Marielle

A lot of people I think, come to me and because I'm a homebirth midwife, they're like, Well, do you carry like medical supplies or emergency supplies? And I'm like, Yes. Like I went to Hopkins and Georgetown like I am like fully stocked. I'm not like coming out to you with, you know, a piece of string and a dirty pair of scissors because I'm in homebirth. I'm like, I bring the birth center to you. I don't think people have to be as low risk as they think like that. You don't have to be like an athlete who is vegan. But it's, you know, lots of iron rich vegan foods and, you know, has a high pain tolerance. I think a lot of people can be homebirth candidates. Are you pregnant? Or a new parent looking to ensure a better postpartum experience? Or are you a birth worker looking to improve your postpartum care skills? Check out thriving after birth, an online self paced course by me midwife and educator Tanya Tringali. It's 10 and a half hours of video content featuring experts in lactation mental health, pelvic floor health, pediatric sleep issues, you also get worksheets and a workbook as well as options to have a one on one session with me, sign up and Mother wit maternity.com/thriving And let's improve postpartum care together.

Tanya Tringali

Hey, everyone, I'm your midwife, Tanya Tringali. Welcome to the mother wit podcast, a show about the issues we healthcare consumers and providers face every day as we interact with the medical system. We'll talk about its blind spots, shortcomings, and share strategies we can use to feel seen and heard no matter which side of the table we sit on.

On previous episodes, I've shared a couple of home birth stories. So I thought it was time to have a home birth midwife on so that we could help people decide where they might prefer to give birth. I believe that everyone can benefit from this conversation because there is so much misinformation out there. There are those who deny the evidence they shout from the mountaintops about how unsafe it is. And this is simply not accurate, especially when clients are selected wisely clear on the risks and benefits and committed to their choices. The decision to birth in or outside of a hospital has a political quality to it that separates us like so many of today's political debates, like abortion and guns, and it doesn't help us promote the profession of Midwifery, which according to the World Health Organization, and various other studies, if it were well integrated into our health care system, it has the power to lower costs and improve outcomes and satisfaction. I'll share some of these in the Resources.

Today, my guest is Marielle Tomlin she is the owner and sole midwife at woman kind of midwifery in Lancaster, Pennsylvania. She's a graduate of Georgetown University's midwifery program where I'm adjunct faculty and I learned while recording this episode, that she's joining us there and a couple of weeks, we actually met while she was precepting, one of my students. And a little aside, for those of you who don't know much about midwifery education, because homebirth is so rare in the US, it's really hard to find these sorts of opportunities for all students who want them. Now, not all students want to attend out of hospital births, but many are interested and would like some exposure so that they can learn more about it and decide for themselves. So what Marielle is offering students in addition to all of the hard work that goes into being a relatively new midwife and business owner is a huge gift to our profession. Hi, Marielle, thank you so much for joining us today.

Marielle

Hi, Tanya. Yeah, thanks for having me.

Tanya Tringali

No problem. I'm really excited to have you. Do me a favor. Tell us a little bit about yourself.

Marielle

Yeah, so I am I guess a kind of Peace Corps volunteer turned high risk labor and delivery nurse turn homebirth midwife.So yeah, I've kind of reached my end goal, or what I thought was my end goal really quickly in my career, because I was just presented with this incredible opportunity from my kind of final preceptor and my school aide to take over her practice or home birth practice. So I just, you know, said yes, and dove right in, and now I own you know, my own home birth practice. So, yeah, I arrived at that. And now I'm just like, enjoying my life and figuring out kind of where I want to go and how I want to shape that practice, which is really exciting.

Tanya Tringali

So I think I hear you saying that you always knew you would become a homebirth midwife. You just didn't think it was going to happen right out of the gate.

Marielle

I always knew I think in my heart I knew I wanted to be a home birth midwife, but I always just said I wanted to do out of hospital birth shots I wanted to likenot set my expectations too high. And I was like, I would be cool doing like hospital birth and birth center, you know, like some kind of combination practice as a midwife. But yeah, I think what really shaped my career was that I knew I wanted to do out of hospital birth. So that's what led me in the first place to do high risk labor and delivery, because I wanted to see like all the things and be able to first of all, recognize them really quickly, and be able to handle them, you know, as much as I could, in a rural practice, so no homebirth practice out of hospital. So I knew for me, I wanted to have that confidence going into doing out of hospital birth of having like this high risk experience, and feeling, you know, proficient and that. So, you know, I think that was always my goal, in midwifery was to do out of hospital birth, or at least to do kind of like natural physiological birth, natural physiological labor.

Tanya Tringali

Yeah, I totally get that. I mean, I came into midwifery with similar feelings as you did. And I link to this episode for people who want a deeper dive into your history and your story, because it is fascinating. There's a podcast for those of you who don't know called Journey to midwifery. And Marielle was on that, and she tells her whole story. So I don't want you guys to have to hear that whole story here, because I have a bunch of great questions that I think everyone will be interested in hearing the answers to. But I came to it very similarly to you. And then just interestingly enough, I found myself in a really wonderful hospital based practice that does do physiologic birth in a hospital that's really supportive of that. We're more midwives caught babies than obstetricians.

Marielle

Yeah, that's so cool.

Sleep for me a little bit.

Tanya Tringali

And super rare, super rare. And it was such a joy. And I trained there and then kind of stayed very similar to you. But I found myself as a hospital based midwife, which was not what I thought I was going to do. I had had a baby out of hospital myself, it was what I was very passionate about. But I was in New York City. And there were not many options. In the birth center, I had my daughter at that I wanted to work at one day closed abruptly, like, the options were very, very limited for me. So it's interesting how two people can start with very similar stories, and diverge. But hey, we're both out there. Well, I'm I'm now only minimally out there, which I'm grateful for, like I'm to the point in my life where I'm happy to sleep at night. But nonetheless...

I'll do my best. But yeah, I get it. And I think that that's really wonderful. And I'm beyond impressed with you and anyone else who early in their career, let alone right out of the gate goes into homebirth practice. So that is impressive in and of itself. And again, I won't dive too much into that so that people can check you out on journey to midwifery for that one. All right. So the point of today's episode is, I would say this is probably a little more for the healthcare consumer. But I think there are plenty of health care providers listening who may not be midwives, they may be pelvic floor, physical therapists, they may be mental health professionals, all of the people that we couldn't do our job so well without, and I think they need some of this information as well, because there's so much misinformation out in the world. And they're going to have conversations with people who have had babies or who are planning births, or who are pregnant and struggling with whatever they're struggling with. And I want to make sure that they come at these conversations from as much of an unbiased place as possible. So I do want to make sure that this conversation speaks to everyone. But let's start with talking about what makes someone a good candidate for homebirth. Because I think that's kind of the starting point is somebody is planning a pregnancy or they're early in their pregnancy. And there are clearly people who assume they're going to go to the hospital never think twice. It's just like, some people may not even realize you can have a homebirths some people may have heard of it, but they're like no frickin way that's not for me. But let's think about the people who come at this and say, I recognize I have options, and I need to understand if these options are appropriate for me. How does one go about exploring that for themselves?

Marielle

Um, yeah, that's a really interesting question. And I think there's a few different ways to answer it. Like there's the very obvious kind of like, someone who is having a healthy normal pregnancy is a good candidate for home birth and you know, someone can start out doing care with a home birth midwife, and need to transfer or transfer care change plans. Um, you know, even up to the last minute even postpartum, that can change, they can have a home birth and deliver the placenta in the hospital. And that's okay. I think most people and I don't think people have to be as low risk as they think like it, you don't have to be like an athlete who is vegan, but it's, you know, lots of iron rich vegan foods and, you know, has a high pain tolerance, I think a lot of people can be homebirth candidates. So there's kind of that, you know, you don't have to have a perfect blood pressure or perfect hemoglobin, like, you know, we work through pregnancy and improve our health. So I think, you know, home birth can be an option for a lot of people, not just the super healthy and fit and high pain tolerance women out there people out there. So yeah, I kind of see some times when people reach out to me, they'll say, hey, I want to meet with you and talk about, you know, homebirth as an option. And as a midwife, I kind of see my job as twofold. As a midwife of my practice, my job is to guide you through your pregnancy and birth, but not necessarily to educate you on like, why to have a home birth, like, I'm not here to convince anyone that home birth is right for them, like, I want clients coming to me knowing they want to have a home birth, and I'm gonna like help you achieve that goal in a way that's healthy and safe for you baby family. So I think that's one misconception, people sometimes come to like a consult, or, you know, drag their husband or partner to a consult, hoping to kind of make themselves believe or make their partners believe that homebirth is going to be safe. So in my midwifery work, I'm not going to convince anyone that homebrew is right for them. I'm like, here when you know, you want to homebirth like, I'm like, let's do this, contact me and we'll move forward. But on the other hand, I do social media and podcasts like this, because I want to bring kind of light to the homebirth world and talk about, you know, homebirth being safe and normal and a really valid option. You don't have to be a hippie, you don't have to be Yeah, young fit super healthy. So I think that that answer your question, I feel like that was all over the place?

Tanya Tringali

No, it's a great start. I'm gonna throw a few more things at you. Because you started off by saying, I think there's a few different ways to answer that question. And I completely agree. Now, I recognize that in your day to day life, you're like, my job is not to convince people. And nor do I want you to convince people here, but I want to touch on a couple of things that I think come up for people, and I'm sure you've had to have these conversations with people anyway. I think the reason that most people who may for a moment consider homebirth and then say, you know, what, it's just not for me, is because people can't wrap their mind around the risk. And what it would be like to have a hospital transfer in labor or early postpartum, or the baby have to go in or you know those things. So do people come to you kind of wanting it but expressing that concern?

Marielle

Yeah, I think a lot of people want a home birth, but want to discuss all the what ifs. So I think it's good to know that like home birth is, it's not a guarantee, like when you you know, want a home birth, you're really hiring a home, you're really hiring a midwife for midwifery care. So I'll tell people that have like you're hiring me for midwifery care. If you don't have a home birth, I'm not going to give you a refund because we failed. Like you're coming to me for midwifery care, I'm going to give you midwifery care, and that's going to play out how it needs to play out. So I'm not gonna, you know, guarantee anyone a home birth, that's the goal, and then we you know, change things as they go. So, uh, you know, and a transfer can be a really normal part of homebirth. I think that definitely needs to be normalized more, you know, a transfer can happen in pregnancy, a transfer can happen during labor, it can happen for baby, it can happen for mom, it can happen postpartum. And I don't think that should be seen as a failure. I think that should be seen as a normal part of home birth. Sometimes that's necessary.

Tanya Tringali

Absolutely. And I think the thing that people don't realize is that the vast majority of transfers are not for complications that are serious. They are for what the medical world likes to call failure to progress, right. Here's all these terrible terms we use right out of the gate. Yeah, we call it therapeutic rest. There we go. Right. So you know, we've got somebody who's having a longer or slower laborer who may need appropriate interventions, and they transfer very calmly and carefully and then you may have people transfer who decide that they need some pain medicine? And sometimes those two stories are very intertwined, right? The vast majority of transfers are for these reasons. And I don't think people realize that I think they instantly picture something catastrophic happening, which is actually pretty rare.

Marielle

Yep, totally.

Tanya Tringali

What would you say in your practice? I don't know if you can answer this question off the top of your head. But what is your transfer rate so that people hear it from a real person?

Marielle

I haven't done stats, I guess I've been in practice for like a year and a half. And I haven't figured out like how I'm going to do it, because I took over in May. So may 1, so I haven't like, I don't know if I'm gonna do it, you know, like, a normal calendar year or do it. But I'd say it's less than 5%. But I am really careful about you know, what clients I take, I only take a certain number of prime apps, which is first time moms each month. So you know, most of my clients are really low risk. home birth clients, a lot of them have had a home birth before. And with, you know, first time women who are going to labor and birth at home, we have a really big discussion about the transfer rate and why women transfer and labor and how it is mostly dehydration and needing rest. And I think having that conversation and saying hey, like you're in early labor. Now, let me give you my spiel about what happens when early labor is, you know, prolonged. And, you know, here's how I recommend you avoid this happening to you, you know, rest, ignore it, hydrate really well, you know, take a bath, go for a walk, take a nap. I think when we have that conversation up front, I often get calls in early labor. And I have this conversation with women. I think that prevents it a lot of the time.

Tanya Tringali

Yeah

Marielle

Just understanding that this is what happens. And here's how to avoid it or prevent it.

Tanya Tringali

Yeah, I jokingly and lovingly say to my clients, ignore your labor for as long as you can. And if your baby falls out, God bless you because the rest of us had to work real hard to get our kids out.

Marielle

I'm like, You're not gonna miss it.

Tanya Tringali

Yeah, the people who missed it did not miss it, because they were ignoring their labor, right? Like when a baby falls out in the bank, that person wasn't ignoring their labor. It's a fluke. It's a total fluke. And you know, people worry so much about being that person, especially people going to the hospital, though, I think, because they're, they're worried about making it to the hospital on time. Or maybe they're worried about missing some arbitrary window to get their epidural or whatever it is. You know, another thing that you said, though, that was interesting to me was what people think you want for them or what people think homebirth has to look like. And I would argue that like all midwives in any setting are up against that, because people think that just because you're a midwife, you are insistent that they have a quote unquote, natural birth. And that's not necessarily true, either. In fact, I would argue that there are more midwives working in the medical system who were perfectly open to epidurals and interventions. And yet, when people outside of this world, hear that someone's a midwife, they get this instant image of what I think is really a minority of us.

Marielle

It's true. Yeah, that's totally true.

Tanya Tringali

It's so interesting to me.

Marielle

Yeah, yeah. And they think like, a lot of people I think, come to me, and because I'm a homebirth, midwife, they're like, Well, do you carry like, medical supplies or emergency supplies? And I'm like, Yes. Like I went to Hopkins and Georgetown like I am like, fully stocked. I'm not like coming out to you with, you know, a piece of string and a dirty pair of scissors. Because I'm in home birth. I'm like, I bring the birth center to you

Tanya Tringali

Exactly. Well, let's unpack that for a minute. Because I want to be careful as we talk about home birth, home birth, home birth, and say that the vast majority of what we're talking about, would pertain to out of hospital birth. And that would mean home birth or freestanding birthing center birth, meaning a center that is not attached to a hospital. A lot of the information that we're passing along would go for both of these things. But there are huge swaths of the country where you can't access a birthing center, but the experience is very similar. So I had a baby in a freestanding birthing center, in part because of a lack of insurance coverage at the time. And my apartment in New York City just didn't feel appropriate. My birthing center was a lovely like luxurious kind of experience. I had things there I couldn't have had at home, right. So anyway, both of these things are very much the same and the experience everything we're talking about with transfers and all that stuff would pertain.

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Unknown Speaker

We hope you're enjoying the mother wit podcast. If you are, please rate us and leave a review in iTunes, Spotify, or wherever you're listening to your podcast. Thanks so much. Now back to the show.

Tanya Tringali

Also, let's back up and talk a little bit more about the health stuff because I love that you pointed out that you don't have to be the perfection of health. But I do think that there are some clear guidelines for people to think about. But also there's language that gets used that super muddy. So how can we shed some light on what it means to be called low risk or high risk? And how people can perhaps self identify what category they actually fit into?

Marielle

Oh, yeah, this is really interesting. And I feel like I end up frustrated all the time. Because sometimes women will come to me and they're, you know, 36 years old. And they you know, are almost self labeling themselves. Yes. Age and wondering if a homebirths appropriate? And I'm like, Yes, totally. Whereas, you know, technically someone at some point has charted them as being high risk. Yeah. But they're not.

Tanya Tringali

Yeah.

Marielle

In my mind, at least they're not so yeah, I mean, I think there are some really cut and dry examples of being high risk. You know, there's the big things preeclampsia, uncontrolled gestational diabetes. I personally don't do any VBACs at home other midwives do, I think that's kind of a personal choice. So, you know, having had a C section before, or maybe multiple C sections, it depends really on the level of comfort, I think of the client, and the midwife or the provider they're working with. So I think, you know, risk level is really more of a conversation than a cut and dry, you know, diagnosis or code.

Tanya Tringali

Yeah. Yeah. So I think another way to think of it is, if you have an underlying medical diagnosis, when you're not pregnant, that might be a reason to have a conversation about how does that interface with pregnancy? Most things are okay. Right. But nonetheless, it's merit to conversation. I think, you know, when we talk about high risk, for example, you gave the best example there is, which is age. And for those of you who don't know what term is used to speaking more about awful terms, AMA, advanced maternal age, which is just such a ridiculous thing.

Marielle

Or even worse, geriatric pregnancy.

Tanya Tringali

Oh, gosh, I've actually never known anyone who says that I've heard I've heard it said, but I've never known anyone who says it. And I'm grateful for that. But nonetheless, you know, we're learning more and more, I kind of have a little bit of a fascination and aside with like, longevity science, and you know, just what we're talking about, we're talking about lifespan and health span. And if you know anything about this, the research coming out of that we all age really differently, right? Like what's going on inside of our bodies has nothing to do with our actual numerical age. And, you know, the things that we have grouped into high risk or even AMA, if we will boil it down to why have absolutely nothing to do with where you have your baby. So like the age discussion, we could really chalk up being a little bit simplistic, but we could chalk up to one's risk for having chromosomal abnormalities. Right. That's the core of it. There's obviously a few more things because as we age, we're going to increase our risk for high blood pressure and other things.

Marielle

Right.

Tanya Tringali

But, you know, at the at the core, that's why we started using terminology like that. It has nothing to do with where you have your baby.

Marielle

Yep, and even chromosomal abnormalities. Those don't always rule out at home. But absolutely, you know, I know lots of families will welcome a baby with Down syndrome at home. And you know, that might be better for them because that baby might be whisked off to the NICU for no real medical reason in the hospital at home. You know, they might have had an ultrasound, everything looks fine with the heart. They know it is just down syndrome, and there's not other complications and they might be able to bond and do immediate skin to skin and work on breastfeeding with that baby in a lot, you know, in a way that's much better for their family. And then you know, when there's fetal anomalies that are fatal, that's also not necessarily, you know, risk out of home birth, those families, you know, often have a home birth and that is, you know, a better way for them to deal with that. And to provide comfort care can be you know, palliative care can be provided at home as well. So

Tanya Tringali

Absolutely

Marielle

All of those different things happen.

Tanya Tringali

So, now tell us a little bit about the population you take care of, because you do have a unique experience, which also overlaps with mine. So this is why I've I not that I didn't take care of the same population as you, but I'll tell you after go ahead and tell us a little bit about how you take care of.

Marielle

So my, the population I work with is really special. And I just feel like I've totally found my happy place. I'm like, I'm never leaving. But I work mostly probably 95% of my practice is Amish and Mennonite clients here in rural Lancaster County, Pennsylvania. So I have, you know, I have two offices, which are only about 10 miles apart. That way people can travel to me on horse and buggy, because they can't go as far I have horse ties out of the back of both offices where they can come, you know, and tie up their horse and their buggy there and come see me. You know, sometimes they come in right off the farm barefoot, we welcome barefoot clients in the office, sometimes I'm barefoot. Yes, so my client population is really special. They are incredible at home birth, because it is ingrained in the culture. So I have learned so much about the strength of women and families laboring, giving birth raising newborns, breastfeeding, it's just, it's incredible. It's super rewarding. I love it here. Then, you know, 5% is probably what we call English women. And English is the term used in this area for anyone that's not Amish or Mennonite. They're grouped together as the plain community. So then I have some English women that I served too, which is really fun.

Tanya Tringali

That's very cool. Do you feel sort of transported to another time often?

Marielle

Yeah. My like, I think now looking back, I'm like, My career goal when I was a little girl was to become Dr. Quinn, Medicine Woman. And I feel like I've totally achieved that. But watch that show.

Tanya Tringali

That's so awesome. I love it. Yeah, so I took care of for many, many years, in fact, much of my career Hasidic Jewish women. And so that's where the parallel is, is populations of people that have large numbers of babies. And I think you get to see some interesting patterns, when you see that. And one of the things that I find most fascinating, I'm wondering if you're starting to see this as well is, for instance, around conversations that have to do with weight gain in pregnancy. So we know that there's a lot of discussion right now about how the numbers that we give people are not based on good science, and they don't make a lot of sense. And I think that can be a helpful guideline, it's kind of like talking about BMI. No, it's not the end all be all. But it can provide you one piece of information if you look at the bigger picture. And I think this way about weight gain guidelines and pregnancy. But when you take care of somebody who might have 16 babies, you see things like someone who always gained 70 pounds, but they always lose it all. And they always have a normal size baby, or you see someone who gains like nothing. And you're like, how did this person have a normal size baby, when they barely gained enough to make the baby. And then they always have a healthy baby, and they're fine. And so it kind of makes you step outside of these guidelines that feel really different when you see people who have between one and three babies, which is what most people see in the world.

Marielle

Yeah, I've been here in this practice, I came as a student, and then just stayed. So I arrived to this practice in January 2020, right before COVID. And I'm already seeing a few people for the third pregnancy with me that I've taken care of them. So it is so fun. I like you know, I know where their snack drawer is in their house. They know what I like to eat. You know, I know how they labor or what position they like to push in. And I feel like some of them are comfortable being like, so I've always done it this way. But like Do you mind if we do it this way this time? So yeah, it's really cool to see the evolution of kind of that midwife client relationship. And I think some of them are like, Oh, we have a younger midwife now. So like, we can push on our hands and knees. She can squat on the floor with me like yeah, you know, I'm kind of up for whatever.

Tanya Tringali

That's awesome.

Marielle

Well, I think they were being really kind to the midwife before me who was older and just like trying to make life easy for her as a as a midwife. And now they're like we can make you work. Like, we're gonna squat on the floor or give birth standing up in the shower, and you can catch that baby. And I'm like, that's fine. You guys can do this to me for a while.

Tanya Tringali

Yeah. And when you get old, that's what students are for.

Marielle

Exactly.

Tanya Tringali

And we meet students being exposed to the style of practice that you have. It is so rare to expose students to this, which is such a shame, because it's why first of all, we have a very low number of midwives in the country to begin with, and a much lower number who go into out of hospital birth. for so many reasons. I think, so many midwives come into this career wanting to do this. And then the doors are shut in so many people's faces, or the barriers are too big, like I know, for me...

Marielle

yeah. As the schedule and the pay.

Tanya Tringali

And yeah, well, and just starting a business, which we'll talk about a little bit more towards the end. So I want to talk a little bit more about reasons why someone might choose one place versus another health aside, what are some of the biggest reasons, in your experience that people choose homebirth? And I might actually want to say, and you told me if I'm wrong, that I want you to think about that 5% of what you call the English population, because that's who's listening to the show? What are their reasons? And why might those same people choose hospital or birth center in your experience?

Marielle

This is kind of an unfortunate reason is money, insurance, I don't take any extra insurance, I think I have a really reasonable price. And I almost that's almost a way of weeding out people who aren't committed to a homebirth. Because like, I'm committed to you, when you're going to be my patient, like, I'm going to love on you. My heart is in this I'll cry if you have a bad outcome or something hurts you, like, you know, I often cry during labor, or, you know, like, I'm in this. You know, like, my emotions are all in this. So I want to make sure like the patients that I take on are committed. So I think that's why some people will just choose the hospital birth, you know, even if they're great would be a great home birth candidate. They they're like, Well, I can I can do it in the hospital anyways, I'll get it done. But it's not going to be fun for them, or beautiful or this wonderful experience, you know, they could maybe have a more beautiful, rewarding experience and their dream experience at home. So I think that's really unfortunate. Like, I definitely think, you know, our whole system needs to change. I don't know if it ever will. But so I think sometimes birth centers are a happy medium there. Yeah. Where women can, you know, have their insurance pay for it? So yeah, I don't have any, I don't accept any insurance. So everyone that's coming to me is paying, you know, out of pocket, cash check, whatever for their home birth. So I think there's a huge level of commitment to this birth there. So I think that's kind of an unfortunate reason why some people will just kind of continue the status quo of hospital birthing. Yeah, when maybe they deep in their heart, they would have really wanted a home birth. And that would have been like this really beautiful. Maybe healing, you know, or really wonderful experience for their whole family.

Tanya Tringali

Yeah, so cost is kind of what you see topping the list.

Yeah,

Marielle

yeah.

That is really, where's it like the plain community that I serve Amish and Mennonite like, that is they don't use insurance anyways. And that is, you know, just an accepted part of life that they're gonna have to pay for, you know, each each birth. And that's how their system works anyways.

Tanya Tringali

And then there's people for the most obvious reasons, right? Like, we know that people who really who come into pregnancy, knowing that they want an epidural or knowing that they want or need a planned C section, those are easy, easy, we're going to have a baby in a hospital cost, I think is something that people don't know a lot about until they find themselves in this situation. I've certainly taken care of people who, especially with second baby, I find that people who weren't open to it with the first may very well be open to it for a second. And they're the probably the best homebirth candidates anyway, right like not to say that people shouldn't have a first baby at home. But if you've had a first successful birth, in general, your second birth is always your safest. And your easiest birth risk goes back up a tiny bit, once we get into third and then up up up from there for different things, not everything. But that's the trend in terms of like looking at the statistics on outcomes. But I think there is this whole group of people and I mentioned it when I talked about why I chose a birthing center for myself. It's that your home just isn't the right place or right environment.

Marielle

I think the main thing is if people want a water birth, you have to have space to put the tub but you don't need it lot of space for that. But I think generally like if you're seeking a home birth, it's because you're comfortable in your home. And that's where you want to be because that's your safe space.

Tanya Tringali

Hey, everyone, it's me, Tanya, your host here at the mother wit podcast. You know, I sometimes invite my clients on the show to talk about their birth stories and postpartum experiences. But I want to tell you a little bit more about what those clients and I actually do together. I started mother wit to help people in the perinatal period achieve their health and wellness goals. That means whether you're hoping to conceive and struggling with high blood pressure, or high blood sugar, or you're having trouble managing anxiety or depression in the postpartum period, or maybe you just need support and advocacy between prenatal or postpartum visits, I can help get a discount on your first consultation with me at Mother wet maternity.com using the code first console 10% off. That's one 0% symbol, all one word. I'm looking forward to working with you. And maybe having you on the show too.

Marielle

Yeah, I know a lot of midwives have like a, like 20 minutes, you have to be able to be to a hospital in 20 minutes. I'm I'm rural out here. But that being said, we do have hospitals pretty close by I guess, I have a hospital that I specifically partner with. So I do have a collaborative physician because I'm in Pennsylvania. And that's how it works here. She is incredible. And I love her. And it's been a really positive thing for me, although I wish it wasn't like legally required. So I partner with the hospital where she is the medical director. And, and I love that hospital, and I kind of bypass another hospital to go to her. Because it's so wonderful. But so I'm thinking oh, yeah, sometimes I'm 3045 minutes away, but I guess not because there is another option more close by if I would need it.

Tanya Tringali

Yeah, you just touched on something I think people don't know a lot about also whether it's you know, healthcare providers outside of the profession of midwifery or consumers. I don't think people understand how much we value and how much of the core of our profession collaboration is. And, you know, we talk a lot about, you know, the medical system, not being up to par. And all of that is true. But when we look at individuals within the system, we need the individuals who support the work we're doing and believe in us. And we need those great relationships. And so can you tell us a little bit about what that great relationship you have is built on?

Marielle

Yeah, so I, when I inherited this practice, and bought this practice, I also inherited this a fabulous collaborative physician who works at a local hospital. And there, they have a great team of doctors and midwives, the midwives really rule the roost of the natural births. at that hospital, they also serve the same community I serve. So a mix a lot of plain women and English women, they do a lot of natural birth in the hospital, there are a lot of VBACs because most of the homebirth midwives in my area, don't do VBACs at home. So I feel super supported. I don't feel like I'm out here floating around alone. I have my collaborative physician and I have other I have like a midwife mom, to I was I asked her when I first started, I was like, will you be like my hospital midwife, mom, because I have my collaborative physician, but I'm gonna midwife, you know, on the ground to in the hospital to talk to, and I can text both of these women, you know, clinical questions or just questions like, hey, what's the new COVID protocol right now? Are you guys testing everyone, when they come in, I'm bringing someone in, you know, in an hour, like I want to prepare them on the on the way things like that. So yeah, I have this hospital that really is, you know, more than my backup, it's, you know, we collaborate together. And I also take care in my practice, and I think this is kind of unique of clients who are planning a hospital birth, but they want to do their care with me, you know, local to their,

Tanya Tringali

Oh, very cool.

Marielle

I'll do all their prenatal care. They'll have one consults appointment with the hospital practice, to kind of get in their system. And then in labor, they'll call me I'll call over to the hospital, whoever's on Call the Midwife on call or the doc on call, kind of call in a report, what kind of phone triage and then they'll go in, have their birth and often go home really soon after less than 24 hours and then I'll do all their postpartum care which is also in their home and then then they're off in the office. So yeah, we work pretty seamlessly with this local hospital, which is really incredible. On top of that, there's also a group of other solo midwives in the area. So even though we're you know, kind of all solo midwives doing our own thing, we all support each other. Are they Sorry to interrupt

how many of you are there? Let's see, there's one fairly close to me two fairly close to me, who are also nurse midwives. And then there's some other professional midwives in the area. Yeah, so I'm like, you know, I am a solo midwife, but I don't feel like it that much, because actually, it happened to me the first time a couple of weeks. So I had two people in labor at once. So I called the other midwife, and she went out and delivered that, you know, caught that baby for me.

Tanya Tringali

And so you each are backing each other in that way, in case that happened?

Yeah.

Marielle

It's very, it's not like, if I get two people, you know, at once, I'm not like, oh, sorry, you have to, you know, take an ambulance to the hospital and half of the hospital birth, you know, we work together kind of in community, to, you know, serve the community here.

Tanya Tringali

So you don't have hospital privileges, right? When somebody needs to transfer, you don't get to go with them. Is that correct?

Marielle

That's correct. And that's by choice. That's how the midwife before me did it. And that's kind of how I want to do it to my heart is really at home, I find that often when it's time for that transfer, the client needs rest. And so do I, as a solo midwife, I can't just keep going. And yeah, I think that would just be too much on my plate. And I have this wonderful resource, right there. So I feel really comfortable being like, Hey, this is the name of your midwife, I just talked her on the phone, she's gonna get you that epidural and take care of you and kind of kissing talking to men, kissing them goodbye, and knowing they're in really great hands. And often, like that midwife, or doc on call is gonna text me and say, Hey, we delivered that baby. They did great. And I'll, you know, wake up from a nap with to that text. So I feel really comfortable with the system as it is. So I don't feel like I have to have hospital privileges. I mean, sometimes I'm like, oh, yeah, I wish I could have like seen this through to the end. But I think for me, that's like, a little bit selfish.

Tanya Tringali

I really appreciate your answer on that, because you definitely shed light on something I hadn't thought of given that I've never been a homebirth. midwife, myself, I really couldn't appreciate fully until you said it. The thing you said that was most powerful was that when they need rest, I often need rest, too. I just kind of had tunnel vision on the part where the midwife wants to see someone through. And I've always seen, first of all, I assumed that for many, and I think this is true that for many homebirth midwives, it's not their choice to have privileges or not, they just they're not going to get them for whatever systemic reason. That is whether that's they don't meet the malpractice criteria that the hospital needs them to meet, or the hospital is totally averse to it, whatever the reason is, but I've only ever focused on the suppose a disruption and care that occurs and never really heard it from that perspective. So I really value that. And I think that that's really eye opening.

Marielle

Yeah, I think I'm toast by that point. A lot of the time, it's like, I want to go home and you know, see, hold my son and, you know, put on some Netflix and fall asleep on the couch. So I feel like, yeah, sometimes it's almost more responsible to hand that patient over to someone who's rested. And yeah, it's just so easy because I have this great practice at this great hospital practice right here in the neighborhood.

Tanya Tringali

So on that note, well, you talk a little bit about what it's like for you to be a home birth midwife and balance the other pieces of life that you have to balance kids, husbands, well, husband.

Marielle

I could use the second one actually, I'm always saying I could use a wife as in addition to my husband. For support, yeah, I'm still figuring that out. I've been a midwife for just about two years. So I'm still I still call myself a newbie, I've definitely settled into the role. I remember my first year in practice, I would have like a panic attack every you know, probably few months where I would just feel this overwhelming sense of responsibility and just kind of dread about it. Because it was really overwhelming. And now that hasn't happened for a while. I've kind of settled into that. And yeah, I'm still figuring out like I don't people always ask me how many patients do you take a month? How many how many births do you do a month and I'm like, I don't know yet. Right now I'm just like taking it as it comes. If it gets kind of crazy. I'll be like Okay, I think we need to stop. And you know, for a few months in the spring I said I want to have a few quiet months because we have a few busy months. Let's only take like one prime you know one first time mom for those few months. Generally I'm just at those Labor's a lot longer and those appointments take longer and I like to really you know, love on those first time moms and make sure they're educated and everything. So I'm learning to set boundaries. I am actually scheduling my first vacation since I took over so I haven't been on vacation a while Well, we're going to England and Scotland in July. And I've had to say no to people. But I'm learning that that's okay. And people have been really receptive to it and have even been like, oh yes, you deserve to go on vacation. We want our midwife to last in our community. So yeah, I'm learning I'm learning. So I have a husband and I have one son who is almost five, he'll be five in March, I gave birth to him at home actually, my husband is a stay at home dad. He manages a few properties we have two but I feel like that's essential for us just so our family can kind of flow with my workflow. And he can always be available for our son when I have to just literally run out the door sometimes. So and when your son's my mom actually also lives down the street she moved up here from Baltimore where we're all from to be with us so she lives a block away we could walk down our alley to her house, which is really critical to I think, so we've kind of built our support system

Tanya Tringali

I heard you say on journey to midwifery that your mom is a nurse and sometimes is your nurse at your births.

Marielle

Yeah, I think she's on call like now because most of my nurses you know want to be with their families over the holidays coverage is a little sparse. So sometimes I call her I'm like mom picking you up so Batman and Robin like drive by my mom's house and she comes out with like a coffee for me and we go to a birth together

Tanya Tringali

Was she a obstetric or labor and delivery nurse at all before them

Marielle

No, not at all

Tanya Tringali

What kind of nurse was she?

Marielle

she did OR like general OR and then she did eye surgery like cataracts and glaucoma and stuff like that. So yes, she says she is retired but will hop out of retirement to you know, go to a birth every now and then.

Tanya Tringali

Does she love it?

Marielle

Yeah

Tanya Tringali

That's so cool.

Marielle

Yeah, so So come along every now and then to a birth and yeah,

Tanya Tringali

Now, your son is almost five. So I'm assuming that means next year, kindergarten would be on the docket? Will your child go to school? Will your child be homeschooled?

Marielle

No, no, we're not. We're not homeschooling and people. Were like, we want a little bit of like, social life for him. And yeah, I don't think we'd be very good at that. We like doing arts and crafts, but not like school stuff. So he's, I think he's going to be in junior kindergarten at his school next year. And it's probably going to be like five morning's a week. So yeah, my husband, you know, takes him to school and brings him home. And that's like his alone time to like, go to the gym and stuff like that. And I've actually just convinced him and he has agreed to help me with my Etsy shop because I felt like stickers and you know, silly little things on Etsy, just to keep me extra busy. So he's going to help me like ship those out and stuff like that, I think because yeah, because my plates full. So he's going to help me with that.

Tanya Tringali

As if you don't have enough on your plate. You run an Etsy store. Yeah,

Marielle

I just started Etsy store over the summer since

Tanya Tringali

your Etsy store birth related stuff.

Marielle

It is yeah, I actually just like wanted to make the sticker for myself and my friends that says homebirth is my jam. I don't know, I saw like a similar one. And I was like, I want to homebirth one like for my laptop cover. And then I ended up ordering like 50 of them because I had someone like design it for me. And I was like, I'll just like give it to like people or like maybe if I go to a you know, like fair or something and have a booth that would be cute to give out. And then I just decided someone like wanted to buy it from me. And then I ended up starting an Etsy shop. And I've sold like 100 of them.

Tanya Tringali

So well. We'll definitely link to that in the show notes. And I'll be checking it out to see what you have there. Well, that was an interesting segue that I didn't expect. And as I said before, I definitely wanted to talk about what it's like to run a business. So I've been I didn't set out to do this. But most episodes tend to end with a final set of questions about entrepreneurship, because almost everyone I have on the show is someone who's running their own business. And I have a lot of listeners who are trying to break in to, oftentimes the birth world, but not always. And that's become kind of an interesting part of the discussion. So I'm wondering if you can speak to what some of the unexpected or unique challenges have been for you and also what you find kind of joyous about doing this.

Marielle

I've learned that I am a business woman and I love it. Which I had no clue before I would have said oh definitely no, I just want to catch babies. I like love being an entrepreneur. So I've got like my little Etsy shop running that I want to add more products to. I'm like always envisioning and how to grow my practice. We're in a little rented space now. And my, my goal for 2022 was a website, and our website is up and just need some few like, you know, finishing touches. I've got to meet with my website lady to do that probably this week. But I was like, goal reached in December, but it's reach. So I have like a nice website that looks professional. Now, my business goal for 2023 is to get a house that I own for my practice that I can make super cute and comfortable and have more space for like my office staff and all my clients and everything. And then I think I want to add another midwife or two and grow this home birth practice. So yeah, I really thought like, Oh, I've you know, I've reached like my career goal. And I'm just going to plod along and enjoy my life. And I'm realized that I'm like a business woman. And I actually really enjoy, like, the challenges of growing and figuring out how to make things better. Yeah, and I like being involved in like the midwifery world too. So I've had two student midwives. Since I've been a midwife, and I am starting a clinical faculty advisor role this semester too.

Tanya Tringali

At Georgetown?Oh, that's yeah, I didn't know you decided to do it. I actually have another friend who's doing it too. I didn't realize I was bringing in people to do this. That's very cool.

Marielle

You should get a finder's fee. My practice was tired of having students, I guess I need a break. Like I just need my patients to have just me as their midwife, I think for a bit. So I'll take a break from having students in, you know, our physical practice, but I was like, I want another way to kind of like give back and keep helping like the next generation of midwives. So yeah, that worked out great. So I'm excited to start that.

Tanya Tringali

Very Cool. So tell me, you, you spoke very lovingly of entrepreneurship, which is wonderful. But are there is there a challenge that was unexpected for you?

Marielle

Oh, yeah, there was so much to figure out with running a business. Like I had to get a lawyer and an accountant, and there's just so much to it. I would say that was harder in my first year than just being like figuring out how to be a new midwife.

Tanya Tringali

If anything, it took the focus off of it, right, you couldn't obsess about all the clinical stuff that I think if you are starting a job where you get a paycheck, you just kind of obsess, you had to set it aside and say, I gotta make sure this ship keeps running.

Marielle

Yeah, I have to open up like a QuickBooks account, I had to hire staff, I had to set up a payroll, I had to set up a 401 K plan. This was all really new to me. And I was like, at some one point, I was like, I guess I'm a grown up now. Like, this is all really grown up stuff. Like I never expected to be kind of a business owner. I mean, just simple things like ordering a sign for outside the building. Like there's just all this business stuff. I've gotten a lot better at delegation, to staff just asking people to do like all these tasks, so I can, you know, get on with my day. But yet learning the whole business side has been really interesting paying all the bills, figuring out you know, malpractice insurance, and there's so many different insurances that you need. When you have a business, there's like, I have to have like business insurance, I have to have another insurance just for the building in case someone trips and falls when they're in my office. I had to get workers comp. Insurance for my like three employees. It's just yeah, all of that was really overwhelming and expensive. But figuring it all out.

Tanya Tringali

What's your least favorite task? of running the business?

Marielle

Probably okay, I really hate like, I tell my mom all the time when I'm chatting with her. I'm like, I need like a personal assistant, like what level of entrepreneurship do I have to get to before I can hire someone to keep my paperwork straight, like my licenses? My like CPR and ACLs? That's probably my least favorite thing, trying to keep my licenses and things up to date. I actually am really bad at stuff like that. And, yeah, I've been a midwife for two years. I actually don't have my prescriptive authority yet, because it has taken so long and been such a disaster. So hopefully, that's gonna come through, like this week. But like the Board of Medicine, lost my paperwork, and then I had to go get fingerprinted, and then they didn't fingerprint me, right, because I didn't like roll my fingers. So I've been fingerprinted again. But yeah, that kind of stuff makes me insane. And it like stays on my brain and keeps me up at night. So that's probably my least favorite stuff.

Tanya Tringali

Funny that you just mentioned the fingerprint thing. What I will say is I just got fingerprinted for a license in another state also, and I'm starting to lose my fingerprints. And I didn't know that professions that work with their hands start to lose their fingerprints and I have always first assisted on C sections. And so I guess from all that scrubbing, I'm starting to lose my fingerprints, which makes it harder to get fingerprinted. Now, I will also offer a tip to you and to our listeners who are managing what you just said, like all the licenses and all the bits and pieces that go together. The thing I do since I have not reached the level of entrepreneurship to have an assistant either I'm like, when do I get? I don't know the answer to that one yet. But, um, I overused my Google Calendar. But to my advantage, I think every time something comes to me and has the next date on it, I literally go into my calendar and like, whatever appropriate timeframe before I put a reminder in that says, Start process of renewing whatever license or whatever certification or whatever it is,

Marielle

that's what I need to do. I've been thinking, I'm like, is there like a software? Should I get like Evernote or something, I need something to be my home screen and just like organize the heck out of my life, because now I'm like doing this clinical faculty advisor thing I know, like, I'm supposed to be the one reminding my students to get things done. So I need to get Yeah, Uber organized.

Tanya Tringali

Part of the reason I do Google Calendar, it's not to say there's not anything better, but I don't even want to know what they are because I'm tired of spending money on things that are monthly subscriptions. And yeah, I pay for enough various software and other things that I'm like, No, I'm going to do this part for free. And so my Google calendar just works wonders. And in terms of being neurotic, I start every day by looking at what's in there. And I move things around. But yeah, when it comes to that kind of stuff, I just like schedule out a year in advance when I need to take NRP again, or whatever it is that needs to happen. So

Marielle

yeah, it's that kind of stuff. That's really hard. So I would say being a solo homebirth. midwife, it's really hard to get things done. Yeah, getting all those things organized is really hard. keeping up to date with stuff is really hard, like returning library books is really hard. I haven't had a haircut in a year, I missed my last one. And they gave me a lecture for canceling last minute. So now I'm mad at them and feel like I need to find a new place to go to. So yeah, my hair gets ragged. And yeah.

Tanya Tringali

Those are the unknown burdens of a homebirth midwife who can't even make it to her haircut appointment. Yeah, wow. Yeah. Awesome. All right. Last question for you have any advice for the aspiring midwife out there, or the student in midwifery school who is dead set on going into out of hospital birth?

Marielle

I would say just follow your dreams. Like literally, I think this is true for nursing in general, but like the world is your oyster, you can really make anything happen with that degree that you've paid so much money for. It's definitely true with midwifery to like, you don't even have to do births. You know, if you want to be mostly a mom and a little bit of midwife, like make that happen. And I think you're a good example of this to Tanya, like, just start a podcast. I mean, I want to like write a book and start some kind of baby skincare line in the future. So I feel like we should just go for it. And you know, midwives can rule the world most likely, like Yeah,

Tanya Tringali

I love that midwives can rule the world. And we should. Thanks so much for this conversation today.

Thank you for listening to the mother whip podcast. If any of the issues we discussed today resonate with you or your experience, I'd love to hear from you. Leave me a voicemail at 917-310-0573 Or better yet, email me a voice memo at Tanya at Mother wit maternity.com. I really want to hear what worked for you what didn't work, what support you'd wished you had, how you got through the tough times how you advocated for yourself, or especially any tips you want to share with our listeners. I want to hear all of it. And if you'd really like to work together, you can get a discount on your first consultation with me at Mother wit maternity.com using the code first console 10% off. That's one 0% symbol, all one word. Okay, that's all. That's wonderful being in community with you all. Thanks again for listening and see you next time.

Lo

And remember, listeners, nothing we discussed on this show should ever be considered medical advice. Please speak to your local provider about anything that comes up in this show that resonates with you and your needs and your health care.

Transcribed by https://otter.ai