My own personal experience with women’s care in Eastern Kentucky is pretty much limited to finding birth control as a teen. A friend drove me to the health department, and I ended up with a doc who was the mother of a younger school acquaintance. She was surprised that I was a virgin getting birth control before having sex. I used Planned Parenthood to take care of all my exams and issues when I went away to school because it was only three blocks away from my apartment and I had no insurance.
When it came to birth, the less than ideal experiences of older women in my family really influenced the desire I had to use midwives and to have less medical intervention in the process. My mother was put to sleep while giving birth to me and was offered medication to prevent lactation even though she planned to breastfeed. Other stories I heard over the years were of women being strapped down in their hospital bed during labor, unable to walk around, having failed epidurals with paralysis, or having little to no support after arriving home.
Telling family I was going to use a midwife was an interesting experience. There were positive stories from the past when an older neighbor lady from down the way would come and deliver your baby in your home. There was one humorous story from my husband’s relatives about a frank breech birth where the elderly midwife informed the crowning mother that her child had a hole in his head. He didn’t. It was not his head. He’s still alive today. This one story could not shake my trust in my midwife, and all three of my children were delivered with midwives on hand to support me.
During my second pregnancy, I joined an online group for mothers and soon-to-be mothers in Eastern Kentucky. We shared information on evidence-based practices, and stories about bodily leakage. We gave warnings about which area hospitals were most likely to give you fits, and posted recipes to help with lactation. We helped each other through pregnancy, birth, and postpartum issues. I met Edna* in the mother’s group, where she later was able to share information related to midwifery as she started her training as a Certified Professional Midwife.
Stacia: You’ve heard mine, but what were your earlier experiences with women’s care in Eastern Kentucky, before kids? Our area had a pretty limited selection for accessing care.
Edna: I had the same experience in high school. I was on birth control to regulate my periods and my doctor could not wrap his head around using birth control for a non-sexual reason. I will have to say that going to the OB/GYN before you get pregnant is only slightly better than when you are pregnant.
S: Your decision to use a midwife the second time around was because you wanted a VBAC (Vaginal Birth After Cesarean). Are the local hospitals in Eastern Kentucky not very supportive of VBACs?
E: As I found myself pregnant, I began to research the providers in my area of rural Kentucky. Everyone I had a consultation with spoke of a repeat cesarean before the appointment was over. I was taken aback, considering this pregnancy was vastly different than my first pregnancy. I wrote a post on Facebook, and one of my friends messaged me about a midwife she was using and gave me her information.
I had a consult with the midwife, Nance*, where I addressed my fears of a repeat cesarean. Right away she looked at my history and my risk assessment and stated she did not see any reason that I could not attempt a VBAC unless something came up in my care that was not conducive to a homebirth.
The biggest reason I found myself drawn to the midwifery model of care is that with every question I had, Nance either had an informed consent document containing the information I needed, or knew where to find the information.
S: How did you feel about your experience afterwards? Did that lead you to your apprenticeship?
E: Nance is now my preceptor, if that explains anything. While midwifery is definitely a calling (nobody signs up for the on-call life because they think it is cool), I don’t think I would have heard the calling if I did not find my midwife. I actually have tried to quit midwifery a few times already, and it seems so surreal that I am almost ready to be a Primary Midwife Under Supervision.
S: As a midwife, what’s the biggest difference you see between what is common medical practice for the area and having a midwife take care of the mother?
E: The midwifery model of care is so different from the medical model of care, and I don’t necessarily place all the blame on the medical system. It is hard conveying everything that needs to be discussed in a 15 minute slot. One of the biggest differences is that with the medical model of care, the health of the baby during pregnancy is ensured through tests and drugs. With midwifery, the health of the baby is ensured through the health of the mother, the mother and baby are an inseparable unit. We see birth as a holistic process; it involves the client’s whole self. There is a chart about the differences in the midwifery model of care and the medical model of care here.
S: So families find you by word of mouth? You mentioned a friend on Facebook connecting you with Nance.
E: That is how most families find us in states where we are not technically legal to practice. Or Facebook. We do go to community events, and community service is part of our apprenticeship.
S: You joked last time we spoke that you had spent a while removing echinacea from seed pods? What other kinds of herbs have uses for birth, or for taking care of a new mama after birth?
E: “Whenever you want to complain about herbs being so expensive, just remember your midwife sitting here picking the seeds out of these prickly pods.”
The herbs I carry with me are usually in tincture form and include:
Smooth transitions (scullcap, oat tops, motherwort): This blend helps a pregnant person when they feel they are in or nearing transition. This is a very intense stage of labor, and this tincture helps calms and centers the client.
Blue Cohosh: Relaxes the uterus and helps keep it from contracting. This is usually used with Black Cohosh to coordinate contractions to make them more effective, but will only work if the uterus is ready for labor.
Centered Mama (wild lettuce, lobelia, valerian): This is a tincture that helps the client relax.
Shepherd’s Purse: This is used to stop heavy bleeding.
Lobelia: This is used for pain reduction.
HemHalt (blue cohosh, bayberry, yarrow, capsicum): This is Used in hemorrhage control
Placenta Out (angelica, red raspberry leaf, blue cohosh, yarrow, sheperd’s purse): Helps expel retained placenta.
There is also a mixture of herbs we recommend for the postpartum period, either to be used in a bath or peribottle. This contains Uva Ursi leaf, yarrow flower, plantain leaf, sage leaf, witch hazel leaf, comfrey leaf and root, and sea salt.
S: Do you feel like your midwifery services are looked down on by medical doctors in the area? Historically, I know midwives were shunned by men in the obstetrics field, who called them “grannies” and accused them of ignorance of any necessary medical knowledge. What kind of relationship do you have with them, if any?
E: We have a good relationship with some doctors. Other doctors, I don’t even think we are on their radar. Ever since the medical profession started attending births, homebirth midwives have been looked down on as ignorant. And while it is true that there are some direct entry midwives that have a different approach to training, the Certified Professional Midwife route has a standardized test and a lengthy application process.
If we are ever in a transfer situation, the relationship between doctors is important. How receptive the hospital is of our transfer is usually indicative of the level of care the client receives. We have had transfers that have occurred flawlessly, we have had transfers that were truly emergent and the receiving doctors had to wag their fingers and shame the mother before she even got care. Regardless of our relationship status with the doctor, if there is a transfer we stay with our client.
S: You mentioned the Kentucky Home Birth Coalition when we talked about organizing around women’s health and birth in the area. They’re the organization behind the new legislation for midwives and licensure. The proposed law is being introduced in Kentucky this year to create a path to licensure for CPMs. It will also allow them to identify as caregivers and share records during hospital transfers of their clients.
E: Yes. It’s a grassroots, consumer-run group.
S: It seems like this would be a pretty empowering type of calling. Your own children’s births are pretty special, but I was recently able to attend a birth in our family. It was amazing to watch a child coming into the world, and a woman become a mom for the first time. I can’t imagine it ever getting old. Do you feel totally awesome after a birth? Any examples you’d like to share?
E: I think it is empowering because we get to witness the client being empowered. VBACs are very special to me, so seeing the “I did it!” look on their face is priceless. Last month, our senior apprentice gave birth. When we started our apprenticeship together, we said we were going to catch each other’s babies. Her first birth was a cesarean, and she was going for her homebirth. Her labor was really long, she was 7 cm for at least 2 days. But neither she nor the baby showed any signs of distress. On the day she gave birth, she was at 9 cm for 6 hours. Baby was as happy as can be, heart rate was normal throughout the entire day. When her membranes ruptured, baby was here in less than an hour. The look on her face was pure disbelief. Moments like that are magical.
*Edna and Nance are pseudonyms to protect the two women from any legal issues associated with working in areas where there is no path to licensure for CPMs.
Stacia Sanders grew up on the side of a mountain with her nose in a book. She now writes books, makes music, and teaches ASL in southeastern Virginia.
Header Image: Creative Commons, photo by Jason Lander.