Emily Mason 0:01
You know you want to birth with a midwife. Routine, however, you aren't sure how to choose the right one for you. Today, we are speaking with Sarah Tunney, a very experienced midwife, to chat about why experience matters, especially for high risk pregnancies and deliveries. Thank you for joining us. This is praggie pals.

Emily Mason 0:55
Welcome to preggie pals. My name is Emily Mason, and I'll be your host today. If you haven't already, be sure to visit our website at New mommy media.com and subscribe to our weekly newsletter, which keeps you updated on all the episodes we release each week. Another great way to stay updated is to hit that subscribe button in your podcast app. And if you're looking for a way to get even more involved with our show, then check out our online community. It's called Mighty moms. That's where we chat more about the topics that are discussed here on our show, and it's also an easy way to learn about our recordings. So you can join us live. Our guest today is Sarah Tunney. Sarah is a midwife trained primarily in low resource settings outside the US and as a community midwife for the Amish in Lancaster County, Pennsylvania, where she developed birth emergency and newborn assessment skills to ensure experienced care for families. Sarah has 25 plus years working in the field of maternal infant health, with the last 10 as a professional birth worker. Sarah, thank you so much for joining us today. Can you please tell us more about yourself and your practice?

Sarah Tunney 2:07
Thanks, Emily, Hi. Nice to Nice to be here. Well, what can I tell you I have become a midwife, not it was not my first career. It was, but it was definitely a calling more than a job, and I'm living in California now, so my practice is based primarily in San Diego County and Orange County, very different from where I trained, but I do find that my the skills that I honed are really, really helpful here with families most of the time. My My practice is primarily home birth families, but I do full spectrum reproductive care, and I care for families with twins, expecting twins, feedbacks breaches, people who are, I wouldn't, I wouldn't call them higher risk. I mean, these are all variations of normal, but people who have had multiple losses, that type of thing. So yeah, and I love where I love where I am now. I'm in a really rich community of birth workers and support for home birth. And yeah, I feel really, really fortunate. I get to work also with other amazing midwives and doulas and doctors and the hospitals here are, for the most part, like very, very cooperative and collaborative with us. So it's a it's a great spot. I feel really, really lucky.

Emily Mason 3:29
I am so excited to dive into this topic in more detail with you, Sarah, but first we're going to take a quick break. You. You. Today, we're discussing why experience matters, especially in certain birthing situations. So this is an easy question on the surface, Sarah, but what is a midwife? Yeah,

Sarah Tunney 3:56
no, that's a it's a really common question, especially like compared to what, what is a doula, right? So a midwife means actually, different things, depending on where you are. In general, midwives are healthcare providers. They provide reproductive care. So whether or not the person's pregnant or just of reproductive age, we can be a provider for most, most things, labs, tests, ultrasounds, family planning, physical exams. We also do newborn care, so licensed midwives at least, and Certified Professional midwives, we're trained to work with with newborns for their first six weeks. So that's another component. We also have a holistic view of the person, right? We look at you as a person, not just a condition that you're in that we're trying to address. So we do look at your family and your history and your emotions and and weave that into the care. So it's a different midway. Phrase a different model of care from obstetrics and gynecology, but we essentially, do, you know, we cover all those things, the quote, unquote, medical stuff, too, but we just, we just approach it with a from a different, different angle,

Emily Mason 5:14
and and I heard you mention the word doula, and I think people oftentimes confuse a doula with a midwife. So can you explain kind of the similarities, the differences, the overlap, how those two individuals can work together for mom, baby and family? Sure.

Sarah Tunney 5:35
So doulas are not medical providers. They don't have medical training, or if they do, it's circumstantial, but they're really there to provide emotional, physical, informational, like educational support for you during pregnancy and postpartum. I mean, they're very valuable. It's to have a resource like that, I find is it's really important, because, you know, this is at least from my mind, pregnancy and birth and postpartum are not medical experiences, right? Their physiologic experiences and and there's a huge transformation and a lot of vulnerability. So, so doulas are really there to be emotional support, but, but they're not there, for example, to assess if baby's okay, or if mom's Okay, or to take blood pressures, or, you know, they're that's not their job. You know, they're there to be a resource for for some of the things that that might require just a more intimate, relational experience. That makes sense? Yeah, yeah, that

Emily Mason 6:41
does absolutely, I don't know

Sarah Tunney 6:43
you're a doula, right? So what's, what's your perspective?

Emily Mason 6:47
Absolutely, um, I am definitely there for the families on that. I would say mental health level, um, emotional physical, to the point of not medical physical like, where are you at in your body's recovering from something, so where are you at in your recovery process? And is it out of my out of the norm? So I definitely think that there's things where I, as the as a postpartum doula, identify, hey, that may not be, you know, within a norm, but I'm also not a medical professional. So how do I bridge those gaps? Like, how do I encourage you to go talk to your midwife and have that conversation? So I definitely think there is a lot of overlap and a lot of teamwork that can happen between doulas and midwives. Yes,

Sarah Tunney 7:36
yeah, absolutely. I'm always grateful when we have a really good doula with us at the birth or postpartum, because then I then I feel very reassured that that family is going to be well resourced, you know, they're going to find, they're going to figure out, even if it's not for me, you know, the right person to go to, maybe for some like emotional support, like social supports, all those things. Yeah,

Emily Mason 8:00
absolutely. And I don't want to say the word rules, but are there rules of what a midwife can and can't do? Well,

Sarah Tunney 8:10
yes, there are some very clear rules, actually, depending on where you live. So if we're just talking about the US at this point, we'll just kind of keep it confined to the united states. Each state has a different scope of practice for midwives, and there are different types of midwives. There are nurse midwives, there are professional midwives and licensed midwives. 35 states have licensed midwives, and so with those licenses, midwives have a very specific scope of practice about what they can and cannot do within within their medical license and within the confines of the law. So as an example, I'm in California. In California, midwives are not able to attend births of twins, breaches if, if if there's not a doctor present, like that's it's for licensed midwives, whereas in Utah, they can and Texas, so, so it does vary state to state, but pretty consistently, things that midwives cannot do. We cannot perform surgeries, right? We can't do a C section. We can't use any kind of artificial or forcible mechanical means to get baby to come out, right? So we don't use vacuums and forces. Now that's licensed midwives. Now certified nurse midwives, if they're within a hospital setting or, you know, a clinical setting where they have those opportunities that that is a different but they're also midwives, right? But they may have, they may have the capacity and the ability to do that within the scope of their practice and midwives. So for example, in California licensed midwives, we have a limited amount of prescriptions that we're allowed to fill, like a limited number of drugs that we're allowed to. Use for our clients, but in Washington State, licensed midwives can prescribe antibiotics and some of the sort of more basic things. So it really depends on where

Emily Mason 10:11
you are, where you are, interesting, interesting. So I know you've had a lot of experience. You said you're out in California. Now, previously, you've been east coast, Pennsylvania area. What is your expertise when it comes to working with birth mothers? What's been your experiences? What fill us in? I just want to know everything

Sarah Tunney 10:37
Sure. You know I started out, I actually started out as a doula in New York City and Connecticut, and so I did a lot of hospital bursts and birth center bursts there. And that was, that was really interesting. I learned a lot about how to assess where someone is in their labor without doing any kind of physical exams, right and and that that that was, I lean on that quite a bit, because in my own practice now, as an example, I don't tend to do cervical checks routinely during labor. I don't feel the need to do that almost ever, unless something is clearly dysfunctional. And so I think, you know my expertise then, like developed, I sought out experiences where I was in settings where we did not have, we couldn't just transfer to the hospital. We didn't have any other options like this was it. So one place I went in Pennsylvania, which was to work with a an Amish community, and there were hospitals within an hour or so, but the community themselves really didn't want to go there unless it was a life or death situation. And then I've had some experiences in low resource settings outside the US, so I feel like that's where my expertise has really come. Come through most is the low resource setting, whether it's a very rural setting where we're not near a hospital and we we really need to deal with any emergency that comes up, or we're in a setting where we don't have resources, meaning we don't have ultrasounds, we don't have lab values, we don't know what's coming out. We don't know if it's twins. We don't know if the baby has a deformity or a defect, right? And and so then managing what happens with that birth, I feel like that's that's the main one. And then I think the other thing that I've been really lucky to be at the beginning of my journey with is really managing people who are pregnant with with twins. And I feel like I got it a good taste of that when I was in Pennsylvania, and now in California, I'm I'm able to do some of that learning as well. That's becoming an area of expertise for me now, which is, which feels really good. You can think, I think for the most part, when folks find out that they're having twins, they assume that they're just automatically in with a doctor and that they can't, they can't have midwifery care. But you know, that's not, that's not the case at all. Twins is a variation of normal too, and so midwifery care is actually shown to be, arguably, we have better outcomes with twins, twin pregnancies, then then higher kind of, higher risk, higher surveillance, rate care.

Emily Mason 13:30
Well, that is some great expertise to have, because that all sounds, I don't know if it's it's thrilling like to not know what to do, but then to be able to just respond. Those are the people I think moms and birthing people need. Are those people that are that are there and ready to respond and are making decisions based on the mom and the baby and the whole family. I think that's really important.

Sarah Tunney 13:58
The I had a really wise midwife say to me that you know birth as safe as life is, and I remind families of that too, because while you can have the most experienced skilled attendant, and that can be even at a hospital or at home, wherever you are, but and there are some things that No matter how skilled you have of an attendant that you know that's there's still things out there are out of our control, and that that happens too, but, but I do feel like what I've noticed is that the safest bursts are when the people present have some experience, have skills, have been and have learned from other midwives or doctors or whomever they're learning with, who also have lots of skills and lots of different kinds of skills, like a big, big toolbox and and so as a result, yes, some of it's the skills themselves. But what I. Mind is the it's always the calmest person in the room. And so if you have somebody who has seen a lot of complications and also seen that everything works out okay, and we just have to do some simple stuff, and everyone just needs to stay calm, then things tend to work out really well, right? And I think that comes with confidence and experience absolutely

Emily Mason 15:21
and so I kind of perused and found your website, and on your website, you mentioned, birth is fundamentally a normal, physiologic experience. Can you elaborate on what that means? Yeah, I

Sarah Tunney 15:36
mean, I feel like there's not it's a normal thing. It's like going to the bathroom, like we something that we do, our body knows what to do, if we just kind of keep give it what it needs, and we feel relaxed and safe and we're nourished, things tend to work out. We don't. We don't need to overcomplicate it now, every now and then, something else is going on in the body, and the physiology doesn't work, right? And so then things go, you know, go sideways sometimes, but generally speaking, I think we know we don't pathologize or medicalize puberty or menopause or, you know, just general, we're just, we're kind of built to reproduce, and it's just like, it's like, we eat, we drink, we go to the bathroom, we reproduce, we die. Like, these are normal. These are just part of our life cycles, and all animals do it. So when it's just, I feel like it's normal. We just tend to get in the way of it. We tend to get in the way of our own physiology.

Emily Mason 16:37
That's a really good way of putting that. We tend to get in the way of our own physiology, like, that's, that's fantastic, yeah,

Sarah Tunney 16:44
and I think the number one kind of culprit that I've encountered is, is the brain, is the mind, and it's usually, it's usually fear, you know, that will halt your physiology like nothing else, right? It helps your digestion. It's the fight or flight. It's the cortisol release. It's all these things. You know, cortisol blocks oxytocin. I mean, it's a one for one, it's very obvious. We have clear indicators that, you know, when we get scared or we, you know, we're having an, you know, an experience that is an inflammatory experience, or something like our it interrupts the cascade of normal physiology. And then things don't work. And then we, then we try to, you know, jumpstart it or, or just get it backed, you know, back into its flow state. So, and I think that's that tends to be where we we we get out of sync with labor and birth and even, like breastfeeding and postpart all of these things, right? We get in our own way by thinking about it too much and having too many things to do and having too many tests. And, you know, I mean, I look, I'm a big nerd. I love tests, I love all the information. I give it all to me, but you know, I do find that most of the time it just leads to more anxiety and fear when there's really probably nothing to worry about,

Emily Mason 18:01
right? Yeah, absolutely. Well, so far, I am super intrigued, and we have more midwifery questions coming up, but first we're going to take a quick break.

Welcome back to pray deep house. We are continuing our topic on experienced midwifery care. So my next question is, talking about the third trimester, what does it look like for women who work with you? How many visits are they having? How long are those visits? And is that more relationship based care, or what's happening during that third trimester?

Sarah Tunney 18:43
Yeah, the third trimester is when it all kind of gets real, you know? So I tend to see folks once a month, up until then at 28 weeks, then I see them again at 32 weeks, assuming everything is normal and it's a singleton pregnancy. So for 28 weeks, 32 weeks. And then we, it gets more frequent. 34 weeks, 36 I usually do a, what I call kind of a birth rehearsal at their home, if they're doing a home birth, and everybody comes and that who's going to be at the birth, and we spend a couple of hours together. And we, we go through everything, and I bring all the gear, and we we really get down to all the questions about what happens if there's an emergency, what do you envision for the birth itself, and what does the immediate postpartum look like? So so that everybody knows that they feel more at ease. They can ask me any questions they want to, and I have a great sense of what they're really, really wanting out of their birth experience. And then, and then how I can support them, like I can try to support their vision. And then I see them at least once a week until their baby's born. If they, if we get to 41 weeks, then I'll see them more often, and I offer them additional surveillance in the four. Form of a non stress test or an ultrasound or a biophysical profile. These are things just, really to check in on how the placenta looks, how the baby is growing, how much amniotic fluid there is, but it's, it's their choice, you know, it's not required. But I, you know, I do offer that if that feels intuitive to them to do and then, really, it's mostly just about, you know, we're always checking to make sure that mom and baby are doing well, right, that everybody's in good shape. And we do a little bit of preparation for, if they want to, you know, for labor and birth, they should have already done a childbirth education class. We talk a lot about postpartum care and breastfeeding, so if that's what they want to do, I very much want to make sure that they're lined up for for that postpartum, I think of postpartum is really a full another trimester. It's really 12 weeks, it's not six. And frankly, I feel like we give a lot of hype to the birth itself, when actually the postpartum can be the some of the most taxing. It's like long term taxation on your body and your mental health and and so just setting people up to feel resourced that they have someone to feed them and to take care of the rest of the family, or the chores, or, you know, whatever it is that needs doing, not just the first week or two, but past that. And yeah, and I usually make sure people have, you know, if they're wanting to do some kind of herbal preparation for birth, that they have all that lined up, and then some other because I also a bit of an herbalist. I really love herbs. I see them working really well for people and and just, you know, nutrition. So we talk a lot about nutrition for the postpartum and for lactation, and then, you know, families do what they what feels right to them, ultimately. But the third trimester is a lot of interaction. We spend a lot of time together, yeah, and

Emily Mason 22:04
you, I mean, and you touched on it, I think a little bit when you were talking about you, you know, you have the birth rehearsal. But what else do you do to help mentally and physically prepare the mother for labor? What kind of how do you get her over that fear? And I know from a person that has had a baby, it was the fear of the unknown. At one point, I was like, Is this gonna hurt? What's this gonna feel like? And I knew, like, I'm a well educated person, I know it's gonna hurt to an extent, but it's that fear of the unknown. So how do you get them, kind of, mentally and physically ready for that? That's

Sarah Tunney 22:43
a good question. Well, I I do. I started doing classes for my clients, and, I mean, they're open to the community too. I just started doing that because I do feel like a lot of folks, they do these childbirth prep classes, but then they're still, you know, they're not quite ready, and especially out of the hospital when there's no medication option, you know, we don't have pain relief. So, I mean, I think some of it is really trying to redirect that a bit with the advice that I've seen that really works. And the first thing is to stay positive, because it's very easy to get into a fear space, or I can't do this anymore. This isn't working. And it's not that those things are not valid, but frankly, they just don't have they don't serve families in that in that moment, right? And so addressing that a little bit in advance of like, how do I know? How do I get myself through those moments of self doubt or fear. What is it that I need to hear? And so my hope is that they people resource themselves or like their partner, is that person for them, but if it isn't for any reason, then in the moment, right? And sometimes we just encounter things in labor we don't expect, you know, things come up, things that we've either buried or, you know, or just they've gone far down, they they come up. There they are. And so I feel like part of my job is to continue to remind people, especially during labor, that they're safe and that they can do it. And if sometimes you just need another person to hold the space of like, I'm going to tell you when it's not okay, but you can do this. So let's just do this for five more minutes. Let's do this for 10 more minutes, and then we can reassess. And usually that honestly gets people over the bridge. It's just to come back to their breath, because you can, in labor, you can control very little, but you can control your breathing if you you can get your mind to do that. So the thing I ask my families to practice in advance is breathing and getting really deeply relaxed in 60 seconds, because that, as you know. Like at the height of your labor, you get a one minute break before the next contraction. And so what I love is, if people can really tap into create muscle memory, almost of deep relaxation in 60 seconds. And it's, it's a it's, it's, it works. I mean, you just see people can relax, and you just are able to let go.

Emily Mason 25:21
And you touched on this too with having the partner identify some of the ways that mom reacts. I know sometimes I and I, in my birth, I was like, I am amazing, but my husband's like, the second she gets hungry, it's bad news for everybody. And like, he he could voice that to people, or, like, when she feels like she's backed into a corner, she'll, she'll just yell at everybody. And I was like, Do I really do that? Oh my gosh. And, and he's like, I just know how you react to stress. And that's where he was able, because it in my world, I'm like, I don't, I don't ever get stressed. I don't know what you're talking about. And he's like, Yeah, you do. But I think that's where partners can be a great resource to be able to really give you and and maybe you know your mom, mother in law, the people that are really going to be there as your circle of care, helping or in the room, or even after you know, my mom knows more about me than I know about me, and she's able to give some insights. And so involving those people, I think, is super important. And you touched on having your partner involved in that. But how else do you bring partners and what? What role does the partner play?

Sarah Tunney 26:44
Well, it really depends on the family. I mean, they really decide some partners, you know, like, they'll have some partners. They really, they want to catch they want to do everything that's great. Other ones are like, Uh, can I just stand in the corner and let you and the doula take care of this person. So you know, and it really does depend very much on the nature of their relationship and what they want. So, but I do find that nowadays, most of the time it's whether it's me or the doula or a combination of us really helping show the partner like, hey, why don't you try pressing here? Why don't we give you two some privacy? And because, you know, there's the things that get babies in, get babies out. You know, oxytocin is that feeling that you get when you fall in love, when you have an orgasm, right? When your baby's nursing like, you have that nipple stimulation, like, that's oxytocin. That is, if you smell your person's t shirt, it's like, stinky, but it just makes you feel like, oh yeah. That feels good. Your whole nervous system just comes down. You have this big letdown. And so trying to preserve that oxytocin flow is so great in labor, and a lot of the times, it's really just letting the two people who made this baby together, in whatever way they did, have some privacy and and maintain that intimate space, because it's it's ultimately their family and their experience. And so I do find that, frankly, most of the time having a partner who is positively affecting her, the pregnant birthing person's nervous system, is one of the most important pieces of like in predictors to having a successful, unmedicated birth, whether you're home or or anywhere else and without it. I mean, obviously people give birth alone all the time, and around here we have a lot of military families. A lot of guys are deployed, you know, dads are deployed, but, you know, and it works out just fine. But, man, it works out really well when you have a partner who you just sink into and just hold you and you feel safe with

Emily Mason 29:03
Absolutely So transitioning, switching gears. We've talked about how to prepare mom during labor, but anxieties can kind of ebb and flow during the whole pregnancy. What are some tips, or some nuggets of advice that you can give to women who are interested in working with a midwife but they're nervous that they may be turned away for whatever reason. What? What are some tips there

Sarah Tunney 29:32
I don't really understand completely the the some midwives turn folks away for whatever reasons. You know, I can't get into their psychology and and, you know, ob practices too. But what I find is that when a person is very clear about what they need and want and they are resourced and educated by. Resource. I don't mean money. I just mean, you know, they're able to say, Well, look, I've, I've been, I've been reading about this, and I feel like these pieces are important to me and and this is I'm going to find these things, and I'm going to line them up, and I'm going to do this research, and I'm going to, you know, they take the responsibility and the ownership for their pregnancy, their birth, their their family. And I think that whether or not the person is over 35 or has had a cesarean, or is having twins, or trying to think of some other more common examples, or, you know, even just somebody who is maybe not, doesn't have the greatest diet, or has had sort of more than one loss, like things that are like, Oh, are they gonna Are they not gonna take me? I just say, you know, resource yourself, but also be yourself. And if the midwife that you approach or the doctor that you approach doesn't want to take you, then just know it's as then you're not with the right person, and you'll, you know then, and that's not about you, you know, it's about them. And I think that you know, in general, good candidates for out of hospital births, for example. And there are a lot, a lot of midwives only do births at birth centers and only do births at hospitals if you're a nurse midwife, right? But we're talking about more midwifery care outside of that setting. Then, you know, don't sell yourself. Just find the right person. Just keep looking. Just Just be yourself.

Emily Mason 31:32
I wholeheartedly agree with that. I think they're so and I look, I'm a question asker all the time, and I'm always investigating. And I I look at having my youngest. When I gave birth to her at 35 weeks, I had gestational a diagnosis of gestational diabetes, and my midwife said, you know, I have to transition you into a OB. Right. Cool. I totally understood. And I was like, absolutely but my next question was, how do I prevent this from happening in the future? Because I want to make sure. Is it something I can prevent? Is it something that you know what? What are the signs? What do I watch for and I think that's where sometimes people get in their own head of what's happened to me once, so it's going to happen to me again. And that's just, that's just what I'm going with. And I think it's always important to ask those questions, uncover every rock, figure out just because every every birth is different, every pregnancy is different, and so next time I may not have anything, or I may have it way earlier, we don't know, but we don't know what we don't know. So figuring out how to ask those questions, I think, is important definitely for women to to not sell themselves short, like you said, or over, you know, oversell themselves, or undersell themselves.

Sarah Tunney 33:04
Yeah, I agree with that absolutely. You know, as I'm reflecting, listening to you too, especially like in the situation like yours, right? Then one of the things that a person can do, let's say they, you know, they had a pregnancy or a birth, and it, you know, it didn't end up and, you know, it had some sort of quote, unquote complication, right? And it is, it's true. Just, just because it's just because it's happened in the past, does not necessarily mean that your future is completely determined in terms of your reproduction, right? In most cases, and maybe going and establishing care with it, with a midwife, if you want to do midwifery care when you're not pregnant, and getting, you know, getting yourself in a really, really good state, even you know, before you conceive. And then, you know, midwives do, this is one of the things that we know midwives are really good for, at least we should be right, is keeping people low risk and helping them if you know, staying low risk, and if you're not low risk, getting you low risk and not doing it with medication, if we don't have to, and if we have to, that's fine, but, but, yeah, I think, I think that's kind of the goal is, let's do all the things that we can to stay in that bubble, like bumper rails. And if you go outside, you know, come back in, come back in, come back in. And I'd say 99% of the time you can, maybe that's an exaggeration, but like 98 7% of the time folks can come back into a, you know, into a low risk. And by the way, just as a PSA I had, I saw some posts recently about moms who are over 35 being told that they're high risk, and it's just not true. You know that's that you're not high risk. You know you're you have. On slightly higher risks of a couple of things, but it's not a high risk pregnancy that requires a maternal fetal medicine doctor, and so I do hope that folks can hear that we had a mom who's 51 have a home birth, you know, like he's not just because you're over 35 doesn't mean almost anything except that, you know, you probably were born in the 70s or 80s. Don't like, do like different music, you know, whatever, right?

Emily Mason 35:28
Wow, that's yeah. Thank you for pointing that out and bringing awareness to all of these misconceptions that people have. Um, yeah. I'm excited to continue talking more, but first we have to take a quick break, and then we'll be right back with some more midwifery questions.

Welcome back to preggy pals. We are continuing our topic with Sarah and our next question Sarah revolves around, what should pregnant moms be looking for when they're looking for that midwifery care team? What kind of care insurance coverages? Other questions, what? What do you advise moms to do in this situation? Oh,

Sarah Tunney 36:22
yeah. Well, so much of it depends on where you live, right, and how much choice you have. So I think in most places, folks don't have a huge amount of choice, because there, maybe there aren't that many midwives who are in their geography. That's the first question is, you know, who's close? Like who's who's going to be close enough, and then also what type of midwife it is. If it's a certified nurse midwife versus a licensed midwife or a professional midwife, you definitely want to make sure that the person has a credential, right? So they're either, you know, depending on what state you're in, they have, they either have a license, or they have, they're certified through the national certification. So you want to make sure that they're actually midwives, because there, sadly, are people who kind of bill themselves as offering native free care, but they're not, and they don't have, they don't have the training, they don't have the equipment or the medication. So be aware of that. And then I think you want to, you want to find out what their experience is and how quick they are to transfer you if something goes wrong, right? Are they going to immediately transfer you out of care if one thing is off, or are they going to work with you and try to resolve it first? Or, you know, sort of, what are their boundaries? I think they think that's a good question to ask. And insurance, well, insurance is the big bear in the room. Again, it depends on it. There's different types of insurance and different states have different rules, but by and large, most insurance will cover midwifery care, to some extent, for the prenatal care and your postpartum care, and they'll often pay for the midwife's time, but what they won't pay most of the time is what's called a facilities fee, especially if, whether you're at a birth center or at at Home, unless the birth center is licensed and accredited, which is, frankly, really hard to do, and most are not. We have a lot of birth centers closing in California because of that. So they just insurance won't pay them back so, but insurance will. Some insurers will pay everything for your care, like the these Health Insurance Co Ops. They get it. They get that it's less expensive to have midwifery care and have your birth outside of the hospital than it is to have conventional care, lots of interventions, hospital birth, surgical birth, you know, they they get it. So they, they pay. And so find out, figure out what your insurance situation is, and so and some insurance will only pay for a nurse midwife, and others depending on your state. You know you are entitled if they if the insurance says that won't cover a licensed midwife, then there are some, some legal settings that you can refer back to that you are entitled to a licensed midwife. You are entitled to this care, which is, I won't go into now, but you do have rights and so, but sometimes you just have to be the squeaky wheel. And then I think the other thing that is good to ask, especially if you're getting a midwife, and they're, you know, most of it is, is cash pay, right? You pay for your care in advance and so understanding if they're going to go out of town, if they have a backup, if you end up getting transferred out of care or go into labor, and it's before your 37 weeks, or whatever, 36 weeks, depending on the state, what's their policy for refunding you will? They still will. They come with you to them. Hospital, will they do your postpartum care just like you had planned things like that? I think those are good questions to ask about. What kind of care can you expect, even when it doesn't quite go to plan Absolutely?

Emily Mason 40:15
And those are some, I think, great beginning interview questions. But just as much as parents are interviewing the midwife, the midwife is, you know, doing the same thing, interviewing the parents to ensure that they're a good fit. So what? What questions are parents asking you during that interview process, or that you think they should be asking you to really find that good fit?

Sarah Tunney 40:46
Yeah, no, that's a great, that's a such a great question. So some of the things I just listed like are questions I love, I love it when they ask me point blank, you know, because I know that that then, then I know they're being they're being thoughtful, and they're probably, it's not, maybe their first rodeo. The questions I like hearing are questions like, What would you transfer me for, whether it's during pregnancy or during labor? You know, what? At what point would you say I'm out as your as the midwife, right? And I think that's a good question to ask the midwives, because you want to assess, you also want to ask them, you know, what their training is like? Where did they train? Did they train with more than one midwife? Like, how many births have they attended? And that doesn't always tell the whole story, but there are lots of really good young midwives. Just because you're newly licensed or something doesn't mean you're not actually a good midwife or great midwife, but I do think that if you've only had one teacher as an example, you've only ever been to 50 verse and you only ever worked with one person. And chances are you, you know, you just don't have a lot of skills yet, and that's okay, but maybe you know who else, who else are you? Are you learning from? So I like it when folks ask me, if I you know how I feel about induction. I like it when they ask me, How do you feel about declining tests, declining, whatever it is, GBS or and I think asking a question like, What would you do if I tested positive for GBS, right? And that's a test that you do at the end of pregnancy for to see if you have a bacteria. And I think that that's a really telling. The answer that you get is really telling. And I think it's a, it's a good question, and, and then I think the other one is, you know, it's not a specific question, but in the end of the day, you know, the good relationships, like most relationships, are ones of trust, and the trust has to go both ways. And so if there's a breakdown in the trust, then, you know, how do we how do we either rebuild it or be honest about it and then make it make a different decision, but, but if people trust each other in this context, then things work, and if they don't then, then they just don't

Emily Mason 43:03
wholeheartedly agree. And I could probably just sit here and talk to you all day, and I'm sure our listeners, I'm sure our listeners would feel absolutely the same, but I want to give them a chance to find you on social media, a website. So where can our listeners find more information about you and learn from you? Even more, I'm horrible

Sarah Tunney 43:28
at social media, I'll be totally honest. So I have a website which is just Sarah Tunney midwifery.com, it's not that original, and so people can check that out or reach out to me. That's probably the best way to contact me. I have an Instagram page where I just started it so it's, it's not very it just has, like, it just exists and and then, like my LinkedIn page, it's like my professional page, but yeah, I mean, I think probably the best way is just through my website and happy to chat with people and get to know them and answer questions. And certainly, if they're wanting to know about care with me, that's fine. But also just, I love to collaborate. I'm actually going to a conference in about a month, an international conference in Dubai. It's one of the International Confederation of midwives conferences, and so I'm going to do some talks there, which is, I'm really excited about just, I love to meet people all over the world, because they are we get to just exchange what's working, what's not working. How we can, you know, how we can get better, how we can have better outcomes. And I just feel like it's really valuable. So, yeah, I love meeting people and chatting. Don't be shy.

Emily Mason 44:41
This has been fantastic. Thank you so much for joining us today, being on this episode, my pleasure. And for those listening, be sure to check out new mommy media.com where we have all of our podcast episodes, plus videos and more. You. Music

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Disclaimer 45:43
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