thru the pinard Podcast
a conversational podcast with @Academic_Liz with midwives & other birth professionals about their studies/ research & how it's changing our practice globally - email thruthepinard@gmail.com
thru the pinard Podcast
Ep 81 Cecilia Jevitt on UK, Canadian and American Midwifery changes and the resurgence of midwives
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Ep 81 (ibit.ly/Re5V) Cecilia Jevitt on UK, Canadian and American Midwifery changes and the resurgence of midwives
@PhDMidwives #MidTwitter #research #midwifery @UBC @world_midwives @MidwivesRCM @VIDofM @Yale @USouthFlorida #canadianmidwifery
Research link - ibit.ly/KzSJD
How does a physical education major become a pioneering midwife? In today's episode, we journey through the extraordinary life of Cecilia Jevitt, a seasoned midwife with over 35 years of experience. Cecilia's path started with a fortuitous encounter with an article about the Frontier Nursing Service which completely altered her career trajectory. She shares her story of determination, from earning an associate's and bachelor's degree in nursing to securing a spot in one of the limited midwifery programs of the 1970s at Emory University. Her plans to practice in the U.S. Virgin Islands and the unwavering support she received along the way underscore her incredible dedication to the field.
Next, we explore Cecilia's transition from clinical practice to academia, highlighting her pursuit of a doctorate in applied medical anthropology. With ethnographic research in the UK and experiences working in a large hospital practice, Cecilia offers a unique perspective on midwifery education and regulation. We also discuss the challenges she faced balancing motherhood and education, the significance of doctorally prepared nurses, particularly in underserved regions, and how her academic journey has fueled her passion for expanding midwifery on a global scale.
Lastly, Cecilia walks us through the evolution of midwifery education and practice. From the shift away from routine episiotomies to modern monitoring techniques, we discuss the critical role midwives play in community health and the importance of higher education. The episode also touches on the urgent need for more midwifery programs, especially in underserved areas, and the complexities of maternal care access in the United States. Join us for an engaging conversation that captures the essence of midwifery's past, present, and future, highlighting the transformative power of this essential healthcare profession.
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Journey to Becoming a Midwife
Speaker 1Thank you very much for joining me , as per usual . Can you introduce yourself , please ?
Speaker 2I'm Cecilia Jevitt . I'm a registered midwife in Canada , but I've been here six years , For 35 years . Before that I was a certified nurse midwife in the United States .
Speaker 1So how did you get into midwifery in the first place ? Or where did you get into midwifery ?
Speaker 2did you get into midwifery in the first place , or where did you get into midwifery it ? You know I'm I'm not one of those people who can say , oh , I've wanted to be a midwife since I was a child . I stumbled into midwifery . I actually started college as a physical education major .
Speaker 1I was on my own .
Speaker 2It was in the days before laparoscopic surgery or MRIs . I didn't have insurance and I couldn't get it repaired , so that plus a real fear of the uneven parallel bars .
Speaker 2Oh yes , I didn't like flying off the top bar Took me out of physical education and in some women's magazine like Homes and Gardens or Red Book , I read about the midwives from the Frontier Nursing Service . Yes , you know . And of course there was a classic photo of them on horseback providing health care in rural America . And what caught me was them teaching about nutrition and activity to keep pregnancy healthy and that pregnancy and birth were normal phenomena that didn't need hospitals and a lot of equipment . And never having met a midwife , I was just snagged . I mean , when I was in physical education classes at high school , the future nurses of America were exempted from PE class . Oh , and I used to laugh at them going off in their little white uniforms to you know practice nursing things . So I had never thought of a health career . But just based on that single article I decided to become a nurse because that gave me the broadest set of skills .
Speaker 2If you studied midwifery in the apprentice model so I mean we're talking the early 1970s If you studied midwifery as an apprentice model in the United States , in those days you were limited to home birth . But I read about nurse midwives and thought , well , if I became a nurse and I became a midwife and there weren't midwifery jobs , I could always teach maternity nurse . So that was my fallback plan because when I became a nurse midwife there were fewer than 1,000 nurse midwives in the United States . One of my cousins said to me when you told us you were going to be a midwife , we thought you were going to join the French Foreign Legion . That's how , like really exotic midwifery , wow yeah that's the 70s yeah in america , uh-huh wow .
Speaker 2So uh , I went to nursing school , I did an associate's degree and I loved nursing . I still do . If something happened tomorrow where I couldn't be a midwife , I would happily be in as a pediatric nurse or a pediatric nurse , and I think that's one of the brilliant things about healthcare . You know , if you get jaded in one area , you can switch it up a little bit . Anyway , when I finished nursing , then I did a bachelor's degree in nursing and I found a program in Chicago which is where I went to grade school and high school where they accepted all of my nursing credits . I took exams and comped out of coursework , so I only had to do rehabilitation nursing , public health nursing and maybe a research course . It was very fast . Then I went to apply to midwifery school and in the year I applied there were only eight programs in the United States for nurse midwives .
Speaker 1And two of them were military . Now that is interesting .
Speaker 2Oh , the United States military . All of the branches had midwives doing a great deal of their maternity care and they are still some of the best midwives because they take charge of wards . They have rank and responsibility . Anyway , I wasn't going to go to a military program , so I had six programs to apply to . One of them was at the University of Illinois in Chicago where I was working as a labor and delivery nurse . So I decided I was going to try for all of them . I saved $12,000 , which would have paid for my midwifery uh education . And there were so few slots that quite often you were admitted but they would say you might be on a waiting list , you might get in in a year or two years . So I set up what I called my war room . I had a big dining room table and it was in the days when you still photocopied things . So you had each program you had to write an essay . So I found all of the common elements in the questions and I wrote one essay .
Speaker 1Nice .
Speaker 2And I had these application stacks and I resolved that if I didn't get into midwifery school that year I was going to go to Europe and see how long I could live on $12,000 .
Speaker 1That's a reasonable alternative , absolutely , and it would have lasted you quite a while over there at that time .
Speaker 2It would have . So I did get into midwifery school , but not the convenient one where I was , and it was the only one I didn't get into .
Speaker 1Oh no .
Speaker 2I had done my bachelor's degree there and , you know , in those days programs thought , well , you should go off and be at other schools . So I ended up at Emory University in Atlanta , georgia .
Speaker 1So right down south .
Speaker 2Going south . I was probably one of about three northerners who were in the program , but I selected that school because it had the largest midwifery service attached to it and I wanted to do everything I could . So as I finished that program , the faculty wanted me to stay in Atlanta and teach at Emory . Yeah , it was . You know , it was very nice . I really wanted to go off to the U S Virgin islands and practice in the Caribbean .
Speaker 2Um , but my program chair put me in touch with a couple of midwives that she knew , who worked in the Virgin Islands , who called me and talked with me and said you don't want to come here , particularly as a new grant . She goes , there's no backup and she said sometimes you can't get women off island for the surgery they need the government paychecks are invariably late and ketchup is $7 a bottle . I still remember that number , wow . So who was in the class ahead of me called me , she'd graduated and she said seal , come down to Florida . It's pretty close to the Caribbean and we need Spanish speakers . She was working for the federal community and migrant health service Yep , for the Federal Community , and Migrant Health Service .
Speaker 2Yep , and I had enough Spanish under my belt to be functional in the clinic and in the hospital . I went down to interview with Sister Jean Moyer , who was a very famous American midwife , and she knew how to sink the hook . She was living in a trailer on a farm , the roosters crowed in the morning and the cows moved and we picked oranges off the trees on our way into the clinic , and that's how I got my start in Florida . A year later , the university physicians , who were our collaborating physicians , asked me to come into the university because they wanted a full range of women's health services , from midwifery care to the highest risk maternal fetal medicine . Oh good , yeah . So I ended up founding the first private practice in Tampa , florida .
Speaker 1Cool .
Speaker 2So I had a continuity practice for about two years . In the meantime I met a Floridian , married him .
Speaker 1As you do , yeah .
Speaker 2So the continuity practice came to an end when we got a new department chair who wasn't so hot on midwives . Yeah , chair who wasn't so hot on midwives and he pulled two of us into his office . There was another nurse who was the department's research nurse and we were both masters prepared and we were instructors and he pulled us into his office and said I will have no one in my department faculty who's not an MD or a PhD .
Speaker 1Oh , okay , that's the setting , the boundaries .
Speaker 2Well , I was just callow enough to think well , why don't I just get a PhD ?
Speaker 1Why not ? Yeah ? Challenge accepted . I'll do it Okay .
Speaker 2I mean , it just did not seem like that big a deal and you know , at the time I think my oldest had just been born .
Speaker 1Oh , okay , yeah .
Speaker 2Yeah , and you know , actually probably a PhD wasn't as big a deal back then . I mean , there were no personal computers , there was no internet .
Speaker 1So what year did you start your PhD ?
Speaker 2Let's see , maura was born in 87 . So this must have been 88 .
Speaker 1Yeah and yeah , computers were the size of a room . Back in those days , using punch cards still .
Speaker 2Oh yeah , oh yeah
PhD in Public Health and Midwifery
Speaker 2. So I really wanted to do the doctorate in public health . I didn't want to do nursing . I knew that . You know , nursing took me down paths that weren't the best support for expanding midwifery in an academic department . For a couple of years I loved the variety yeah , some days in the clinic , some days on labor and delivery , some days doing research . I had I had managed some oral contraceptive studies for the department .
Speaker 1Yep .
Speaker 2So I recruited the women , I did their entry physicals , I followed them , I just I found it so very interesting so that I wanted to stay in academics . So I thought , well , you know , okay , I'll do a doctorate . And I actually ended up leaving the department and went to work for the large hospital practice . It was a hospital that we were affiliated with and I had worked with , you know , for , oh , at that time , probably about four years already , but that gave me a better schedule for being a mom and starting a PhD . So this practice at its peak had 14 midwives . A couple of them were part-time , but , yeah , the hospital at the time was a tertiary level high-risk hospital and we did shift work on labor and delivery . So we , the midwives , were responsible for educating the first-year residents about normal birth .
Speaker 1Oh sweet .
Speaker 2Yeah , we staffed triage , so there were always two of us on labor and delivery . That hospital at the time had 7,000 births a year .
Speaker 1Okay , so a sizable amount , absolutely yeah .
Speaker 2We had our own clinic with our own caseload , so women from our caseload would come into the hospital for birth and and they were our first priority . Second priority was to help the Yep , so our service itself had hands on just over 2,500 births a year . It was not unusual . So we would do two 14-hour labor and delivery shifts and then a day in the clinic a week and then a day in the clinic a week . So that gave me easy days off to attend classes or you know those long , solid days you need when you're writing or analyzing data ?
Speaker 2Absolutely so . I wanted to do public health , but public health demanded full-time study and I couldn't do that . I had a friend who was a professor of anthropology and he said you need to come and do applied medical anthropology . Oh so you know , I talked with them and you know , once again the stars were in alignment . They had a program where you didn't have to have a master's in anthropology . I took master's classes in the four fields linguistics , cultural anthropology , physical anthropology and math . Um , archaeology , oh nice , yeah . And . And once I'd completed those , I prepared my qualifying exams yep and um off I went and so part-time .
Speaker 1It took me five years yeah uh , which is shorter than some people take full time yes , but true you know , I just like how did you narrow down then , going from a very different kind of discipline looking ? How did you narrow down then what your , what your actual focus was ?
Speaker 2well what it enabled me to do . I mean , midwifery was still so new in the united states at that point that you know , we were kind of trying to figure out how do we grow midwifery here in the united states , and a lot of the literature about midwifery was in the anthropology literature . Oh , okay , yeah . So you had documentation of midwifery being done in other countries .
Speaker 1Yep .
Speaker 2Other than that , we had Maggie Miles and Helen Varney's first textbook on nurse midwifery . So you know , I was reading about midwifery from all sorts of other countries and birth in other countries . So I designed an ethnography of midwifery in the united kingdom . Okay , and I , I went over to the uk for a summer . Um , my husband and daughter came with me . He was , you know , like daytime child care , um and uh , my daughter had her fifth birthday in the uk oh , how divine meanwhile , I was pregnant with number two okay uh , but I looked at education , practice and regulation right yep and ended up with this .
Speaker 2You know massive dissertation um , I think it runs 300 , some pages and it would have been typewritten as well but I had a by then . I had a word processor oh okay , yeah , but my oldest remembers like standing up in her bed because my office was across from her bedroom and I remember her standing up and yelling be quiet in there . Stop it , I'm trying to sleep Because the printer had that old rocket paper . Yes , you know that went .
Speaker 1Yeah , oh , they were very noisy because that was the old dot matrix , yep .
Speaker 2Yep , part of the reason to go over to the hospital practice was that the hospital paid my tuition . So not only did I have a supportive schedule , I had , you know , tuition payment , and that made it very easy .
Speaker 1Absolutely .
Speaker 2Yeah .
Speaker 1Especially because there wouldn't now . Okay , this is possibly a kind of like an assumptive question how many women were doing PhDs at that time with you ? Oh ?
Speaker 2I don't know about women in the US , but I know that I was always worried about getting a job and I had a doctorally prepared family nurse practitioner on my PhD committee . Wow . And she said to me what are you worried about ? You're worth your weight in gold , a doctorally prepared nurse . Are you kidding me ? You'll never have trouble finding work .
Speaker 1Yep .
Speaker 2And and you know , actually remember one of the reasons I became a nurse midwife was that midwifery jobs were so rare in the United States that I thought , well , I could always teach maternity nursing . I always found work as a midwife and the reason I didn't end up back in the Midwest , which was kind of my home , was that that was one of the last areas where midwifery developed . Midwives were brought into the southern United States because maternal and infant morbidity and mortality were so bad . The southern states have always been pockets of poverty in the US . So a lot of midwives but still some of the poorest reproductive outcomes . Some of the poorest reproductive outcomes .
Speaker 1And from some of the reading that I've been doing , looking at the differences in the rates and the fact that in some countries and in some counties in fact , the rates are actually increasing again now because of a whole pile of political involvement and taking away safe access to reproductive care . But it was the originally when the slaves came over and the African kind of like women came over with their knowledge and then the whole racism kind of was part of that controlling of midwifery care and almost making it illegal in several of the states , and it's only been , I think , what the last 50 years that the resurgence is coming back again .
Speaker 2Oh yeah , it was . Midwifery was driven out of most of North America and South America because physicians came over from Europe and they realized pretty quickly that if they supported birth , they kind of had the family for life . And that's still the way US hospitals , which are , you know , for-profit entities , think about birth . If we can get families in for birth , we become their hospital .
Speaker 1So you've had quite a bit of time between when you did your PhD and your subsequent career . You've been involved in lots of other projects , but what's something that still sticks in your memory from your PhD , from doing your PhD or your PhD results in looking at what you found in Britain to what you then was able to bring back to America .
Speaker 2I think what surprised me in the United Kingdom was the cultural knowledge of what midwifery was .
Speaker 1Ah , yes .
Speaker 2You know , we went into a restaurant one night and I was asking for a table and the woman at the counter said oh , you're a Yank . You know . What are you here for ? You know , are you touring ? Because it was the summertime ? Yep , and I said , well , no , I'm here studying midwifery . She said , oh , are you going to be a midwife ? And I said no , I'm studying the midwifery system . And you know , she knew exactly what I was talking about . Um , and , and I thought that's where we need to be in the United States . And so I come back to the States and I'm with this giant practice , right , and I'm chipping away writing the dissertation .
Evolution of Midwifery Education and Practice
Speaker 2The practice was employed by the hospital , but we provided support for the university , physicians and residents . Well , the hospital went bankrupt it was this huge community hospital and they laid off . This was St Patrick's Day , March 17th of 1993 . My middle daughter was a baby in arms at the time . Some of the midwives said well , they can't lay us off , they can't operate without us . Well , you know , they figured out how to do fast deliveries without us , and I think there were 12 of us at the time .
Speaker 2We went off to different practices , so I was welcomed into a practice in the rural county where I lived , little level one hospital . For the two prior years I had been managing what was called a pre-certification program for internationally educated midwives . Internationally educated midwives and a half dozen of those midwives were in the county where I lived running this little level one hospitals maternity unit . And they said , oh God , come up here , we need a director , so bad . So I got up there and I said I'm not going to finish that PhD . I'm out of the university , I've been laid off . There's no reason for me to do it . And two of them sat me down and said you are going to finish that ?
Speaker 1Oh good .
Speaker 2You're too close and we're going to cover your call days . Oh beautiful , just get it done . Just get it done . So you know , for years now , when I have coworkers who are working on a graduate degree , I'm like get that done . Yeah , I'll adjust the schedule , I'll adjust the workload , just get it done .
Speaker 1Hang it forward .
Speaker 2Yeah , exactly , exactly , and you know that knowledge really helped us figure out what needed . Gynecologists said to those of us in leadership take normal birth back .
Speaker 2We are plenty busy with maternal fetal medicine , gynecology , reproductive endocrinology , so we don't have as much territorialism as there used to be . Oh , that's good , but we still need to produce more midwives . The retirement of my generation , the baby boom generation , has kind of decimated ranks , but within about the last three years there are something like six new midwifery educational programs opening . Oh wow , in states that really need midwifery , in states that really need midwifery like Alabama , louisiana , arizona , has a relatively new midwifery education program .
Speaker 1Do you think that's related to ? The African countries have even declared state of emergencies to get midwifery and maternal care up into high priority , to get more staffing , more funding in that . Do you think that's their way of doing that , from a place that they can make change by operating schools ?
Speaker 2There's been a big boost in funding from the federal government and , yeah , a lot of it is couched in improving maternal morbidity and mortality . Yeah , even in Florida there are areas where women drive two to three hours for maternity care or birth . There may be some services , but women with any sort of complication are told to move south after 36 weeks and just wait for the baby to be born , which is , for a lot of families , almost financially ruinous .
Speaker 1Oh , not just financially , it's also when you're looking at the emotional side of it as well , and stress and anxiety in that last month yeah and then , if there's anything , they've got to stay there longer , separated from families , from children , and there's so much that kind of adds on to that need to not be able to birth in your own kind of network , in your own kind of community yeah , yeah I'm kind of so much as , like america is such um a high , like the best country in the world , but when you look at the little pockets and every country has got rural and remote areas , that we do have a tiered system in every healthcare system because of geography , because of availability and of services , that whilst theoretically everyone has access to the same service , when you look at the reality of it it's not true . Yeah yeah .
Speaker 1So what did you find the differences in now working in spending so much time in America ? You've now done your PhD , Kind of like . What then were you able to change ? Because then you ended .
Speaker 2Well , canada was unanticipated . You know , the kids were growing up and their father was not healthy and decided he didn't want to be a father anymore . So one day I'm in my office . Now I'm back in the university teaching nursing , but I have a midwifery practice again with the Department of Obstetrics . So I'm teaching midwifery under contract with some other universities . But I have an office in Florida and one of my faculty colleagues swirls into my office and says you need to meet the Dean of Public Health . You two are living the same lives Social work . You need to meet the Dean of Social Work . So she said I don't have time to cook you two dinner . I'm going to introduce you to my mom . So she introduced us and she goes right now .
Speaker 2Look at his CV . It's posted online and you know I open up his CV and I find out that he did his master's degree in Chicago , which was my hometown , and that he did his PhD in New York . And my father's family were New Yorkers . So we kind of have that in common . I can chat with him . So we went out for a glass of wine . After work , turned out he was a Canadian and on that first date he said to me he asked what I was teaching and I said well , I'm teaching public policy and international health . And he said oh yes , governments have such different relationships with their citizens . And it was like fireworks went off in the back of my head . I was like this guy gets me , I love it , I love it . So we both knew on the first date that there was going to be some history .
Speaker 2And eventually , when we were retired , he said we want to go back to Canada because you can't beat the Canadian health system Right , particularly when you're elderly Canadian health system , particularly when you're elderly . So a job opportunity came up , directing midwifery at the University of British Columbia . And although his family was originally from Ontario , they were all now in British Columbia . So I got the job here and a lot of frequent flyer miles in between the two sets of kids , british Columbia and Florida , um , opposite corners of the continent , um , and you know , I think this is the best job I've ever had . I only wish I were 10 or 15 years younger because you know I would be able to stick with it longer .
Speaker 2About the mid-1900s said oh , we don't have enough maternity care providers and we need to think about our cousin systems , the United Kingdom , australia , new Zealand . So the provinces actually sent out teams to kind of look at models and British Columbia settled on the model that was then used in New Zealand . So from the start , direct entry , bachelor degree , educated midwives , home birth was an essential component of the model . Reimbursement by the province , continuity of care , you know kind of baked into the model . Now again , with the retirement of the baby boomers and you know post-COVID the baby boomers , and you know post-COVID , we're having difficulty providing continuity of care in many places .
Speaker 1Yeah .
Speaker 2So we're you know we're a little bit more episodic , but home birth is available , it's appreciated and it's just a beautiful thing .
Speaker 1So how many midwives are you now seeing going through into kind of like postgraduate and doctoral studies , kind of like , say , in the last 10 years , compared to what you've seen since your qualification ?
Speaker 2Well , you , there's a real difference between the United States and Canada . So in Canada we're just at the point where we have more midwives interested in master's degree studies and doctoral studies , mcmaster University in Ontario . So there's six programs in Canada . Yep , mcmaster is the oldest and the largest and the best funded .
Speaker 1Yep .
Speaker 2Last year they established a master's degree .
Speaker 1Oh , wow , so you're still , because I remember one of my early interviews would have been Megan Malone I'll have to go back and have a look at it and she was Canadian and she had to do her PhD through the UK system because she was saying that there wasn't in the area , in the province that she was in , there wasn't any high degrees .
Speaker 2So McMaster's is a master's in midwifery , and it's the only one in the country .
Speaker 1So if you want to go higher than that , you're still required to do it , you're still doing public health or nursing or something else . Which there's a lot of crossover .
Speaker 2so yeah , yeah , and we would love to establish a maestros program here at UBC .
Speaker 1Yep .
Speaker 2It's in the strategic plan , but who knows when we'll get the critical mass to do that .
Speaker 1And that's what it all comes down to , doesn't it ?
Speaker 2Mm-hmm . So in the United States all but I want to say all but one of the programs are housed in schools of nursing . Okay , yep , colleges of Nursing decided that all nurse practitioners , midwives and nurse anesthetists should be educated at the doctoral level . So in the United States they have doctorates in nursing practice .
Speaker 1So that's the DNP . Now they have started . Is it Illinois ? They've started , dnp they have started .
Speaker 2Is it Illinois ? They've started .
Speaker 1DMP .
Speaker 2It's Thomas .
Speaker 1Jefferson University in Philadelphia . No , but my American geography is nowhere near close enough . But yeah , because there's only one or two places that do the DMP at the moment .
Speaker 2Yep , there's only one , thomas Jefferson . Columbia University actually went through the process , wrote the plan , did the site visits and were ready to go . And that's New York City , Mm-hmm . And the state system never funded them for it .
Speaker 1Oh , so they would have been the second and you know , in my heart I believe we need doctorates in midwifery . So what is ? Because one of the things let's ask before we kind of go into the future and stuff I want to go back and ask one question how did you celebrate finally finishing your PhD ? What did you do as a celebration ?
Speaker 2You know , I really don't remember . Okay , I'll tell you honestly . Shortly before I defended , my father-in-law at the time decided that he and my husband needed a bonding trip and they were going to go to England together .
Speaker 1Oh no .
Changing Midwifery Practices Over Time
Speaker 2So the two weeks before I was going to defend my dissertation , I was hosting my mother-in-law . I had the two girls at the time and it was a wild ride .
Speaker 2Oh , my goodness so my husband and father in law returned home the day before my defense and I said to my husband do not say anything to your parents . I got myself a room . There was a resort near our home that was quite tony at the time . This is Florida . I reserved myself a room , I stocked up on chocolate and I said I'm going overnight , I'm going to prep for my defense , I'm going to check out and go to my defense and then I'll be back for dinner . And that's what I did .
Speaker 2I ate a lot of chocolate and drank some bourbon the night before . I love it . And when I came home , I guess my husband couldn't keep quiet . My mother-in-law was furious with me for leaving them .
Speaker 1You have to do what you need to do to get your head in the right space .
Speaker 2Yeah , yeah . So I'm sure I did some sort of celebrating . That was the first graduation I ever went to . I didn't go to my bachelor's degree or my master's degree , but my daughter , my oldest , was well , she must have been six at the time by then and I wanted her to see me walk , and she remembers that my folks came down and you know we had a big celebration then .
Speaker 1To show that all the printing at night was actually worth it .
Speaker 2Yeah , and you know I would say the best celebration . So that girl . Some of the years when I was on call we still had a landline right and I would be at home on call for births . So the year she was seven I heard the phone ring and as I'm coming across the house I hear her say uh-huh , when did the contraction start ? Uh-huh , has the bag of water broken ? Uh-huh , have you had a cesarean section ? And I'm like I get her . I'm like give me that phone . You know , I talked with the woman and then I got off the phone and I said you can't ask those questions .
Speaker 1Did she become a midwife by any chance ?
Speaker 2Did she become a midwife by any chance ? She did not . She's a recreational program planner , interestingly , very interested in physical education , right ? That girl had my first grandchild in February and at an out-of-hospital birth center she was like , oh , I can't do the hospital thing , mom , no doctors . She called and I said oh , are you on your way to the hospital ? She said no , I'm on my way home . I went in for my 37-week prenatal check and I broke the bag of water this morning I said what ? And you didn't call me . She goes , well , I was just waiting for labor to start , you know . So I sent it home with a recipe for a cocktail . We just picked up some castor oil .
Speaker 1Oh , my goodness , you would have seen quite a lot of change in practices of what people recommended , especially from being in the southern states with a lot of the old-style remedies .
Speaker 2Liz , when I studied at Emory we learned old sterile births . We helped women put their legs up in stirrups , you know , strapped their legs in , put sterile gowns over . In my education every primate received a pudendal block and had an episiotomy . And my first job in Florida , we staffed birthing rooms . It was an in-hospital birth center because the hospital didn't have enough room . And it was those same university physicians who said to me a year later we want a full range of maternity care . We had two birthing rooms outside of labor and delivery . We had two birthing rooms outside of labor and delivery and labor and delivery was so crowded that there were women in stretchers down the hallway with those , you know , hospital folding screens around them . So we're in these birthing rooms and it was just like an out-of-hospital birth center . We very rarely used intravenous therapy . Women came in , they labored , they gave birth , we got them ready and they went home four to six hours later .
Speaker 2First birth with Sister Jean , I had this young primate from Mexico and she had a big baby that turned out to be about a nine and a half pounder . So she was pushing and pushing and Sister Jean said to me well , why don't you get her on the toilet and have her push there . And I was like , okay , and she goes here , take a flashlight , just sit , you know , have her push there . And I was like , okay , and she goes here , take a flashlight , just sit , you know , in front of her . And I'm sitting there cross-legged watching the perineum in this little bathroom , thinking if my teachers at Emory could see me now I think they'd stroke out .
Speaker 1What changes do you remember having made because of research and that kind of made big changes , and was it easy for people to change practice as new research came in , or did you find there was still a struggle to kind of understand and accept it ?
Speaker 2Well , I think one of the biggest changes that happened , and right about that time as people learned more about birth in Europe and the fact that they didn't use routine episiotomies in Europe , and I don't think it was as much women don't need these and they'll be more comfortable as one less thing for us to do . I think that's kind of why obstetricians embraced it , but you know , that was a huge change . Rape went from close to 100% down to they're less than 20% now and they're almost only used when there's an instrumental birth . Yep .
Speaker 1So do you have the we call it perineal bundle and I think they call it OASIS ? That is , a bundle of complex , hands-on perineal massage , digital examination , rectal digital examination . Do you have that kind of bundle of care over there , or is that each state has their own little different thing to prevent third and fourth degree tears , supposedly ?
Speaker 2You know there were kind of regional differences . But now that you're reminding me , I mean that's another thing that fell out . Rectal exams for everybody Gone . I mean , if you put sutures in , sure Do a rectal exam to check . Yeah , there's a lot , I would say .
Adapting Midwifery to Modern Challenges
Speaker 2The changes are like the introduction of ultrasound . Ah , um , I practiced before ultrasound fetal , my original maternity nursing I I had like not a pinard but one of those big fetus scopes . Yes , it's a really heavy head that weighs about a pound . But then , so you know , everything flipped to external fetal monitoring . Now , within about the last , oh , six to eight years , even in the United States I mean , it's well established in Canada , but in the United States a return to intermittent fetal monitoring .
Speaker 1Yes , yes .
Speaker 2Which is just horrible .
Speaker 1Well , we still don't have the research really to show what the effects of ultrasound is , and especially now that you've got women who are buying individual ultrasound machines online and doing it themselves , and kind of the freedom of technology is a double-edged sword . So what's next for you ? What are ?
Speaker 2your grand plans for the next 12 months and now beyond . Well , you know , I'm 71 years old this year , so the horizon is getting closer . What I'm doing is really working on promoting nutrition , the best nutrition and optimal weight gain in pregnancy .
Speaker 1Yep .
Speaker 2That's almost fallen out of midwifery education . And you know , our health starts not just in utero but with the eggs that were formed in our mothers and grandmothers . So you know , to really help families have the best nutrition and for midwives to know what is good nutrition , you don't need to be a vegan . To know what is good nutrition , you don't need to be a vegan and you don't have to be eating protein bars around the clock . You know , let's just normalize it so it's not such a burden for women and in many areas that means the government's got to support better nutrition . I don't know if you've ever seen my website , advantage Midwifery .
Speaker 1I have , but not kind of like in the last couple of months .
Speaker 2So I need to shape it up , because the work around weight gain and nutrition in pregnancy is I mean , it just evolves so rapidly . Yes , even if you're just looking at the search term obesity in pregnancy , in the last five years , more than 20,000 manuscripts have that title attached to them .
Speaker 1And especially when you look at the increasing in gestational diabetes . But now you're looking at what the change is and they're now trying to go . The damage is already done once you've got that diagnosis . And now looking at , well , we actually need to be looking at insulin resistance even earlier to try and stop that , and the fact that if you do get gestational diabetes , if you don't control that insulin , then you're going to have type 2 later on . So all of this and they're all modifiable lifestyle kind of activities- so I'm very interested in metabolically healthy obesity .
Speaker 2I've got research that I've been trying to get published for a year now Another researcher and I following the lead of some other researchers and some of it midwifery researchers from the UK . You know , if you look at individuals with high weights in the perinatal research literature , it's kind of doom and gloom . You're at risk for this , you're at risk for that . Well , when you look at outcomes , more than a half of individuals with high weights even the highest weights have no complications during pregnancy and birth , no hypertension , no gestational diabetes , and the literature really ignores them . For me , I think that is the perfect group for midwives to be assisting . You want to preserve health ? Here's the best you can do .
Speaker 2You don't have to do all of it , but you know here are some options . What can I help you do with that ?
Speaker 1Yeah .
Speaker 2And you know , sometimes my students will say you're weight shaming . And you know , sometimes my students will say you're weight shaming or you're putting so much responsibility on women , you know , while they're pregnant . Well , you know what it's a real responsible child ? Yeah , absolutely . There's no way of well , I will say , there's no way that I will ever say parenthood isn't the biggest responsibility we have . You can have more , you can have many responsibilities , but you can't dump that one off .
Speaker 2No , so I think , going into the future , those Indonesian midwives that we've met through VIDM , they're always after me to give them inspirational talks . Their education is in English and you know there's more than 200,000 of them in Indonesia . And you know there's more than 200,000 of them in Indonesia . So they've asked me to do an upcoming talk on midwives and climate change . Oh , cool . So , and particularly focusing on disaster . So you know we think of ourselves in the United States . We've talked about midwives as the experts in birth . Well , when you have a disaster or great changes , that's what you have . These are our best instruments , our two hands , right , right , um , so , um , helping midwives future . Think what is our water and our food supply going to be like in a decade ?
Speaker 2yeah uh , I mean the , the storms this last year , fires and , in other places , drought . So we must remember how to support women and their families when there are no resources . I mean it's like going back I don't know 300 years and who , but the midwife .
Speaker 1Those essential skills and that's where we will , because you have mentioned Vidim , which is a virtual international day of the Midwife Virtual Conference held every year on May 5th for the last 16 years , and you have been very much a committee member for several years of that , and I'm a new committee member over the last couple of years , but this year's was actually looking about sustainable midwifery . So if people want to go check out the website , which is vidmorg , there's quite a few of the presentations given this year that actually talk about preparation for disasters and natural disasters and what you need to think about and this is from lived experiences that it is that information , yeah , we do need to share because we don't have technology and it goes back to the old skills .
Speaker 2You know , as an example , when we came to Canada we had a portable air conditioning unit kind of rolls around the floor and my husband said , oh , we won't need that . In Vancouver it never gets hot . And I said I don't live in a home without one room that can be air conditioned .
Speaker 2Well and , sure enough , up we come and every year we have one or two heat domes where several hundred people die from the heat , when we're in inescapable heat , premature labor rates like this . When I was pregnant with my son , I think , the air conditioning in Florida broke in July and I was immobilized . The heat was so oppressive and I started contracting and you know , I want to say I was probably 32 , 33 weeks I checked us into a hotel just to get some air conditioning . Yeah , you know issues we're going to have to grapple with . I say to our graduates you have mastered the midwifery that you're practicing now . It's going to be different in 10 years , 20 years , 30 years . Practicing now it's going to be different in 10 years , 20 years , 30 years . And I , you know , I find that part of the charm . There's this solid core of knowledge and techniques that doesn't change and can be applied anywhere , but what goes around it ?
Speaker 1yeah , we learn anew absolutely , and that was that kind of came to me very distinctly when I was in um bologna and in the obstetric museum and they've got a , an obstetric kind of collection there that has clay , terracotta models that were made in the 1750s . It's so worth going , it's in the university and these were just amazing . But they had a leather padded pelvis and a glass dome that was the size of a nine-month uterus and what they used to do is they and it had an opening where the kind of vulval opening was , and then you could lift the top of the uterus off and put a doll in there . And so what they used to do to train the midwives and the doctors in the 1750s 1760s was they would blindfold them and get them to actually do a VE and find out the position of the baby .
Speaker 1And I was standing there and I'm kind of like just crying in front of this model because , like the week before , I was using a brand new Koken model , so a much newer model , abdominal model . But I did the same thing . I blindfolded the students and pairs and got them to change the position of the model and they had to feel what the position just using Leopold's . But it was like those techniques we kind of keep doing . It's just the tools that we use or the toys that we use and the way that we do .
Speaker 2It changes , but the techniques stay the same , which is that art of midwifery that has stayed the same for millennia yeah , yeah , I was at a holiday party last year and one of the games the hostess took a you know christmas stocking and put all sorts of things
Sensory Perception Game in Education
Speaker 2in it . There were maybe I don't know about 15 things and you had to feel from the outside and make a list of what was in it and I got the most correct and they were like what , Think about my business , business .
Speaker 1I'm always feeling things blindly that could be a really fun game with the students , right ? Oh , you've got me thinking there that's so cool , um . Thank you so much for your time . Oh , liz , it's been delightful .