We are continuously fascinated by different birth practices around the world. There's a funny dichotomy: the more we are exposed to, the more we are reminded that birth is birth no matter if you are in Texas, Australia or Guatemala. The more obvious it also becomes just how much the birthing person's feelings of trust, respect and security, influence outcomes and their overall sentiments about their experience. And it's how those feelings are either fostered and supported or neglected, that really differ from practitioner to practitioner, institution to institution, culture to culture.
For all the lack of access to care and evidence-based information, obstetrical violence and denial of informed consent that's out there, there are also some really inspiring people and places that are setting the groundwork with practices and models that we can all learn from.
From the Birth Room highlights the people and places working hard to make all facets of care and support around reproductive health better.
BIRTH AT THE FARM
While on a family trip to Nashville, Ash recently stopped by Ina May Gaskin's famous Farm Birth Clinic in Summertown, TN. She was psyched to simply stand on the grounds of this seemingly magical place, but also really interested in investigating what parts of their practice could be emulated in other places: As, let's be real, most of us are not birthing in any place like The Farm. She met with Farm midwife Deborah Flowers to find out.
The first thing that really struck was that The Farm is not actually a Birth Center. While the midwives here catch about 120 babies per year, they operate as home birth midwives. When women birth here, they are having a home birth, just at someone else's home. Why is this relevant? Because this designation, or lack of, allows them to have much more lenient construction standards and insurance/liability needs - the two things that make opening and maintaining a birth center so difficult in many places.
And it truly is quite homey there. When people come to birth at The Farm they drive up a long, secluded road and are welcomed to a birth house which is nestled in the woods. Each house has a kitchen, tub and large bed. The entire family is welcome to stay throughout the labor and birth. And some families stay for weeks, even months, leading up to their birth (and sometimes after) - especially if it's someone who has traveled across the globe to be there. With such a peaceful, inviting and inclusive atmosphere, it's no wonder they are willing to make the trek. And treks truly are made! Most recently, two women came from Turkey -where some practitioners have a c-section rate of 90%- and one from Senegal -she had all three of her children at The Farm after her doctor told her the very first time they met in her first trimester, that she'd need to have surgery. (She gave birth vaginally just fine.)
And while they may be taking birth refugees from OB practices around the world who are telling their clients that, "You must want your baby to die" (no joke) or "Your pelvis is too small to birth vaginally", The Farm midwives are also working hard to collaborate with the medical community at large. For example, a new policy was recently passed that requires an oxygen saturation test to be performed at the time of the newborn screening to help prevent against congenital heart disease. In the past, newborn screenings were performed by the midwives, but the saturation tests were not. So, local doctors actually invited the midwives to attend hospital trainings so that they were able to perform this test at The Farm. Additionally, The Farm receives infant resuscitation trainings from a local nurse, who also started an Angel Ambulance (like a NICU on wheels) that would come to The Farm (and other outlying areas) in the rare case a baby was in need, so she could be treated while en route to the nearest hospital. And, to even better build relations and trust, Deborah shared that she will sometimes go with a client to her doctor's appointment so that she can meet him or her face to face. At times she'll even bring her resume to show them her license, experience, training and expertise. What a difference this can make if a transfer is needed!
Because The Farm is such a staple in the birth community, they have been able to have a great impact on policy too. CPMs (Certified Professional Midwives) are now legally able to practice with licensure in Tennessee, thanks in large part to Farm midwife Carol Nelson. In some states only Certified Nurse Midwifes or CNMs, can practice. The CPM is a more direct route to becoming a midwife that can only practice in a birth center or home setting. And, last year, they hosted a group of doctors, nurses and midwives from Alabama (where CPMs can't legally practice) so that they could learn more about how legalized midwifery works and to create a greater conversation and collaboration around working together.
So what can we take away from their practices? Thinking about the language we use and the environment a women is laboring in is a great place to start. What can we do in other birth settings to create more of a sense of privacy, quiet and calm? Maybe it's as simple as ensuring curtains and doors are closed. Maybe it means keeping lights dim, or playing music or soundscapes. How can practitioners communicate so that they are building trust and respect over time instead of making birthing people feel like they are ill, or stupid, or like they are simply a container?
The other important thing we can take from The Farm's practices is their willingness and ability to bridge gaps and open lines of communication with the birth community at large -political, medical, advocacy based- all of it. Because at the end of the day, we can provide the best care if everyone is working together to make the birthing person feel honored and supported every step of the way.