Tuesday, April 12, 2016

Q&A With A Midwife: Exclusive Interview!

Here is the interview I did with my midwife that I promised! Sorry, it kind of took longer than planned because I've been so busy! There is going to be a Part 2 hopefully soon that will be my experience with midwives and my last delivery, and my thoughts on her responses. Thanks Liz, for doing this! 
My amazing midwife Liz(to the right) and her amazing assistant(left)! Birth of our Dahli Mama.Picture taken four hours after the delivery.

Utter happiness doesn't get rid of the exhaustion afterwards.

Sleepin' with my lovey. Both work hard.

Our beautiful flower girl.

Elizabeth Smith is a Certified Professional Midwife as well as a State Licensed Midwife and has

been practicing for thirty years. She began her apprenticeship in 1985. She has delivered 1,432


Information that is good to know (not a part of the interview):

What different types of midwives are out there​? There are CNM’s (Certified Nurse

Midwives), Certified Professional Midwives, State Licensed Midwives and Direct Entry

Midwives (Lay Midwives).

What is the difference between them?​Certified Nurse Midwives (CNM) are registered nurses

in midwifery. Because of that reason, they are most commonly found practicing under a doctor

in a practice. A Certified Professional Midwife (CPM) is an independent midwife that has

received their certification from NARM (North American Registry of Midwives). A state

licensed midwife is a midwife that has a license to practice midwifery within a specific state. A

Direct Entry Midwife (aka lay midwife, traditional midwife) is a midwife who learned the

practice most likely through self­-study and apprenticeship. CNM’s, CPM’s and State Licensed

Midwives all have to take tests to receive the title. There are no requirements for Lay/Direct

Entry midwives.

Both Certified Nurse Midwives and Certified Professional Midwives are able to administer

medications under certain circumstances (i.e. I.V’s, pitocin in the case of hemorrhaging,

numbing medicine for stitches).


How do you think midwives compare to OB’s?

​It really depends on the midwife and it

depends on the OB. But, the main difference is that an OB is taught about abnormal birth. They

are skilled in dealing with complications and a lot of the times they interfere in the natural birth


How many transfers have you had?

​I don’t have the exact answer for that. I probably transfer

about 4­-5%. I’ve dealt with just about every complication imaginable in childbirth. If you ask

me, “have you dealt with this?”, the answer is probably yes. But, I have never lost a mom or

baby during home birth or with transport.

Do you think that your perception of what is an emergency differs than that of a doctor? If

so, why? 

​Let’s rephrase the question. Is my perception of high risk different than a doctor’s?

Yes, definitely. Is my definition of an emergency different? No, not a whole lot. Sometimes I

think doctors are more nonchalant about an emergency than I am. If a heart beat is dropping

during contractions, I think I react more than they do. We do differ but I don’t exactly know how

to explain it because sometimes I think they overreact and sometimes I think they under react. It

depends upon the doctor.

Would you recommend delivering with one type of a midwife over another?

​I don’t because I’ve seen good and poor in each category. My own midwife is not licensed but I wouldn’t want anyone else. I don’t think that the license or certification means that you have the “gift.”

Do midwives ever double as doulas?​

Yes, I provide doula services sometimes.

Is getting an epidural actually bad for you or the baby? Why would you recommend

against it?

Danger of epidurals?​Google it. There are physical dangers and psychological

dangers. An epidural is mostly safe but there are risks they don’t tell you ranging from

headaches to death. It lowers the oxygen to the baby by lowering your blood pressure. Because

of this the baby is more likely to go into distress with an epidural. Epidurals make logical sense

to most people. Why feel pain if you don’t have to? BUT, there is a lot you give up when you

get an epidural; and I’m not talking about money. Rather than be an active participator in the

birth of your baby, you are a spectator of it. That baby is going through the birth by himself, not

with mother. It affects imprinting and bonding, because it interferes with the flow of oxytocin.

You will still “Love” your baby, that comes natural, but you will not “Know” your baby like you

would if you had left natural imprinting alone. You’re also giving up that euphoria, the most

wonderful, beautiful feeling a mother feels after delivering drug free that comes as a result of

endorphin releases during natural labor. Labor is very bearable, and shouldn’t be feared, and the

more pain you go through, the greater the euphoria when it’s over. It is the most painful and

hard, yet beautiful and wonderful experiencing a woman will ever experience in life. When you

give up that brief period of pain (only the final moments of dilation seem unbearable), you give

up the fullness of joy that awaits you, as well as complete imprinting and bonding. Sometimes I

compare it to running a marathon even though it’s very different. Why would somebody run 26

miles if they didn’t have to? What’s in it for them? A medal? Bragging rights? From what I

have been told, having a baby naturally is easier than running a marathon. So why do you get

patted on the back when you run a marathon but get told you’re crazy when you deliver drug

free? With the right support, having a baby naturally can be a very, very beautiful experience. If

you’re just allowed to scream and then have nurses tell you, “We have epidurals for that,” it can

be a horrible experience.

Do you deliver twins? Triplets?

​Definitely not triplets. I used to deliver twins, I have delivered

at least 14 sets of twins but State regulation in Utah doesn’t allow Licensed Midwives to deliver

twins. I had to trade twins for the privileges received with licensing. Otherwise I’d love to

deliver twins, but only after careful and prayerful consideration.

In what ways does natural delivery with a midwife benefit the baby and mother more than

delivering with a doctor in a hospital?

There are multiple benefits. There are some doctors that

are very natural minded and some that aren’t. The main way it differs is the time you will get

from the midwife as opposed to a doctor. The midwife knows you personally because she has

spent a lot of time with you during your pregnancy. You will receive customized care that is

personal for your needs and your wants. That is a huge factor when it comes to safety. Doctors

put everyone in the same category and follow protocols assuming the worst until proven

otherwise. A midwife can eliminate the worse, until proven otherwise, because I know my

clients, I have better intuition in helping and caring for them during labor and postpartum. You

also don’t have to wait in doctor’s offices for hours just to see the doc for three minutes. All your

questions are answered. Sometimes during the prenatal period that time spent one on one can be

crucial. For example, sometimes I don’t catch a serious problem until the end of the appointment because it

has taken the woman that long to feel comfortable enough to ask me that embarrassing question.

With a doctor, she just wouldn’t have mentioned it. Everyone gets at least half an hour at each

appointment, but appointments can take up to an hour if needed.
I listen to the mom and I take every complaint seriously and investigate it until I have ruled

out anything serious as a possibility. In reality, doctors can’t compete

with midwives on the quality of care. They just don’t have the time 
because it’s impossible to spend that much time with you and be that available for you. When

you go into labor the midwife is there with you throughout the duration of the labor. Not coming

in at the last minute to catch it. You’re paying for the obstetrician but the nurse is the one that

delivers you. If you get a rooky nurse who doesn’t know what she’s doing, it can be dangerous.

At least with your midwife, you should know what you should be getting.

(Liz) I listen to the mom and I take every complaint seriously and investigate it until I have ruled

out anything serious as a possibility.

What do you think about babies lost during home birth?
​It’s sad because home birth can be done so safely. When I was training, back in the 80’s, you never heard of bad home birth

experiences because midwives were skilled, careful and prayerful. In my opinion, losing one

baby is too many. There is no excuse. If done properly, mortality and morbidity in home birth

should be very very rare. Safety needs to be the number one priority, not the quality of the

experience. The quality of the experience is a close second to safety but not number one, because

if the safety goes down the train, the quality of the experience goes down the drain. To get a

quality experience, sometimes people ignore safety. Why take a chance with a baby’s life? I’d

just never do it. I couldn’t do it. Once that birth becomes more risky at home than it would be in

the hospital, then it’s time to take her there.

Social Media Questions:

Have you found your career peers declining? Are they being pushed out by insurance? (or


No they are increasing. I think that one of the reasons is that there is a higher demand for them

and another reason is it is easier to become a midwife now. But, not all of them are adequately

trained, in my opinion, because many are not learning the hands on skills and they are not getting

the birth experience they need prior to setting out on their own. There are more private midwife

schools now, and some of them encourage apprenticeship after the students leave the classroom,

but they aren’t all getting that essential part of the training. It is a hands-on profession yet fewer

and fewer midwives know HOW to complement the birthing experience so they just stay out of it

and say that is the best way to do it. The result is longer labors, with resultant increased

cases of maternal exhaustion, hospital transports, postpartum depression, etc. Let’s take vaginal

exams, for example:. It took me at least 50 exams to begin to figure out what I was feeling up

there and several years to becoming refined at reading cervixes. Pregnant women’s vaginas are

just a bunch of mush to a novice. Many midwives, who don’t have that refined skill, will say

that vaginal exams are bad, but I have had cases where a vaginal exam was life-­saving and MANY

cases where vaginal exams gave us knowledge that enabled us to prevent or correct problems in

labor. The girls coming out of those schools know birth by the book very well, and how to take a

test, but they don’t know the hands-­on aspect of it as well as those who completed lengthy

apprenticeships. Having those hands on skills and knowing how and when to get involved is

even more important than the book knowledge, but having both, is best of course. Remember

that a “hands on” midwife can be “hands off” when necessary, but a “hands off” midwife, cannot

be “hands on” because she doesn’t know how. “Hands on” is learned by doing.

What do you recommend for women that want to support this career or are interested in

this career?

​I actually have an eleven page booklet I wrote to answer that question. I am

accustomed to getting many phone calls from women saying they want to be midwives. I’ve

learned that that phone call takes about two hours of my time, so instead, I wrote a booklet on

becoming a midwife and the different aspects of it all that I will email to them. In this booklet, I

initially try to talk them out of it by being truthful as to the drawbacks of the profession, so that

they don’t waste their time and money pursuing midwifery, only to realize that it’s not for them.

I have trained so many apprentices and only one is currently practicing. Most women don’t

survive the first 50 births before they are done with this crazy life­style. It takes a long time and

lots of work to become a midwife. You need to study and train until you can say that someone is

as safe or safer with you as with any other midwife or practitioner in your area. It’s not

something you just learn like CPR or a doula, this is something where you need to be an expert

in your field, which should take you years. You need all of the book knowledge, and also

experience before you go out on your own. You need to be equivalent in education in natural

birth and the early detection of problems as the obstetrician is in their knowledge of

complications. You need to be a “doctor” of natural birth. It took me eight years ­­­between

college self study and apprenticeship. It was an intense eight years. That’s how long it took me to

be able to say that people are safe with me, now. It’s not something to be taken lightly. And this

whole “trust birth” campaign is a bunch of baloney. Don’t trust birth, trust God. And “respect”

birth. In reality, birth is basically safe and most of the time babies will come out just fine, but

you need to be able to watch for signs of complications that can happen for reasons beyond our

controll­­­ and they do happen. For someone to say they don’t, they are living in a cloud. A good

midwife can handle those complications and risks sometimes better than a doctor can, but she

needs to know when it is beyond of her level of skill. That is what makes home birth safer than

hospital birth: If you have a good midwife who knows her limits, you are eliminating the risks of

the hospital but you are also eliminating most of the risks of home birth. Those risks are also

greatly minimized when there is a hospital nearby (within 20 minutes) and you have a midwife

who is willing to use that hospital. Any midwife that says bad things don’t happen, is a midwife

that hasn’t been practicing long enough and she shouldn’t be calling herself a midwife. I’m

worried about the way the “trust birth” movement is going and that it may eventually cause the

illegalization of all midwives.

Are there insurance companies that are more midwife friendly than others? If so, which or

how do we find out which?​

Yes there are. Clients need to ask to find out before they purchase

insurance. I can tell you some insurances that have covered me in the past and recently, but what

I find with insurance is that everyone has different plans. You might have Blue Cross Blue

Shield, however you have a different plan than somebody else so you have different coverage.

Ask the insurance company what type of midwife they cover and for how much.

How do I find a good midwife?

​Interview them. Talk to people randomly who have used

different midwives. Experience and her safety protocol should be what you look for first. She

needs to have at least a 3%­6% transport rate. If it is less than that, she’s taking too many risks,

and if it’s higher than that she might be too nervous and transporting too often. Another thing

that I would look for in a midwife personally is whether or not she prays. Obstetrics is a blind

profession even with the use of ultrasound. There are too many unseen factors and I don’t see

how anyone can do it properly without the help of the Lord. That is a scientific fact. There is a

spiritual side to bringing babies into the world; and anyone who denies that side or is unfamiliar

with it, is at a very big disadvantage. You can’t ignore the physical side either. We live in a

physical world where blood runs through our veins, and if we lose too much of it, we die. A

midwife who respects and acknowledges both the spiritual and physicals are the ones that can

deliver hundreds and hundreds of babies throughout their careers and never lose one. IMO, A

midwife needs to at least have 100 births under her belt that she actively participated in,

including the prenatal care of, to have the minimum of adequate experience.

How do they handle high risk pregnancies or complications with the pregnancy? When we

decide to have more kids I would like to have a midwife but I'm hesitant because of my

pregnancy history.

Usually people like her are the ones who most need midwives because a good midwife can take

many high risk situations and help them to become low risk with proper preventative care during

the pregnancy. I’ve had several women come to me who were labeled high risk and a lot of times

they were ​high risk but by the time they had the baby they were low risk because of healthy

eating and/or supplementation. I have a lot of women come to me because they are high risk and

they need that extra care that only a midwife has time to give them. Good examples of high risk

that can be treated are: history of high blood pressure, preeclampsia, premature delivery,

previous C­-section. In some situations a high risk woman will benefit by seeing a high risk

specialist OB and a midwife simultaneously.

What resources can I go to, to share with my medically and scientifically minded husband

to educate him about the safety of birth outside of the "normal" hospital setting?

Libraries and internet have much information and statistics that can be found on home birth. I

invite women to bring their skeptical husbands and have a personal consultation with me where

he can just shoot out whatever concerns or criticisms he has. Most of the time their skepticism

stems from lack of information. It’s also because they care and they feel protective. They don’t

like to shoulder the responsibility of the outcome, something possibly going wrong and failing as

an adequate protector. Most of the time it just takes a consultation with the midwife and some

reassurance that she’s not going to allow your wife to bleed to death. If he can feel comfortable

in her abilities to care for his family, that is usually all it takes, because home birth is favorable

to dads as well. We fear what we don’t understand. I provide free classes each month that are

specifically geared to provide that needed information to these couples. My own husband was

that way originally. Back then, I went to the library and researched the pros and cons of home

birth. I just read things to my husband, because he wouldn’t do it. He eventually became okay

with it over a course of time, but when our baby was born, he became totally converted!