All language subtitles for The.Mama.Sherpas.2015.1080p.WEBRip.x265-RARBG2_English

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.