Emily Mason 0:01
Congrats, you are pregnant, and whether this is your first pregnancy or more, you will need to think about the care team that you would like to have while carrying your bundle of joy. Today, we are talking about the growing trend of women opting to go with a midwifery team rather than their normal OB, and essentially calling their midwife. Thanks for joining us. This is preggie pals.

Emily Mason 0:57
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 discussed here on the show, and it's also an easy way to learn about our recordings. So you can join us live. Our guest today is Erin. Ashley. Erin is with intimate journey birth and wellness, and is a respected midwifery practice that's conveniently located in San Luis Obispo and featuring the only fully equipped birth center in the Central Coast region. Erin and her warm and supportive staff have years of experience serving expecting mothers and their families looking for a more in depth and personalized birth journey. Erin specializes in the more technical aspects of Midwifery, including minimizing tearing and expert suturing. Erin, thank you so much for joining us. Can you please tell us some more about yourself?

Erin Ashley 2:14
Thank you so much for having me. I became a midwife because I was told about midwifery when I first got pregnant with my first child, 18 years ago, and interviewed with the midwife, and instantly knew that that was the path for me. And after three amazing home births, I was just so inspired and couldn't wait to become a midwife myself and give that care to every mother out there as well. And so my journey, I I trained in San Diego, and then I always had a love for the Central Coast, and came up here about three and a half years ago and opened a birthing center, and have been serving mothers ever since and their families. And I have a family of seven, and all five kids were born at home, so I'm very proud of that.

Emily Mason 3:06
Wow. That is That is fantastic. Well, Erin, thank you so much for being here today. We are going to dive deeper into today's topic, but first, let's take a quick break.

Today we're discussing why women are choosing to go with a midwife or midwifery team rather than their OB So Erin, we're going to start with an easy question. What is a midwife? If you're going to explain it to somebody on the street. How would you explain that?

Erin Ashley 3:42
I would say that a midwife is a holistic medical provider that specializes in monitoring the health and well being of the expecting mother and her newborn baby and their family. And we do in depth care that, you know, we're certified or licensed to do basically everything an OB does, but we just pour more of our heart and soul into that. That

Emily Mason 4:16
was a great explanation. I think that definitely helps to discern what that midwife does. And I think some people can, at times, confuse a doula with a midwife. Can you explain the difference between the two and where similarities may lie as well?

Erin Ashley 4:36
Absolutely. And I give that question a lot, Abdullah is basically they're certified to be kind of an emotional support coach for not only the mother but the partner, and so they're there to help with comfort measures, getting mommy's in comfortable positions, showing the partner how. Best support the birthing mother. And a midwife is a medical professional, and we carry a medical license with the state of California, or whatever state you that you practice in, and we're really responsible for the care of that, the health and safety of that mom throughout her pregnancy, into the labor, birth and postpartum period, and even can take care of the newborn six weeks up to six weeks postpartum. But they're both such an important profession that we work really well together for a complete package for just to help the mother accomplish her dreams of an unmedicated birth.

Emily Mason 5:53
That's amazing. So you talked about a certified versus a licensed. Are there things that a midwife can do versus things that they can't do. Yeah.

Erin Ashley 6:03
So under our practice guidelines, we have, basically, we are only allowed to take care of low risk women, and that really includes a lot of medical things. Surprisingly, we can do blood draws and order ultrasounds. We can also administer medications postpartum to stop bleeding, or administer IV therapy if you're really nauseous and vomiting in pregnancy, also antibiotics, if it's medically indicated, and of course, if the client consents to any of those things, we never do anything that's against them, whereas sometimes an OB will just pressure a mom to have whatever they deem necessary and don't ask consent. First, what we can't do is, in our guidelines, we can't, unfortunately, even though it's a variation of normal, we can't deliver breech babies or twins in California, some states do allow that, though. Oh, okay,

Emily Mason 7:13
interesting. And you said you talked about low risk patients. What are their guidelines from hospital to hospital, or from state to state, as what qualifies as a low risk client.

Erin Ashley 7:27
We have a basically a document online called licensed midwife practice guidelines, and it just basically sums up any medical concern like diabetes or hypertension, anything that would basically indicate that they would be under a physician because of their medical condition, especially if they're needing medication throughout their pregnancy and so low risk is that they're just really Healthy, and we're monitoring that and making sure that they have a normal pregnancy, and if they somehow skew off the normal track of pregnancy, we can usually do some herbs or supplements to bring back into the normal range so they can still stay in Our care. And if we cannot adjust it with diet and exercise and all of those things, then we would have to seek a higher level of care. But most women, if they eat really well and they take care of themselves and they exercise regularly, it's really possible to have a normal, healthy pregnancy and be a candidate for out of hospital birth with a midwife.

Emily Mason 8:43
When I was having my second daughter, I went with the a midwife in the hospital, in a hospital setting, and I got to about 35 weeks, no complications. And then they, you know, I had gestational diabetes that set in at 35 weeks, and I got transferred to, you know, a physician, but I was able to kind of bring my midwife along with me, since they were in the hospital setting. Is that something that's the norm or that people maybe don't know that they can ask to still get that support? Because I didn't know that doctor and I but I knew my midwife quite well, yeah,

Erin Ashley 9:17
well, unfortunately, licensed midwives don't have the recognition in the hospital like a nurse midwife, so a lot of people do tend to go the nurse midwife route just because of having an obstetrician as part of their team. However, if we do, for some reason, have to go to the hospital. I would take them in and do the transfer of care and give report to the OB there. So no matter if we have to change locations, which, obviously, most of the time we don't, they still have the support team with them. As you know, we're there to advocate for them. So. But usually it's because we need a higher level of care. And a lot of times with gestational diabetes, if we catch it early enough, we can modify it with diet and exercise. But if you are, if any of our clients are diagnosed with diabetes, we would have to transfer care. If we it's not if it's not managed. Okay,

Emily Mason 10:21
so, and I guess I maybe need more clarification when you said the licensed versus a nurse midwife. Are there midwives that can work in a hospital versus can't work in a hospital? Yes,

Erin Ashley 10:38
so certified nurse midwives typically work in the hospital under an OBGYN, and they can administer medication like epidurals and Pitocin to induce labor. Licensed midwives are basically only working out of the hospital, and we cannot do medication, you know, medications to augment or change labor. And I meant to say previous that we are just don't have privileges in the hospital. We're still our license. We can work anywhere, but it's just the hospitals that have policies against licensed midwives. Unfortunately, gotcha, that makes sense.

Emily Mason 11:25
And so have you seen an increase in pregnant moms that want midwifery care? And is there a trend as to why they're seeking that out? Absolutely,

Erin Ashley 11:39
I feel like the only blessing to covid Was that it opened mom's eyes to other mothers to look for different alternatives when it came to birthing, because they were making them do covid testing and wearing masks during labor and also separating partners, and even sometimes the babies from the mother during that crazy time. So a lot of moms were like, there's got to be a better alternative so that I can have the birth that I want. And so that's when we started noticing a huge upswing with midwifery care. And I think the most important thing is women are starting to recognize that they have the power over their birth and they can make their own choices. And unfortunately, you don't get that choice in the hospital most of the time, unless you have somebody advocating for you and fighting for your rights. And so they're seeing that if I go with a midwife, you know, it's a lot of work, and it's more planning, and I have to be on top of my care, but I feel so much more empowerment because I get to decide it's my baby, it's my family. And of course, that should be the way. And I'm proud of all the moms that are starting to jump ship and realize that this is the better alternative.

Emily Mason 13:05
Yeah, that's absolutely, very interesting, interesting statistic of of where people are at right now. So we've got more midwifery questions coming up, but first, let's take a quick break. You Music.

Welcome back to preggy pals. We are continuing our topic on midwifery care and the uptick in women seeking this type of care, and we are here today with Erin Ashley and Erin, we're gonna pick up kind of where we left off before the break. But how important is it? You talked about the planning and the and getting things ready, but how important is it to have your birth team around you and the mom and having that trust between everybody where? Where does that fit into the equation?

Erin Ashley 13:59
You know, I compare it to like when you're conceiving a baby in the bedroom, it's an intimate space, and birth is a lot like that. And so if you have somebody, if you have an environment that you're feeling safe, and you have a team that's supportive in what your wishes are for your birth. That's when a woman can completely surrender and give birth to her baby, and so the it's like knowing who's there and who you trust outside of yourself and then trusting yourself inside. That's ultimately where the secret lies, and giving birth

Emily Mason 14:44
that, yeah, that's beautiful. So we've talked about giving birth and your midwife being there with you. We've talked about diet, exercise, talking, you know, through the majority of the pregnancy. But. So when should a mom seek out midwifery care? When is the right time to start looking for a midwife? Yeah,

Erin Ashley 15:08
as soon as they find out, really, because you want to find the provider immediately that you're going to be with so you can develop their the deep relationship with them. So I have moms calling me, you know, four weeks, six weeks, I do tend to see at about second trimester, on 28 weeks, where moms have seen their OBGYN just a little bit more and in the second trimester, and they're starting to realize there's a lot of pushback with their OB, and they're not really listening to what their concerns are. And so I interview a lot of people around that time, where they're like, there's got to be a better option. And I definitely would take them in, but I encourage everybody, the lot, the more time you have with your midwife, the more you can develop that deep trust know how you know the safety is going to be in your and trust with your team. And so that's really important to establish as soon as you can. And plus, we like to start doing the blood work early, and if you need ultrasounds, we need to start getting that ordered, and each visit builds on itself so that we can help you ultimately prepare for your natural birth.

Emily Mason 16:31
Are midwives covered by insurance?

Erin Ashley 16:36
Yes, they are. It's a little bit complicated, and it depends on what their policy is. You know, some policies state that they are covered by a nurse midwife. Some say they cover both a licensed midwife and a nurse midwife and a physician, and then they specify if a birth center is covered home birth, and then it depends on the deductible and all the other insurance stuff. Luckily, I have an insurance biller that takes care of all of that complicated part. So the way it works with midwives is typically you do a cash pay payment plan to the midwife, and then the insurance biller starts billing for your reimbursement after the birth, so for all the care that we've given and labor, birth, postpartum and even newborn care. So the insurance biller is responsible for getting as much back to the client as possible. So it all kind of works in the opposite with a hospital, where they bill your insurance during care and then they throw you random bills at the end, which you never know which how much that's going to be. And typically it's about the same cost as our full scope of care or package, compared to, like, just the hospital birth, and that can be ranging from anywhere from probably 7000 to 78,000 depending on what your insurance covers at the hospital and what procedures and medications and stuff are done. Yeah,

Emily Mason 18:16
that's interesting to hear that side of it. And we were kind of talking during one of the breaks about what schooling looks like. Can you kind of go in depth about what schooling would look like for a midwife?

Erin Ashley 18:32
Yeah, it's usually a three year program, sometimes for, I mean, sometimes even longer, depending on how long it takes to get clinical hours. But most of the time it's online, or if you can find there's they're rare. But the campus schools like I went to in San Diego, so you do all of your schoolwork, what they call didactic learning through the school, and then you set up a relationship with what we call a preceptor, who's a licensed midwife, who you're learning under them, so they're you're joining their clinic, and you're attending their births, and you're getting experience, and you Need to have approximately 60 births and 2000 clinical hours of experience before you can sit for the state exam, which is about an eight hour test. And that's how we get our what is called a CPM certification, which is certified professional midwife. And then you get your license through whichever state you live in. So the Medical Board of California gives us a licensed midwife. It's

Emily Mason 19:51
a process. I mean, it is very interesting, and you yourself had a midwife. What was that experience? Like for you.

Erin Ashley 20:01
So I my midwife actually was a nurse midwife, and she was allowed to practice in Colorado with her license and doing home births. There weren't any birth centers where I was, and I just never even knew about a midwife. And so that's why one of my friends said, can I tell you about the difference between my hospital birth and my home birth? And as soon as I heard the story, I went, sold. I want to meet the midwife, and I did, and I had several midwives with different pregnancies, but just unbelievable, and I still think fondly of them, and they obviously inspired me to do this for other women. That's

Emily Mason 20:47
amazing. Well, we have more midwifery questions coming up, but first we're going to take a quick break.

Welcome. Back to preggy pals. We are continuing our topic on midwifery care and the uptick in women seeking this type of care. Before the break, we were talking about your experience using a midwife, and we've really covered an array of topics, but one question I still have is, you touched on this just briefly at the beginning of what a midwife can and can't do when it comes to administering or providing medication. But can a midwife help administer pain medication during labor? So

Erin Ashley 21:39
the one thing I wanted to talk about was that most people seeking our care do not want pain medication. They trust in the process. They want to build a birth team. They want an environment that it's safe, and they want to trust their bodies and the natural physiological process to give birth how we were intended to ultimately, and I think our society is all about taking the pain away when actually experiencing the intensity of labor can actually be really empowering for the mother, and it's hard work, but ultimately it's the most rewarding thing in the end, when They've done it, and it almost makes the women feel like they have a new, super, newfound superpower. And so most of the time, I would just say that's what they're trying to avoid. And it's really difficult to have an unmedicated birth in the hospital, because that epidural is right there, easy access. It's like when you have chocolate in the refrigerator, you're going to want to go have some, just like when men and medication is being pushed on you, you're going to eventually be tempted to take it

Emily Mason 22:50
absolutely. That makes sense, absolutely. And I know I don't keep chocolate in my refrigerator for that reason. I do. There's there's health components to dark chocolate, yes. So what advice do you have for pregnant moms who are looking for a midwifery care team?

Erin Ashley 23:12
Most important, I would say, is to start doing your research on who is available in your area, what their beliefs and values are, what their experience is, and go meet with them and see if you can have a connection with them and you kind of your values match, because that's really important.

Emily Mason 23:35
Are there any specific questions that maybe over the years you've seen or come across more frequently, or that are missed that moms might not even think about. I'd

Erin Ashley 23:46
say one of the best ones is to make sure that they have availability on your due date. And you know, it's good to come with a handful of questions, but some people come in with 50 to 100 questions, and then we don't really get to address the most important things, which are, what is their motivation to have an out of hospital birth? Because that's ultimately what's going to get them to the end in that those trying moments, they have to have that desire. What? Why are they doing this? And though those reasons can build up over time, like I want my baby to come into a safe environment, without the bright lights, and I can, you know, delayed cord clamping, and nobody's going to be like rushing in to interfere with me in my baby's bonding time. And the other thing is, a midwife is actually interviewing the patient, just as much as they're interviewing her, because she's risk assessing to make sure that they're low risk, she's determining also if they're a good candidate for out of hospital birth, if their health is good, and if it's a good fit between the relationship. Sometimes they might be a better fit for someone else. So there's a midwife for everyone, and it shouldn't be a forced thing. It should be just a natural this feels right to me instantly.

Emily Mason 25:13
That's amazing. I definitely have some new questions to ask if I ever do have another baby, and definitely another route to to go down and and explore more. This was super informative. Aaron, where can listeners find more information about you? Where, where can we follow you on social media? Yeah,

Erin Ashley 25:35
I love that. Um, intimate journey, birth on Instagram. I'm also on Facebook. My website is intimate journeybirth.com we do a lot of blogs and FAQs, answering as much questions about midway free care as possible. And I try to do entertaining and educational videos informed consent, information about what mother's options are, because that's that education isn't given in the OB setting as much. And yeah, I'd love for everybody to come check us out on my website. I also have an intake form where you can fill out your information and always come do a free consultation and tour at the birth center, and you don't even have to be pregnant to do that. Erin,

Emily Mason 26:26
thank you so much for joining us today. Be sure to check out new mommy media.com where we have all of our podcast episodes available, plus videos and more. You music

that wraps up our show for today. Thank you for listening. If you love craggy pals as much as we do, please consider checking out the amazing businesses that sponsor our show week after week, and we'd also love for you to tell another pregnant mama about this resource, which, of course, is absolutely free. And if you want to check out some of the other podcasts we produce, such as newbies parent savers, the boob group and twin talks, then visit our website at New mommy media.com thank you for listening to preggie pals. Your pregnancy your way.

Disclaimer 27:25
This has been a new mommy media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those are new mommy media and should not be considered facts while such information and materials are believed to be accurate, it is not intended to replace or substitute for professional medical advice or care and should not be used for diagnosing or treating healthcare problem or disease or prescribing any medication if You have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider you.