BIRTHFIT Podcast Episode 67: Jocelyn Brown (Midwife)
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Hello, BIRTHFIT Community. This is Dr. Lindsey Mathews, your BIRTHFIT founder and today we have an awesome guest, Jocelyn Brown. She's a midwife at GraceFull Birthing Center in Silverlake, California. That is the east side of Los Angeles for those of you that do not live in LA or California and may not know where that is at. But first, I want to tell you a little bit about some of the upcoming events.
We have tons of BIRTHFIT Postpartum Series, BIRTHFIT Prenatal Series happening around the United States. So go on birthfit.com. Go to the Regional Director's tab to find someone near you. Now, if you're interested in becoming a Regional Director, go to the Regional Director's tab or go to the blog area. You can search for this blog: "Now accepting Regional Director applications". Either one, you'll find information. And you'll see a list of requirements. When to get in by. Basically, how much it costs. That sort of thing. We accept applications anytime throughout the year, but we will not start reviewing applications until November 1st. All applications are due by December 1st. So if you submitted an application December 2nd, that will go in the file for the next calendar year. Just the way it is. That's the rules. We can't be accepting applications all times throughout the year. But yes, applications will be reviewed November 1st through the beginning of December. All applications are due December 1st.
So, a few things we look for in a Regional Director. You can be a chiropractor. Or you can be a strength conditioning coach. We would also like you to have some background in DNS. DNS stands for Dynamic Neuromuscular Stabilization and you can find this online. I'm pulling up the website right now. Go to rehabps.cz and you will find the Prague School of Rehab. If you've taken any of our seminars or any courses with us, you know why we use DNS. DNS developmental kinesiology. It is all the basics of human movement. These are innate motor patterns in which we are designed with. Designed to have. Designed to move with. So, this has got to be at your core foundation of movement. So, we look for DNS. We also look for strength and conditioning experience. So, things like CrossFit level 1. Or Strongman experience. Or Powerlifting. Those are all really good things. If you are a chiropractor, we look to see if you've taken any ICPA courses. Specifically, Webster or The Logan Technique. Those are all really good things. So check out the list of requirements.
If you have any questions, Dr. Lindsey Mumma of BIRTHFIT North Carolina will be doing a free webinar, Monday, July 3rd at 5PM, Pacific Standard Time. And she'll go over all about becoming a Regional Director. That process. What the expectations are. And basically the whole first year of what a Regional Director may look life. She will also go over BIRTHFIT coaches and BIRTHFIT professionals. So, BIRTHFIT coach and a BIRTHFIT professional are a less involved way to get involved with BIRTHFIT and the BIRTHFIT tribe. You can become a BIRTHFIT professional or BIRTHFIT coach by attending either one of those seminars. Submitting applications, getting interviewed. And then from there, you'll go on our list of referrals. And then you'll work directly with your local Regional Director. So we are creating the standard and there's a lot that goes into the application process, the selection process and it has to be done this way so that we can change the way our world brings babies into this world.
So those are the major announcements. Our BIRTHFIT Summit is happening in mid-July. So be on the lookout for photos, videos, all things coming from that. And then in August, we start back up with the BIRTHFIT Coach Seminar. And September, the BIRTHFIT Professional Seminar. If you have any questions, as always, email us email@example.com. All right, now on to Jocelyn.
Jocelyn is a wealth of information. She's located at GraceFull Birthing Center in Silverlake, California. And I certainly hope you enjoy this show.
Well, welcome back to the BIRTHFIT Podcast.
Jocelyn: Thank you!
Lindsey: Yeah. For those of you listening, we had Jocelyn on. This was probably about a month or two ago, but we lost the episode. It was a tragedy. I'm staring at Machete right now. Yeah, so the conversation was really fricking good. And I couldn't wait to actually publish it, produce it, whatever you say to get it out in the real world. But yeah. So that's why we fricking had to redo it. But let everybody know who you are and what you do. And then we would dive right in.
Jocelyn: Okay. May name is Jocelyn Brown. I am a licensed midwife in California. And I work at a birth center in Silverlake, Los Angeles called GraceFull Birthing.
Lindsey: Awesome. How did you get started down your midwifery path?
Jocelyn: Oh, I think it's been around since I was little. I think that for a while, I thought about being a doctor. And then I had so many really terrible experiences with doctors as an adolescent and in my early twenties. I was really young and really broke and would go to these public health clinics where I don't believe that I was treated fairly well. And I just thought enough with doctors. I don't want to do this. I don't want to be a part of this health system. And then all sorts of things happened. And I had career changes. And I became a yoga teacher. And yoga teaching was working out really well for me. And I loved the anatomy and the physiology. That appealed to me and I was teaching this one gentleman. He was a private client of mine. Really nice guy. Working for him for quite a few months. And he goes, "Hey, guess what? My wife is pregnant. I want you to be her prenatal yoga teacher."
And I just thought, "I don't know anything about that. I'm not going to touch that." That's not an area of expertise for me. So I called up one of my teachers and I said, "Who do we know who's a great prenatal teacher? So I can refer my client's wife to this person?"
And she goes, "Jocelyn, you know there's a prenatal yoga teaching workshop at the studio this weekend. Why don't you just take it? Why don't you just do the education for yourself?"
And I thought, "Well, that'll be nice for my resume. That will be just a nice skill to have if some pregnant person pops in once in a while." It wasn't a particular passion of mine at all. And then I took this workshop and to be honest with you, it wasn't a great yoga workshop. I had to do a lot of research on my own about how to teach yoga to pregnant women. But what the workshop did for me is that it opened up my eyes to the fact that we're having kind of a maternity care crisis in this country. And that there are such things as midwives. And that blew my mind. I thought midwives got burned with witches. I really did. I didn't think they existed anymore. I thought they existed in the past only. And I thought, "Oh, I could be a midwife? Well, that's what I'm going to do." [0:12:33] [Indiscernible]
And then I wasn't sure if I could handle midwife school. I wasn't sure if I could do blood. I wasn't sure if I was reliable in an emergency. I've never been in an emergency before. What if I'm one of those people who is useless and frozen in an emergency? And I thought, "Well, you know, I'll be a doula for a little while. And I'll do the doula thing and see if that works out for me and if it does, then I'll apply to midwife school. So I was a doula for a couple of years and I remember the first time I saw a baby being born. I was like, "Yup. This is it. Got no problem with that. This is what I want to do." And I applied to only one midwife school. I had my heart set on it. And I was like, "I'm going to get in and this is what I'm going to do." And I got in, thank goodness. Because I didn't really have a Plan B. And I moved to Portland to go to midwife school.
Meanwhile, I was doing a lot of prenatal yoga teaching, which was awesome. And a lot of couple programs at a couple of studios off the ground and that was really wonderful.
Lindsey: Yeah. So you got to be around the pregnancy motherhood transition energy from way far back.
Lindsey: What was your training like in midwifery school in Oregon?
Jocelyn: I can to my training. The thing about midwifery is that it has been around since the dawn of time. It's been around since before doctors. Since before nurses. Before nursing school. Before medical school. And so it is by nature somewhat unregulated and somewhat unstandardized. And a bunch of people are trying to get together and regulate and standardize it. Because we want it to be accessible to more people. And we want it to be covered by insurance. And we want midwives to have lab privileges and ultrasonography privileges and so on and so forth. And the only way to do that is to standardize.
So my licensing comes from three years of brick-and-mortar classroom training, butt-in-chair, lectures, skills classes, what-have-you. And then I did a two year clinical training of about 100 births. And what we joke about in midwife school is whenever anyone says, "How long does it take to become a midwife?"
We joke, "It takes three to ten years." Because what happens is the programs are built to be family friendly. Because midwives often stop and have a couple of kids along the way. We are women who value childbearing and a lot of us have kids. So you can go as slowly through the program or as quickly through the program as you want. As long as you get your classes in. And get all your hours in. And your get all your births in. And get all your skills mastered.
And so I'm a rip the band-aid off quickly kind of person. And I just wanted to be out in the field working. I couldn't wait to just get going. And I don't have kids. So I didn't have that kind of time constraint. So I did it in three years and one semester. Because I layered my clinical training over my classroom training. But some people will do them separately and it takes five years or seven years. So it's all very personal.
Lindsey: Wow. That's quick.
Lindsey: What would you say is, as you said, each midwifery school is different. But what would you say your basic philosophy is for midwifery?
Jocelyn: It's really boring. It's very boring and very pragmatic. I think what happened is when I decided to become a midwife, I had this thing in my head like, "Birth is always normal. And there's just no reason for anybody ever to go to a hospital and hospital's are stupid. And they force things on you you don't want. And stay away from the hospital." And I had that opinion because I was working as a doula in New York City hospitals. And they're pretty rough. They're really rough. I saw some things that I'm not sure what's more traumatized. Me or the patient. And then I moved to Oregon, where the hospitals are a little more compassionate. And where the hospitals are really open to working without hospital midwives. And I remember the first time I started my clinical training. And for like three months, we just had normal birth after normal birth after normal birth. And babies just kind of coming out. Normally. And all that normalcy just reinforced my idea that birth was always normal. And I remember the very first time I did my first hospital transport with a client who was having challenges at the birth center. We really needed to go to the hospital. And I felt this very unfamiliar feeling of gratitude.
I was like, "Wait a minute? Why do I feel happy and thankful that we're going to the hospital?" And it was because we were in a situation where it was actually needed. And I hadn't experienced that yet. And so the conclusion that I've come to for myself to help my mind and my nervous system settle around when bad things happen. Because bad things sometimes do happen is, you know the human body is ingenious. We have all of these physiological systems. And they all work so well. And they work well without us even thinking about it. My heart beats and I breathe. My brain is working. And my kidneys are filtering my blood. And I'm digesting my food and I'm doing all that without even thinking about it. And it's miraculous. It's so cool. And yet, every once in a while, these systems break down. And that's what doctors are for. That's what hospitals are for. That's what these interventions are for. And I feel exactly the same way about births. Most of the time births just chugs right along without us thinking about it. And I actually thinking it's even better when we're not thinking about it. Birth works the best when it's undisturbed and unobserved. And then once in a while, it doesn't. And then we assess for that and we monitor for those risk factors and we go to the hospital when needed. I'm grossly oversimplifying of course, but that's kind of it in a nutshell.
Lindsey: Right. I like that. So I want to take just a question for you. Because I know some women, men, anybody that's listening may have a question about, "Okay, why would a mom that's doing a home birth or birth-centered birth transfer?" What are some of the most common reasons that you've seen or witnessed that you've seen in your line of work?
Jocelyn: Our number one reason for hospital transport, statistically, is a first time mom who's having a very long labor. And words "very long labor" are real triggering for people. Because one of the things we talk about in birth is how long is too long? And birth takes time and birth requires patience. And so on and so forth. But the mom gets to decide how long is too long. She gets to decide that. And when we're monitoring moms and babies and when things are taking a long time, we get to gather a lot, if they're laboring at home in early labor. Or we could be at the birth center in active labor for many hours and we're having a discussion. "Right now, your vitals are perfect. And right now, your baby's heart rate sounds perfect. And we've been doing this for 36 hours. How are you feeling about that?"
And some women will say, "I'm good. I want to keep going. Let's keep going." And some women will say, "I've really had it. And I'm really maybe changing my priorities around pain medication. And I'd like to maybe get an epidural and take a nap. Let's go."
So we call the hospital and let them know what's going on. And we get in our cars. Mom and dad get in their vehicle. And I get in my vehicle. And we caravan up to the hospital and we reconvene there. And at our practice in Graceful, we're really lucky to have women can go to whatever transport hospital works for them, what's closest to their home and what's covered by their insurance and where they're most comfortable. But what we recommend usually is a hospital downtown because we work with a group of doctors there who they really get it. They really get it. They understand that our clients even though maybe now they're at the hospital on an epidural where they didn't really want to be in the first place, let's make the best of that experience. Let's give them more time now that they are medicated and have a little space to sleep and rest. And really give this more time. And the doctors do that. And so we have really lovely vaginal births at the hospital actually under these circumstances. It's not like you go to the hospital and you get rolled right into the OR. It doesn't work that way. And we're very happy about that.
Lindsey: Yeah. It sounds like you've have some good connections and experiences both in Oregon and in Los Angeles. What do you think was missing from the New York scene? Or could still be missing.
Jocelyn: That's a really good question. I don't know a lot about the difference in licensing requirements, state to state. So you have to ask a New York midwife. My understanding is its much, much more challenging to get the licensing to be a midwife in New York. And they make you jump through a lot more ridiculous hoops that don't actually reflect your skills or education. From what I understand, from what I've heard through the grapevine is there are a lot fewer midwives. And I really believe there are powers in numbers. And there's just a lot more midwives in LA. A lot more midwives in Portland. A lot fewer midwives, I think, in New York City. And it's hard for people to come together and really say, "Hey, let's create this practice standard. Let's create councils. Let's educate people." And I also think too that it's up to the individual midwife to create relationships. I feel really grateful to my employer, Elizabeth Bachner at GraceFull because she will just pick up the phone and call the people at OB and be like, "Hey, let's be friends! Can we send clients to you?"
Lindsey: For sure.
Jocelyn: "Can you be our guy? Can you be our lady?" And that's one of the reasons why we have such good relationships at GraceFull. There may be wonderful relationships with other midwives and other OBs and other practices, but I can only speak to ours.
Lindsey: Right. That's super interesting. The state-to-state differences. You definitely touched on midwifery's been around since forever. There's a great book and I've read it a while back. It's called Lying In. But it definitely talks about what you mentioned as a, you know, the midwifery care model has been around forever. But what's missing or what I guess is preventing it from almost becoming super common or as common as going to see the doctor has been the lack of standard of care or regulations as you mentioned earlier. How do we change that? How do we change our maternal care system to maybe mimic something like the Netherlands or Sweden or...
Jocelyn: Canada. Our neighbors immediately to the North who seem to have it mostly figured out. I think things are changing. Before I go on about this, I want to be really sensitive to some of the midwives in the community who don't want to be standardized. Who don't want to be part of the mainstream health-care system. They are touching on that ancient art of midwifery. And they want to keep that. They want to keep this differentiation between doctors and midwives and they don't necessarily want to be in the mainstream. And I really respect that. And I have a lot of, how do I say it? I really respect those midwives.
And also, as a person, I want be able to bill insurance. I want to be able to draw labs and get the information I need. I want to be able to communicate with other doctors. I want to be able to make money and pay my bills and be kind of normal middle-class person. So in a way, my desires are somewhat selfish. And then also, I really believe that when we have a great highway of information and communication between out-of-hospital birth and in-hospital birth, that makes things safer for everybody. Because no woman should have to be forced to choose. If I'm having a home birth and I have no access to anything that's going on, that is not okay with me that people are stuck in this corners, that they are made to politically affiliate themselves with a particular movement and then they don't have access to other things that they might need.
Lindsey: Yeah. I see what you're saying. I've met some awesome midwives, ass you've mentioned, that just keep to themselves. They fly under the radar. But I've also met women who, like you've mentioned, have been forced to decisions because they don't even know midwifery care exists. Or they don't have that option in their state, like Alabama. I don't know if standardizing the care is the answer. Or putting it under insurance. Or whatever. I don't know what the answer is. But I do know that women don't know all their options.
Jocelyn: Or they do know it's an option but they've heard it's inherently unsafe. Or they do have an option but their insurance won't touch it, and they don't have that money to pay out of pocket. You know, I get it.
Lindsey: So how do we change that? No.
Jocelyn: I don't know. All I know is I look at the Canadian system and again, I'm not an expert in the differences in licensing. But from what I understand is that you have these countries: Canada, Finland, the UK, right? Where midwives, home-birth midwives are integrated into the health-care system just like any other maternity care provider. And so, first of all, you don't have the money thing. You can just decide as a person, "Okay, everyone's decided that I'm a good candidate for out-of-hospital birth. So that's where I'm going to start out my care. And if the baby comes out at home, great. Wonderful, we all celebrate. It's covered. And if I need to go to the hospital, well that's kind of a bummer. But the hospital right there, I know my universal health-care insurance is going to cover it, just like it covered my potential home-birth. And my midwife's going to come with me." And I believe that in Canada, the home-birth midwives are required to have hospital privileges. And that's one way that they smooth that transition is that the midwife can deliver your baby in a hospital.
Currently, under my licensing, I don't have hospital privileges. So I go with the client if they need to go to the hospital to ease that transition and to advocate for them and to support them. And that's a very important role that I play. And I take it very seriously. But I'm no longer their care provider. They are switched care. And that's something that rattles people too. "You're not my midwife anymore." "You're right. I'm still here. But I'm not your midwife anymore." And that, I'd love that. The midwives just go seamlessly in-hospital out-of-hospital. So that's huge as well. And then because of that seamless transition, the OBs and the perinatologists are a little bit more open, or maybe a lot more open to communicating with midwives.
Lindsey: I think you touched on integrating the midwifery model into the care system. And then having them just transition right over to the hospital.
Jocelyn: And not have the money hang over their head.
Lindsey: That's such an issue.
Jocelyn: You know, when I'm in care with people, we talk a lot about what would happen if we need to go to the hospital. We make a really solid plan. And one of the things I do is over and over and over again say, "Did you call your transport hospital?" and "Make sure that you're in network." And most of the time they do. And every once in a while, somebody's in a little bit of denial. Or they've had a crazy, busy pregnancy and they haven't made that phone call. And if they go to the hospital, they look up at me and they say, "But will my insurance cover this?" That ship has sailed. I don't know. So you don't need that stress on top of already having a stressful situation and of needing to change the venue. Changing location in the middle of your birth is a bummer. That's why people have home births. So that they don't have to go anywhere. So now we have somebody who didn't want to go anywhere, going somewhere. And they got to deal with that.
Lindsey: You mentioned this on our practice podcast.
Jocelyn: The rehearsal?
Lindsey: The rehearsal. When somebody comes into care with you, you mentioned something really good about, let's talk about finances. Let's talk about put the money on the table. And you let basically your clients know upfront. Can you explain that for everybody listening right now?
Jocelyn: My way of explaining things is to just basically tell them how confusing it's going to be from here on out. I'm really transparent about how confusing it is. We have catch rates at GraceFull that are right there on the website. And so if you want to wrap your mind around how much money this is going to cost you. If you want to pretend you don't have insurance. Or if you actually don't have insurance. It's pretty simple. And so the prices are right there. Go check it out. We're fully transparent in that way. The problem is that everyone has a different insurance plan, and people go to the interview with the midwife and they go, "Will my insurance cover this?"
And I go, "I don't know." We need somebody who knows what they're talking about and who knows how to ask the right questions. Call the insurance company. Get a verification of benefits and then do the math around what percentage is your insurance company going to cover of this experience. And what percentage is left on you. And then if you need to go to the hospital, we do that math all over again at the hospital. And so there are sometimes two separate bills coming in. And that's really one of my main frustrations is that people can get it all ironed out what the birth experience is going to cost them at GraceFull. Because we're low risk, low intervention. There are only so many things we can bill you for. We'll bill your health insurance company. Because we give very simple low-tech care.That's what we do. It's what we're best at. But if you go to the hospital, that opens up a whole thing of "I could have a C-section", "I could have an epidural", "I could need a blood transfusion", "My baby could go to the NICU", which is $3,000 a day or whatever. And then that is a whole other thing that has to be dealt with. And that's why I admire systems like the UK or Canada where people don't have to do this really uncertain math in their heads.
So what I have people do when they come to interview is I say, "You know, this interview is purely about midwifery care. It's purely about getting to know me and whether you think you'd like me as your midwife or not. And then I need you to call Nicole, our biller, who's going to sit you down and really explain to you how your insurance works. And we have a class at GraceFull called Insurance Magic where you can show up and sit for an hour and a half and learn about how insurance works. And I know it doesn't sound very interesting. But it's a really good class. And it will help you understand. Because even though you can't predict your cost in the hospital because it's all over the place, you will at least be armed with a little bit of self-advocacy and information when the bills start coming in. Because unless you have really good insurance, the bills are going to come in."
Lindsey: Right. So I want to ask two questions. What is covered in the class at GraceFull because it's awesome and I want to give everybody a sneak peek and tell them that they should all travel to California and take it. But what would be maybe the top three objectives?
Jocelyn: I think she should just do a webinar. I have no idea. I've never taken it. I do know that I have walked by the classroom space sometimes when I'm at work. And Nicole's up there doing a lot of numbers on the board and a lot of people are staring intently. She breaks down the math. It is why I think people are intimidated by it, because nobody wants to take a math class. But I think it really worthwhile.
Lindsey: So, you have recently started group prenatal cares, which I think is a great answer to help some parents navigate this cost out of pocket stuff. Can you explain those a little bit?
Jocelyn: The group prenatal care started a few years ago. I'm still personally doing research about it because I want to learn more about why we're doing it and how it was started and why it was started. But I'm looking at research from back from 2010, 2012 so it's a pretty new idea. But the idea is that if you look at classic midwifery care, the model is me sitting either at the client's home or at one of our birth rooms in the birth center with the mom, possibly and often with the dad or the birth partner and anybody else who wants to come. Aunts, uncles, other siblings. And we do clinical care. We listen to the baby. We feel the baby's position. We measure the uterus. We might draw some labs. We might talk about what ultrasounds are needed or not needed. We're taking blood pressure and pulse. And then that whole thing takes 10-20 minutes tops. The clinical care is so quick, which is why OB-GYNs are in the system where they spend 8 minutes of face time with our patients. It's because we really can get clinical care done fast.
But then we spend another 30 to 45 minutes doing education about how to prepare for your home-birth. How are you sleeping? And can we help you get a god sleeping pillow and get you into some good sleeping positions? Because suddenly there's this baby in front of your spine that was never there before. And that's a huge adjustment. How are you eating? How can we strategize your nutrition to improve your lab values? And that's the bulk of the visit.
And when people pay for something in a group, it always costs less. And when people pay for something privately, it always cost more. I use yoga as an example. You go to a yoga class with a bunch of other people costs you 20 bucks. When you hire a yoga teacher to come to your house privately, it costs over $100, right? So what they've done is that they've taken that educational piece where midwives are sitting and just talking about all the important things in your lifestyle and they've said, "Let's get everybody in our care together in a group all at once." And so it looks like a 90 minute session where I spend 10 minutes with each mom. Going through the belly check and the blood pressure and the pulse. Maybe drawing some labs if it's needed. And then after everybody's been seen individually for 10 minutes each, we all get together in a big group and we do the educational piece.
Education, I mean it is education. But when I used the word education, I think people visualize it as a class, but I really want to emphasize that group prenatal care was never intended to be a class. It's intended to be a discussion. And it's a discussion between a bunch of pregnant women sitting in a place together and supporting each other. And helping each other advocate for themselves. And holding each other accountable for the decisions they make for their health. And I was reading about it this morning because I wanted to brush up. And there was this nurse/midwife talking about how she had a smoker, a really heavy smoker in group prenatal care and another mom was like, "You know, it really makes me sad that you're smoking this much. What can I do to help you stop smoking? Let's get you off these cigarettes. Let's cut this back. I quit smoking, so can you. Let's do this." And the nurse/midwife said, "I never could have said that to a patient. I never, in a million years could have said that to a patient." But now this woman has this buddy to help her quit smoking. So that's why we come together like that.
And I found when I'm in group prenatal care, I tend to sort of take the lead. And I tend to come at it from again that I'm using air quotes here, that "educational perspective". And what I found is that if I just shut the eff up and back off, the group takes off for itself. And I'm just facilitating and making sure that we touch on all the important points. And they support each other and they educate each other and it's awesome.
Lindsey: The community aspect of it of anything is so powerful. And you know, I know people listening may not do CrossFit or group fitness but I think that's the number one thing that they did right was put everybody in a room and there's such power in having somebody next to you suggesting out of the box ideas or be your support. "Hey, can I bring you lunch later? I've seen you having a tough time." It's so powerful. The group prenatal cares, I've just been innocent bystander and I've loved the energy they put off. So if anybody's in Los Angeles and they're looking for midwifery care, I would say check it out for sure. It's awesome stuff.
Jocelyn: Yeah, it's really cool to really watch it all play out. And the research says that there's improved outcomes. There's reduced preterm birth. The babies who were born preterm were born later and larger. So even the premies were healthier and it's particularly good for adolescent moms. And that's so intuitive to me that when you're a teenager shifting over to looking from your parental figures for all your support to looking to your peers for all your support. So naturally, putting a pregnant teenager in a group of peers, of other pregnant teenagers, is going to find a lot of support there rather than dealing with this very parental like midwife or doctor. And higher breastfeeding rates. And just overall patient satisfaction. You know, whether or not their birth turned out exactly like they wanted it to, everybody looks back to the group prenatal care and says, "Wow. You know, I'm really glad that I did it that way over and above the individual care." And then these women form lifelong friendships. That alone. Forget it, you know?
Lindsey: So if somebody was looking to either join the group prenatal care just be under [0:39:52] [Indiscernible] free care with you. What are some of the things you look for when taking on a client?
Jocelyn: I look for generalized health issues. Does this person have any blood clotting disorders? Does this person have a history of diabetes? Does this person have a history of high blood pressure? One of the arguments against midwifery care that I keep reading is midwives patients self-select. The research is inaccurate because they self-select. Yeah, well of course we self-select! Because most women are intelligent enough to say, "Gee, I have Type I Diabetes. Maybe I'm not the best candidate for out-of-hospital midwifery care. Maybe I should be in care with a perinatologist who's going to help me adjust my insulin and my medications and my blood sugar. So of course we self-select. And I don't see anything wrong with that. So honestly, the vast majority of women come in and they're just healthy people.
One of the really interesting things that happens a lot with out-of-hospital midwifery care is that we have I think a disproportionately high number of women over the age of 35 coming to interview with us. And if you go into hospital care, you will see that they are called elderly primigravidas. Or they're called women of advanced maternal age. And there's been some research in the past that says that they have higher incidence of poor birth outcomes, certain health issues, so on and so forth. And the reason why I'm comfortable with the 35 year olds and older is because most of the health issues that they have or that they are prone to are things that we can catch early. Such as that increased risk of gestational diabetes. Well, we're going test you for gestational diabetes. And if you have it, we're going to do everything we can to keep your blood sugar under control. So you can continue to have a healthy pregnancy and have a birth with us in your living room. They do have a higher incidence of blood pressure problems. Well, guess what? We're taking your blood pressure. And if your blood pressure gets high, we're going to handle that. Or transfer you out of our care if it gets bad enough. So we have protocols around those things. Which is why I don't worry about it too much.
And I don't know if you're familiar with the MANA statistics. MANA is, I have got such a hard time with all these acronyms. Midwives Alliance of North America. And we are doing research exclusively on out-of-hospital midwives. And as an out-of-hospital midwife, I have to participate in this huge study. Logging in all my numbers and all my outcomes. And it's really cool. And it's Canada, United States and Mexico, I believe. And it's the only project of its kind on this side of the ocean. And it has all these numbers but North America doesn't as much. And they have amassed so much decent research that they've been able to not only prove that out-of-hospital birth is safe, but they've actually been able to differentiate who's it safe for. Who are the good candidates? And they found that the moms over the age of 35 really didn't have a significantly higher incidence of poor outcomes at all. It really wasn't the risk factor that we thought it was. And I've always intuitively known that. And I've always felt that way about my older moms. That they're just fine. But we now have research that says that. Which is really cool.
Lindsey: That's awesome. There's literally somebody who just messaged me on Instagram who's 40 years old and she was telling me that her doctor wants to induce her and she's a week early. And this was probably about another case, it was about two years ago, three years ago, there's a doc here in Sta. Monica that told my doula client that her placenta would stop working. But I've had the same thoughts as you do. Where I felt comfortable with them. Even one month, there is. I think this was about two years ago. I took on three doula clients and all three of them were 40, 42 and 45. And they all birthed naturally at home or at a birth center on their own. They were completely fine.
Jocelyn: There's one study out of Britain. I try hard not to quote studies if I can't find them and cite from them easily. But I was doing some research for a mom that I had in my care last year who was 50. And she was like "What is the big deal? I want to know."
And I was like, "Let's look at it together. Because 50 makes my heart rate go up a little bit. I would be honest with you." And there was one study I've read that says the older moms did better in midwifery care. They had improved outcomes. And that doesn't surprise me because we push nutrition and lifestyle so hard. At every visit. How are you eating? Are you exercising? You're not exercising. Okay. Let's forgive yourself for that. How can we get you exercising? And just the nutrition and the fitness alone improves outcomes.
Lindsey: The lifestyle. The advanced maternal ages definitely something that as you said, you hear a lot but I hear at least that and then what's the other one? Oh, too big a baby. So far as induction goes. Which is crazy. You're right. We got find the research on it. And we got to make that known or share it and I think the research brings validity to it. Or at least calm some people's nerves.
Jocelyn: It's important. And I love that I can share those numbers with people. Rather than just saying well, this is my experience as a home-birth. I mean, of course I'm going to say that. I want people to hire me. There's conflicts of interest going on here. I admit that. So to have these big studies and to have these people be able to trust those numbers is really cool.
Lindsey: So we didn't talk about your work in Haiti yet. Oh yeah. And that's where you met Elizabeth from GraceFull. Correct?
Lindsey: So I want to just totally shift gears and have you share a little bit about your experience there and what that was like.
Jocelyn: I have trauma from it. I have a lot of trauma from it. And it's so multifactorial but most of my trauma comes from I believe, in hindsight it's easy for me to see and it took me a while to catch onto it. But I think that I was a part of, for lack of a better word, a certain kind of colonialism. And I think that there's a really good book, and I'm going to look it up right now for you that I really enjoyed and elucidated for me what I was feeling. It was like one of those books where you're like, "Oh, this is what I've been trying to put into words. Thank you, author." I think it was called The Travesty. I'm on Skype so now my internet is slow. Let me see if I can do it on my phone instead. Anyway, it's Travesty. Let's see what pops up here on Google. But anyway, the book is about how there are so many NGOs in Haiti that it's doing more harm than good. Yes, it's called The Travesty in Haiti. And I believe that it is by a man named Timothy Schwartz. And he really put into words what I was struggling to articulate while I was there and after that.
But people in America and lot of other countries decided, "You know, those Haitians they haven't pulled it together yet. Let's go there and just plant ourselves on the ground and do things our way. And tell them what to do." And saw it affect the people personally. It's not just a political thing. There are children and young adults and maybe older. My history is not perfect. Maybe older who've grown up not knowing Haiti without an NGO on every street corner. Handing out food. And the doctors from America. And the midwives from America coming down to rescue them. And it's so hard. Because you see the human suffering and you want to help and yet there's so much arrogance and privilege in that in and of itself.
And I don't know if I love the model. And I've done a little bit of research. I was there. I won't say the name of the organization that I was with because I'm not interested in saying bad things about the people I was working for. Because I love the people I was working for. And I respect them and I think they're good people. But there's another organization which everybody's familiar with called Doctors Without Borders. And they're model as an NGO is to only go in to disaster sites. Only go into war-zones. And then they get the heck out of there. They're not interested in setting up this permanent thing where they're giving ongoing help. And I'm using air quotes "help". And I really respect that about them. Their model is a little bit more my speed. And one of the reasons I haven't worked for them is because they require people to do 10-month missions. And I'm a homebody and I love my job, and I don't want to go anywhere for 10 months. The reason I respect them so much is the very reason I'm not going to work for them. And have people to do 10 month missions because the thing about Haiti is you can get on a plane for 300 bucks. Or when I bought plane tickets to Haiti, it was 300 one way. And fly two, two and a half hours from Miami to Haiti. Work for a weekend as a midwife and then fly home. And there's no requirement for learning about the culture. There's no requirement for any kind of etiquette around how to do this in a respectful way. And I don't love it. And I was there for four months and it was really interesting because I thought four months wasn't very long. And what my experience was is that at four months with this NGO, I was like the longest-running employee they had or volunteer rather. And everybody came to me for answers. "Oh, ask Jocelyn. She's been here for four months. She knows."
And I was like, "What? How can I be the old hat at four months?" That's how much turnover there was. And it used to be that as a midwife student, you could get skills checked off and numbers under your belt for your clinical training by getting on a plane and going to a different country and doing international work. And people are starting to get wise to the fact that that's not necessarily respectful or helpful to the people of that country. And the accreditation people for midwives for America have decided not to give people numbers or skills checked off by doing international work. And I really respect that decision. I mean, a student midwife can decide, "I'm going to go to Haiti for the weekend and get some skills." But she' not going to get those skills signed off on by a teacher or by the accreditation people. So I was really happy about that.
Lindsey: That's a good stand there. So based on your experience. You've had a ton of experience, both as a doula and a midwife. How has your, I want to say philosophy or opinion about birth changed or about women or even this is just you personally throughout those years.
Jocelyn: One thing that I'm really on fire about this right now. And I tend to be on fire about different things about different times. So you could ask me next week and my answer would change. Right now, I've had a couple of experiences recently in which not only are we seeing these obstacles come up for women in terms of not being able to access out-of-hospital care. Not being able to pay for out-of-hospital care. Feeling politically made to choose. Am I going to be an in-hospital birther or an out-of-hospital birther and never the twain shall meet. Those kind of obstacles are infuriating to me and they make me very angry. But I also find that women have these other obstacles when they give birth as well. And one of the things that I've really tried to do as a midwife is figure out what is this particular woman up against? Is it poverty? Is it smoking? Is it her verbally abusive mother-in-law? Is it her husband who's very controlling? Is it her sister who's jealous that her younger sister's having a baby before the older sister is having a baby. Like what is this thing? Is it a history of sexual abuse? And are the memories of the sexual abuse going to come up somatically during the birth? And I really believe that.
It's just gotten to the point where I go, "You know, you never can just sit down and have a baby." There's no "just having a baby". There's always some other layer of things that women need to cut through. And I don't know why birth works that way. But that's just been my experience. And I want to explore it more and learn how I can be more helpful and just learn how I can really gently bring that up with women. Because sometimes women bring these obstacles to the birth with them and I didn't even know they existed. And I go, "Wow. What could I have come up with? How could I have helped this woman prenatally resolve this issue before she was in labor?" Because you don't want to deal with this shit when you're in labor. But people do. And I think sometimes, I don't want to say it's like, this is so, I really want to stay away from this place of victim blaming. But I think that sometimes, women will bring their challenges with them to the birth and they've got to slay those challenges to prove to themselves that they can push out this baby. I think it's really psychological. And I think sometimes women do it maybe not on purpose, but it's just something that they have to do.
But whatever we can do to handle those issues in pregnancy and resolve them in pregnancy so that you don't have to slay any demons while you're pushing out a baby. That would be awesome.
Lindsey: I completely agree with you. I may word it a little different. It's funny you say that. I completely agree with you in that. I always tell women, "Hey, no matter what during this motherhood transition. Whether it's trying to conceive or the end of the year, first year postpartum. You're going to be faced with the most challenging in your life."
And I think this was in a book or something that I read recently, the lessons that you're supposed to learn in life, they're going to keep coming up until you learn them and then you can move on to the next lesson. So like you said, if they haven't resolved anything. Or they haven't addressed any kind of sexual aggression or sexual abuse. And that's in their history. That's definitely going to come up. I've seen it. You see it more so in the thick of the labor and delivery part. But I always see when pregnancy is going super smooth and then all of a sudden somebody tells mom she has a breech baby.
Jocelyn: I knew you were going to say breech.
Lindsey: But sometimes they have to face. "Okay, I've never been to a chiropractor before. Is this something I believe in? What do I do? Do I just schedule that C-section? Does it go against my values, my philosophy?" You really have to hone in and get clear on who you are and what you believe in in this world. And I think you're so right in that. It's crazy. Stuff does continue to come up. Thanks for sharing that. That was good.
Lindsey: Yeah. I think we covered a lot of stuff. Is there anything that's come up in your heart or on your mind that maybe we haven't touched on yet?
Jocelyn: No. But you know, a few minutes ago, I was talking about how we have this really large number of older moms. And while that's really exciting and I'm really happy to serve those women, I think one of the reasons we have so many older moms is they're the ones who can afford us. They're the ones who have gotten to the point in their lives where they don't get pushed around by the powers that be as much anymore. They know themselves better. And then that makes me feel sad that we're not getting more younger moms. Because maybe the younger moms aren't in such a good financial place. Or I know that when I was in my early twenties, if I had gotten pregnant, I would have just gone straight to an OB-GYN and gone down that chute. Because I didn't know any better. And now it took me until my late twenties to even have heard of a midwife as a thing. And so if that's my experience, I can't imagine other people having a tremendously different experience. I mean, sure we do get some younger moms. But a lot of our younger moms are moms that were themselves born at home. So that's something they grew up with.
Lindsey: It's their norm.
Jocelyn: It's their norm. Exactly. So now that we've got this older mom situation ironed out and I feel good about it. Let's focus on how we can get the younger moms in. Because in terms of statistics, mainstream medicine-wise, they're even better candidates. They get better support as young maybe less supported women in midwifery care than they do in OB care and especially with the group prenatal stuff. How can we get the younger moms in? And I think it's money a lot. And doing the group prenatal care brings the prices down but it doesn't bring the price down so much that it's going to be covered by Medicaid or it's not like it's Keizer where you go in and have a baby and there's a twenty dollar co-pay for your entire birth or whatever it is. So we still have a long ways to go.
Lindsey: That's so interesting. And I think also part of the money aspect of it but also they haven't, I don't want to say education but their life experience is like education is probably the wrong term because you might think academically. But their life experiences maybe haven't led them to seek out midwifery care or have it be their norm like you mentioned for some women. That's good. Good conversation, Jocelyn.
Jocelyn: Thank you!
Lindsey: Yeah. Where can people find you at?
Jocelyn: Well our website is GraceFull.com and GraceFull has two Ls. And we're at Instagram. I think @GraceFull. What is our Instagram?
Lindsey: I think it's GraceFullbirthing.
Jocelyn: So those are the places where I'm found. Facebook as well. But hit up our website. And there's a lot of information on the websites. And if you're interested in maybe having a baby with us, you can schedule a full hour, which is free of charge. Just to see the birth center and pick our brains. So you will get a really good overview just between the website and meeting up with a midwife.
Lindsey: Yeah, that's such a good recommendation. At least go check it out. Awesome. Well, anything else you'd like to add before we hang up?
Jocelyn: I don't think so.
Lindsey: Awesome. I certainly enjoyed this conversation and thanks for practicing it again with me.
Jocelyn: Me too! It's fun.
Lindsey: Awesome. Enjoy your Tuesday.
Jocelyn: You too.
Lindsey: All right. Bye, Jocelyn!
Lindsey: All right, BIRTHFIT Tribe. I hope you enjoyed that episode. Lots of information deep down in every crevice of that conversation, so you may have to listen to it again. But one thing that I want you to take away, and both Jocelyn and I touched on it, and that is we've got to learn our lessons that are put forth in front of us in our universal path. Hopefully, that makes sense. But there's a whole metaphysical aspect of this motherhood transition that you'll just flat out miss if there's no awareness or there's no mindset practice or if you just don't slow down and breathe. And like she said or like I touched on, there's lessons in life that will keep coming up, and especially if we haven't learned them. We will have to face those head on most likely at some point throughout the motherhood transition. So we all have issues. We all have baggage. We all have bullshit that we carry with us. So try to work on that. Try to create a practice. Try to create a support group. Seek out help. Enroll your friends. Read some books. There's some great books out there. But try to filter through the habits and the stories that you tell yourself prior to conceiving during your first trimester, and make it a practice throughout your whole pregnancy and even into that first year postpartum. This mindset practice, this awareness practice will become so useful. So dig deep. Take a deep breath. Be present. And feel from your heart every day. [1:02:39] End of Audio