 Hi, welcome to the Think Tech Hawaii studios. I'm Lisa Kimura, host of Family Affairs, a show for exploring issues on how healthy public policies help improve the quality of life for families in Hawaii. Just to note, the views and opinions expressed on this program are entirely my own and those of my guests, and do not necessarily represent the official policy of any other organization, employer or company. Thanks for tuning in. With me today are my first guests Sharon Thomas, along with my other guests Jamie Lewis and Piper Lovemore, to talk about a very hot topic, midwifery and the right to choose where and how to give birth outside of the hospital setting. Welcome ladies, thanks for joining me. Thank you for having us. Sharon, I wanted to ask you first, tell us a little bit about your experience giving birth and what kinds of choices you made in order to do that. Well, I actually gave birth to my son at home and it was beautiful and wonderful experience with a certified professional midwife who provided me care in my home. It was everything that I would hope it could be and actually the care superseded any care that I have received from any OB or doctor really in doctor patient setting in my entire life. So it was great. That's a pretty big statement. What kinds of choices went into your decision to choose a home birth and was there anything that surprised you about it? The choices, well I'm a nurse by trade and thank you for reminding everyone that this is in my own personal views and definitely has no ties to my nursing as a professional, but my experience as a birthing mother. I felt like I wanted to be safe and I do have a medical background and so I have different ideas probably on what is safe. So I needed to feel like I had a well-prepared practitioner at my side and supporting me, but also I felt it's really important that she knew my story. She knew what was important to me. But then on the other hand she knew it was important for me as well to stay safe. And where to draw the line on what is safe and what isn't safe. And so I did speak with many different midwives and the practitioner and luckily was able to find some of the others comfortable with. Very good. Would you say your experience with a midwife surprised you in any way or is it what you were hoping for and expecting? It surprised me in many ways because like I said this is a whole person approach to providing care. I felt like she knew me. So she did. So she asked. She took the time to look into my eyes, into my house. She got my family. So the surprising thing was that she took that time. The surprising thing she was extremely professional, had a computerized medical record, that she was able to speak, was consistent with how note-taking and anything that you would expect in a doctor's office. She had that, but yet she also had that extra key person-centered care. Fantastic. I'm going to ask Jamie and Piper a little bit. So what she was saying about maybe some people are a little surprised to know that there's electronic records or to know that all of the equipment that you need to give birth is available with a midwife home birth delivery. Tell me a little bit about the kinds of skills training that you folks go through in order to become midwives. Sure. Well, I think a large part of it is integration and experience. Even through the CPM route of training, it's very experience-based, hands-on. There's extra work outside of that to do as well. And I think also self-care is a big part of it. If you can take care of yourself, then you can take care of other women well. As far as equipment and things, I think that's very dependent on the midwife that you're looking for and what you're seeking. Some feel very comfortable and safe in that sort of technological space. And some feel safe in a space that is not so heavy-handed in the technological world. I think a CPM is a nice blend of both. And I think that here in Hawaii, there is a mix of everything, which is really great. It's great. We'll put some pictures up on the screen so people can see what home birth really looked like. Because a lot of people have never seen it. Some people don't know it's an option or even that it's a legal right for moms to choose how they want to birth. But as far as Jamie and Piper, what made you choose a career in this field? Wow. For me personally, it was a calling. I was on a completely different trajectory with my professional aspirations. Although my parents are both in the birth field and health-related field, so it was something that I was aware of. And going through my own first birth experience really congealed for me the resources that I personally had to offer and the fact that I felt like I could really be of service in this way. But prior to pursuing it at all as a career path, I had definitely served loved ones in my family and in my community, as an interested and invested community member. So I was aware of the impact that a holistic experience could have and the lasting impact of being able to wholly integrate the birth experience. What that looked like as it played out in the family, as it played out in the larger community. So I was interested in the ramifications of the birth process prior. And then I just felt like it called me. I did want to speak really quickly to the previous question as well about training. I think that one of the bigger distinctions that I see in the home birth-based midwifery training versus other birth attendant options is being rooted in the community. I think that some of the value of being able to work with a home birth midwife specifically of your community is that she's able to bring nuance to your care. That I think in a grander sort of medical model is eliminated as a variable that is not necessarily central to providing effective care. And I think that as it pertains to the birth paradigm, it's actually crucial. It's really important to be able to meet a woman where she is and address her specific concerns and have some understanding of the container wherein she'll be embarking on her motherhood journey. Sure. And we talked a little bit about what the distinction is and more of that person-centered care. But what kind of women choose home births? All kinds. And not only women if we're going to get specific about it, right? I mean it's a family-centered thing. I think that people who are on the gender spectrum feel often more seen by someone outside of the conventional model just because we are able to be flexible, we meet our people where they are. But it's for everyone. It's for everyone. Yeah. If it feels true for them. Right. Right. Well, how can a woman be assured of the quality and the training that her midwife brings with her for that experience? My personal thoughts on that is to be absolutely insatiable with your questions. I think that one of the things that I've found interesting about the home birth debate as it unfolds is that it sort of really decentralizes the families making the decision. And I prefer to keep them at the center of the dynamic. So there's never a question that's off limits for me. I will often encourage them to ask others as even as they have chosen me to be their guide, get a second opinion, really digging it not necessarily because I feel as though mine isn't valid, but because I really want them to dig into what their subconscious is yearning for. And I think that in order to be able to treat them as a whole person, we need to also sort of steward the unfolding of their process. Many people begin their pregnancy journey is feeling overwhelmed or uninformed. And I don't aim to supplant that journey of integration, of learning about the process with my own expertise. I would rather the family be curious and be interested in their process and ask all the questions. And I happily refer them along to other people for that to satisfy questions that I may not be able to answer or for varying perspectives on those that I feel confident in as well. And for those women that are really trying to choose something that aligns with their values and what they're looking for, how often do they start with you from the beginning versus do they ever change their track as far as the birth plan is concerned? Well, birth is very organic and then normal physiological. So we sometimes meet people right at the beginning, the minute they find out, they know this is what they want. Other people find somewhere along the way that maybe the provider they're seeing doesn't necessarily align or doesn't see them as who they are, or maybe their provider is a variety of people. And so they're looking for a more interpersonal experience. There are also people who might become a little less healthy along the way and need to actually shift back into a more medicalized situation for the best health for mother and baby. And so we really do try to facilitate all of the journeys. Fantastic. One thing I've noticed as an educator, having been a birth educator before I became a more active birth worker, is that many people aren't really sure what the what the differences in care really look like until they become more informed. And unfortunately, many people end up sort of waiting until they're like, Oh, wow, this has to get out of where. Okay, maybe I need to learn a little bit more. And so just as an educator, I recall holding space for families who felt like they needed to waffle a little bit at the end that they were learning things that perhaps they didn't see happening in their care practice. And they wanted to explore their options a little bit later on. And so we are usually fairly flexible with accommodating people. The longer that we're able to work with them, of course, the more benefit they get out of the care that we're able to provide. But I do think that the conventional model sometimes has people changing course fairly late in the game as they become more informed. Back to Sharon for a second. What kinds of factors for you were the decision making points to go with a home birth? Upon learning that my OBGYN was planning for a C-pressor, that startled me, shocked me actually that this was even a consideration for a normal healthy. I mean, of course, if there's problems, you know, you address problems when they arise. But to plan ahead for it was not part of my birth plan. From what you've seen or experienced, Sharon, how would you say your birth experience varied from what might have been a hospital birth or even a C-section birth? Well, my laboring, I was able to listen as loudly as I wanted to my favorite music and dance and do what I needed to do to help my son enter the world. And I didn't have any shame. I didn't have any fear of anyone being disturbed. I was in my own home and I wasn't under any policies and procedures necessarily. I was able to relax and birth in a natural way. And what would you say was the most important factor to you in choosing the particular midwife that you selected? Well, you know, I said I was a nurse, but I'm not a labor and delivery nurse. Whenever I spoke to, if I even mentioned it to my labor and delivery nurse friends, they thought I was insane to even consider it. But I was able to get specific questions that I needed to ask. So I gathered questions from more informed individuals and asked, okay, well, in this situation, what will you do in this situation and what sort of medications do you carry and why and when would you use them? And so all of those questions and then in addition, and actually as I was looking for midwife, I spoke with many, many different midwives on the island and they all have a, not all, I mean, everyone has their own approach and their own practice. But what really it came down to was how that personal connection and knowing and that deep, deep place within you where you feel safe with this person and their judgment. Absolutely. That's really what it came down to. Yeah. And Jamie and Piper, I know that for a birthing woman, being safe, being comfortable, obviously makes it much easier for her to go through the birthing process. But like she mentioned, a very common response is that you're insane for choosing this. Why wouldn't you go to the hospital? Why do people choose this route? There's lots of different reasons. For some people, they feel safer in a hospital. The bottom drops out. Other people don't necessarily feel safer in a hospital. And in fact, maternal mortality and infant mortality rates are not great in U.S. hospitals. So I think that there is some question that's starting to happen and women are really starting to look to people who can actually make that personal connection. I feel like transparency and truth and trust is what gives that woman the confidence and that ability to birth wherever she is, wherever she chooses, and that if she has that comfort and that confidence and that trust that the person in front of her is also in that same space of being transparent, then the outcomes are better. Fantastic. We're going to talk a little bit more about this in just a second. We're going to cut to break right now. So stay tuned and we'll be back. We're going to be talking a little bit more about regulations and oversight for Midwifery. Aloha. I'm Wendy Loh and I'm coming to you every other Tuesday at 2 o'clock live from Think Tech Hawaii. And on our show, we talk about taking your health back. And what does that mean? It means mind, body, and soul. Anything you can do that makes your body healthier and happier is what we're going to be talking about, whether it's spiritual health, mental health, fascia health, beautiful smile health, whatever it means. Let's take healthy back. Aloha. I'm Yukari Kunisue, the host of Konnichiwa Hawaii, Japanese talk show on Think Tech Hawaii. Konnichiwa Hawaii is all Japanese broadcast show and it's streamed live on Think Tech at 2 p.m. every other Monday. Thank you so much for watching our show. We look forward to seeing you then. I'm Yukari Kunisue. Mahalo. Welcome back to Family Affairs. I'm the host, Lisa Kimura. And with me today, we have Jamie Lewis and Piper Loughmore, midwives talking to us about their career field as well as Sharon Thomas, mother and registered nurse who is, for herself, chosen home birth. Jamie and Piper though, I wanted to ask what are some of the common misperceptions people have about midwifery in general? Well, you know, that's an interesting question because our history really indicates a very ardent smear campaign. And so I think that there is a lot of misinformation now. That was, and anyone who's interested in that certainly should be able to find plenty of resources on both the propaganda that was generated and its sort of proliferation into modern pop culture. So I think that people just don't really understand a lot of the mystery that surrounds the practice. And then I think that it has also been sort of actively maligned. I remember meeting with a friend years ago who was sort of really surprised that the midwife showed up to their birth with more than just a box of towels, which is, you know, a running joke. But I think that that's kind of the perception that if you're not choosing the medical paradigm, then what's left for you. And in fact, that's just a misperception because obviously the practice of midwifery or the art of midwifery predates obstetric practice by centuries. And so there's quite a bit of expertise. I think that what is also interesting is that in practice, it can be more challenging for the observer to identify. Some of what Sharon indicated about feeling wholly seen and very grounded by her practitioner, those are things that exist on the inner landscape of the birthing person. They're not necessarily demonstrative, nor do they need to be. So it really reflects sort of a contract between the client and their provider. And from the outside perspective, it may seem as though not much is taking place. That is evidence of the art unfolding. You know, there's a measure of confidence that comes with being expert in your field and a measured restraint that comes along with that. And so I think that when you have been conditioned to see medical experiences repeat with lots of accessories, tubing and needles and things that we've come to associate with medical care. When you see something unfolding without those things, it's hard for some people to understand where the actual practice is coming in. But many midwives are able to function just by holding space and allowing things to unfold and are certainly there representing the product of years of learning and applied knowledge as well, but not necessarily feeling as though they must demonstrate that in order to prove their worth, but rather that they can hold that for someone if they need it and otherwise allow them their experience unhindered. Add to that. Well, I don't disagree with any of that actually. And I also think, you know, different midwives bring different tools. Sometimes I think our greatest tool is observation. And then in addition, we of course monitor vitals and things like this too. So we do things that sort of align in that paradigm on some level, but we also, it's not the main focus of, you know, we spend at least an hour usually in our prenatal appointments. We talk about all kinds of things. And so that way when the birth is unfolding, many questions have been answered about what that will look like. So you don't have to have those conversations in the midst of it unfolding. They know when you might slide in and listen to the baby and oh, you don't have to move. We work around them and sort of build this up so when the birth unfolds, they feel like they can just go into it. Well, even that, you know, an hour prenatal visit is something you definitely don't get with a traditional obstetric provider. So that's definitely one of those key differences. But there seems to be kind of a persistent myth that outcomes are not going to be as good with a midwife or that it's not a safe option necessarily. How would you respond to that and what kind of training truly can we know is taking place to assure that women's health is being protected? I think that that's a great question for the obstetrical field. I think that there is an assumption or a misunderstanding that completion of a specific program equates to quality of care. I'm definitely not denying that undergoing a program of study is beneficial, but I don't necessarily think that it always equates to quality care. I think that we see this across many different modalities. It's not just limited to birth. That some of that comes down to the personal integrity of the practitioner as well as their ability to match well with their client. Different clients will want different things from their providers and thus should have the freedom to choose someone that resonates best with them. And so I think that again I feel as though it's really important to listen to families and see what it is that they are actually seeking and give them the range of options to really find the best fit for themselves. I do think that it's not necessarily something that you just sort of pick up out of osmosis and every birth worker that I've worked with has had years of training and also considers herself a lifelong student. I don't know that they ever believe that the training is completely finished and look forward to the opportunities to learn from the experiences as they unfold. Another thing that you see a lot in the midwifery paradigm is open and authentic communication with clients. Midwives may think that a birth went seamlessly and then learn from their clients that they had some reservations and there is space for unpacking those things later so that the midwife is educated about what nuances may have been lacking and the client also understands how to better advocate for themselves in the future. It really is a very organic process so I think that part of the challenge and in sort of equating these two is that we are trying to impose a structure onto midwifery that is not necessarily organic to the process itself. If you're trying to equate it into the medical paradigm and look for those sort of matching points it may not always even out. Well going back to though you know the question that people want obviously to be sure that there's consumer protection in place that women's health is being preserved as well as her baby's health how do you tend to respond to that in terms of assuring them that legitimately this is something that you understand well and how do you demonstrate for example outcomes and speaking to the fact that people tend to be concerned maybe overly so about difference in outcomes. Well I think there's a lot of statistics out there now that they have been collected that actually home birth is as safe if not in some situations safer than modern obstetrical care. I also think that it very much looking again at the whole person right there's a lot of sort of oh well you and your baby are healthy you know and a mother's mental health is an incredibly important part of her not only becoming a mother but then in that losing of herself afterward. So as far as accountability I again I think that every woman has the right to know what whoever her provider is how many births have you done how many how many things have come up that you've how many emergencies have you actually had to deal with and how did you deal with those what happens if right as Sharon mentioned she had a list of questions to ask her midwife. I know that here on Oahu we have a very tight knit community of midwives and we may even we if we feel like the person interviewing in front of us is not the right bit we might say you should actually go interview this other person I think she would be the right one for you but in response to the legislation that has come up for several years asking for accountability or asking for quality assurance the midwife island wide across all neighbor islands many of them are getting on board for this Hawaii home birth collective where we can collect stats we can monitor what's going on in the community we can have you know peer awareness and help support each other maybe where someone doesn't fit the bill exactly they can bring the other midwife in to help support holistically that client maybe you align very much with this one but she doesn't have this skill that this other midwife has so they can come in and support each other to support the woman as best they can and that's interesting what you say because I feel like a lot of the criticism or a lot of the questions always go back to oversight and so what would that look like in terms of this collective and how would people record or where would that be housed per se well I want to speak to that point also and again just just re-empowering the families that are delivering there it is essentially a self-regulating body but really it's community regulated as is the practice of midwifery in these islands for so long I think the midwives here really pride themselves on their transparency I've never met someone who was hesitant to share her statistics or share her authentically what her experiences were which is sometimes enough to persuade someone to choose a midwife over the care provider they may have already seen where statistics and transparency can be more challenging to ascertain and so the body itself is aimed at providing space for midwives to invest in one another to support one another and to address any shortcomings that they may feel arising typically that would come from the midwife herself but certainly it is a body that is that is intended to support the midwives amongst each other ladies I love this conversation I wish we could keep it going but we are out of time already I'd love to have you back again to talk more about this issue because it definitely has a lot of repercussions for a lot of women and providers so thank you for joining me today on Thanks Tech Hawaii this is Family Affairs I'm Lisa Kimura and I will see you next time