Person Centered Midwifery Care | Justina Nazario, CPM

The provider you choose shapes the birth you have, but most families make that decision without ever really knowing who they are choosing or why it matters.

That's why I created Birth Your Way - so you never wonder if you chose the right person.

This week I sat down with Justina Nazario, a homebirth midwife in Fort Collins, CO.


Connect with Justina
Instagram: @rootedinmidwifery
Website: www.rootedinmidwifery.com

Links and Resources:
Website: www.greatestjoydoula.com
Listen to the Birth Your Way Podcast 
on Apple Podcasts: https://podcasts.apple.com/us/podcast/birth-your-way/id1891727848
and Spotify: https://open.spotify.com/show/5XaaUhUPmPUB3497gTQSje
Watch on YouTube: https://www.youtube.com/@birthyourwaypodcast

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Transcript

SPEAKER_01 0:08

Welcome to Birth Your Way Fort Collins. I am thrilled today to have Justina, one of our local home birth midwives. Yay! I'm so glad you're here. I love to have a home birth midwife on the podcast.

SPEAKER_00 0:18

Always and forever. Yes. Introduce yourself for the people. So I'm Justina, as you just said. So I've been living in Fort Collins for how old's my youngest? For about eight years now. And I'm a mom of three little humans. They're getting bigger. It's depressing. And my history is I started off as a lactation counselor, became a birth duela, and then was like, all right, we gotta, we gotta keep this train rolling. And then went to school and got my bachelor's of science in midwifery. I practiced at a really high-volume birth center in the Thornton, so Denver area, for about four years. And then I started a home birth practice because I just love home birth and I just wanted to be back in the community.

SPEAKER_01 1:12

So we're so glad you're here. Yeah, me too. What would you say drew you to birth work in the first place?

SPEAKER_00 1:19

What brought you here? Great question. I think I think what drew me to midwifery specifically is the birth of my first son. I knew when I got pregnant, I my best friend, she had her daughter. And when I got pregnant, of course, she's the first person I call. I was like, I know I don't want to be in the hospital. That's what I do know. I know that you were at a birth center. She ended up giving birth in the hospital. But I was like, I know that you were at a birth center. I'm really interested. And then the care I received there was just amazing. And it like literally changed my life. And so after I had my first son, I was like, oh my gosh, I need to do that for other people. I had always had this feeling. I mean, years back, I had to be young, very young. Maybe, maybe 19 or 20. I went to India. And when I was there, a midwife came up to me and was like, You're gonna be a midwife one day. And I was like, I literally don't know what you're talking about. Like, I know what a midwife is, but yeah, great, sure. Yeah. And so I think it was like planted there, that seed, but then having starting my own family and the care that I received from my midwives, I was like, Oh yeah, this is like juicy and yummy. Yeah. I can't do anything else. Yeah.

SPEAKER_01 2:38

You know, what led you to do the journey you did from lactation to doula to midway?

SPEAKER_00 2:47

When I had my first son, nursing was hard. And like everything I had been shown was like, it's easy. And I was like, lies. It is not easy. And so then with after I had him, I was like, okay, I want to help people with lactation. I love it. I became a pro, obviously, because I nursed three children. But I helped a friend, she started an organization called Long Beach Breastfeed. So I would support her and what she was doing, and I just became truly obsessed with it. And then after that, I was like, well, now I want to be at people's births. Yeah. Obviously. Obviously. And so then I got certified as a birth duela. But even in those spaces, at the time I was in Oakland. So kind of like the Bay Area. And I was just realizing so many systemic failures for people giving birth. And the hindrance that I had was like, I want to show up more, but I can't because I'm a support person. And so that was hard for me because I was like, I want to be able to provide people with a different experience. So that, and then it I call it the gateway drug. And then it just led me to just led me into midwifery.

SPEAKER_01 4:06

So that's really it. Tell me a little bit about your education. There's different education for doula versus becoming a midwife. Of course. Talk us through a little bit of your journey there.

SPEAKER_00 4:15

I mean, yeah, so huge differences, right? Becoming a birth jewula is someone who's trained as a support person. And becoming a midwife, I have my bachelor's of science in midwifery. I'm a trained provider. So I'm trained to provide the care that a person needs to make sure that they're safe and, you know, two different types of roles. But yeah, I mean, I went to a college specifically for midwifery.

SPEAKER_01 4:40

Is it Midwife's College of Utah? Yes.

SPEAKER_00 4:42

MCU, Midwife's College of Utah, and I loved it. Four years. So the uniqueness about the route that I took is that I don't have an undergrad in nursing. I knew that I wanted to specifically train in midwifery. So I got specific training for four years to become a midwife. Other paths are different, right? Some paths, some people train to become a nurse first, and then they get two years of midwifery training. But I was like, I know that I just want to be a midwife. So you did four years. I did four years of midwifery.

SPEAKER_01 5:13

Right.

unknown 5:14

Yeah.

SPEAKER_01 5:14

Right. And so now you can catch babies in birth centers and at home.

SPEAKER_00 5:18

I mean, it would be really great, wink wink, if one day we could have hospital privileges because we do know the best route of care and other states do it, right? So following suit, the best route, the best continuity that you can provide for safety of your clients is to be able to go into a hospital system and still provide that same care. Obviously, you would still have to function within that system and be overseen by someone else and practice within your scope. But that's something I'm like very passionate about. Is like, how can we better integrate midwifery into our healthcare systems so that we have better outcomes for families? So super passionate about that. I think that midwives, you know, my midwife type, I'm a CPM certified professional certified professional midwife, but all providers should be able to have hospital privileges, not just because you have a different letter in your name. So super passionate about that and trying to get that integrated in our system.

SPEAKER_01 6:21

Yeah, I know you do incredible work with Elephant Circle here in the state of Colorado. I'd love for you to share about your work and changing policy.

SPEAKER_00 6:30

Yeah. I'm very passionate about just advocacy in general. And I, it's funny because at this conference that I was at now almost two weeks ago, I really came to the realization within myself is I'm like, I love families. I love my community, which is why I think I'm such a good advocate. But what I love even more, which is saying something, I love midwives and I want to make sure that we're protected so that we can show up for our community, you know? And so right now I work at Elephant Circle. I'm the statewide operations coordinator there, and I really work on integrating midwifery into everything. So in policy, we're centering midwifery. We're making sure that any bills or laws, legislative actions, anything, we're centering it within that midwifery model of care. And yeah, I mean, I just do, I am just so passionate about making sure that families are safe. And it looks, there's so many intersectionalities between midwifery and like how that shapes family systems. Literally, I think of family units as little mini ecosystems. And when you have someone where you're providing person-centered care and it's truly impactful, it deeply impacts family, which families, which is why people love the midwifery model of care, right? And we have enough data to show integrating our type of care could really help our morbidity and mortality crisis. But when you do that, like when you're able to serve a family from, you know, let's say you came into my care, I serve you, but then I do all your follow-up care. And then you need resources for early childhood stuff. It integrates into everything. The way that you're treated, even before birth, into that really impacts lineages, like generations. And so I think that's why I'm so passionate about policy and advocacy and making sure that I'm showing up as a midwife in multiple spaces and not only in my practice.

SPEAKER_01 8:40

Not just at birth.

SPEAKER_00 8:41

Not just at birth. Yeah. I really want to make sure that I'm doing all I can in this lifetime to open the door for other folks to come in and continue the work and hopefully not have as many barriers and just to do a lot of education that's needed in these spaces, which is very taxing. But you love it. And you're I love it. I love it. I love it. Yeah. Majority of the time.

unknown 9:05

Yeah.

SPEAKER_01 9:05

Um, and for anyone listening who doesn't know what what Elephant Circle is or the goal, you want to look at that.

SPEAKER_00 9:11

We're a birth justice organization. So we really look at, again, intersectionality. So birth justice is more than just giving birth, it's making sure that people have access to all truly all the things. Birth justice really is looking at the full spectrum, like I was kind of talking about. But at Elephant Circle, we work in policy and then we do movement building. So that's things of supporting others with their policies, supporting like literally across the United States, supporting other organizations. So we're like the fiscal sponsor of organizations that need support. I think we have right now like 40 organizations that we support in that way, which is huge. Um, law and advocacy. So we have lawyers on our team, so that let's say someone has CPS involvement, those families need support. A lot of the times it really is a systematic thing. And so we're there to make sure that we're showing up for families. So yeah, when people are like, what does Elephant Circle do? I typically go, What do we not do? Is like the better question because we do so much to make sure that people are supported during the entire perinatal period. Right. Yeah.

SPEAKER_01 10:19

Yeah. Can you speak to, I know you've been involved in some recent policy changes in Colorado. Can you speak to those?

SPEAKER_00 10:24

Yeah. Elephant Circle passed a few bills in 2021, which were amazing in regards to Medicaid, postpartum for families. So there was a lot of bills that were passed. But we do a lot, like what we're focusing on, specifically this legislative session, is to make sure that we're doing a lot of education for folks. Of most people don't know what reproductive or birth justice is, or we have this, someone's bringing this bill forward and they're talking about X, Y, and Z. They typically come to us as experts. What do you think about this? Does this help what you're centering and what your organization is? You know, so we're doing a lot of that, like education this session. We're not running any bills this session, but we're kind of monitoring, making sure that we're testifying on bills that we support or testifying on bills that we oppose. So I'm I'm doing a lot of testifying this session. Wow. Yeah.

SPEAKER_02 11:21

Yeah.

SPEAKER_01 11:22

I don't know what I'm so glad. It's like, I'll have to make sure to ask Justine. I know you do so much policy work in addition to supporting family thinking.

SPEAKER_00 11:28

Yeah, I mean, and I'm new to the policy world, right? I I've done a lot of advocacy, but I'm a little baby. I'm like a little, I was just conceived in regards to policy because it's so I feel like it takes years and years to actually really get a grip on it. Yeah. But yeah, I feel like I'm doing pretty good for the little Yeah. Little teeny tiny.

unknown 11:49

Yes. Yes.

SPEAKER_00 11:50

Baby babies do great.

SPEAKER_01 11:51

Baby policymakers do great. Absolutely. Well, returning to home birth midwifery work when clients are coming to you and are thinking about hiring you. What are some of the top questions that they ask you in a consult? Oh, yeah.

SPEAKER_00 12:06

Top questions. Is this covered by insurance? I would say it's one. And I tell people, sadly, no. But I do work with a great biller that can typically get people reimbursed, but it is like an upfront cost. So it's a little tricky because we don't have good insurance integration with midwives, with midwiferies. So another policy.

SPEAKER_01 12:29

When they can get reimbursed up to a certain amount depending on their insurance, can some insurance is reimbursed most of it?

SPEAKER_00 12:34

Totally. It depends. I mean, insurance is a whole different. Yeah. I don't even know. I like half the time, I'm like, I don't even know what's going on here because it is just a whole, I don't know, we'd have to talk to an insurance expert or something. I'll say about that. Yeah, I'm like, you know, we might have to do that. But um, so that's my main thing is do you take insurance? The answer as of now is no, but people can get reimbursed. And then another thing is, do you take Medicaid? Um, and technically I could, but because Medicaid reimbursement is so low, like disgustingly low, it would send me out of business. I wouldn't be able to practice. And so it's kind of the fine line of I want to stay low volume and not be too high volume to where I'm so burnt out. I want to be able to focus on my client. So I can't take Medicaid right now. So I feel like those two are the top ones. And then the following one is what happens in an emergency. So then we do a lot of that chit-chat.

SPEAKER_01 13:37

Can you kind of give at a high level what does happen in an emergency if you're in your care?

SPEAKER_00 13:41

Yeah, so prenatally, we come up with a plan. We come up with something called an emergency transfer plan. So I want to know where the nearest hospital is, which luckily we're in Fort Collins or the northern Colorado area. There's hospitals very at our disposal, right? We're not in a rural area. It's easily accessible. So we go through where the nearest hospital is to your home. We go through reasons why we would transfer. And what I talk to people about mainly is like my whole job as a provider. I don't want a red flag, by the way. That's not fun for me. Yeah. It's not great for my nervous system. So the whole time I'm looking for pink flags. It's a part of my whole job. A lot of people, I think, have this misconception of midwives of like, ooh, like we're just these like cool, I don't know, like hippie people. I mean, like, midwives are cool. We are very cool. Okay, well, we're not just cool, we're super extra cool. But like, literally, my whole job is to make sure that things are staying within normal range. If I see something coming out of normal range, first of all, I'm gonna talk to my client about it. Say, okay, let's try to do these things to correct this issue before it becomes a red flag. But if I'm noticing something's becoming a red flag, we're gonna do something about it. We're not gonna mess around. And so a lot of the times I'm reminding people of that. Like, that's my whole job. So make sure that things are staying normal. In the case that something were to become out of that normal range, I have all the first line medications and things that they would at a hospital to make sure that someone is stable enough to transfer to the nearest hospital. So a lot of things that come up is postpartum hemorrhage. That's one of the main emergencies that we tend to see. And so I just remind people I have all the first line medications that they would have at a hospital. I do drills and I train to make sure that I'm able to provide that type of care. And if I'm seeing that things are coming out of that normal range, we will call EMS and we'll transfer and I'll be there with you providing the care in the ambulance. Yeah. So you're well equipped. Well equipped. Very much, very much. You should see what I bring to a birth. And a bag, yeah. The birth bag is extensive. Wow.

SPEAKER_01 15:49

Yeah. That's amazing.

SPEAKER_00 15:51

Mine is really nice, by the way.

SPEAKER_01 15:52

I bet it is. I have no doubt at all. I'm like, I'm gonna send you a picture later. Please do. We can include that. Here's Justina's bag. How awesome it is.

SPEAKER_00 16:00

I'm like, it's labeled and so pretty.

SPEAKER_01 16:03

I don't really believe that yet. I've seen Justina's uh office and it is beautiful and so well organized. I like to keep things very nice and tidy. Yes. Are there any questions that you wish clients would ask you? Like when they're trying to decide if they're gonna hire you.

SPEAKER_00 16:19

Gosh, what a good question. You know, I think I'm a true believer in people ask what they need. Like people ask way different things. Like, you know what I mean? There's people prioritize different things over others, and it depends on that family unit. So I feel like it's a tricky question, but I think what I wish more people asked is is there a price on having person-centered care? Like it is not cheap to have a home birth, but it is way cheaper than a hospital by the so many thousands. Yeah, right. And so a part of it is almost like I wish there was more curiosity of can I put a price on the care that I'm gonna receive with this person? Because in my opinion, I don't think that there's a price that I could put on it. I would prioritize having a provider who listens to me, who believes in me, who spends time to actually get to know me and my family over anything else.

SPEAKER_02 17:41

Right.

SPEAKER_01 17:42

It's almost like a question for themselves. Is that a barrier that comes up often that people are like, oh, it's gonna be out of pocket because not covered by insurance?

SPEAKER_00 17:47

Totally, which is very so fair. I mean, that is the most fair. I mean, the reality that we live in is cost of living is insane. I mean, most people are living paycheck to paycheck. I understand, right? Like, but what I'm so passionate about is making sure that I'm meeting people where they're at. Pay in whatever way you need to pay. Oh, right. Absolutely. I'm like, whatever works for you and your family unit, that works for me. I want you to have this type of care, you know, because I think it's so impactful. And not just because I'm a midwife, I'm also a parent. Yeah, right. Like I'm also just like a sister and a daughter. So I try not to be biased, but it really is. Like I'm like, I really want this for you as well. And so, yeah, more curiosity about hmm, what do I envision for myself and my wellness?

SPEAKER_01 18:41

Yeah, I think a lot of people, maybe they really would like a home birth, but they're scared by the cash price. Totally. If you're selecting a hospital birth, it's almost a little bit scarier because you actually get a surprise bill. Oh, yeah.

SPEAKER_00 18:54

What's it gonna be today?

SPEAKER_01 18:57

So that's always a question. One of the reasons I have this show is I want people also to ask themselves, what is it that I want? And what is it that I need? Yes. And there's going to be a cost and a risk associated with whatever choice. Totally. One percent right.

SPEAKER_00 19:10

100% correct, correct, right answer.

SPEAKER_02 19:16

Thank you.

SPEAKER_01 19:16

I want to so something that comes up a lot when talking with midwives in particular, but particularly home birth midwives, is what constitutes low risk. How might someone know if they're interested in a home birth that they might be a good candidate?

SPEAKER_00 19:30

Yeah, so I have it on my website. Um, so I have like things that would risk you out of care. Again, like I said, my whole job is to make sure that you're staying within that low risk range. But things like, you know, if you have hypertension or you're a diabetic that's on medication, those are things that would involve higher level of care and making sure that you have access to things like an NST weekly in the third trimester, which I also have an NST in my office. And BPPs, you know, but it does constitute making sure that you have a provider that has the skills to manage that, which is why we love hospitals, we love OBs. I am a provider and a person that really wants good relationships with other providers. I think it's instrumental, but yeah, so there are certain things that would risk you out of care. Sadly, in our state, if you're having twins, you can't have a home birth, which a lot of us receive extensive training on twins. The same with breach. Breach is like where my heart kind of goes, you know, I'm like, please let me do a breach birth. Yeah. But yeah, so those are some things that would risk you out of care. What about VBAC? VBACs. I can take a VBAC. I love a VBAC or tollac, so a trial, a trial because they haven't achieved the vaginal birth after cesarean yet. So that that trial of labor, I love taking tollacs and v backs and giving them that hopefully redemptive birth. Yeah. Yeah, absolutely.

SPEAKER_01 21:07

And in your opinion, what other things besides meeting the criteria for low risk birth? What other things would you say are required for somebody who's considering a home birth? Outside of what medically? Yeah, okay.

SPEAKER_00 21:22

That's fair. Um, I would say I'm laughing because I just I just had this conversation with a client. It makes me giggle. I try to ask questions that come up a lot. It makes me giggle. Because in a home birth setting, even a birth center setting, you do have to have some sort of responsibility and take charge of your care. You have to be just as invested as I am invested in you. You know, if you're having these signs and these symptoms, and I'm like, okay, well, let's talk about nutrition. Let's talk about what we can do to really and supplements to support what's going on. On, or if I'm reading labs and I'm like, okay, this is now I'm getting more of a full picture. At the end of the day, I can only do so much. So there is that part of like, I'm gonna say something that may be controversial, but like our society has for the most part stripped specifically women of a lot of autonomy. And so it is almost like reclaiming that part and your power. And so it's like, no, this is my body, this is my birth. And a part of that is your responsibility. As a provider, I cannot, first of all, I can't have your baby for you. I can't, you know, do all the things that need to be done for you to ensure that you have your home birth. So I work with that with my clients a lot. And I'm like, hey, we do a lot of informed consent. So this is gonna take, I am not gonna tell you what to do. So this is gonna take you reclaiming that part and making a choice for yourself and your family unit, which some people just aren't used to at all. Some people, especially if they've had other birth experiences, and then they come to home birth and they're like, wait, I can decide that. Like, yeah. Yeah, it's your body. Of course you can.

SPEAKER_02 23:20

Yeah.

SPEAKER_00 23:20

You know, and I'm very transparent with my clients of obviously in the case that there's something emergent, I may be like, hey, I feel like I need to do this because X, Y, and Z is happening. But we have these conversations prenatally. So it's nothing new, right? We've already established trust within each other. That if I'm coming to someone, I'm saying, I really think that this needs to be done. First of all, I have to have trust in you because I need to know that you trust my clinical judgment. And then I need you to have trust in me, knowing that I would never do anything that's gonna harm you. And so working together, this is not just a one person show here, right? This is true collaboration.

SPEAKER_01 24:01

Right. So no, I hear what you're saying. I think culturally there can be an expectation, especially for someone's first birth who hasn't experienced it yet, is that we can outsource decision making to an expert. But I I hear a lot of providers, and you included today, it's a really a partnership that can make these decisions together. Yeah.

SPEAKER_00 24:19

And I always tell people, I'm like, you're the expert in your body. I'm the outsider here. If you tell me, I mean, I've had people something just doesn't feel right. And I'm like, I trust you. Yeah. Great. That's like enough clinical evidence, in my opinion, for me to go, all right, let's get some follow-up. Let's figure out it what this is because you're the expert in your body. I don't know your body the way that you know your body. I'm the expert in my body, right? When you have expertise in the female body of burning. Of course. But I really trust that real feeling, that real intuitive knowledge that we hold within ourselves of we know. Yeah, you can feel something's going on. I'm like, yep, totally trust you. Or if someone's like, I feel like I need to be seen sooner. I don't know. Like, great, let's do it.

SPEAKER_01 25:10

When you kind of leaned into the next question I have for you, I love to hear the difference between what a prenatal visit is like for someone who has a home birth midwife versus maybe even like a CNM versus an OBGYN. Like, how would you describe that difference and your care specifically?

SPEAKER_00 25:26

So we follow the same community standard of care. So the same scheduling that anyone within this field does in the obstetric field. But what's different is that my first initial appointment with clients is two hours. That's like we're going through first of all, hi. Like I actually want to be like, oh my gosh, so nice to meet you. If your family's there, yeah, you know, what are things that you want to share with me? We go through a very detailed background if they've had other pregnancies or losses. You know, I want to know a part of their history. And then we go through a lot, all the forms, you know, all the forms that you have when you go to see anyone. Yeah, we go through them together. Cause I'm like, you are not gonna sign something that you don't know what you're signing. So we go through all of that together. Yeah, we go through all of it together. I'm like, this is what, this is what this one is, and then in the future, boop, boop, boop. You know, so we go through all that. And appointments typically are like an hour. All of them. All of them. Yeah. I would say, you know, and today, like even today, I had a 36-week home visit. It was a two-hour home visit. They got to meet their birth assistant that will be there at their birth. I got to see their home, see their family unit, be in their space, you know, figure out, okay, this is where we're gonna set up, this is where we're envisioning. So again, I do that home visit as well, um, which you're just not gonna get in um the typical obstetric model of care. And I mean, in comparison, right? Like even an hour appointment in comparison to maybe 15. If you're lucky, to be honest. Um and then the most important to me, and I think to a lot of people, is the postpartum follow-up. Yeah. Oh, that someone comes to you in your home. Like I go to your house. I go to your house. I'm on call for you 24-7. You can I always tell me I'm like, just even if you just need someone to talk to and text, text me. My clients text me. I'm having a rough time. Yeah. Can can you talk? Yeah, yeah, I can. Do you want me to come to your house and come? What's going on? You know, and so I do that follow-up care for the first two weeks and they're home. Like, you can't, it's amazing. Yeah. In a typical obstetric model, you're not seen until six weeks postpartum.

SPEAKER_01 27:46

For 15 minutes.

SPEAKER_00 27:47

For 15 minutes.

SPEAKER_01 27:48

That's just the way the system. And then I yeah, I always want to clarify it's not to demonize OPs, it's just like how that system is stressed.

SPEAKER_00 27:54

It's systematic. Yeah. It's not fun for them either. Yeah. Do you think someone wants to see? I mean, I know for me, I don't want to see 20 patients a day. That's insane. There's no way that I could. I mean, I worked at a high volume birth center and I seen quite a few people, but I was still able to make sure that I was giving them 30 to 40 minutes of good quality time. I can't even imagine being in a model where I literally only have 15 minutes because of actual time. Right. There's just no way. Yeah. There's no way, and that's the difference. It's, you know, my whole like, is it a slogan? I don't know. Is that what it's called? Like a tagline. Yeah. Yeah. It's like person-centered care because that's really, I'm like, I adjust the care to each different person, to each family unit. I don't have like this blanket. Everyone's different. Every family unit is different. It has different needs. I have to meet them differently. You know? And so it's like, you're not going to get that. Yeah with an obsectric care. And it's not, it's not always their fault. Some of it is. They do have to take accountability for how they show up in spaces, right? As we all do. I have to take accountability if I'm like rude to a barista for no reason. That's not cool. Right. Like it's on you as a person. So there is some accountability that needs to be taken, but it's also systematically the way it's designed.

SPEAKER_01 29:15

So yeah. How would you define a successful birth?

SPEAKER_00 29:23

I don't think it's my place to define what a successful birth is. I think that it's up to that person. What do you define a successful birth as? I mean, I've been doing this long enough to have seen lots of things. And I've seen people go through every intervention that could be had. And they have their baby and they're like, this was the best thing in the world. I've seen people that have had no interventions, but it was very traumatic for them. And so I don't think that that's up to me to interpret what a successful birth is. I know what a successful birth for me is. For you, for myself as a as a person who has given birth, not as a midwife, as a person that's given birth. Yeah. You know, I could never and I would never define what that would look like for someone else.

SPEAKER_01 30:22

Yeah. What beliefs do you hold about the body's ability to give birth?

SPEAKER_00 30:30

All these questions that are so good. What belief do I hold? I believe that everyone has the ability to give birth. I believe that birth is defined as many different things. I believe that belly birds is birthing your baby. I believe that vaginal birds are birthing your baby. Like, I guess it's a part of that trauma-informed part of me too, where I truly believe that everyone has the ability to give birth, no matter the route in which your baby was born. I have met people, when it comes up that I'm a midwife, as you could imagine, to people, they're like, oh, and they share your birth stories, right? Oh yeah. And so it becomes a thing. And so, you know, and I've been a part of people just being like, oh my gosh, like, you know, I had to have these C sections and it, so I didn't really birth my baby, and I'm like, absolutely not. Excuse me? Of course you did. That is so powerful. You, I'm sorry, but like gave your body to that is a really invasive surgery that you did. So that this person walking around, frolicking around, can be here. That is birthing your baby. And I'm really sorry. I always apologize to them. I'm sorry that it's been framed in a way to where you think that that is not birthing your baby. I don't know. A lot of the times they're like, oh wow, I'd never really thought of that. Or I don't even know where I received that information. And I'm like, yeah, no, that's amazing. Yeah, you birthed your baby. So I guess I don't really have any no comment.

SPEAKER_01 32:11

I thought it was a great comment. I was saying, honestly, I think we're really aligned on that. I always correct people when they tell me that their provider delivered their baby. Oh, and then it sends me over the edge. You delivered your baby.

SPEAKER_00 32:24

I always say I I catch babies. I don't deliver a baby. Well, yuck, no, absolutely not. You do all the work. Yeah. And even when like I have so many wonderful clients who are like, thank you so much. You did, and I'm like, I literally did nothing. That person did all the work. Like, I just made sure everything was like staying safe. And like, and of course, like, yes, I provide wonderful care and I understand where they're coming from, but I'm like, I didn't do anything. Like, I caught the baby. Yeah. If that, because sometimes I'm like, do you want to catch your own baby?

SPEAKER_01 32:57

Yeah.

SPEAKER_00 32:58

You know? Yeah.

SPEAKER_01 32:59

But you're there as the provider. You're like, you're providing an incredible like service and support. But yeah, ultimately.

SPEAKER_00 33:05

Yeah. I'm like, you did you did all the work. I didn't do anything. Grew that whole person. Yeah. I'm like, I'm beep bopping around now. And I don't have to go home and nurse a child. I'm not nursing your baby right now. You're doing all that. You're now in that station. You really are doing all the work.

SPEAKER_01 33:23

Yeah. Yeah. Yeah. Um, I'd love to know. So, and birth generally, as fear and uncertainty are like part of the experience. And I'm curious your perspective working with people who are opting for home birth. What do you do to work with clients who are confronting fear and uncertainty as it comes up prenatally, as it comes up in birth?

unknown 33:45

Yeah.

SPEAKER_00 33:46

There's been a lot of it, a lot more. I think that globally, I think it would be crazy to not acknowledge. Globally, people are feeling this sense of severe stressors and uncertainty and fear and trauma. Like, I feel like we're all experiencing so much trauma because we have access to it at the drop of a dime. And so it's been very much impacting people that are pregnant. I mean, you can't watch something of children starving and then be like, but I'm okay. And I like it's so mentally so difficult. And so one of the main things I do, like honestly, sometimes even as a provider, like I put my provider and I tell I like I'll be like midwife hat off, human to human, your feelings are so valid, and it is very difficult. Like I don't always have to have on a provider hat. I can see you on like a human parent feeling, like wavelength. And then of course, like when you're having a baby or you're pregnant, there's a lot. There's no such thing as a guaranteed outcome ever. Ever. No matter where you choose to give birth, there is no such thing as a guaranteed outcome. And I'm very transparent with my clients about that. We go through a whole questionnaire where I say, if an outcome were to happen that is something that no one wants, right? How can I best support you and show up for you and your family? And then when we're going through this questionnaire and we're like talking about it with typically them and their partner, what comes up of here's the thing is we've made it almost a taboo in our country to not have conversations about loss or grief or, and I just don't function on that wavelength. I just think the more that we can normalize there is no such thing as a guaranteed outcome. How could I best support you if something, if an outcome like this were to happen? What could I do to show it for you and your family? What is your normal response to stressors? Like that's one of my questions. Because the way that you normally respond in life, I need to know so that if there's something happening, I know, okay, she tends to withdraw and stonewall. Totally got it. I know that that's what's happening. Like, so I make it normal to have these conversations. I just think it's so important. Yeah, it's it's it's a variation of normal. And I know that people don't like to hear that, but it's true. And so I tend to have those conversations as let's talk about it. And most people are like, whoa, no one's ever talked to me about this. And I'm like, Yeah, that's pretty crazy to me. Yeah, it's just crazy. See the value of unpacking. Yeah, really digging. Let's work through it because then after we have these conversations, if they have something coming up, I'm able to be like, let's talk about it. Okay, what's going on? You know, and I feel like people are more open and there's some more willingness to actually have a conversation about what's really going on.

unknown 36:55

Yeah.

SPEAKER_00 36:56

And they don't feel this feeling of, oh, but I need to act this type of way or whatever that may be. Right. You know what I'm trying to say? I do. Okay. Yeah.

unknown 37:06

That's good.

SPEAKER_00 37:08

Does that make sense at all? It does.

SPEAKER_01 37:11

Who would you say is a good fit for you as a client?

SPEAKER_00 37:15

How would you describe them? Describe them. Anyone who's like chill and ready to have a good time. Is that you? Is that you? Are you chill and ready to have a good time? No. I mean, really, anyone. I think I'm gonna toot my own horn. I think I'm a really good provider. Like, I don't act, I'm always gonna show up as I am. So people either really like my personality, just like any other time in life, or they don't. And I'm like, great, there is totally a provider for everyone. Yeah. My style is I'm like, I'm gonna show up as I am. I expect that you will show up as you are because I don't ever want you to think you need to be performative for your provider. There's times where I'm like, my kid has to come to this appointment because they don't have school this day, but you still have an appointment. So you get to meet my kids. It's like a little bonus, you know. Yeah, I'm just like, I am a provider for all, unless you're a douchebag. Okay, who is not a good fit? Then I am not the provider for you.

SPEAKER_01 38:17

Can you define douchebag for the people?

SPEAKER_00 38:19

Like, what might that mean? Unless you're really uncool, then you know. I will say one of my hard lines is like when I have people come to me, they're like, we want a home birth. This is what we want. Can you try to convince my partner? Absolutely not. That's my hard. I'm like, no, I don't need to convince anyone, and I will not convince anyone. You guys have to have that conversation on your own, but I feel very firm and like you cannot, I just feel like that's yucky. I'm not gonna try to convince someone into having a home birth. Either you feel aligned with it or you don't. And I'm just a believer in that. I also believe that I attract the clients that we will very much um like we align with each other and we there's uh reciprocity. Yeah. And so, like if I'm ever uncomfortable with someone, I will truly just say, I actually don't think that I'm the right provider for you, but I'm more than happy to send you over to someone who you think might be. Yeah, because safety is important to me. Safety in I need you to trust me, I need to trust you, and then safety also in environmental. I'm going into these people's homes. I need to know that I need to truly feel safe in someone else's home. Yeah, so that's important to me too.

SPEAKER_01 39:39

Can you share about a challenging birth that you've attended and how you managed it?

SPEAKER_00 39:47

Those darn shoulder distos. Um, actually, that one wasn't super challenging because we have the ability with our clients that they can move. So um, but I will say I won't speak on one specific birth because if I talk about it too much, this person might know who it is.

SPEAKER_02 40:07

Yeah.

SPEAKER_00 40:07

But I've had multiple births like that. Again, I'm looking for all the pink flags, but typically I set myself up for success. If I'm noticing someone's pushing for a long time or they have a higher risk of having a postpartum hemorrhage, I'm already really setting myself up for saying, okay, if I need to resuscitate this baby while this person's bleeding, let's have a game plan. So that's just the way that I like to function. Luckily, I work with really great birth assistants or midwives that are trained, that I've either trained personally or that known and have a great working relationship to where if someone is hemorrhaging, I'm managing that, they're managing a resuscitation if needed, things like that. I was thinking steps ahead. Think like 10 steps ahead if possible. But really, I would say not even those, because those are hard. Resuscitating babies is not my favorite thing to do on the planet because it's so taxing after I'm like my adrenaline is like, woo, okay, we've had a time, we're done.

SPEAKER_02 41:03

Yeah.

SPEAKER_00 41:04

But I think the most challenging ones are truly what ones where they've had to transfer and then they feel like a failure, or there's that self-criticism, those are really challenging for me.

SPEAKER_01 41:16

Right.

SPEAKER_00 41:17

Because it's just it's so hard. And I see them so much, and I like see the pain in that. And there's a lot of work to do after, and most of the time we're able to work through it. And it doesn't even have to be a transfer, it can be anything, right? Any scenario, but anytime when one of my clients we develop relationship. I know you. You're like a part of my little family now, right? And so I really do. I'm like, I want to make sure that I'm nurturing and taking care of people, but at the same time, I'm just one person.

unknown 41:51

Yeah.

SPEAKER_00 41:51

I'm just a person. I'm also a mom, you know. So sometimes then I'm like, ooh, it's it's a lot, it's taxing. Yeah. So then making sure I'm feeding back into myself and not bringing that energy into another birth space, it can be hard sometimes to like take care of yourself. So yeah, midwife yourself.

SPEAKER_01 42:09

Yeah, it's almost impossible. Yeah. So building a support team is important in birth and in life, it turns out.

SPEAKER_00 42:17

Yeah, crazy.

SPEAKER_01 42:20

If someone is watching this and is considering a home birth and is feeling maybe a little unsure about how to choose a provider or about choosing a home birth, what might you say to them as they're grappling with that decision?

SPEAKER_00 42:32

I would say go with your intuition in your gut. I think that it's very informative. Sometimes, again, when people think about themselves, they don't think as deep. What would you want for your daughter or your sister? Or I'm like, that's really important because I know for me, I was like, I for sure I know what type of experience I want. And I was lucky to have that. But not everyone has that. And so I always tell people, I'm like, interview multiple people, not just one person. Yeah, interview multiple people, see what you like about their energy or what they provide. Like it's really important. Also see what their client load is like, right? I think that's another really important question. And how many clients do they have during your birth method? Yes, yes. Because I know for me, I'm very low volume and I like it that way because I want to be able to show up fully when I'm out of birth. I came from a very high volume practice and I'm like, I'm good off that for a while. Yeah. And so now I'm able to really show up for families, and I think that's really important. So no matter where you are, if you're going into a hospital system, make sure you're asking the appropriate questions. If you have certain wishes, make sure that you're talking to that provider about it. What do you think about delayed cord clamping? Um, what do you think about, you know, or what are your C section rates? Like those are important. That's really important information. And I know for us community birth providers, we're more than willing to share. Stats because they're always so good. We're like, we'll share whatever you want, you know. And so just asking those questions with the zooming out mindset of what that would look like and if it fits you and your family's needs.

SPEAKER_01 44:15

Justina, I'm so glad that you're here in our community. Wonderful, wonderful resource.

SPEAKER_00 44:19

Where can the people find you? So you can find me at rooted inmidwifery.com on Instagram. I think it's rooted in midwifery. It is. Um my main social is my Instagram and then my website.

unknown 44:35

Yay!

SPEAKER_01 44:36

Thank you so much for coming on the show.

SPEAKER_00 44:38

Thank you. So glad you're here. I appreciate you. Bye, catch you. We did it.