MyMaine Birth: Mid-week Midwife Edition -Ariel from Saco River Midwifery shares her Home Birth Stories
My Maine Birth : Mid-week Midwife Edition - Ariel, from Saco River Midwifery Shares her Home Birth Stories
Welcome to the mid-week Midwife edition of MyMaine Birth! In these episodes we explore the world of childbirth, pregnancy, and motherhood from the perspective of midwives in the great state of Maine. We’ll delve into the latest research, share personal stories, and experiences, and connect with experts in the field to bring you the most up-to-date and reliable information. Whether you’re a soon to be mom, a seasoned mother, or simply interested in the world of birth, these episodes are for you!
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Join me for Episode 12 of the My Maine Birth Podcast as we hear from Ariel of Saco River Midwifery as she shares her two home birth stories, as they intertwine with her life’s calling to become a midwife. You are not going to want to miss this episode! Ariel lays it all down in this episode of My Maine Birth. Find it wherever you normally listen to podcasts or right here https://www.mymainephoto.com/mymainebirth
Listen Here! Scroll down for the full transcript.
Angela: Hi Ariel Welcome to My Maine Birth
Ariel: Hi
Angela: So to get started will you share a little bit about you and your family?
Ariel: So it’s my spouse and I, and we have two girls, both of whom were born at home and have spent their whole lives with their mom being a midwife which is either the most adventurous childhood or the hardest, I’m not sure. I had to be away from them for three days this week for a birth, but I think they are used to that by now. So yeah, my oldest is 11, and my youngest is about to be 7 next month.
Angela: So today you are going to be sharing about your birth experiences, and also about your journey to becoming a Maine midwife, why don’t you go ahead and start where it feels right to you.
Ariel: Yeah, they all kind of flow together. I became a Doula about 15 1/2 years ago. I was in a really serious car accident, and after that car accident I started learning more about different kinds of alternative medicine and holistic health care, mostly as just part of my recovery from the car accident. And it weirdly entered me into a whole new realm about different types of health care that I didn’t know about previously. I had always been really passionate about reproductive health care and reproductive justice, I had been really involved in a lot of things in high school about that as well, but I didn’t know anything about birth other than people went to a hospital and they had a baby and that’s what birth is. And in meeting more people that were more involved in - I hate the word “alternative health care” - because honestly I don’t like that it implies that its the alternative to this mainstream thing - but I don’t see any of that as fringe and I don't think it should be treated as such, but maybe holistic health care, and looking at people as a whole person. Body systems are not separate, things that are happening in our lives are not separate from our health and our well being. Meeting more people in that realm, and then meeting someone that had a doula at her birth, I immediately was like I am very interested in this, and I decided to do a Doula training in Israel where I lived where it is a much longer process there. Often in America, I know with Dona it is a weekend course plus other experiences, but there was a 9 month program that I was in. And the summer before the program started we had a bunch of required reading to do and my spouse and I were actually in on a roadtrip in America, and I read all these books, and I read half of them out loud because I was getting very passionate about it. I read Spiritual Guide to Midwifery by Ina May Gaskin https://a.co/d/6I56Hg5
and also The Thinking Woman’s Guide to a Better Birth by Henri Goer https://a.co/d/4f2gvgO
I read Birthing from Within https://a.co/d/1hUFG2e I read just a lot things that made think, whoa, I think we’re doing a lot of things wrong. Why doesn’t everybody know about this, why doesn’t everybody talk about this? And I was very excited to become a Doula. And then I went to my first birth, and it was some friends of mine who were having their first baby, and very graciously said I could come and be their doula. And it was a very difficult birth, there were a lot of challenges, and there were a lot of things that were very difficult to witness. Especially about how she was treated because of a major lack of autonomy, and lack of collaborative decision making. By the time the baby was born I remember the parents feeling like these things had just happened to them, there had been no real decisions, it was just like, this is happening.. and now this is happening.. and I remember being so saddened by that after having read all these things, and thinking wait there is a different way. Why is this how this works here? And I felt very immediately that my calling in life was to become a Maine midwife.
I was in college at the time for linguistics and I thought I was going to go into academia but I was like, no wait, this is what I am meant to do. And after working as a doula for two years I became pregnant with my first child and I was working throughout my whole pregnancy as a volunteer at a shelter for women who were refugees from Sudan from the civil war there, and it was the only shelter in the country that would take pregnant refugees. And we were a team of volunteer that were working very hard to get them care and support, we had a lot of barriers for that. Financial obviously, but also language, culture, and trying to integrate people into a medical system that they had never experienced before, who were separated from their country, their culture, their language, their families. I met women who had to leave children behind in order to escape. There was a lot of trauma. It was a lot to go through while I was also pregnant. I had a very difficult pregnancy, I had hyperemesis with both of my children so that was hard. But my experience of working with those women and supporting them through their pregnancies and their birth experiences was really a very pivotal moment in my life where I really knew that my journey was to become a Maine midwife. And my drive as a midwife was that we must make birth better. This most intrinsically human of experiences to create more humans, to bring forth life, reproduction is the most basic function of all organisms - the way that we treat people during that process stays with them for the rest of their lives - this deeply impacts all of their being. And it deeply impacts this new person - we may not remember it, I don’t know anybody that remembers their birth - but I deeply believe the way we are born matters, the way we give birth matters, and if we are giving birth in situations that are unkind, or that worse are cruel and devoid of love, and compassion, and respect, and care, then we are harming our social eco system, in so many ways.
Michel Odent who is a famous Obstetrician in France, I have had the blessing of meeting him in person and hearing him speak, and he often talks about how the hormone of birth is oxytocin and oxytocin is the love hormone. And the feelings of love that one has during that time is so intrinsically important moving through birth, and moving through labor and birthing and bonding with our child. So much of what is being done in modern medicine with the birth process is really like trying to remove love from the equation and manage everything in a synthetic way, and disassociate from those most primal human aspects of reproduction - and he questions, if we are taking love out of the equation, what is that going to do, what is the downfall of that with humanity if we continue to try to do that, to take love out of the equation of being born? And that has always resonated with me very deeply.
There is absolutely a place for interventions, there is a place for synthetic oxytocin - for Pitocin - I am not against any of those things, I have seen them be incredibly important tools, but I don't think that they should be the standard of care in all situations. I don't believe that birth is pathological. Midwifery care at it’s foundation really believes that birth is a normal event, and we should treat it as a normal event until or if we are proven otherwise, and then we act. But intervention should not be preemptive, we should intervene when it is necessary and not because we are supposed to or because we think we should or because we are impatient.
So much of how medicine works is the attempt to standardize care, so everybody can have the same thing, well birth can never be the same for everybody and no birth can unfold exactly the same, so an attempt to standardize it would mean that you are trying to take away the individuality of that experience. I think, as Michel Odent says - and he wrote a book called Child Birth in the Age of Plastics - and it’s very much like that thing, like how do we just take all these other factors out of it and make birth mechanical instead of human. And I think we are seeing very much right now, how much that is harming birthing people, and women, and not just in this country but across the world. But especially in America where we are one of the only nations on earth where it is becoming more dangerous every year to be pregnant and give birth. And yet, for some reason that’s not appalling enough of a statistic to create enough of an urgency to change something.
It’s clearly not about a lack of resources, because we have the most resourced health care system in the world and yet somehow we are killing people. And we are killing them because we are trying to take the individuality out of care. If you have 7 minutes with a provider, and they can’t really get into the specifics of your lifestyle, your family dynamic, what does your social support system look like, what are your resources, what does your housing look like, what does your income look like, all of these things that we know impact peoples health and well-being, and we can’t do any of that, and then we’re like why is everybody getting sicker in their pregnancies, and then why are these people who are sicker in their pregnancies having more serious outcomes? Because we are not good at preemptive health care in America, we are good at interventional health care.
We are good at like, ok now we have an emergency we have to handle it, but we don’t really do anything before that point. And that is really leading us to become terrible at taking care of people. And I knew I was witnessing that, and I knew that I did not want to do that. I did not want to become an Obstetrician, I did not want to further the way the system was going, and I wanted to figure out how do I be a part of a different paradigm in maternity care? And with everything I was witnessing, and everything I knew, I knew I didn’t want to birth in the hospital.
So when I had my first child, I knew from the moment I was pregnant - I am going to have a home birth I want a midwife, I don’t like what I am seeing going on and I don’t want to be a part of it. I learned pretty early on that I couldn’t tell people that a home birth was my plan because as soon as I did I would be told - It’s too dangerous… what if this.. what if that... everybody had a what if, everybody was convinced that something would go wrong, or they wanted to tell me I can’t handle the pain or I can’t handle this or that.. It was very demeaning in a lot of ways, to constantly just be being told “you won’t be able to do it” and I was like, really?
Women give birth every day, all over the world, and if we couldn't do that then we wouldn’t exist as people, so why is everybody so convinced that it’s their job to tell me that I can’t birth their baby. But everybody had a story of their sister, their cousin, their friend who almost died giving birth and that is the reason you have to be in the hospital. But I had also learned through my experiences attending births in the hospital, of how often those complications and serious outcomes are a result of interventions that may not have been necessary, or was over-used, and what was that causing as well? And I had a lot of skepticism about- does everybody need to be induced? Does everybody need an IV? Does everybody need to have a c-section? That doesn’t seem normal, why is that what’s happening?
And that isn’t to say that emergencies don’t happen. I have been a Maine midwife for 8 years, I am well aware that emergencies happen, and that terrible things can happen, but it’s not the norm. And it has definitely in our culture become the norm. We believe inherently in our culture that child birth is unsafe and that bad things will happen. And I think that’s because that is becoming the birth story that most people have. But instead of questioning why is that the experience we are just saying birth is dangerous, and we need more intervention to make it safer. And we aren’t questioning whether these interventions are making birth less safe. And there is some pretty good data that shows that some of the interventions that we have as standard care are indeed creating harm. I was reading something lately that was talking about this idea that we have to do all this perineal counter pressure when the head is emerging to prevent tearing, actually is more likely to cause tearing - because your actually putting more pressure on the tissues externally and not allowing them to expand - like that makes sense.
All the things that are done in birth that assume that nature doesn’t know what to do, is always very interesting to me. I have witnessed this so much in the hospital setting, and it can occur in any setting with any provider, but definitely in the hospital there is a strong culture of - we must be hands on, we must do these things. And sometimes I see, especially residents, when they are doing all the cardinal, like the hand maneuvers for birth that they are taught - and I always think to myself, what if, they actually witnessed a birth and they just sat back, and they didn’t do that, and they got to experience the first hand knowledge that a baby can actually be born, and do all the things without somebody manipulating their head while it’s happening, and would that change their perspective? Because I understand if you have only ever seen that then maybe you believe that, that is what must be done. But we also know that if we start to mess with the baby while it is attempting to navigate through the pelvis, maybe we are going to cause a shoulder dystocia, maybe we are going to cause something to go wrong because why did we have to touch them during that process? They are doing it. I really feel like my job is to sit back and watch, and wait.
Clearly, as a Maine midwife, if I see something that is not normal, then yes, I am going to intervene and I am going to do it very quickly, and that is what I am trained at doing, that is what my skill is to do. But my skill is not to pull a baby out of somebody - because they are just coming on their own. And we should allow them to do that. We should allow them the TIME to do that. And as a Maine midwife every time I read studies that try to prove one way or another, I kind of have to laugh, because I think, why can’t nature be the baseline? Why do we have to prove that nature is ok in order to stop intervening? It is like we have to prove the intervention is wrong to stop the intervention from happening, when it’s like why did we have to intervene?
So I knew I did not want that, I wanted a home birth, I wanted a different kind of care. In Israel it was definitely more outside the norm to have a home birth. We have socialized health care there, but it did not pay for a home birth. We were young and did not have a whole lot of money, so it was a huge financial decision for us to make that investment. But I felt like we weren’t just investing in an “experience”, I think a lot of people view home birth as an “experience”. And I feel like the people that view it that way are people that have a negative opinion on it, they think that like, people are doing it to have these picture of them sitting in the tub, or some sort of aesthetic, or some sort of experience where the maternal experience is more important than infant safety. And I think that’s so silly, because for me, it was really about investing in my holistic health as a human being, and as a woman, and as a mother, and I am so grateful for it.
I had a 9 pound baby for my first pregnancy - I am 6 ft tall so it was not a problem for me - but I know, if I had a planned hospital birth that the standard of care would have been to do an ultrasound when I was admitted in labor, and they would have said based on estimated fetal weight, most likely they would have recommended a c-section. That was just the standard of care in that situation. And what a shame, because I didn’t need a c-section. And if I would have needed one or it would have been necessary, it would have been available. But it wasn’t necessary, so I was very grateful. I also had a very long labor, I had a very slow labor. I’m sure given the culture of care where I was and the environment that existed there, there would not have been a very high tolerance for me to be in labor for that long without saying I have to be on Pitocin or we have to do something else. Being able to be in my own space was so important to me. I had a lot of medical trauma, and the idea of having a lot of strangers around me or touching me, or being close to my body would have felt very unsafe for me.
So I really truly felt safest at home. It wasn’t just like I needed to be home to avoid intervention, it was like I feel safest to birth my baby in this environment, I felt unsafe if I would have to be in the hospital. And I honor and recognize that as definitely not true for everybody and I feel very strongly people need to birth in the place where they feel safest with the support people that they feel safest with - and for some people that may be in a hospital with an obstetrician and all of those kinds of resources, and for some people that might be a free birth, on their own, and everything in-between, and that it is really really important that we protect that level of choice, because I also believe that that is what makes birth safer and improves our outcomes.
We have been dealing something over the past few months in Maine about a bill that would potentially harm midwifery in Maine. We have been successful right now in pushing back on this bill, but we know these things come up all over the place, its not going to be the last time. And the infringement upon our bodily autonomy as women in America right now is horrifying, and I believe all these things are very much tied together. To tell us what we can and can not do with our reproductive destiny, and to tell us where we can give birth or with whom we can birth, it’s all about control. None of that control leads to healthier populations, it doesn’t we know this. It’s not my personal opinion, there is a lot of statistical data about that, in places where women have the least amount of options regarding their reproductive choices they have the worst health care outcomes, and that’s fact. And we need to protect that. I believe in that very strongly, because we need to have the right to chose what is happening with out bodies, and how those things take place.
I had a beautiful home birth. It was long and slow, but it was great. I was so happy about it. I felt like I needed a lot of time during my labor process to move through different things emotionally, and release those things. This was a very powerful lesson for me later as a Maine midwife too, to really understand how much comes up psychologically in labor, we are literally walking this path between life and death and existence, and I really believe it is the most sacred and holy of spaces to exist in, in that moment. We are quite literally a portal for life. I am Jewish, and in Judaism when a person is in labor they are considered to be between worlds. And I think that is very true, we really are, and that should just be so deeply respected, and treated with such incredible reverence and dignity. Any anytime that is not given to a person, we are really de-humanizing them and that will affect them forever. In my 15 years of birth work, I can’t keep track of people, like grandmothers - elderly women, they hear that I’m a midwife and they just want to tell me their birth stories, it just pours out of them. And so many of them have said, that they never were able to talk about what happened, and so many had very traumatizing stories of how they were treated, and how they weren’t listened to - especially people who birthed in the 50’s and 60’s in America - and weren’t told what was happening to them, weren’t given any options, had sometimes really horrifying things done to them as well, especially with scopolamine, and the twilight sleep, and all these things. These stories just pour out of people, because we also don’t give people the space to process these stories, we just tell them, you had a baby, your baby is fine be grateful.
We discount the experience that has on the person that gave birth, and how that will carry with them the rest of their life. How that will shape them as a parent, and how that will shape them through everything. Our birth stories are our most impactful, important stories of our lives. It is a transformation that nothing else can replicate. People will always remember how they were treated. They may not remember all the details of their birth, but they will absolutely remember if they felt safe or not, if they felt like they were respected or not, if they felt like they were listened to or not. And I felt very much called to be a part of like, we must change that. That should not be the norm. It should not be the norm to be traumatized by giving birth and then told you can’t talk about it.
So after my daughter was born, I had a really difficult time postpartum, I felt very isolated. I really didn’t have a lot of support, or enough support. I didn’t have enough people around me helping me understand that what I was experiencing wasn’t normal. So I really felt like it’s just me, and I’m having too hard time being a mom - instead of understanding that I was experiencing postpartum depression. Nobody screened me for it, unfortunately, nobody talked to me about it, and it just got worse. And I just thought, why am I struggling so much to be a mother? Why is this so hard? But I also knew I wanted to continue my pursuit to become a midwife, so we moved to America so I could go to midwifery school here.
Before I started midwifery school I became a certified lactation counselor educator, because I also really struggled with breastfeeding and I thought - Why can’t we get more help with this? This is so silly, I’m asking for help, and I still can’t find enough support. So I said, I've got to do something about that, because this should not be that difficult. I ended up breastfeeding my daughter for 3 1/2 years and it was a really important relationship for me to have, but I did have some trauma from it about how difficult it was for so long. I was feeling very isolated in that, because nobody was offering support, they were just telling me to give up. And I think, because most people didn’t know how to offer support. It wasn’t until she was older that I found LeLeche league, and that was very impactful.
Once we were in America and I finished the midwifery courses, we moved up to Washington State so that I could apprentice with a midwife there. I had a really immersive experience working with her, she is an elder midwife who has been practicing since the 70’s and I think it was a really good education for me in a different perspective of midwifery as well, and being trained by someone who became a midwife in a different time with different resources and different expectations as well. Everything was always really hands on. I became very good at palpations because everything was hands on, we never used the doppler until someone was in labor. Everything was just really grounded in respect, and love, and care. It was a wonderful experience.
Then I got accepted to Birth Wise midwifery school in Bridgeton, Maine and we moved to Maine. I did my preceptorship at a birth center in New Hampshire, which was great because I knew I really wanted my preceptorship to be very different than the other trainings I had. When I had started school, I had already finished - if you know about the NARM exam - to become a midwife you have to have a certain number of experiences, so I had already finished all of my observe and assist numbers at that time, so I came into school with a little bit more experience of attending births than some of my class mates, so when I did my preceptorship I started as a primary student under supervision. I knew that I really wanted to be in a different kind of environment and experience a different kind of midwifery there. It was nice because I had three preceptors at the birth center and one was a nurse midwife, so I got to see different styles, different approaches to things. A different population that was choosing birth center birth versus home birth.
At the very end of my preceptorship I became pregnant with my second child, and I fortunately was done because I had to stop going to births for a little while because I was sicker in my second pregnancy than my first, unfortunately. I gave birth to my second daughter 6 days before I graduated from midwifery school, so she came with me to graduation which felt like the ultimate full circle experience!
Toward the end of my pregnancy, I had also started a Maine midwifery practice with another student who was also graduating. We had already completed all of our requirements to graduate, but graduation was only once a year. And I did not take a maternity leave, which I have always regretted, because you do not get that time back. Even midwives need people to care for them after they give birth. My daughter came 15 days after her estimated due date, so it was a very long pregnancy. I was very excited at first to feel much better postpartum, than I had with my first. But a few months later, I did develop postpartum depression again. I felt it was a gift to be able to recognize it that time and to know, this is not how your supposed to feel. I think the hard thing the first time that it happened, so immediately with the birth, that it is so difficult then to know something feels different because I was a first time mom, how do I know that you are supposed to feel any different? I just thought you are supposed to be sad and overwhelmed all the time. And being much more aware of it the second time was good, and I chose to go on medication, which I feel like was a really important thing.
I have tried to do a lot with the families that I have worked with to reduce that stigma, because people don’t want to talk about postpartum depression. I think we still treat it as something that is shameful, as if it is somehow somebody’s fault and it’s not. So I like to be very open about it because nobody was open about it with me. And when I was experiencing it, it is very scary. And it can be very scary to have thoughts that you know are not ok to be having but also that if you tell anybody that maybe something bad will happen to you or your baby. Unfortunately in America, we also see that sometimes it plays out that way, people say I’m having these thoughts I need help, and then they call CPS and they take their baby away and that’s not solving anything for anyone. It’s not helping them feel safer, it’s not getting them the care they need. So I like to talk openly about it because it’s like, if someone has pre-eclampsia in their pregnancy is that their fault, do we blame them do we shame them? No. We tell them oh my goodness, it’s not your fault, it’s ok. But for some reason, if someone says I have postpartum depression or postpartum anxiety, its like oh, well what’s wrong with you, why don’t you love you baby, why aren’t you happy, why aren’t you so excited to be a mom? And we really negate the experience that this is not in their control. I have always been very passionate about postpartum mental health disorders for those reason as well. I survived postpartum depression twice, I don't say I lived though it, I survived it - because it is also one of the leading causes of maternal mortality in America.
We are not doing enough to address that either, to talk about it or to offer enough support. We don’t have the village, it’s not coming to feed us and care for us and hold our baby when we need a break. So I feel like the more we talk about that openly though, then we can change the consciousness around that and we can hopefully shine a light on how important it is to have that community and to have people show up for you when you say like hey I’m not doing good, I need help. But I know so many moms are afraid to say that, they are afraid to say that. Everybody see’s you and they’re like how are you doing and your like “great” , but maybe you don’t feel great, but your scared to say that your not feeling great.
So I think it’s important, I wish more people would talk openly about it, and that our providers would have open honest conversations with their patients about it. Just having someone fill out the questionnaire is not addressing the realities, and there are some good studies out there too that show that often people fill out the surveys but then even if it is clearly shows that this person is experiencing a postpartum mental health disorder, nobody even does anything. The most common time it is identified is actually by pediatricians, not the mothers care provider. If you give birth in a hospital with an obstetrician you might see them one time postpartum at 6-8 weeks, and if you have a 10 minute visit with them, are they really going to do something about it? But if the pediatrician sees you three times they might notice something, or they might ask you about it. But also, they are the pediatrician they are not your provider, so what are they doing about it? They aren’t sending you somewhere either, they just hand you a list of resources and say go get help. That’s not helping people.
So I feel like I had a lot of different experiences through having my own children, that really helped shape me as a Maine midwife and to see that perspective of like, oh why is this like this, and why are these things missed? And to understand those things myself and yet I still couldn’t get the help that I needed, when I knew that I needed it. It’s like if you are in a position of so much privilege to understand all these things, and to know how the system works, and to know what’s available, and yet you still can’t get it when you need it. It only teaches me, the people who don’t know what the resources are, they are definitely not getting it. That is really unsettling. I see people get asked these questions but it’s like what are they doing about it? Are they sending a social worker to come hang out with you at home, a visiting nurse? Is everybody getting a postpartum doula to come make them a meal? No. So how are we taking care of people who are at risk. And I just feel like there are so many layers to the system from before you get pregnant to after your baby is born that we are just falling people and it is so upsetting to watch.
Last year in the fall I decided I was going to apply to grad school to get a masters in public maternal health. It is really the policies that are killing people in America, it’s not a lack of resources. We have money, we have the things. Yes there are places where there are maternity care deserts for sure. But we aren’t dealing with a system like oh we can’t get medications, or we can’t get electricity. I follow very closely this birth center in Haiti called @mamababyhaiti and just the things that they deal with I can’t even fathom sometimes how they carry on. And what an incredible life saving force they are for the community there, and they can’t get the most basic of supplies sometimes. And in America we have everything, sometimes I freak out at the amount of stuff getting thrown out at the hospital because its like ahh you don’t even know! They can’t get running water and your just like yeah what’s another one, toss it in the trash. We can’t keep moms and babies safe in this country? That’s unacceptable.
So I am starting my sebaticle soon for my Maine midwifery practice. I have one more baby due right now, and then I will be in school in the fall. I have decided, we have to change these policies, this isn’t working. Do we need more studies to tell us why people are dying and we do nothing about it? I just watched a congressional hearing about it. It’s like, it’s not like we don’t know, we know, and for some reason, we literally just do nothing. I don’t understand that. Not even to speak of the desparaties based on race or socio-economic status, and rural vs urban locations, the desparaties in health care in this country are so insane to me. That should not determine whether or not you live. That is so unacceptable, so we clearly need more people to change the policies. Because the polices are dictating this care. And the care is not adequate.
Angela: Yeah, I completely agree! So how long will it take for you to get your masters in public health?
Ariel: A year, I got into an accelerated program at Harvard because I have been a health care provider for a number of years already. So I will be in a cohort of all people who are mid-career professionals which I am really excited about. It was a big part about why I wanted to be in that program, I knew that I wanted to be with other people who know exactly what it is they want to change in the system, and not people who are not yet familiar enough with the system. I want to be with all the other burnt-out health care providers who are like “screw this, we have to change it”! Because those are the people you want fighting for policy, the people who know how wrong it is, to be honest. Not that it should be like that, but it is. So I am really hopeful that I am going to be able to access those things and work on those kinds of projects to hopefully create real change. Because every day we aren’t doing that people are dying, and that’s wrong. And I think even just to not focus on the mortality, but people are being harmed by it every day. Like I was saying, it should not be that the normal birth story is one of trauma. We need to change that. We have to change that with a very different approach to care. And one that is not grounded in uniformity but really grounded in honoring the individual, and protecting the individual experience. And our system has become such that it is very mechanized, it is very factory like.
We try to guarantee quality with every outcome but we are not getting the quality with every outcome, so clearly the more we try to create a uniform way to care for people, we are un-intentionally creating more harm. And I think that is what is so beautiful about midwifery care, is that we are so focused on the individual, and how do we care for the individual. And that’s what I really love about my practice, is I just really get to know people. I know who they are, I know their family, I know where they live, I know what they need, I know what resources they have and don’t have, we talk about postpartum planning and all these different things and we give them the space talk about it. I know their other children, I know their dog, because that’s part of their life, this is all going to be part of their experience. I sit with their mom at their birth and I love that because I know them. I know how to help them as much as I can. I know what resources they might need. I know how to fill those gaps when I can.
But it’s also very hard because you have a tremendous amount of responsibility in that way then. There is a lot of burnout to carrying all of that liability on your shoulders and not being able to share that with others. In a hospital there is a whole team of people that share that together, and at home it’s me. And I take that so seriously. And I take that with my whole being. Because if birth does not unfold the way that somebody had envisioned it, and I know how they envisioned it because we have been talking about it for months. I feel it so much in my heart, because I want everybody to have what they envisioned, but I also recognize that birth does not always unfold in that way, plans sometimes have to change. We have to adapt to things that we weren’t expecting. But, I care for people so much and I want them to feel so good about things, even if it’s not what they had exactly envisioned or planed for. But I want them to feel good about it, because I think when people feel that their autonomy was respected, that they were leading the ship, they were making decisions, they had the opportunity to really be conscious about those decisions - not just like, will you consent to this, right now, sign this thing - then even though when it’s not exactly what they had planned for and envisioned, they can feel at peace with it. I think often the trauma comes not just from a birth that wasn’t what they expected, but when they felt like nothing was in their control. That they weren’t even a part of what was happening, even though it’s happening to them.
I have seen that too much unfortunately, where nobody is asking you things, nobody is just slowing down and explaining it and talking you through it and explaining to you what your decisions are. That is often I think, when people feel really traumatized, because they feel like everything is happening to them not with them. And I think no matter how a birth unfolds, that is always just a very main focus of mine. I always want people to really know what is going on, why, what decisions can we make at this point, what do those options look like? And in the very, very rare moments where there truly is not time to have those kinds of discussions, I feel like the benefit of having built these very deeply personal relationships over 9-10 months of care, is that in that moment if I say “we need to do this and we need to do it right now” people trust me, and they trust that I am making that decision with their best interest at heart and that this was absolutely the most necessary thing to do in that moment because they know that I trust them and they trust me, and that consent has happened as a part of our being a team together through their pregnancy and birth, and that I am not going to do something to them that wasn’t necessary in an emergent situation, and that if it’s not an emergent situation then they have the time and autonomy to make that choice about what they want and don’t want.
Angela: absolutely! Is there anything you would like to add?
Ariel: I think I am in a moment in my life where I am really reflecting on what my career has been and what my journey has been. It is a lot, I have this one birth left right now before I start school, and I really feel like I am sitting on my own precipice to go through my own portal.
I have had a lot of people ask “when are you coming back, because that’s when we’re going to have another baby”. I think the truth is right now, I don’t know. I am very open to where things take me. I think I will ever not be a midwife, for as long as I live. Midwifery is not a job, it is a role that we have. As much as I can never not be a mother now, I really believe I will always be a midwife. It is really the lens I see the world through. But I don’t know when I will return to practicing as a Maine midwife, and how that will look exactly. But, I am really passionate about creating low barrier access to better prenatal care. I really truly believe that is something that can have a dramatic impact on birth outcomes in this country. We are kind of at this point where it doesn’t matter if people get sick because we will just induce them. That should not be how things are happening. We need to have really holistic prenatal care and that should be the foundation not the exception. So I am really passionate about bringing that sense of what midwifery care looks like, that needs to become far more accessible to the greater population and that needs to be integrated into the larger system of maternity care in this country. I am really driven to making that happen. I am excited to see the things that come next and the things I am going to get to work on in school. And the opportunity to work with people who are coming from all over the world to be part of this program because we want the same things - to improve maternity care. I am just really excited right now about what that opportunity is going to look like and what will happen as a result of it.
Angela: yeah, I am so excited to see what you do with that! You have already put in a lot of work here with other Maine midwives on the bill LD 1205, do you want to share a little bit more about that?
Ariel: yeah, so right now it has been postponed until the next session. It won’t be heard this session. Which took a tremendous amount of work but I think we have shown that the midwifery community is strong and we are not going to go silently about anything. We are quite tenacious and we are quite determined to continue to serve the families that we work with and to continue to improve birth outcomes here in Maine. When we look really closely at the date, we have wonderful outcomes. We are creating a system of really wonderful care that is supporting families and leading to really positive things for them, and we are going to continue to do that. We are not going to just be stopped because large corporate medicine doesn’t like that. I feel very, very strongly about those things. I was talking earlier about autonomy and the right to make your decision about your reproductive fate. We can not legislate where people can have their babies, and how and when. And any attempt to do so is going to be met with a tremendous amount of pushback, and I think maybe the people who proposed that bill didn’t realize how hard people were willing to fight for that. And maybe they thought it would be a little easier for them to take away some of those rights. But I hope that message is coming out really loud and clear to them that it is not going to go that way here, and I don't want it to go that way in any state in America. Especially all the states that are working so hard continuously to get midwives licensed, to get them access to basic resources, to protect the choice and place of birth, all of those things are incredibly important, and we need to keep fighting for that on a really large scale.
I am hoping - I’m not a native Mainer - but I know the saying - “As goes Maine, So goes the nation” - so I really hope that since this was the first bill of its kind that any national organization was aware of, and it was here in Maine, and I really hope that it sends a really good message far and wide that we aren’t going to let it happen here and we aren’t going to let it happen anywhere.
Angela: Absolutely! Well thank you for all of your work pushing back on LD1205, and thank you SO much Ariel for sharing your story today.
Ariel: Thank you, it was great to talk to you!
You can find Ariel online at https://www.sacorivermidwifery.com
You can Ariel on Instagram https://www.instagram.com/sacorivermidwifery/
And on Facebook https://www.facebook.com/sacorivermidwifery
That was MyMaine Birth. Thank you everyone! I would love to hear your feedback about this episode! Shoot me a DM over on instagram @mymainebirth and let me know what you thought! If you haven’t subscribed already, that is 100% the best way to support the show! You can listen wherever you normally listen to podcasts or https://www.mymainephoto.com/mymainebirth
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