Something Was Wrong - S23 E6: Dignified Maternal Care with Doula Melissa Espey-Mueller

Starting point is 00:00:00 Wondery Plus subscribers can listen to Something Was Wrong early and ad free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts. This new year, why not let Audible expand your life by listening? Audible CA contains over 890,000 total titles within its current library, including audiobooks, podcasts, and exclusive audible originals that'll inspire and motivate you. Tap into your well-being with advice and insight from leading professionals and experts on better health, relationships, career, finance, investing, and more.

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Starting point is 00:01:24 dollar criminal empire. Every suspicious text you ignore masks a huge network of compounds where thousands are held captive and forced to scam others under the threat of death. Follow Scam Factory on the Wondery app or wherever you get your podcasts. Something Was Wrong is intended for mature audiences. This season contains discussions of medical negligence, birth trauma, and infant loss, which may be upsetting for some listeners. For a full content warning, sources, and resources, please visit the episode notes. Opinions shared by the guests of

Starting point is 00:02:00 the show are their own and do not necessarily represent the views of myself, broken psychomedia, and Wondery. The podcast and any linked materials should not be misconstrued as a substitution for legal or medical advice. Origins Birth and Wellness owners and midwives, Kaitlyn Wages and Gina Thompson, have not responded to our requests for comment. This season is dedicated with love to Malik. You don't know anybody until you talk to someone Hey friends, firstly I want to say thank you so much for your support of this season and of the survivors.

Starting point is 00:03:13 We are so thankful to hear that many of you have been feeling validated by the survivors sharing their experiences. Last week we had the honor of traveling to the iHeart Podcast Awards at South by Southwest, where Something Was Wrong was nominated for best crime podcast for the second year in a row. To celebrate the day before, we held a small private meetup party to test these kinds of events for the future, and it went incredible. It was so wild to meet friends in person and experience live discourse, feedback, and community.

Starting point is 00:03:47 Thank you to everyone who attended. We hope to host similar events in the future to raise funds for local nonprofits that serve survivors in the cities we visit. If you're interested in attending an event like this in your city, please let us know in a new or updated review by adding a PS at the bottom and telling us the city you'd like us to visit. Now, before we get into the more investigative portion of Season 23, the coming together of these incredible survivors and their ongoing efforts to help others, and the ongoing legal investigations of Origins Birth and Wellness, we wanted to share Adula's perspective. Adula's perspective is unique and important because they typically work with birth

Starting point is 00:04:32 clients and health practitioners in many settings. As a reminder, Adula is a birth worker, typically without formal obstetric training, who is employed to provide guidance and support to a pregnant person during labor. We are thankful to Dula Melissa from North Dallas Dulas, who previously worked directly with survivors who were clients of Origins Birth and Wellness Center. I'd like to also thank our associate producers, Amy B. Chesler and Lily Rowe,

Starting point is 00:05:02 for conducting this interview while I was unavailable. Longtime listeners will recognize Amy's voice from season seven of Something Was Wrong, where she shared the harrowing story of her mother Hadassah's senseless murder at the hands of her now convicted brother. Amy, or ABC as we call her, is also the talented host and co-creator of our short-form docuseries show What Came Next. ABC is an incredible interviewer, host, and human. The Broken Cycle Media team is thankful to have her important perspective. We'd also like to celebrate and give a shout out to ABC's newest podcast, Familicide, which

Starting point is 00:05:46 she co-created with Sam Metler, the creator of A&E's hit docu-series, Intervention. Links to ABC's new show, Familicide, and North Dallas Dulas, can be found in the episode notes. Thank you so much. Episode Notes. Thank you so much. My name is Melissa Espy Mueller. I am the owner and founder of the largest doula practice in the state of Texas. I currently serve as a certified birth doula, a certified childbirth educator,

Starting point is 00:06:26 a gynecologic teaching associate for Texas A&M University. And I also work as the director of prenatal education at Baylor University Medical Center in Dallas, Baylor Scott & White McKinney, and Medical City of Los Colinas. Those are three hospitals here in the Dallas-Fort Worth area. I have been practicing as a doula for 25 years, and I have attended just over 3,500 deliveries to date. Doulas are held accountable to the highest standards by their certifying agencies.

Starting point is 00:06:56 There's usually a program that they will go through to become certified doulas, and those organizations require many different things. Sometimes there's codes of ethics, there's practicing in the scope of a doula. I certified with DONA, which stands for Doulas of North America. And Doulas of North America is an international certifying organization. That is where I certified initially. And then eight or 10 years later, I did an additional certification with ProDula, which offered me elite Dula certification, which is for people who are more experienced Dulas. So there's a list of things they want you to have in order to have that certification, which becomes a lifelong certification. I

Starting point is 00:07:46 personally did both of those things, but there are many other certification agencies that are well known. But what you're looking for when you want to certify is the pathway that fits you the best. For instance, the doulas who work here with me, many come out of the field of nursing. Perhaps they've been a labor and delivery nurse for over 10 years and they say, Melissa I'm really interested in shifting careers and becoming a doula. What do I need to do? I don't know that I would encourage them to go through Dona. There are as many things you have to do. You have to do some reading. You have to write some papers. You have to get signed off by doctors and nurses.

Starting point is 00:08:27 That particular person has kind of done all of that and then some. So I might encourage them to go somewhere like Medrilla, which is an online certifying agency, because they don't need as comprehensive a training course per se. Whereas somebody who's never been in the field, never walked with someone through the birth space

Starting point is 00:08:47 or maybe only walked through it with their sister or their best friend, those people really need something more comprehensive where they're going in and sitting in a classroom with other people who are asking questions. They are learning hands-on. I never sought out to become a doula. I actually was in school at Dallas Baylor University Medical Center and at the time was a single mom

Starting point is 00:09:12 they were paying for my school and I was working as a hospice care provider. I thought that I would follow through into the nursing career working in hospice care which is taking care of people who are transitioning out of this life. And then my unit closed due to funding and I found myself without a set job there, if you will. So they still employed me and I went to different floors every day, but I was finding that nothing felt quite right. I happened upon an article that was talking about this woman who was a doula, and I thought, wow, that is so interesting. Let me look into this, and I ended up calling that woman, and she became my mentor. I took her workshop one or two weeks after that article that I read had come out.

Starting point is 00:10:02 It was everything I loved about hospice care, which is comfort, dignity, education. If I could do this on the other end of life, that would be so incredible. You know, it's happy endings. Taking care of people in the hospice world, you'd fall in love with them, and you knew that ultimately they were gonna pass.

Starting point is 00:10:22 It was really rewarding, but also draining. So I went and worked for an obstetrician here in Dallas. He had a giant practice and truly they helped build my practice. I thought to myself, I want to do this and I want to do it at the highest professional level. And that to me meant that I needed to have a very good team in order to support me. For it to be sustainable, I knew that I needed doulas who could also take clients with me

Starting point is 00:10:53 and who could serve as my backup if I was sick or broke my leg or had to go to a funeral or whatever. I didn't want someone to hire me and something like that happened and I wouldn't have anyone to send their way. So I put this practice into place, which is North Dallas Doula Associates. I modeled it after the physicians that I worked for. We have been doing it since 1999 and I again didn't intend to do this. It seems kind of like it was gravity, like I was just pulled into it, if you will.

Starting point is 00:11:25 And it now has become for me less of a job and more of a mission. I feel like it's truly a divine assignment. I never get called at 3 a.m. with someone saying they're water broke and think, oh crap, I have to go to work. I am like, okay, today's the day. It's not lost on me.

Starting point is 00:11:42 There's such a level of gratitude that people trust me enough to invite me into their space and allow me to be a witness to this experience that is so transformative and transitional in a person's life. Birth and postpartum doulas provide informational, emotional, and physical support during pregnancy, labor, and the postpartum period. We're not offering clinical support. It's different for everyone, clearly, as far as how long their actual birth is going to take. We spend a lot of time with people on the front end guiding them through what the phases and stages of labor might look like. But they're not a textbook textbook so just because early labor is usually more comfortable or manageable you may not feel that and you may need your do list sooner.

Starting point is 00:12:33 But usually we have helped them find ideas of things they can do through early labor. That might look like if it starts at night these these very sporadic period-like cramps, that maybe you're going to take a nice warm bath, get a massage, and try to sleep as long as you can. Then if you wake up, give me a call. Or it might be happening during the day and they're like, well, I've got a few things to do at my office. Then I'm going to do a target run.

Starting point is 00:12:58 Then I'm going to get a mani-pedi and then I'll call you. Early labor a lot of times is just staying distracted, resting if you can, or staying busy if it's daytime. But we're talking every one to two hours usually, unless they're asleep. There's a lot of communication. Once they cross over and they're having more patterned contractions that are making them pay attention and stopping them in their tracks, that's the time we'd like to be with them. The goal in joining them is to be as active as we can. Think about positions that are gonna help facilitate progress, we are thinking about how are they doing

Starting point is 00:13:35 in their head and heart space? Are they hydrated? When's the last time they ate? Have they emptied their bladder? How are they managing their pain? We're helping them through all of that and helping to guide them on things like, oh, now we should go to the birth center,

Starting point is 00:13:50 or oh, now we should go to the hospital. And then once we get there, whether it's a birth center or the hospital, then there becomes a lot of interpretations. We're helping them interpret some of the things that are being offered to them or what they're signing as far as consent forms go or what they can request as far as amenities. There's a lot going on there. So a lot of times we're joining them around that time when things start to pick up. And then

Starting point is 00:14:14 we stay with them all the way through pushing and during pushing, we're helping them find productive pushing positions, thinking about ahead of time their recovery, what pushing positions are going to help facilitate less tearing, less drama to the perineum, have we spoken to their chiropractor, have we spoken to their physical therapist about best pushing positions, how can we help facilitate that? Because we've got that knowledge ahead of time and we're all working collaboratively, so we will stay with them through pushing. And then usually about one to two hours post delivery to help initiate feeding, especially if they're planning to

Starting point is 00:14:52 breast or chest feed, like we want to make sure that we're helping them get off on the right track. So we don't usually scoot away until that is all taken care of and they're feeling as good as they can feel for the first time that they've ever put a baby to breast. That can range in time. We could be with someone for six hours, 12 hours. We had a doula that recently was on and off with someone going through a long induction for three days. If someone chooses, for instance, to get an epidural and we've all been laboring together for the last 10 hours,

Starting point is 00:15:26 and I think, sister, what you should do is sleep for an hour or two, and I think then we'll be close to pushing, I might run across the street to my office and take a nap too, set my alarm, come back in two hours and finish it off. We do our best to navigate that based on the situation or the circumstance for our people.

Starting point is 00:15:43 On our team, we will tell you in advance that if we have been with you 12 to 18 hours, that we have the right to tap out if you're not close to delivery and call in one of our backup doulas to take over because I believe that people pay for a doula who's at 100%, which means that they're gonna be there to think clearly for you and then

Starting point is 00:16:05 help you through the physical part of labor. That's just how it works for our team. I'm not sure exactly how other singleton doulas do it. I will add that if someone has experienced trauma or if they're moving through something that was unforeseen and is in the higher risk category or a huge detour from their birth plan, we're probably not going to ever leave them. We're going to be with them throughout that and help them navigate it because there's clearly something going on that was not planned. One thing that is hard for us as doulas to help navigate is you oftentimes will have

Starting point is 00:16:41 this person whose desire is to stay out of the hospital and it can be somewhat rigid at times, especially if there is trauma in the past and all of us bring baggage to our birth experience. We don't always know what that is until we're experiencing it or triggered by it. We can have a client who is just adamantly opposed to transferring and everything in us is thinking that's what needs to happen. And you see the provider really encouraging that, but there's a lot of pushback. And we've seen the flip side where the client is unsure of what to do and everything in us is thinking we should transfer, but we are not a clinician and we don't make those

Starting point is 00:17:22 calls. All we can do is give the information that we think will allow the client to make their own choice. And then we're there to journey with them post-delivery, reflecting about their birth. There's a lot of things that we see as doulas in the background. A lot of ways we do our best to bridge the gaps.

Starting point is 00:17:44 I think that that is 100% the doula's role. It's not necessarily the industry as a whole more so than it's the individuals who have to take accountability and stand up for leaving birth better than they found it. And that means that we don't have time for people to be dismissed when people say, oh, all we want is a healthy mom, healthy baby. No, people deserve more than all of that. That is their birthright to have. But they need to be seen and heard.

Starting point is 00:18:15 They need trust. They need to feel 100% sure that they are not going to experience racism, that they are not going to experience racism, that they are not going to be dismissed, that they're not going to be further traumatized or assaulted in the birth space. I want them to have their own voice. I want them to find it and I want them to use it. So giving them the information to speak back,

Starting point is 00:18:41 to ask questions, to speak what they need at the time and not be fearful of it is important. If there's something within us saying, I need to go, I don't wanna be here, I feel like I should transfer, or I know that everything in me wanted to avoid the hospital and didn't want an epidural and didn't want pain relief, but now everything in me thinks that's what I need to do. So often we ignore the voice inside our head.

Starting point is 00:19:10 We shut it down, we turn it off. We're taught throughout our lives, especially as women, to just push that down and move forward. Don't hurt other people's feelings. Be polite. Do what you're supposed to do. This isn't the time for that. And for me as a doula, it's important that I make sure that people know what their options are

Starting point is 00:19:31 so that they can speak those words and say what they need to do. We do sometimes once a transfer happens, experience in the hospital, a little bit of pushback from staff, kind of like, oh, so you thought you were going to do this naturally at home and now look where you are. It's not outwardly said necessarily, but it's felt and that needs to change. And that is something that I feel like we could do better

Starting point is 00:19:58 at as a birth community, at figuring out how to connect and collaborate to keep that from ever happening. I know where I work at Big Baylor, there's an outreach coordinator whose sole job is to do that, and I think she does a fabulous job. It's definitely something that the nursing staff is very aware of and mindful of, but that's not everywhere. Texas is giant. What do you think is unique to the Texas maternal health system or the birthing landscape in Texas? The culture of birth here is, I feel like in a lot of ways, it's amazing. But I think it's hard because although we want to have

Starting point is 00:20:42 accountability and we want to have accountability and we want to have oversight and we want to have regulations, it's not something we want to do to the birthing person. For me personally, as a survivor of violence, as a brown indigenous woman, I feel that sometimes I have to be even more protective and preemptive of the clients that I'm serving, especially in certain circumstances. It comes from Black and brown women being completely dismissed in their birth space. I have had experience where, for instance, I was at a hospital and overheard a nurse saying this person's coming in on the ambulance.

Starting point is 00:21:30 She's screaming and acting like perhaps she's going to push out her baby, but when she gets here, she's probably going to be one centimeter and it's just that Hispanic panic, those types of things. It comes from blatant racism. One of the things that I'm very fortunate to do for the Baylor Healthcare System is to have a place on their prenatal internship panel. So I get to speak to the new nurses who come in as interns who are going to work in the women's and children's service line. And it's system-wide, so it's not just here in Dallas, it's anyone who comes into our hospital system.

Starting point is 00:22:10 I get to speak about dignified care, I get to speak about women who are being dismissed, I get to speak about racism and dignified care. It's one of those things that every time I speak about it, the room gets quiet and people are so surprised. How are we not more aware of this? When it's so obvious and in front of us, black women are dying at an unimaginable rate. It's something that no one person can take care of alone because Texas has so many deserts where there's no care unless a midwife, usually an LM or CPM, can travel to you and take care of you. If there wasn't that midwife,

Starting point is 00:22:51 that person may not get care. They may be having what's called a free birth, which is a birth that nobody attends. It's just the two parents, sometimes a friend or sister. But a lot of people believe the key is midwifery to helping with these mortality rates in the state of Texas. We see amazing outcomes in that field of midwifery every single day. And because we are having these issues

Starting point is 00:23:19 where there's this care that people are not at bare minimum practicing standardized care as midwives. It's kind of ruining it, if you will, for all the people who are not only doing this right, but doing it to the highest level and sometimes not even getting paid a fair wage for it, because they are the ones who are serving the people who are here without a green card

Starting point is 00:23:41 and afraid to go to the hospital because they may get in trouble, or the woman who doesn't afraid to go to the hospital because they may get in trouble, or the woman who doesn't want to go to the hospital and experience racism and be dismissed. Imagine this. You help your little brother land a great job abroad, but when he arrives, the job doesn't exist. Instead, he's trapped in a heavily guarded compound,

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Starting point is 00:24:40 Follow Scam Factory on the Wondery app or wherever you get your podcasts. You can binge all episodes of Scam Factory early and ad free right now by joining Wondery Plus. My relationship with the local hospitals, it feels to them that I can offer them a little more guidance in a place that I'm very familiar with. I think last year I did a little over 100 deliveries. I do less than a dozen home or birth center births in a year. So it's definitely not for me my primary place to support people. We do work with many certified nurse midwives in hospitals. I would say over 50% of the people I serve

Starting point is 00:25:29 are seeing a certified nurse midwife in the hospital setting. That could be because they are not at the lowest risk level, so they wouldn't necessarily be able to deliver at home or a birth center, but they could deliver in hospital with a nurse midwife and they're searching for and hoping for that midwifery model of care experience.

Starting point is 00:25:50 Working probably in the last eight to 10 years, the large majority of people who seek me out are on the list of high risk. They are a lot of times advanced maternal age. They are vaginal birth after cesarean. I've had a lot of people who don't identify as women who are coming to me, a lot of people who've experienced birth trauma, or are survivors of domestic violence or sexual assault.

Starting point is 00:26:17 And I think because I have been doing that work for so long and doing it within the hospital, it just tends to be who is coming my way. One thing we've heard consistently is the birthing community, especially in Texas, is small. Did you have a relationship with Origins? I think that most doulas in the Dallas area have had a relationship with Origins, meaning that we have served as doulas for clients that deliver there. I will say that there has been a lot of ebb and flow as far

Starting point is 00:26:54 as that particular birth center goes. I've been doing this for 25 years. When I had been doing it about three years, I actually went to work there when it was Birth and Women's Center and a CNM owned it. And she was this fierce woman, just an amazing preceptor. People were a little afraid of her when she trained them, but in a good way because she just demanded so much of you. I mentored under her for a while just to learn more with the idea that perhaps I would shift into another role in some time in my life. And then the new owners that you guys have spoken of purchased it. As far as origins goes, there was a shift in the number of midwives who were there,

Starting point is 00:27:39 whereas you used to just have one or two. This became a place of training. So they started training midwives. And so then you would have lots of students there. And it wasn't quite as intimate as it used to be, was what I had noticed there. Doing business in this profession, you're doing it to earn your living. You're not doing it to get rich. I think the vibe changed in that way, because some of the services that were added made people feel that way because some of the services that were added made people feel that way,

Starting point is 00:28:07 but we didn't work with them or chat with them often unless we were serving somebody. Our practice does what we call doula round tables. Whenever there is an issue in the community with a provider or an experience that we've had, we will get our team together and we will talk through it with that doula, what could we have done differently, what could we do better? Do we

Starting point is 00:28:28 want to refer to them again to check ourselves, to be accountable, to make sure that we're providing what we're promising? We had many in regards to that birth center, and a lot of it had to do with decisions based on transferring. Personally, I wonder if that happened because there was a lot of it had to do with decisions based on transferring. Personally, I wonder if that happened because there was a lot of pressure put on these brand new midwives and or student midwives to make these calls or judgments.

Starting point is 00:28:55 On the flip side, their bosses who pay their paychecks have an expectation for them not to transfer too soon. So there's a lot of wonder what is actually causing that. Is it truly that newer midwife who's at fault or was it the guidance that she received or didn't receive? That a lot of times would be some of the discussions that we would have because we couldn't understand why that was unfolding so often and the outcomes were not good. For instance, we were having people who would be in labor for three and four days

Starting point is 00:29:31 and sometimes be like eight or nine or 10 centimeters. And usually when you're eight or nine or 10 centimeters, you're about to have a baby. You're not waiting 24 more hours. You have early labor, active labor, transition, pushing. Transition, we always say, is the hardest part of labor, active labor, transition, pushing. Transition, we always say, is the hardest part of labor, but generally the shortest, and that's eight to ten centimeters. It's really hard on the person giving birth because those contractions are hard and fast.

Starting point is 00:29:56 You're doing every single thing that you can to move through it. I mean, I've had five children and I've had them all naturally, completely drug- free. And I remember getting into transition and just like literally leaving my body. You just think, well, I've come too far, I've just got to move through it. Even when I've been with people in hospital, if they get stuck in transition and their contractions fade out and something is changing, there are interventions that sometimes can help protect

Starting point is 00:30:23 the energy level of that person because what we have to think about is, I know this person wanted a natural childbirth, they wanted to avoid interventions. If I get them there naturally, are they going to have the energy to push? So for me, you also have to be protective of that. You have to think that it's not always about the pain of labor, it's also about the duration. And if we are leaving people in this duration for so long that they're so depleted, they're dehydrated, they are outside of their body, their body is starting to shut down, it's not even contracting anymore, they need help.

Starting point is 00:30:58 Because it's not now just about that natural birth and worrying about the pain of labor, it's also now this duration that we've been in and it's not meant to take that long. All we have to do is listen. The story that the body and the baby are telling us is that I'm over this. I'm not going to keep doing my job. I'm not going to keep pumping out oxytocin for these contractions to happen and this is an optimal. So sometimes people need help to realize that and move through it with that person and for that person so that they can be protected. We would have conversations about what that looks like and how we could best support our people when the duration was that long and

Starting point is 00:31:37 that is unusual. Those outcomes would end in prolonged rupture or babies who have had different types of trauma. And why was it happening? And was it that the pressure was being put on these newer midwives or student midwives to make the call rather than the business owners not putting eyes on these people? And that was a disservice to not only the patient or the client, but also to those midwives who were doing their best to learn and receive guidance that perhaps they weren't. But again, this is us just looking through the window. We don't actually know that's true. This is just us having these roundtable discussions about what could we do and what could possibly

Starting point is 00:32:18 be happening. There's all kinds of things, and this is not exclusive to originsins. That could happen anywhere, but that was primarily what our issue was. There were doulas in my group who would say, well, Melissa, should we stop serving clients there? And then another doula was like, they need us to serve them even more. That's the truth. And on the flip side, too, we had instances where doulas were our clients and came to us and said, we don't want you to be our doula anymore.

Starting point is 00:32:49 Our midwife or someone who works at the birth center told us that we don't need you, we don't want to move forward. And we could only assume that was because we were giving people information or more options on kind of questions to ask, etc. We never ever are in the business of shit talking providers. That's just not who we are. So we would never do that. But we do give people questions to ask their providers. If someone comes to us and says, I'm not being heard by my provider, well, we'll talk with

Starting point is 00:33:20 them about ways to communicate and things that they could ask. Or if their provider is recommending something that they're adamantly opposed to, it's a relationship. We want them not to be afraid to have those conversations. We'll help them find ways to have that and I think we might have been doing that a little too often. I don't know but we were getting people who had paid us and we'd been working with and all of a sudden they would come to us and say, our midwife told us that we don't need you anymore. And that was really unusual because that isn't something that happens for us often at all, but it was happening

Starting point is 00:33:56 there more and more. To clarify at origins. Yeah. What would you say to birthing people, even when they're empowered, they're not quite in the right mind because they're in their birthing brain, if you will, and the trust is then broken through a series of actions that was prioritizing a lower transfer rate than their own health? You have a birth team for a reason.

Starting point is 00:34:22 It's not just you and the midwife. It's not just you and the midwife. It's not just you and the doula. You usually have also a support person. So that could look like your partner, your sister, your mother, your best friend. That is someone who ideally is the one that might be coming to your visits with you or doing your childbirth class with you or coming to your doula visits with you and listening to all of your hopes and plans for your birth experience. That person oftentimes is the person that could also help speak up for you in times

Starting point is 00:34:53 when you cannot speak for yourself. Part of my role a lot of times with the couples that I serve is to also empower the partner. This is a culmination of your love story. This is your experience too. When your baby turns 18 years old, I'm not going to remember it. The midwives not going to remember it, but you guys are going to remember it and you're going to remember it vividly. So it is your responsibility and your right to have a voice and a choice in your care. And if she cannot speak because she's gone to labor land, you can speak for her.

Starting point is 00:35:28 This time before you deliver is an opportunity to talk and walk through everything that could potentially come up and decide if it does, what are some things that you guys have talked about and you feel comfortable doing. As a doula, at around 35 weeks, we do a birth preference meeting with our clients and we have a template that we use. It's like a worksheet. And we go through every single

Starting point is 00:35:50 thing that might come up, questions that would be asked of you, even in emergencies, things that they're going to offer you for your baby. So that if you're going through that and you are outside of your thinking brain and in this primal space, either your partner can speak for you or you shared with me your point of view so that then I can say, oh, I think that she had hoped for this. Those conversations should be had ahead of time. It's important to understand that so that you can feel as comfortable as possible with the person that you're working with. Sometimes asking these questions can make people feel bad or like they're gonna come off as sounding high maintenance

Starting point is 00:36:31 or it's not appropriate. You are hiring these people, they are not hiring you. You have every right to ask any and all of these questions and you should. Sometimes people will come to me and they'll be like, Melissa, this is the birth that I want. I'm going to hire you. And I say, oh, great. Who's your physician or midwife? And then they tell me who it is. And I think, oh, sister, that doesn't align with the birth you're telling me that you desire. We need to talk that through and consider

Starting point is 00:36:59 whether or not you would like to stay there or make a change. That's a hard thing to do to make that change. But what we never thing to do to make that change, but what we never want to do is look back after we have our baby and wish that we would have, hope that we could have, or maybe we should have. It's great if we can do that on the front end. What pieces of information would you want to equip them with in their potential finding of a midwife or care in general, especially a doula as well? of a midwife or care in general, especially a doula as well. In planning to interview a doula to be with me during my birth experience, I think that the first thing I would want to know is where did you receive your certification and training?

Starting point is 00:37:35 What does that look like as far as what you're doing to keep that up that serves to represent that somebody is doing this at a professional level. I would also ask them not how long you have been a doula, but instead, how many births have you attended? Some doulas do it on a professional level where this is all they do. So for me, I have my hand in a couple pots at the hospital, but this is my primary job or profession. I am a working professional doula, which means that I will take three to seven birth clients a month, and that's the way it works with everybody on my team.

Starting point is 00:38:11 So we're constantly at a birth. Sometimes we're backing somebody else up at a birth. In other words, a doula that works here for one year, let's say, will maybe have seen at least 30 births on her own and perhaps five to 10 when she was a preceptor. She has seen birth in hospital, she has seen it in a birth center, she has seen it at home in a bathtub,

Starting point is 00:38:33 she has seen it in the OR, she has seen multiples, she may have even seen someone born in the car. Whereas somebody who is a doula, let's say for 10 years, but has been doing it as a hobby, and maybe not even barely charging, you ask her how many births she's done, and she's done six, and three were family members. So my question would be, what does that look like for you? What have you attended in the past? And even if I wanted a home birth, I would want to know that

Starting point is 00:39:01 the person I was hiring has seen other things, even a C-section, et cetera, because if I need to transfer and I need her there, she's going to know answers to things I don't know the answer to. And that's really important. I would also ask, who is your backup doula? What happens if you are sick? Do you have a backup that not only you know, but you know their background, you know their philosophy. It's not somebody that you just picked off of a doula website that you've never met before. I chose you for a reason. I trusted you, I vibed with you,

Starting point is 00:39:36 you know everything about me. If I have to have a backup, I want you to be able to give the person all that info about me, but I want it to be seamless. I want her to take over where you left off. And for me, when I send a backup to a birth, I want them to like my backup better than they liked me so that they will use them next time, they will feel supported. They never missed me at all because they got exactly what they needed

Starting point is 00:40:02 from that backup doula. So that's very important. And then I would want to know, do they charge money? Because you might think, well, maybe someone would love it if their doula said I'm free or a hundred dollars, but it's hard to sustain being a professional doula if you don't charge money. You have to charge money in order to keep up your credentials, to pay for insurance, to pay for gas in your car, to pay for your phone so that they can call you, to pay for your website, to pay for your continuing education hours, to pay for childcare, your food, et cetera.

Starting point is 00:40:34 Those are some of the questions I personally think are important when searching for a doula. And of course, doing your own research, taking ownership of your birth, go and read their reviews, look at their website, look at their social media, see if you align with them, and their energy is something that you would want in your birth space because that's also very important. That's a very sacred space and you want to be protective of it.

Starting point is 00:41:13 What questions would you ask prospective care providers before hiring them? Do you advise people to have a doula in the birth space? Are you a provider that works collaboratively with a doula? If that person says no, if that person says, you don't need a doula, you'll just have me, that person likely doesn't want you to have more information than you need because a doula is there to give you options. That provider might say, hey, let's try this plan A.

Starting point is 00:41:38 And your doula might say, oh, well, that's great. You could do that, but you could also speak to them about if they would be willing to let you try BCND first. And you go back to that provider and ask that, and they say, well, give me some time to do that. I hadn't even thought of that, but yes, we can do that. Because providers who work with doulos routinely and are accustomed to it,

Starting point is 00:41:57 they are not offended by that at all. It can be helpful to bridge that gap. And then if I was asking questions to a prospective physician, I would want to know what is your personal c-section rate? What is your episiotomy rate? What is your induction rate? Do you practice evidence-based care?

Starting point is 00:42:19 And what does it look like at the facility where you deliver or where you have privileges? Are you, as the provider, telling me you're low to moderate risk, you can have intermittent fetal monitoring, you can eat during labor, you don't have to push on your back, yet you get to the facility and that provider is only coming at the end of your delivery and the facilities policies are, you need to be monitored continuously. We don't let you eat food here. You need to be back in that bed.

Starting point is 00:42:51 All of those things that you were hoping for are now changing because you didn't think about the facility. You only thought about the provider. So it's really important that we tie those two things and. If we were wanting to hire a midwife i definitely think it's important to understand credentialing. What more importantly to understand not only the initials behind their name and what they mean as far as training goes. who trained them and how long were they trained. It goes back to what I was talking about with doulas and like you can be a doula for a long time

Starting point is 00:43:29 but only seen a very small amount of births. It's the same as far as training goes with midwives. I would want to know for midwives, who is your backup? What happens if you can't attend my birth? Who would come in your place? And what are their credentials? And what does that look like? Because sometimes you're in labor,

Starting point is 00:43:49 it's such a vulnerable time, you cannot come out of labor land and come to your thinking brain to comprehend all of that in the middle of birth. You need to know this ahead of time. What happens if someone else has to come? And who do you bring with you when you come to my birth? Do you bring with you another midwife, a birth assistant?

Starting point is 00:44:08 What does that look like if you're coming to my home? What does it look like when I arrive at the birth center, as far as that goes? Or if you are a hospital midwife, talk to me about what that would look like in the hospital space. Who's gonna be there besides you? I would want to know their transfer

Starting point is 00:44:25 rate. And we focus on this idea that having a low transfer rate as a midwife is the key ingredient. But for me personally, the answer to that question that I would love to hear, one of our favorite midwives always says, I transfer 100% of the time that I need to transfer. And I love that answer, because they have the wherewithal to know and understand, this has shifted, this is out of my scope now, or I don't feel comfortable with it,

Starting point is 00:44:56 let's go to the hospital. There's so many things to think about when you are pulling your team together, and all of those puzzle pieces need to fit nicely. I'm not a midwife, so I don't know what their oversight looks like or who they hold accountability to. But what I do know is that the field of obstetrics was built on the back of village midwives and Mexican midwives and black slave midwives and midwives who were seen as witches and burned at the stake prior to the 1900s. And that's kind of when obstetricians

Starting point is 00:45:33 took over delivering babies in the US. And now in our country, we have one of the worst mortality rates in the industrialized world. Some of the highest C-section rates, generations of embedded birth trauma. In other parts of the world, babies are primarily delivered by midwives. Quite frankly, their statistics put the US to shame. In my opinion, the problem is not necessarily the field of midwifery, but instead kind of the culture of birth in our country. If every clinical provider practiced evidence-based, dignified care, body autonomy, informed consent, then we may not be in the place that we find ourselves today. So as far as regulations, I think accountability is the key for all non-clinical and clinical

Starting point is 00:46:28 providers. Although our business is birth, birth is not a business. What I mean to say when I say that is we have to earn money, whether it be doulas, whether it be midwives, whether it be physicians practicing our professions, but midwives, whether it be physicians, practicing our professions. But we need to be careful that that is not what is driving us, that we remember the foundation of what drew us into these professions in the first place, which is to provide people with dignified care, with informed consent, and all of those things that I've listed. It's not appropriate for me as a non-clinical provider to speak to what regulation should be put

Starting point is 00:47:14 on someone who is a clinician, because they're responsible for both of their lives, for mom and baby. But when I think of the birth community and birth professionals that I work with, what stands out to me with the very best of them is that those are the ones who do the most simple thing, which is just to listen to what the person wants

Starting point is 00:47:40 at the beginning, to listen to their body and their baby and to trust what the body and the baby tells them no matter what that is. So if we are in the middle of the birth space and we are hopeful for a normal natural vaginal delivery with no trauma and drama but the body or the baby is telling us something different then we have to listen. If we do that and we shift and make room for whatever outcome needs to happen to facilitate a good connected birth experience for that person, then I think that birth itself could change. I think that that's what's being forgotten as a foundation of

Starting point is 00:48:22 this work. That's not to say that the people who are doing it to the highest standards and who want the best for their particular professions wouldn't want or welcome different types of standardized care, boards or oversight. I know that wouldn't bother me if, for instance, something came up where DULAS had to do X, Y, and Z, would I adhere to it? Absolutely, this is my life's work.

Starting point is 00:48:48 I wouldn't turn my back on it and be like, that's too hard, that's too expensive. I'd do it. If it meant that birth as a whole would be better and that less women and children would be dying and that less women would be experiencing birth trauma and that more people would be experiencing birth trauma, and that more people would be experiencing the dignified care that they deserve, then there would be nothing that

Starting point is 00:49:10 would stop me. I would like to add, if somebody asked me, Melissa, what do you think is the most important thing for me to do prior to giving birth? I would say that it is to become as informed as you possibly can. I tell all of my clients, you have to take ownership of this experience. Remember that nobody cares about it as much as you do. So if you're finding yourself in a situation and you think, well, you know, it's too hard to switch providers now.

Starting point is 00:49:42 I don't feel comfortable. This gives me a red flag. Maybe I'll just wait until my next baby and I'll do something different. We would never do that if we were getting married and we were planning our wedding. We'd never say, if this wedding doesn't turn out the way that I want it, with my next one, I'm going to do X, Y, or Z. We have to realize that as people giving birth, nobody else is in charge of it. But as people giving birth, nobody else is in charge of it. We are the ones who are in charge of our birth space, our birth team, and hopefully when

Starting point is 00:50:12 we get as much information as we possibly can, our experience will unfold closer to the way that we had hoped. Birth again is unpredictable. It's an initiation into parenthood, So there's surprises along the way. But they don't have to equal trauma. So I would just say, find a good childbirth class, hire a doula. So that would be my one piece of advice that I would want to leave you with. Thank you so much.

Starting point is 00:50:40 It was all vital information for the listeners. Next time on Something Was Wrong. It was all vital information for the listeners. Next time on Something Was Wrong. I definitely heard that my situation was talked about and that it wasn't the first time that something like this has happened. This was just something that I learned after building a community and after talking to more people and hearing stories. It was a few women that had joined first. It was a little quiet at first.

Starting point is 00:51:12 Nobody was really saying their stories or anything, but then we started getting more and more people joining or trying to join our group. I messaged Marquita. I knew something terrible had happened and I just didn't know what it was. It had to have been a couple days later, she left her review. That's when she was talking with Kristen. Kristen created a survivors group on Facebook that has reached 40 plus women now that have all had traumatic births with origins. Thank you to our extended team, Lauren Barkman, our social media marketing manager, and Sarah Stewart, our graphic artist. Thank you to Marissa, Travis, and our team at WME, Wondry, Jason, and Jennifer, our cybersecurity team, Darkbox Security, and my lawyer, Alan.

Starting point is 00:52:19 Thank you endlessly to every survivor who has ever trusted us with their stories. And thank you, each and every listener, for making our show possible with your support and listenership. Special shout out to Emily Wolf for covering Gladrag's original song, You Think You, for us this season. For more music by Emily Wolf, check out the Episode Notes or your favorite music streaming app. Speaking of Episode Notes, there every week you'll find episode-specific content warnings, sources, and resources.

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Something Was Wrong - S23 E6: Dignified Maternal Care with Doula Melissa Espey-Mueller

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