Original subtitles

Breathe, breathe, breathe, breathe, breathe.

Okay, take a breath.

Keep breathing.

Good. Nice and slow.

Good job.

You're doing such a beautiful job.

Push nice and slow.

Nice and slow.

Okay. Another small push.

Good. Take a breath.

That's the way.

Good job. One more.

Now stop pushing.

Give a small push.

There you go.

Oh.

Okay. Reach down.

Baby.

Hi. Hi.

So let's help you turn around and sit back on there.

Okay?

Oh. He just peed on me.

Yay.

Good job, baby.

You did it.

The thousandth baby.

Yes.

[ Applause ]

Celebrating the thousandth GW midwifery baby is

so unbelievably awesome, and we're so proud to have

arrived at this moment together with all of you.

Our work is not done until this model of collaborative care

between doctors and midwives can be extended to every woman

in America and to the world

so that we can optimize the low caesarean section rates,

the high rates of natural birth

and healthy moms and breastfeeding.

All right.

Have some cupcakes.

Right? Today we eat sugar.

Enjoy.

We celebrated the thousandth birth

because it was a milestone in our practice.

We were growing at such a rapid rate

in three short years we delivered 1,000 GW midwifery

babies, and that's a large practice for us.

I wanted to thank you on behalf of C-section mamas

for giving them a real chance to VBAC in a hospital

Because, when I was pregnant with Emerson

I didn't have that option. You guys weren't around yet.

And it forced so many women out of the hospital.

And thank you for giving them a real chance.

Yeah, and we're proud of our 93 percent VBAC success rate.

So there's a lot of VBAC mamas here and they're so emotional

because they're so grateful.

And the filmmaker here is a VBAC mom.

She's -- so she's making her experience having a vaginal

birth after caesarean inspired her to make a documentary film

about midwives delivering in hospitals

and having a collaborative practice.

[ Music ]

When I was 34, I gave birth

to my 7 pound, 15 ounce son Stanley.

He was induced at 41 weeks and after 22 hours of labor I ended

up with a C-section noted as failure to descend.

Three years later when I was pregnant

with my daughter Josephine I couldn't imagine going

through a C-section again.

Not being able to change her diaper.

Not being able to care for my four year old.

It broke my heart.

I wanted to be in a position where I could take care of both children.

I knew that my best chance to do that was a VBAC.

But I remembered Whitney,

a midwife whose practice caught babies in a hospital.

I didn't know anything about midwives,

but if Whitney would support my goal of a vaginal birth

after caesarean in a hospital, I was in.

I did manage to give birth vaginally to Josie

who was 9 pounds, 10 ounces.

Always a filmmaker, 10 minutes after her birth I blurted

out that I had to make a documentary

about nurse midwives.

It took me years to talk about it without losing it.

But the bottom line is I had an unnecessary C-section

like a lot of women.

And I was induced with pitocen.

So it was just the typical cascade of intervention.

I wasn't eating.

So really tired, worn out, nervous,

and with by like 10 o clock I had only got to 3 centimeters.

So he said, "Well, I really think you need

to start thinking about a C-section.

It's not an emergency, but your baby's really big

and you're just not making progress.

And all of this labor is really stressful for the baby,

and even though his heart rate's fine now,

his heart rate might not be fine in 30 minutes.

And, you know, I can't promise the anesthesiologists

and the surgeons will be ready."

And, you know, "You have this C-section window right now."

It was that famous 10 p.m. window.

The like, "Doctor, I want to go home" window.

I had made the huge mistake of not educating myself

that this was a pattern and the things he was saying

to me were frankly manipulative.

I mean things like, "Your vagina will be so much nicer afterwards

if you have a C-section."

And saying, "You won't care."

This is the one I will never forget.

"You won't care how you had this baby once she's in your arms."

And he was -- couldn't have been more wrong.

Is it even possible for women to have a natural childbirth in a hospital?

Whitney's midwife philosophy reflects a commitment

to limited interventions.

She educates women about the process of childbirth

and encourages women toward healthy living.

There's a patient that's not on this sign-up.

Okay. Should we go meet her before you

to the operating room?

Yes. That's a good idea.

So first let me look.

I think it's Ms -- it's this lady right here.

Okay.

Who got admitted just --

like I said, while we were in sign ins.

Okay.

Okay. Good.

Let's go meet her.

She's in room 2.

Okay.

My passion has always been natural birth

in a hospital setting.

96 to 98 percent of certified nurse midwives deliver

in hospitals.

I started this practice in 2007.

It was a practice where we were going to rely on the wisdom

of women and midwives and we were going to balance

that with the use of evidence based science

to promote the best outcomes.

And to not be intimidated by established policies

and practices in a hospital setting

that would limit my ability to follow scientific evidence.

--Good to see you. --Good to see you too.

So what's going on?

Getting ready.

Full term.

Everything's really coming together, I think.

I have no idea how this labor is going to go.

You have no idea how this labor is going to go.

It may have that same slow, long, protracted course

as you had last time.

And if it doesn't and it's smooth and rapid, you'll be very happy,

but if it does, you've coped with it before.

Yeah.

And you can cope with it again.

Yeah.

You know, having a multiday labor the way you did last time

taxes all your systems.

And you remain steady and strong and I want

to be really reassuring that if it happens again you're going

to be able to manage it.

Great.

Casey how are you feeling about it?

Good. Just trying to wrap our head

around a little person again.

Another new person.

Actually less about that and more about how to manage

that with two wild and crazy --

You're more worried about postnatal than birth itself.

Right?

Yeah. I'm not worried about birth.

I've seen her do it and I know she can do it.

Yeah.

And I expect that things will go very well

with your labor and birth.

Your primary person to be in touch with when you go

in to labor is the midwife that's on call.

All right.

Any other questions?

No. I don't think so.

We do know that a caesarean section rate upwards

of 30 percent which is where we are

as a country is way too high.

But caesarean delivery is a life saving surgery for mothers

and babies, but it isn't risk free and it can lead

to a higher rate of maternal mortality.

I've always incorporated VBAC into my care ever

since the very beginning because I know that vaginal birth

after caesarean is the very safest thing for women.

You get the birth that you need.

Yeah.

Okay? Every birth that you have is a part

of your own personal journey, including the caesarean section

and then the vaginal delivery.

And then we'll see what the soul brings us.

Can doctors and midwives find a middle ground?

Can they compromise?

As I looked at midwifery practices across America,

I became intrigued with Sutter Davis Hospital located

in the college town of Davis, California.

Here midwives work with doctors inside the hospital

to promote vaginal birth, even in cases of breach position

and twins as long as it's thought to be safe.

Dr. Fineberg trained at GW.

She practices in California.

Her strategies and her collaborative practice model are

very parallel to those that we offer here at GW.

Ashley is a 26 year old who's having her first baby.

And she got to about 36 weeks.

They noticed she was breach.

By the way the breach is low in the pelvis,

she has a good chance of delivering.

Do you have any question for me about the birth or anything?

I don't know how much you've talked to Dr. Wilson.

My mom's kind of freaking out now.

She's a nurse and she's been hearing like horror stories,

but I feel comfortable doing it.

Yeah.

Because there hasn't been any problems with any

of the breach deliveries at Sutter.

Correct?

No. We haven't had problems, but there's still, you know,

there's still the statistics.

What they have quoted is about 1 in 500 risk

of the baby dying which is not really affected

by how the baby is delivered.

And but a 2 percent risk

of short term significant side effects,

significant complications like maybe, you know,

needing resuscitation.

Most of the ones that you would get are not life threatening.

Like you might have like a broken arm,

but the things you really would worry

about that are rare would be, you know,

obviously brain damage or, and that's pretty low.

Okay.

And once you get really close to delivery then we'll have,

we'll bring you in to the delivery,

in to the operating room

where we don't really normally do births.

But we can still, you know, you can bring

in your husband, your mom.

You know, if you have -- you can bring them in.

So we're not necessarily on the operating room table.

We'll have anesthesia kind of standing

by in case there's a problem.

Okay.

We try to still make it kind of nice

like a birthing room you know with the lights

down and things like that.

So.

Right now what's happening

with your baby are your baby is hearing us talk right now.

It knows your voice and it knows your husband's voice.

And is starting to recognize those voices.

Isn't that just so fabulous?

Amazing.

Yeah.

I know.

It's amazing.

I've known Barb Boehler for about 10 years.

She's really good about supporting women

when things are normal and then intervening

when it's appropriate.

The CommuniCare model of care is collaborative.

We collaborate with the Sutter West Women's Health M.D.s,

Physicians, OBGYNs...

And then midwives do all the prenatal care

and postpartum care as well as the births.

All right.

Now I can do the tape measure.

I've been doing this so long, you see,

I just do it with my hands.

Hey, baby.

Are you getting a massage?

Now we'll massage down.

I'm thinking his leg is sort of like over here

because you can feel him kick a lot on this side.

And the head's nice.

It's a perfect position.

I want you to just keep listening to your body.

The breathing you've been doing is totally perfect.

One of the things that makes this practice really special is

the access that women have to water birth.

But just tell me when you feel

like you're moving the baby down, when you feel like pushing

because we need two more nurses to be

in here before your baby's here.

Okay? Joy is one of them and we always call an extra nurse

in just for the baby in case the baby needs some extra support.

Okay?

When she has her kids, I don't want her to be afraid.

I want her to experience childbirth the way

it's intended.

She's 12 years old now and she wants to be a doctor.

So it would be good for her to be hands on.

[ Background Sounds ]

Will you do me a favor and take that off?

You're so close.

Grab your baby.

All right.

Oh. Wow.

Oh.

Her baby girl,

when she came out she was really quiet and really alert.

And often babys do that. They're just quiet and they're looking around.

They're transitioning from in the amniotic fluid

in the belly in to water.

It's a really gentle transition for the babies.

Look at you.

It was peaceful

and I remember the midwife was a really big help

with my breathing.

She would remind me to breathe slow

and so I would remember to relax.

She can't feel that?

Nope. She can't.

So you're going to cut as close to the plastic as possible.

One of you, can you feel it?

And you can use both hands.

Just make sure you know where you're cutting.

And were you planning to breastfeed?

I'm still looking into that.

Okay.

I was like not really sure.

Tell me a little bit about what you think of that.

It's kind of -- it's just different to me.

I don't know.

So not something you've really thought

about a lot yet or -- Okay.

I don't know.

Okay.

What's wrong with the bottle?

Is that -- I mean isn't the same?

They're like -- well, and then I was looking in to it.

There's like both habits -- what do they call it?

Positive attributes to the baby.

I don't know.

So I'll just tell you my opinion about it,

and then what I really recommend that you do is meet

with our lactation consultant.

So basically the recommendation here is if you can

and you're willing and committed,

we understand that's a lot of work,

but to breastfeed exclusively.

Only breast milk for the first 6 months.

Okay? That's the ideal because you're going

to produce milk better if you're actually latching your baby

on to your breast.

But I have had patients who don't feel comfortable

with that idea and they may end up pumping

and feeding their babies through a bottle,

but their own breast milk.

So there are ways to work with you if you're --

if that's the part that's uncomfortable.

We are what we call a baby friendly hospital.

Meaning everything we do

in the hospital is helping promote breastfeeding.

So when your baby's born we put your baby right on your chest

so that your baby can smell you and get those first instincts

to start finding your breasts.

And all of our nurses will help you with breastfeeding.

Okay.

We have a lactation consultant which is someone

who specializes in helping women with breastfeeding.

So all of that.

Exactly. No.

No. This is why we bring it up from the beginning.

We think it's really important.

But I'm going to put a little note saying that I want you

to meet with our lactation consultant before you deliver.

Yeah.

Okay.

At CommuniCare all of our patients are low income.

All of them get funding through Medi-Cal

which is California's Medicaid program.

And we serve primarily women who have immigrated from Mexico.

I'd say maybe about 60 percent

of our patients are monolingual Spanish speaking patients.

We were having a group for women that have diabetes

during pregnancy. And there's a

health educator that's facilitating the group

discussion and then I'm checking on the women individually.

And then we'd come back together as a whole at the end and see

if there's any questions that I can help answer at that point.

We always end in a nice circle to kind of close it.

And give each other a little back massage and kind

of have a little bit of a time

when we're providing that support.

Hi, buddy.

How do you feel up in here? Any tenderness at all?

Okay. Do as best a situp as you can do.

Perfect. So this area in here where the muscles tend

to separate in pregnancy is totally back together.

So basically in terms

of exercise you can do whatever you want.

Like no precautions there.

Now I'm just going to feel kind of low on your belly here.

Should not be able to feel your uterus anymore.

Just kind of backwards feeling kind of back where it should be.

Any tenderness on the sides at all?

Good. Carry on.

Let me give you a hand up there.

Yeah.

Precious.

Look at you.

Yeah.

He's a chunk and he's always like --

Got a second chin.

Fully in.

Fully in.

Yeah. His legs are still pretty skinny, though.

He's definitely puts his weight up here.

Got it.

Got it in my cheeks.

Take care you guys.

Okay. Bye.

The process of giving birth

to these children will teach you many lessons about yourself.

And that is the start of your parenting.

Those things that you learn and the depths that you reach

in labor is what you take forward

as you have these kiddos.

There's some powerful things to be taken from that.

Centering pregnancy is a format of prenatal care

that is conducted in a group setting.

We meet with them one on one to make sure

that any personal issues are addressed,

but most of the time is spent as a group and we have a chance

to address more questions than we do one-on-one

in prenatal visits in the office.

And particularly for first time moms they can be uncertain

about how to prepare for taking care of a baby

and they can hear all day long from me, but really being able

to connect with other women who are dealing

with this exact same thing at the same time is so powerful

to normalize what they're experiencing.

[ Background Conversation ]

Collaboration can be difficult.

If you have midwives and doctors working together

and they're just all doing the doctor's model, you're not going

to really get different outcomes than if you have only doctors.

The midwives push us to be better and to be more patient.

And to really think about when we say we're going

to do an intervention to really think about it.

That's how collaboration works.

Just going to put a lot of pressure here.

Right there.

Nice.

Ashley was a good candidate for a breach

because she was very motivated.

She had a not a huge baby, not a tiny baby.

She had a great pelvis on pelvic imagery.

The first time I checked her

in the office the butt was very low, cervix very soft,

like the kind of baby that's really going to come.

Okay. Okay.

Bear down.

Okay.

Good. Good.

Good. Come on.

Come on. Good.

Perfect. Perfect.

You're doing great.

Excellent.

Wonderful.

Okay, so Ashley, when that --

I want to have you move to your hands and knees.

Okay? When's that -- I know you can feel super uncomfortable

because the baby's so, so low.

But I'll just have you move to your hands and knees.

Yeah. There's no way that's going to be comfortable

until this baby's -- okay.

Yeah. Okay.

Now move up a little bit towards the pillow.

And we can even move that.

That's actually probably an okay height.

Okay.

You can do this.

You've already come this far.

Give her a minute to kind of get it together.

Yeah.

You know, and see if it kind of comes around.

But don't be worried if he or she comes out very stunned

and often we'll hand them over.

But we'll see.

We'll see how the baby's doing.

If the baby's kind of coming around we'll wait a little.

And if not we'll just send her over to

Annie to help her -- help him or her out.

Nice. Great.

Come on. Stick with it.

Stick with it.

Yes, Ashley.

Yes, yes, yes.

That's it.

That's it.

Good, good, good.

You're doing so great.

Good, good, good.

The hips is the hardest.

Then everything else usually will follow.

The next contraction just give us all your might.

Okay?

Good, good, good.

Good, good, good.

Okay. Great.

Thank you.

Got a foot out.

Let me get the other foot out here.

Okay. Perfect.

Okay.

Yeah.

All right, Ashley.

Keep going, Ashley.

Come on. Let's see your baby.

Let's go.

Yeah.

Good, good, good.

Keep going.

Keep going.

Keep going.

Keep going.

You got it.

We know the arms are good.

Nice. Nice.

When you can see the chest together with -- Yeah.

Okay. She's good.

You got it.

Should we put -- Good.

Good.

Let's -- I think I'm going to take over this side just --

-- Let's ee how we're doing.

Okay.

Hey, there, little girl.

There she goes.

Get a bowl.

Yep.

Wakey, wakey.

Okay. Let's hand her over.

Yeah. Oh, she's so tiny.

She's not that tiny.

She's a good size.

She's a pretty normal size for first baby.

There you go, mama.

Look what you did.

You are amazing.

It was a lot of work.

You did it.

Thank you.

I felt very supported here.

It was awesome having Jessica because she's been

through this experience with me through the beginning.

I was worried about the breach

because I had people keep saying like, "Hey, your baby can die.

It's not right.

You need a C-section."

And it's just all these people

that don't actually really know what they're talking

about because in the US it's not common.

I wanted a water birth and it felt like I was kind

of losing something in a way.

Then I had to try to tell myself, it's okay.

You have to let go of that.

It's all worth it.

I'm happy that I just didn't let go of the plan that I wanted.

And I was nervous.

What can midwifery look like within a doctor-based practice.

Physicians and Midwives is a large private

medical group in Alexandria, Virginia.

They provide care for women who have insurance

and deliver 40 percent of the births

at the local community hospital.

So,

I'm saying the boob department.

It hasn't changed.

And the belly hasn't changed either.

[ Laughter ]

After 24 years.

The same shoulder.

I decided to become a midwife when I saw my first midwife delivery

And I said, "That's it.

I have to do that."

I didn't see myself doing that ever before.

It's like, "God, I have to make this part

of my contribution to the world."

It's going over.

Just go right to that edge of the drawer line.

When you've climbed a mountain you never climbed,

you're a different person period.

End of story.

It's just you've never done it before.

You become a different person.

No matter what happens as you access the mountain.

[ Music ]

All right.

So.

Talk about this baby.

I'm just trying to be a little extra active.

See if that will get things moving.

Oh, yeah.

Set up a path that you can walk.

We have a dog.

I've been getting on the treadmill, though,

so I can do some good inclines and everything.

So --

Okay.

You know, walking and I climb the stairs at work at least once

for 10 -- once a day for 10 minutes.

How many flights is that?

3.

Good for you.

All right.

Go ahead --

Okay.

All right.

He's on this side.

He just moved a lot.

He's --

That's funny.

All right.

See --

What's unique about Physicians and Midwives is

that we are a private practice.

A midwife and a doctor will be taking care of you together,

pretty much simultaneously.

Sometimes the doctor watches more.

Sometimes the midwife watches more.

But we're both watching at the same time.

All right.

We'll see you guys.

And keep in touch.

All right.

That sounds good.

Thanks so much.

Take care.

My mom said that she had a dream and there was a

baby's foot with a pink background.

And so she thinks it's a girl.

But other folks have said, you know, it will be a boy.

So.

It's a boy.

It's definitely a boy.

If it's a boy we're thinking Sawyer

and if it's a girl we're thinking either Harper

or Henley.

Here is cervix.

All the black here around the baby is the amniotic fluid.

What do you call him?

I don't call him anything.

All the soft tissue is pointing south.

We have a girl.

Congratulations, Hunter.

[ Music ]

Hi, dad.

I want ice sculptures at my wedding.

I told Kayla we didn't have a preference

or I didn't have a preference either way.

We, you know, we figured out the name for the boy

and that was one reason we were leaning toward a boy was just

to be able to use the name.

But I was looking forward to it either way.

Because now it gets my initials.

You see women.

What are the good ones?

The ones that I think that went fine

that have the most success are the hypnobirths and hypnobabies.

The coping skills that they offer I just find are

really good.

I'm kind of trying to be like as natural as possible.

And I've read things about like the cord pulsating and all

of that and I -- what are positions on all

of that at the hospital?

All of them advise wait at least

until the cord stops pulsating.

Takes about 2 minutes.

Okay.

And the World Health Organization recommends 2

minutes, I believe.

Okay. That's good.

So we're all pretty, you know, hands off in that area.

All babies go skin to skin,

especially if they're crying and doing well.

Then we just kind of leave them there.

Okay. Do I have to get an IV in at the hospital or no?

We usually try to get it in just to have the access.

And then after if we don't need it we can take it out.

Okay. I think I'm good.

All right.

So we will see you in 4 weeks.

Awesome.

Are you going to listen to your baby brother?

[ Music ]

What's that?

Just looking at it.

-- in your belly.

You just -- you don't know what to think about that.

Do you?

I chose to become a midwife

after working as a labor and delivery nurse for three years.

When I started getting patients back for their second birth

and then I was able to see them again, and I wanted to be

more involved with these mothers during the pregnancy process

and get to know them throughout their pregnancy.

And then take care of them after and just have more

of a relationship with them rather

than seeing them once every 2 or 3 years when they came

in to have their baby.

I want to have you actually get down on the floor and get

in to these positions and see what feels comfortable

to you now.

So dad will be the bed here.

And you guys will just cuddle in.

You'd still be looking back towards your baby belly.

You could even look -- can you see between your legs?

Can you just see that baby's head come out, maybe?

You could have the front row seat.

Okay. And so you'd just be breathing.

Okay. So go ahead, mom.

Great. Do you want to sit back?

So how many people, couples, are thinking

about receiving their babies?

Anyone?

I'm just considering it.

You're considering it?

-- just from like the head and shoulders.

Okay. Well, then.

[ Laughter ]

The head will come out, face down.

And if mom was doing it she could pull it out.

Just whatever they tell you to do.

Have you guys talked to your healthcare providers

about doing that?

They're okay with it?

You guys want to jump on the bandwagon?

[ Music ]

Everything has been great.

I actually -- so I transferred from a different group

that didn't have midwives.

And you know it's OBs that are there

and they weren't particularly warm and fuzzy.

So I just on a whim went to Physicians and Midwives

and the first appointment that I had

with the midwives once I got pregnant, you know,

it's just they're so like happy and excited for you.

And they're like, "Anything you need."

It's very cool.

I'm very low stress about it.

Everybody on Earth got here the same way.

So treating it that it's, you know,

like a normal thing makes a big difference.

[ Music ]

You want to do the honors?

Since you've been here so many times.

There you go.

And you can have the --

Okay. Well.

I haven't done this.

So --

That's okay.

I love to put you on the spot.

You're so welcome.

Do I have to push the button?

Yeah. I would go for right here.

[ Heartbeat Sounds ]

Now just try that side and see if you find the real

like horse hooves kind of sound.

[ Heartbeat Sounds ]

Anything you see this morning we need to try to work with?

Everybody's good?

And how many patients?

-- for the whole day.

For the whole day?

Okay. Well, that's a full day.

Yep.

Let's get to work.

Okay.

So.

At Physicians and Midwives we stay focused

on the successful completion of a woman's pregnancy.

We think that vaginal delivery is preferable.

We think that a labor where the patient is kept immoble,

hydrated, and unmedicated when

possible, is preferable because it leads to a safer delivery.

Our practice, especially with the midwives,

generally gives the patients more time than in other

physician only practices so that these moms can have a vaginal delivery.

You want to come forward and squat?

[ Background Sounds ]

Chin down.

Whoosh.

So don't be afraid of this pain that you're having.

You're getting really good and close.

Push. Push.

Push.

Let's keep it to a warm compress.

That's it.

Okay. Bear down.

Bear down.

Push in to this.

Move her down.

Yeah. There you go.

Okay. Push down.

Push up. Push up.

Feel the -- yep.

Feel that progress.

You'll have to hold my legs.

Okay. All right.

[ Background Sounds ]

Very close to delivery.

She's going to be in your arms in a minute.

But if you need to, you can drop the rail on the other side

in order to get closer to her.

Going to be here soon.

You don't have to breathe through it.

Keep going.

Is her head still there?

Oh, yeah.

Yep. There we go.

Keep going.

No. Keep going.

Keep going through it.

Keep going.

[ Screaming ]

Look at me and breathe.

Slow, easy pushes.

Okay? I'm going to help her stretch so that you don't tear.

Okay? I know.

It hurts a lot.

Okay? Slow, easy pushes.

Steady.

Steady.

10, 11 -- Or 11 10.

[ Music and Background Conversation ]

There she goes.

She's beautiful.

Oh, my god.

[ Music and Background Conversation ]

Good cries.

We chose to go with a midwife because we didn't look

at pregnancy as this big, huge medical issue.

And the midwives don't treat it as such.

They're very easy going about the whole process.

It was a balance.

This was a midwife and physician practice.

And so that really is what sold me on it.

Thank you.

Yeah. Congratulations.

Appreciate it.

Yes.

Hospital based midwifery is just the way it's going to be

for the majority of the world

and that's what this practice is all about.

And that's what a lot of the practices

around the United States are all about.

What is midwifery like at a large, education based hospital?

What I found at Baystate Medical Center is hospital midwives

are often on the frontlines of poverty.

Excepting Medicade reimbursements that are too low for doctors.

And providing women with holistic primary care.

Baystate Midwifery and Women's Health is a clinical practice,

takes care of women in Springfield and the surrounding communities.

We see patients at six outpatient sites.

We do about 400 to 450 births a year.

Besides just a midwifery practice,

here at Baystate midwifery is bigger than that.

We have the midwifery education program so one

of our missions is to educate nurses to become midwives.

Today we have a little physical exam

where we're going to be going into a fake patient room

and doing a real exam on a real patient

and our professors watch us and observe us

and make sure we have the right techniques

for a full breast and pelvic exam.

And they have to pass us and check us off to then go

in to the clinical setting and do it on our real patients.

And so first I'm just going to inspect the outside.

You're going to feel my hand here.

Okay? Can I have you squeeze with your muscles down there?

Good. And then relax that.

Good. Okay.

Now I'm going to get this ready.

Okay. And just relax your muscles.

I'm going to put the speculum in now.

This is where I would usually go in and do the specimen exam.

I would lock at --

Does she have any discharge or --

Yep. She is menstruating right now.

Now I'm going to be feeling with two hands, Teresa.

Okay.

Okay. So I'm feeling it far back in to the side.

So I can feel underneath.

And I'm moving back and forth that it's mobile

and I can tell the texture difference.

Are you supposed to palpate it?

A little bit.

So the more you move your hand, the harder it is for her

to keep her muscles loose.

Okay.

So try just applying deep smooth pressure.

I think that I felt it move.

It felt like it.

Yeah. So that's it for the annual.

You have to get her out of this awkward position.

Okay, Teresa.

All right.

So I'm going to have you scoot back now.

Okay?

So what comments do you have?

Well, I just kind of need to like be practicing it

and be observing it more to get a better flow down.

And last week I was really rushing.

Never done it.

So.

You've never -- it was a first time.

We don't expect you to be able to like do things

and feel confident about them the first time when you do them.

But I felt a lot better this time.

The format of the program is very much

like a graduate program.

It is full time.

So they spend a fair bit of time in the classroom just

like any graduate student would.

And in addition to that they spend time in clinical

with clinical training.

SA is a thirty-three year old parent of three

in for a postpartum visit at three weeks postpartum.

She's on Wellbutrin, which was perscribed on the 22nd of October

She delivered on 10-22 at 41 weeks.

It was a normal vaginal delivery.

And she's breast and bottle feeding.

Back to the Wellbutrin?

She is actually not taking it because there was an issue

with getting that prescription filled.

So we're going to need to --

Okay.

Follow up on that.

I just kind of have the feeling that you're doing a lot.

If you notice that you have a big gush of blood

after you're doing some activity,

then that's -- you're just way above your limit.

So just try to rest as much as you can.

Like you know if you're waiting at the bus stop for your kids,

sit down as opposed to standing up.

All that kind of stuff.

Whatever you can do to get more rest.

And you're still good with the tubal?

Oh, yes.

Yeah?

I mean -- but daddy says yes.

And do you want to do that?

I'm too old for this.

Okay, but you do know

that there are other long term options besides sterilization.

Well, I heard about the Essure --

Essure which is supposed to be like the tubal.

Yes. That's permanent as well, though.

Yes, but no -- permanent.

No more.

Right. I just wanted to make sure you knew that.

Yes.

Okay. Because it's your decision, not his.

He don't know.

I'm -- with the pain that I went through

and during the pregnancy, we're done.

You're done.

Okay.

We're done.

All right.

We got three cute kids.

So at least the two I see are pretty darn cute.

Thank you.

All right.

So just hold on a second.

We're going to see if we can figure out the Wellbutrin

for you and then we're going to see you back in three weeks.

Okay. Thank you.

So what do we do about the --

how do we figure out that Wellbutrin thing?

I've been trying to call.

It's busy right now.

What I want to do is send it downstairs

so that we know, you know.

If there's a problem I can just go down and talk to them.

Right.

But I was trying to call them.

So is she all set and she's ready to rock and roll?

Yeah. She's -- I told her to hold on a second so we could --

Okay. Let me call one more time.

They were busy when I called.

Initially the home birth midwifery route was perfect for me.

But when I started having kid of my own

the lifestyle got a little bit hectic.

And I wanted to be able to reach a wider patient population.

So I decided to go back to nurse midwifery school.

I wonder how many jackets that baby's going

to go through as she grows.

I feel like she's making a lot of progress.

She's contracting like every minute and a half.

All right.

And she just threw up.

Oh, gracious.

A little shaky.

So she was checked about two hours ago.

It would be nice to know where she is.

Okay.

And the baby.

All right.

All right.

Great.

They work hand-in-hand with a certified nurse midwife

who helps to guide their learning,

helps to teach them their skills,

and help them fine tune their skills.

I've been a student midwife for about fourteen months now.

This is birth numper 25 for me

and it was keeping on your toes type of a birth today.

So what's going on right now is

that your baby's heart rate is down.

So we're trying to get more information.

We were concerned about the fetal heart rate tracing

and the information that we were getting and whether

or not it was accurate.

We essentially had to move quickly.

We at the same time are trying to do retrieve and resuscitation

of the baby to improve the baby's heart rate tracing

at the same time that we're moving toward an operative

delivery, should that be what needs to happen.

Are you okay with a blood transfusion if it's required?

They just put a lot of trust,

and it was such an emotional moment for them.

And the fact that they cannot hear

and they rely on an interpreter.

It's not working?

No.

So we're just putting another one

on because that's the best way to get information.

Okay. This one's working for now.

[ Background Conversation ]

There can be several reasons for it.

In Jackie's case it might be

that the baby was descending really rapidly.

That could be part of why she had that deceleration was

from a normal thing that happens in a lot

of women's labors is the baby coming

down rapidly and cervix dilating.

She's fully dilated and --

Lovely.

All right.

Okay.

Thank you.

So when you feel that intense, intense pain,

hold that push a little bit longer.

That's what's going to bring your baby to you sooner.

You are doing great.

Yeah. It's okay.

It's okay.

Keep your legs open.

It's okay.

It's really important to keep your legs open while you're

pushing so that we can help you get your baby out.

Oh, there she is.

Keep your legs open.

Legs open.

You can do this.

You can do this.

Okay.

Legs open.

No. Don't go away.

It's okay.

Let your baby come.

Good.

Okay.

All right.

Good. Oh.

I'm going to clamp.

Okay.

Good girl.

Baby's mouth.

Okay. Hold on.

No. Hold on.

Let me --

Hi, pumpkin pie.

[ Baby Crying ]

Give me the bowl please.

Here.

Thank you.

[ Music ]

The thing I love most

about midwifery is still clinical care.

After all this time it's still taking care of women

through all their health needs,

both in the office doing antepartum care, pregnancy care,

family planning, gynecology, and still labor and delivery.

Helping women have their babies.

I wake up out of my sleep coughing, gasping for air.

And throwing up sometimes.

Yeah. Tell me about your contractions.

When did they start?

Like around 6 something this morning.

Oh, really?

Yeah. Like I thought it was gas,

but then it got real intense like around 8:30, 9 o'clock.

And I was like, "Uh."

So I called Teresa.

Okay.

She said once they start getting like 5 minutes apart

or whatever, then it will be time to come in.

Okay.

Yeah.

So that's what happened?

They got 5 minutes apart?

Well, they're not exactly 5.

I'm going to say like 8.

Close enough.

Yeah. I don't want to wait too long.

So how big did we think this baby was last time you were

in the office?

She said about 8 pounds which that kind of scared me.

Jeepers.

It went from like 5 and a half to 8 within like a week.

How big was your first one again?

She was probably a little bit over 7.

Good size, but not too big, not too little.

Yeah.

Okay. I'm just going to unhook this one here.

Just going to turn this off for a minute.

It's making too much noise.

This could be the very early real thing.

Okay.

Or it could be false labor.

Okay.

I'm going to sit you up a little here.

Oh. So the only way to tell is time.

Oh, lordy.

You have to promise me you won't be disappointed

if it's not the real thing.

Uh, I'm going to try not to be disappointed.

I know.

You get so uncomfortable at the end, I know.

I know.

Yes.

But if the baby's not quite ready then the baby's not

quite ready.

Oh, lord.

Okay.

Yeah. Get your head together with that.

I know you're anxious to get this over with.

Tissues. Now you can't rush this.

You're better in the long run if you just let your body go

in to labor by itself.

Right?

Right.

[ Music ]

Did you not want to be -- go late like the last time?

Is that what you're worried about?

No. I'm not worried about going late.

I'm trying to have pains and it's getting more difficult.

I can't sleep at night.

Sure. Even if it's not the real thing,

the fact that you've had a day of contractions,

your cervix is starting to make changes, that's very positive.

If it's not the real thing, we will talk

about some more options to make you comfortable

for the next little while until you have the baby.

Help you get more sleep and stuff.

Okay?

Okay.

One of the interesting things

about our practice is we take care of our community of women

which is all kinds of people.

The challenge is to figure out where that is they are

and help them move forward from that

for whatever their specific needs are.

We have refugees in Springfield from Vietnam

and most recently from Somalia.

And those women come to us and get their pregnancy care

and their family planning care and gynecology care.

So, today I wanted to talk a little bit --

or have you talk some more about depression.

And something called PTSD.

And that stands for post traumatic stress disorder.

Has anyone heard of it before?

So many of the women that were part

of the group had been talking about their feelings.

They'd been talking about feeling sad, feeling depressed.

They felt getting through every day was a really hard thing.

And being able to hear

that other women had the same experience, that it was hard

for them too, could be helpful.

The group format had been so supportive in helping them

with their pregnancies, why not help them

through just their lives?

Dahabo, who's fairly new to this country,

this is her first pregnancy here.

She has gestational diabetes and she also has placenta previa.

It's just not safe for her to have a baby vaginally.

Explaining that to her and helping her understand the risks

and why surgery is a good idea is a challenge.

Have you had your ultrasound this morning?

Okay. Did you understand what happened?

Did you understand what they saw?

Right. So some of the placenta is on top of the cervix

which is the part where the baby comes out of.

The safest way for you to have the baby is to have a caesarian,

to have an operation that takes the baby out through your belly.

It is another way to have a baby

and in your case it's actually the safer way

because when the placenta is covering the spot

where the baby is going to come out,

when the baby comes it's going to press against that spot

and you can have a lot of problems.

You can have bleeding and the baby can not get enough oxygen.

Not do as well.

So when you have the surgery you will be able to be awake,

but you won't feel any pain and you'll have a midwife who can go

in to the surgery room with you.

And your husband can come as well.

You're going to feel -- you can feel some things like it kind

of feels like pulling a little bit,

but you won't feel any sharp pain.

[ Music ]

Pretty quickly your son will be out

and we'll bring him right to you.

[ Foreign Language Spoken ]

So you can see him.

Now it takes a little bit of time afterwards,

but you know once you have your baby you'll know

everything's okay.

So the people from the NICU, the pediatrics,

the baby doctors, have come.

And the baby looks fine.

Okay? Just fine.

At first he wasn't making a lot of noise.

Okay.

The American College of Nurse Midwives is the

professional organization for certified nurse midwives

and certified midwives in the United States.

It's an opportunity to get reenergized around your work.

We know we've got to be wise.

We have to be patient. We have to be diligent,

grateful for what we have.

Still keeping our sghts on what we don't have yet.

We have to be humble.

You are how I found midwifery.

I didn't know that.

In the seventies I found your book in a bookstore,

"Spiritual Midwifery" and I think a couple of generations

of midwives found midwifery that way.

The benefits of bringing nurse midwives

in to the hospital setting are that we start

to get some correction of the extreme practices and habits,

routines, that were developed 100 years ago which tended

to separate mothers and babies.

This put an unbridled, unbalanced kind of obstetrics

into the driver's seat, into the policy making

in all the institutions.

There was no appreciation of what the midwife brought.

I think it's sort of like parenting.

You watch them go from stumbling like toddlers,

finally going off, they're graduating

and they are beginning clinicians

who have all the skills that they need to go on

and practice as nurse midwives.

I think we're all set.

Another year.

Another class.

It's no longer any kind of hierarchical kind of situation.

I have no power over you whatsoever anymore.

And I'm pleased to have you joining us.

Anna, congratulations.

[ Applause ]

Thank you so much.

Thank you.

It's been a pleasure.

Thank you, Barbara.

How do you mentally and physically prepare for birth?

Can the help of a midwife be intrical to the experience?

These were some of the questions

I had when pregnant with Josephine.

We're day 8 now.

Kind of thought it would be nice if you came today,

but it doesn't feel like it's happening.

We want to wait for labor to begin on its own.

That's the best thing to predict a smooth, normal birth.

So just got to keep waiting.

Yeah.

How's the baby moving?

Good. I mean he's slowing down a little bit,

but still very dramatic movements.

I'm definitely feeling him.

Okay. Good.

I've spent my entire professional life building

collaborative practices where I can offer women a natural birth

experience in a hospital setting.

The majority of women in America choose hospital birth.

And the majority of certified nurse midwives like myself

provide hospital births.

Unfortunately in many hospital settings midwives aren't able

to provide full scope midwifery care because of policies

or protocols that inhibit full scope midwifery practice

and evidence based strategies.

And that's something that services all

over America struggle with.

Some movement every day is important,

but the baby should be sleeping deeply the same way the baby

will sleep when it comes out.

Okay.

Okay?

We're in the business at GW of training doctors so that

when they go out in to their jobs they're used

to working side by side with midwives and with the patients

that are attracted to midwives.

And so we want our doctors that we train at GW

to be the very best at everything.

And that's the kind of doctor that we're turning out.

I've very, very proud of that.

The baby's back on the left side this time.

Yay.

Right?

Exactly.

So where are you going to hear the heart beat?

Right around --

Perfect.

She's good.

She does not need you.

Wasn't afraid to touch either.

Sometimes they stand here and they go --

How about a career in OBGYN for you Megan?

Our VBAC moms carry a certain vulnerability.

Their pregnancy and labor can be complicated not only

on a physical level, but also on an emotional level.

And that can make them more fearful of labor.

And in your situation you had a long hard labor.

And you had to work really, really hard

for about six hours, to breathe through

your contractions and wait until that baby had rotated

in to the position that I knew it was going to fit

through the birth canal.

And it still took another three plus solid hours

of active pushing to get the baby out.

That takes a lot of fortitude, Bridgette.

Be the midwife, to stand by you and work with you for those hours.

And that's why I do what I do. So that I can help women

have that profound moment of accomplishment and love

that comes flooding.

The level of care that I got with Whitney is what I thought women should get.

And I didn't realize that was unusual.

Midwife means, "With Woman." That's what it means.

And there are many different models of midwifery

that I've learned in doing this documentary.

But for me at that moment with my labor

and delivery I needed somebody who was with me.

Having her there enabled and empowered me to have Josephine.

[ Music ]

We're going to have a baby.

Are you ready, Casey?

All right.

Are you excited?

Did your water break in there?

It just broke in there.

Oh. Great.

Awesome.

So hopefully the pushing is easier this time.

We'll see.

You never know how it's going to go.

It should be.

It's never easy.

Never easy.

Yeah.

You're doing great.

[ Background Sounds ]

Just going to -- tell me when you're ready.

I'm just going to put a warm towel.

Yep. Just cleaning you off.

Okay? Nice.

Yeah.

That's it.

Good job.

Good job.

That's it.

Let your baby come down.

You're doing great.

That great, Mariah.

You're going to have your baby before you know it.

Do you want a mirror or are you --

No.

No mirror?

No.

Oh, the baby's right there.

Just right in to the warm towels.

Doing great.

Okay.

It's all right.

Okay.

You're okay.

You're okay.

You're doing good.

You're doing great.

You're doing everything you're supposed to be doing.

Here you are.

This is it.

It's okay for me to rest like this.

Right?

Yeah. You can rest.

Okay.

Doing great.

Okay. Okay.

Just rest in between there.

Okay. It's okay to rest.

It's fine to rest.

You want to rest.

That's it.

I got you.

I got you.

Keep it coming.

Don't be afraid.

Okay.

You're about to have a baby.

Okay.

Is he coming out?

Yeah. He's coming out.

Awesome.

Okay. Reach down for your baby Mariah.

Reach down.

Reach down.

Hi, buddy.

Reach down.

Pull your baby out.

I can't.

Yes. You can.

You're not going to drop him.

I'm going to drop him.

You're not.

Take your baby, Mariah.

Two hands.

Awesome!

You did it!

You did it!

You did it!

Hi.

He's so little.

He's perfect.

We did it, buddy.

You did it.

You train for months, spiritually, psychologically,

certainly physically, for a marathon.

Giving birth is the most athletic thing a woman can do.

Why wouldn't you train for that too?

What I think set this birth apart

and what was the most fulfilling

about it was how calm and confident I felt.

I could tell my body knew what to do.

And that was a really neat feeling.

I just remember feeling totally at peace with the process,

and the experience, and knowing that I could do this, you know.

I VBAC'd twice. By body

knows how to do this, and it was the ultimate sort of revenge

on this provider who again had told me that, you know,

my body wasn't meant to do this.

Well, yeah.

Actually it is.

It's so meant to do this.

And I know that now because of the birth.

She owned it.

She was empowered.

She was in just the finest health and form ever.

She was confident and triumphant.

That's an amazing moment as a midwife to watch someone come

that far over a four year period.

You know, coming from having had a previous C-section

to the trepidation of trying for a vaginal delivery

to the success of having a vaginal delivery

and then having a second vaginal delivery after caesarian.

Absolutely triumphant.

We did it.

I Know.

[ Music ]

These four midwifery practices are very different

from one another, but what I witnessed is midwives accepting

women where they are in their lives

and providing holistic support.

To me that's being with woman.

Whether it's advocating for natural childbirth

or supporting a woman's decision for an epidural.

Meeting us where we are and guiding us safely

to greet our children.