week. They don't have office hours to get back to. They can't, because it's not, people are like, oh, the C-section, you make so much more money. And it's not technically that like insurance pays out so much higher.
00:28:18
Speaker
it's that It's the timeframe to delivery. If you can reduce the time to delivery, what you're recouping is better and you're not losing money from mis rescheduling office visits, rescheduling, et cetera, et cetera. So when you have a generalist, they're there no matter what. So they can be like, yeah, all right, now you're sitting. So it's a generalist meaning for people like me who have no idea these terms, generalist meaning a doctor that's not necessarily in private practice, but a hospital.
00:28:45
Speaker
paid, salaried, whether you deliver or not, they're getting the same pay and they're going home at the same time. Correct. That's a beautiful thing. And that's typically in academic centers, more typically in academic centers, there is a leaning towards doing this now, because again, there is a lean countrywide to reduce the cesarean rate of delivery. And we know that factors in but not every hospital is adhering to that. And I think that private practices really put that off because then the private practices have to decide like how many extra salaries are in the investing. Cause if they can just do the work themselves, why would they pay someone else to do this? But then you got to ask what their C-section rate is.
00:29:29
Speaker
right but You have to not just think about profit in a for-profit, right but you have to also think about patient outcomes and overall health and a rising maternal mortality rate. um that's It's so wonderful to sort of see this inside behind the scenes you know system that you're considering because it's not just that you're well-trained, right it's not just that you are this clinician. It's also how do you fit into this larger landscape? And even
Intuition and Relationship in Birth Safety
00:30:02
Speaker
when things on paper are all equal, you know, it matters who's on call. It matters their experience with the last transfer that came through the door. It matters with the executive approaches. Right. Wow. So here's a question that's sort of related. um
00:30:18
Speaker
what are you bringing with you to a birth? Like what types of things? Very heavy bags. What types of things mary are on you? I love it. So I was just like full disclosure. I was a home birth midwife assistant um briefly, very briefly, but I did a little training for it. I learned how to take blood pressure. I learned, you know, what I was expected to do. I was like recording, you know, heart rates and and all kinds of things and times of birth and that sort of thing. I was setting up you know, resuscitation equipment. And I think for me, even someone who had been a doula for years, it was so eye opening. How much medication, how many medical supplies are in these bags? Careful. Now we're all going to get labeled as medwives. yeah I despise with every ounce of my being so disrespectful.
00:31:11
Speaker
It's it's interesting that it medwives absolutely is said anytime that term is said it is said in a disrespectful way but I think that there's this real like for somebody who has like a nervous partner or a mother-in-law that's like the reason they're not doing it or whatever like choosing home birth. I think that there's there has to be something said for just how how much midwives are completely prepared as they walk into the home space, because I think in practice, and this is just me and feel free to correct me if I'm wrong, but in practice, midwives do a lot of sitting on their hands at home birds, because that's their role, right? Is to like engage and wait and patience and all of the things, and yet,
00:31:55
Speaker
there's a bag full of so many life saving, life assisting medication, like for every single scenario. And I didn't realize it until I went through um the midwife assistant training. And this was after I had a home birth. So even as a home birth person who had one, I did not realize what actually um was brought into my home to create a safer setting. And Part of why I bring it up is because I think there's this balance, right? And we spoke about this like between talking about the positive and the negative. Like we wanna talk about birth as like, we're gonna open like a flower and we're gonna physiologically just expand and have our babies, you know? And we don't wanna like talk about hemorrhage. We don't wanna talk about not breathing. Like there's these big scary things but I wanna talk about it briefly only because even if we're not saying it out loud as like part of our advertising for home birth,
00:32:50
Speaker
yeah It's often the thing that scares people the most or the worst case scenario. What'd you say, Michelle? I answer ah answer these questions with every interview. um much kind all right so So I'm, and actually that was my main concern when I was choosing my home birth was hemorrhage. So talk to me, why should I not be worried about it? Should I be worried about it? What, what do we think about home birth hemorrhage? What do you bring as a home birth midwife to manage emergencies?
00:33:19
Speaker
Well, it goes back to the safety conversation, doesn't it? And then like those ACOG recommendations, having a skilled attendant and having a pro and a skilled attendant is going to come with equipment because we know that part of our skills should they be needed, right? Are available.
00:33:37
Speaker
You can't, I can't handle an emergency if I'm i'm running out to get a lead to like gauze, that's not how it works. So yes, I come with an enormous amount of equipment that I am trained to use. And the nine out of 10 times, I don't have to use it, right? But when I do, sometimes I exhaust what's it, you know what I mean? I never exhaust because I carry so much backup, but because I'm really type A. But so it's,
00:34:06
Speaker
So what do I come with? the The short list would be I have these very well-stocked bags. i have I have accounts with all of the medical companies right where I order my stock and equipment. I keep track of it. I check on my expiration dates. I'm restocking, et cetera, et cetera. All this to tap into the back of your brain for when we discuss financing home birth and why it costs, what it costs, because think about what I'm buying to hold space for safety.
00:34:33
Speaker
um Anyways, so I have all resuscitative equipment. I have anti hameragic agents, all of the standard medications that are going to be available to you in the hospital setting. No, I cannot perform emergency surgery, but I also have IV fluids. I have antibiotics if you have group beta strep. I have, like I said, the anti hameragic that can be given in a multitude of ways.
00:34:54
Speaker
I can repair a laceration rapidly if that's the source of extensive bleeding. I can resuscitate a newborn if we have a newborn that is struggling to get started up. i'm not It's not just that I'm capable, I'm i am trained.
00:35:08
Speaker
i take basic life support, advanced life support, neonatal resuscitation. I have taken out of hospital birth emergency skills training courses. I have put my assistant through all of those classes as well. I travel with an assistant always, no matter what. That is part of what is deemed appropriate and safe level of care for the house and hospital setting.
00:35:30
Speaker
right So I have a skilled attendee that comes ah along with me. right So this is part of maintaining the safety. I have my oxygen tank. right I have a multitude of things. And then I also have my phone to call 911 at the end of the day. I do have transfer protocols in place. We are discussing this throughout your prenatal care right about what it looks like in what settings. How are we going to the hospital in what settings? If it's a true emergency,
00:35:59
Speaker
Where are we ending up? What is the closest system to you? So there is a lot that comes into it. So the long and the short of it is you can go into my office, there's a million boxes, each one has its different components, then there's the small boxes with the smaller components, you know, and then there's a whole system by which I go through that I sterilize my equipment, I have instruments, right? And I have my hands.
00:36:24
Speaker
And I have my ears and I have my eyes and I have my intuition that I develop over time. And I actually really believe in that. Obese have intuition. Hospital-based midwives have intuition. Women have intuition. Fathers have intuition. babies eight Michelle, and me sorry week me and the babies, all of all my clients know I develop a relationship. Why? Half the reason I want you coming to the prenatal visits, I want to check on you, but I also want a relationship with your baby. My clients joke that the babies know me when they hear my voice and they're born. They're like a crazy person. I know that voice. Without any, without telling the whole story, I just want to like acknowledge that I was a doula at a birth where Michelle was the midwife and
00:37:09
Speaker
there was this baby, this amazing baby inside of an amazing mother that we both love so much. And this baby knew what she needed and she knew what she didn't need. And I will leave it at that, but I just, I have never believed so strongly in the baby's intuition and the baby's knowing than I did at that birth. I'm getting goosebumps about it. It's not my story to tell, but it was She just knew what she needed and she made it clear um by making something not happen. And it was only after she was born that we all
00:37:43
Speaker
were like, oh, wow, what a smart little cookie this one is. And it it doesn't surprise me at all, but Michelle, that birth
Conclusion and Next Episode Tease
00:37:50
Speaker
like changed my understanding of existence when I understood that that baby was communicating with you and that baby was actively partaking in her birth. And it was really, really cool to be part of. So I just want to make sure we talk about the babies. um but Let's dive in. Let's talk about them.
00:38:13
Speaker
theel If we disrespect and dishonor the fact that they are sentient beings, we are failing in our assessment. So I will review with clientele that a big part of the prenatal care for me is making a connection with this baby because how do I monitor this baby in your laboring time? It's through heart tones. This baby's heart is what I'm listening to. how can i the heart and listening to this heart. Now, technically, yes, it's the beats per minute and how they're responding to contractions and what stage of labor you're in. And are we imminent to birth? And what is the cadence of their, you you know, heart tones? But this is my communication with them. And it's energetic as well. And I'm saying to mom like,
00:38:57
Speaker
tap in, how's this baby moving for you? Are we getting what we need? As this baby's crowning, I'm taking, is this baby wiggling for me? Is this baby's heart don't go? How are they communicating with me, letting me know that their wellbeing continues to maintain? And that relationship, just like with the client and the trust gets developed, it's with the baby as well. If I have a relationship with this human, we can trust each other to continue forward in a safe manner.
00:39:23
Speaker
and I have to listen to them. If this baby's like, I'm not trying to get born here, okay? Then you know why. Even if you might go on to have a vaginal birth in the hospital setting, that's fine. It doesn't mean that we've lost all, we're not lost all because the surgical birth is not losing. it's it's a It's a completely normal way to give birth in the sense that it can be safe and appropriate and necessary. um But these babies are telling us things.
00:39:54
Speaker
yeah they They just thought whether they're refusing to descend, whether they are in a position, they're so asynchlicic and they can't change it, whatever the case may be, they give us messages. And we have to listen to them and honor and respect them because they also know things. None of us have an x-ray window into the uterus.
00:40:15
Speaker
We have sonograms, we can see things. The cord around the neck is not the be all end all of the world. But we don't, um we're not x-raying pelvisies. We're not doing these things. We don't know what the uterus shape is. Sometimes these breech babies will get themselves all squirreled up and we can flip them and then they flip back and then we can flip them and they flip back and I'm like,
00:40:34
Speaker
Okay, what are they telling us? Like they know, they're the only ones that they know the most about what's going on. And then the mothers. And then the mothers know the most, at least of the people who can speak in the room, right? so they Are communicating with each other. There's yeah like a relationship of a pregnant individual with their fetus. Absolutely. And then it's our job to like, if you're tapping in, like holy.
00:41:04
Speaker
Whoa, that is that's a profound connection. And there is a lot of knowing there if you can tap into the into the intuition. I hope you enjoyed the first part of our conversation with Homebirth with Michelle Leo. Part two of this conversation will be coming out next week. Be sure that you subscribe to our podcast so that you will get alerted when it's live. Be sure to check our show notes for links to Michelle's website, links to start your registry on BeHerVillage, and also a free download that includes all the questions that you should be thinking about as you interview Homebirth Midwives. Until next time, everybody, bye.