Midwifery for All Series

“Midwifery for All is for you—education, support, and exploration of the options for your care.  You can use it to start discussions with your physician or midwife about the kind of care you would like to receive.”


Midwifery for All is intended to highlight some of the areas where fear has built up a tradition of practice that might not be in line with either good science or your needs.  We understand that the greatest risk many face in their pregnancy care is the perspective and bias of providers and the healthcare system.  We are missing out on options for preventative health care simply because of preconceived notions and societal and systemic stigmas about the health of pregnant people.

Read: Size Friendly Pregnancy Care

This causes devastating effects across multiple outcomes–leading to extraordinary emotional and financial costs for families and decimating the healthcare system.  While providers and systems are responsible for the tangled mess we are all in, it is the consumer–people just like you–who can create change by changing our expectations and demands for education-based, preventative healthcare.

We are managing to save a lot of people from the brink of severe conditions during pregnancy.  But it is not enough to save someone from dying. That is a terrible standard of care when so many pregnant people have clear signs and symptoms of needing help long before they need a life saving rescue.

We believe we can prevent almost all of these conditions from progressing to disease through kind attention, education-based care, and skilled and thoughtful provider behavior. You deserve to live in good health, strength, and with all of the energy you need to do what you would like to do each day.

Midwives have the time, space, and skills to address underlying health needs over the course of your pregnancy and life.  In our practice we focus on predictable, preventable, and reversible conditions that start off with just a hint of something not quite right (you know the feeling!) and progress all the way into a diagnosed disease. Our goal is to pay attention to the first hint, your signs and symptoms, and to respond in partnership with you to quickly turn a corner into good health. We don’t wait for pregnancy to start this work–if you are considering your first or subsequent pregnancy, or might want to have a family one day–we can help get you prepared through this same program.

Through this series we dig deep into the issues that so many of us are afraid of when it comes to pregnancy: race, size-friendly care, stress, poverty, preterm births, prior cesarean births, smoking, HIV, and many more.  Check back often as we upload booklets, we will live-link them here.

Midwifery for All is for you—education, support, and exploration of the options for your care.  You can use it to start discussions with your physician or midwife about the kind of care you would like to receive.  It is a tool for pregnancy and birth decision making, and we would love to hear which booklets you enjoyed, what questions you have, and how you are moving forward in your care.

Wishing you the best for healthful and joyful pregnancy, birth, and parenting!

Do you have a topic you would like to see addressed?  Contact Us and let us know!

Size Friendly Pregnancy Care

“The typical experience for people of size with healthcare delivers guilt, shame, and fear as front-line medicine instead of kindness, support, and education.”

Click Here to to Download a PDF of Size Friendly Pregnancy Care.

Scroll down to see the preview.

Our Midwifery for All Series aims to close the gap between what is known by science and what is understood by healthcare professionals, pregnant people, families, and communities.

Click HERE for an introduction to the philosophy of our care and learn why Midwifery for All matters so very much.  Click Here for our favorite resources

Do you have a topic you would like to see addressed?  Contact Us and let us know!

Click Here to to Download a PDF of Size Friendly Pregnancy Care.

Read:  Midwifery for All Series

Read: Midwifery Philosophy 101



A Layered Question: Midwifery Philosophy 101

“How do we address public health outcomes while caring for one family at a time as if all public health depends on only their outcome?”

Let’s take a look at this multifaceted question:

How does a person navigate the stormy waters of pregnancy healthcare if you are anything other than a 5’7 140lb white, married (to a man) woman who identifies as such, hovering in the middle to upper class?

As you can see we are dealing with multiple layers of the human experience and their effects on pregnancy healthcare: your health before pregnancy even starts, BMI/Obesity, race, sexual and partnership identification, lifestyle choices, and economic status. I hope to address these topics from my midwife-minded perspective in the coming posts, starting here with our general approach and philosophy regarding pregnancy healthcare.

For my friends in the north: I am going to stretch this a little further and choose to add the extraordinary complication of living in the South to this discussion. I did not know, and could not understand, as a northern midwife, that my southern counterparts and the families they serve face challenges far far far (did I say far?!) beyond what we do in the North. I knew of course that things were different but I didn’t really understand.

I have tried 85 times to write about what it’s like to live in a place where faith-based healthcare makes room for providers to decline to mention during prenatal care the option for genetic screening (taking this as one example of dozens). They do not inform patients of these options because their faith (read: the PROVIDER’s faith, not the FAMILY’s faith) does not allow consideration of options that include the termination of a pregnancy under any circumstance. So there is no option for screening given. Not even when a pregnancy poses danger to a woman’s or pregnant person’s life. Not even when that baby will live less than an hour and in terrible agony. Not even when a family would choose to live life with an intensely high medical needs child, or one affected by a genetic anomaly, but wants the opportunity to prepare their home, family, work, and resources to meet their needs. Not even when the mental health of the mother or pregnant person is in jeopardy.

I’ve read charts here with “nuchal translucency” (a screen completed prior to the 14th week) noted at 22 weeks. There’s no such thing!  But this deception is allowed and encouraged….and this is only the tip of the iceberg. Want a tubal ligation but your husband isn’t present to consent?  You may have difficulty accessing this surgical form of family planning in the south. Of important note is that there are providers in these systems who do not practice this way but the system supports those who do. There are four major healthcare systems in this city—three of those with multiple hospitals that support providers who practice faith-based medicine according to the model that the physician’s faith determines your healthcare options.

If you are a person of faith, this might sound nice on the surface, but I would put forth that it is our religious leaders who should help us navigate the decisions we are faced with in our lives. They have training and education that enables counseling and support for our spirituality.  They help us stay aligned with our religious values and belief systems in all areas, including our medical decision-making. Our physicians and providers should offer us healthcare options, discussions, consent, and treatment based on shared-decision making. We are responsible for ensuring we integrate our religious, social, and cultural outlook into our healthcare by engaging all of the systems and people that matter to us in that process. At the same time, many systems are designed to ensure that culturally relevant care is nearly impossible to acheive and it should not be the burden of the consumer to correct this but the burden of each provider, administrator, and system to make it right .

The care options that are here are not healthcare as we know it in the North. For all of you, I know, this post so far will seem frankly unbelievable and unrelatable. The posts linked to below about health and lifestyle choices will seem dated and broad. You are working on terminology, micro-aggressions, systemic racism, and deep systems issues. We are working on basic access and consent issues very much related to the ethics behind Informed Consent and the Nuremberg Code couched in overt racism packed in systemic racism, micro-aggressions, and deep systems issues.

Conversations about lifestyle, access, and health disparities are coming into the light in many corners here. Questions are being asked:  Why is it like this?  Does it have to be like this?  What it would look like if healthcare wasn’t like this?  The midwives here have been advocating and caring for families in all the ways possible—faith based and non-faith based. And even with the two of us new to practice here, there are five of us in or adjacent to the city I’m living in now. Five who are practicing in community-based settings. Five who can create protocols and follow guidelines appropriate to the profession and their community.

We need space for conversation and inquiry here, we need routes for education and change. The South is not some backwards “other”—I am not at all trying to say that the South “needs saving”. I am new here, but I’m right here where this community is at: listening, participating, wondering. Pregnancy, birth, breastfeeding, parenting, general health. These communities are rising up and looking for solutions to the very real barriers they face. I recognize that process. It has a familiar rhythm, grit, and complexity. There is tension, anger, frustration, desperation, and there are large gaps between what is known and what is understood.

For our practice it boils down to this: How do we address public health outcomes while caring for one family at a time as if all public health depends on only their outcome?

I have answered that question many times in posts and articles and interviews.  I stand by my answer.  We must be kind and use our skills to meet people where they are at.  The rest will follow. I am committed to this model of care which leaves room for so much possibility.

I have the great privilege of holding a license to practice midwifery and of being supported by a local, long-standing clinic and non-profit organization that constantly looks to be a partner in community solutions. I have my clinical experience, my willingness to learn and to meet people right where they are at. I have the fundamental belief that kindness matters and that none of us has anything that matters until all of us have access to reach our potential. This awareness and mindset allow me the opportunity to be a part of families’ lives in the very ways midwives have since the earliest days of society.  In the very ways midwives all over the south and indeed the world are a part of healthcare systems, families, and community health.

I have the unique benefit of working with a practice partner who is fierce about identifying solutions and solving problems. She is brilliant, experienced, kind, and unafraid of stepping in to dismantle the hardships families face. We are not looking at pregnancy as an isolated, siloed experience. It exists in the layers and complexities of the lives of the people and families we serve. We are working on a number of projects right now centered around how we acknowledge and prevent non-pregnancy related medical and socially generated pathologies from determining pregnancy outcomes. My practice partner states over and over again that these problems require providers to change their understanding and behaviors,  and stop promoting the false idea that “these women” and “those families” just don’t want good health badly enough.

We believe the barriers that have separated “Self” from “Other” need to fall—we are all of us people just trying our best to give our all and find love, connection, and health in our lives.  We are unique individuals with complex cultures but we share so very much. What if as providers we use our licenses to open up this conversation and create new paths to robust health for all families?  That is the work we are engaged in here in the South. And each micro-community has to find its way in the larger social construct. We want to pull apart the loaded, layered question and answer simply, “yes, I believe in you, your interest and capacity for learning is vast, and together we can find solutions that meet your needs in the right way at the right time for you.”  There is nothing to stop us from applying this philosophy of care to pregnant people of all races, sizes, orientations, cultural backgrounds, and socioeconomic truths.

Next Up:

Midwifery for All Series

Size Friendly Care


The Link between Justice and Health

…Our health is the launching pad which allows us to reach our full potential. Healthcare that actually improves health, protects access to the opportunity to participate in the economic, social, political, and personal lives of an individual’s community and world…

If you are new to the idea that health, healthcare, and justice are linked:  here is the fundamental reason we all need access to high quality healthcare:

Our health is the launching pad which allows us to reach our full potential.  Healthcare that actually improves health, protects access to the opportunity to participate in the economic, social, political, and personal lives of an individual’s community and world.

Beyond this, there are of course complicated, systemic and overt drivers that prevent communities from participating in the political, social, economic, and personal lives of their community and world.  I am not here to say that those aren’t  real, impactful and destabilizing for the individual.  But without health, those determinants play second fiddle.  With health, the engagement of identifying problems and solutions becomes a discussion and a possibility from within a community.

In today’s world where inflammation, insulin resistance and adrenal dysfunction are deeply tied to each other and the way we–or whether or not we manage to–integrate and recover from stress, this is more true than ever before.

Let’s look together at a dramatic example:  Before I knew to offer education for this, I watched immigrant women who had arrived in America in the year prior to their pregnancy, continue to eat the same diet they had in their home country with one exception.  The ingredients were American.  The flour refined and void of the fiber naturally found in the food they grew up eating.  These women disintegrated before my eyes and their health became almost exactly like the health of most women coming from whole lifetimes of American poverty and the “typical” American diet.  In fact, the occurrence of maternal child outcomes taking a nosedive within the first generation of arrival in America has been well documented, though not well explained. How is it possible that women arrive from developing, or even war-torn nations and their health declines?!

The women I saw developed persistent fatigue which made work a complete drag and engaging with their family a lost art.  Mostly, when asked, they ascribed it to the difficulty of being away from family.  But their sense of their vigor and their actual blood glucose levels told a different story.  Interestingly no one blamed pregnancy–they had all grown up where pregnancy was viewed as a normal, active, and healthy time in a woman’s life.

During a home visit, one of the families cooked us dinner and it was there that as I chatted in the kitchen with the mom while she prepared the food that I saw what I came to demonstrate in my practice as the one of the Real Culprits.  With guidance to find imported flours–and to eliminate the processed American foods–blood glucose levels returned to normal.  The extra belly fat melted away as the muscles could once again absorb the insulin being delivered by the pancreas instead of creating a toxic and hostile environment from which each woman was supposed to work full time, care for her family, establish herself in a new home with all of the stress that moving brings, and support the activities at her church or community center (or both).  This food was not so slowly and ever so surely poisoning these women and their babies, who often grew so big that despite well supported labor and best practices, were born by cesarean section at alarming rates.  This was true for first time moms who naturally carry a higher risk of cesarean birth, but also for 2nd, 3rd, and 4th time moms who had healthy vaginal births as part of their health history.

I combine catered education about nutrition with stress reduction strategies at each prenatal visit for every family.  Have a mom bring in a picture of her pantry if you can’t do a home visit.  Frame it is a starting point, not a place to drip shame, fear, and humiliation into her life.  Let’s learn together–have her teach you about her life, her stress, her nutrition, her loves.  Rich or poor, immigrant or 4th generation American. Everyone receives education that meets them where they are at and responds to their life in that moment.

One of the more important maternal/child health results of addressing these deep needs of mothers is that babies grew to be the right size for their mother’s body.  That is a reduction in healthcare costs in the tens of thousands per mother/baby. It reduces so many immeasurable personal costs and so very many short and long term healthcare costs.  A healthcare actuary could have some good solid fun with seeing the numbers all the way through.  It lends to the potential for each baby to be born to a mom ready to mother physically and engage mentally, because they feel good, they feel energized, they feel like themselves.  Even in a foreign country.  Even with a minimum wage job when they are actually qualified mathematicians, accountants, doctors, or teachers.  Even when they miss their family and are learning a new language. Even when they want to somehow muster the  capacity to attend night school to learn a new trade or earn a new certificate so that they can move into a life of opportunity for themselves and their children. 

**an interlude for all of you now fuming advocates from the world of the threat of a big baby  = cesarean birth.  Let me save you from skipping the rest of this article so you can leave an inflamed comment.  This is not that.  These babies are at real risk–their pancreas having been tested and pushed beyond its limits while en utero, they develop a lot of brown fat around the cheeks and shoulders, and are usually 1-4 pounds heavier than mom’s other babies.  These are not the robust babies who could have been born vaginally if mom had providers who knew to use positioning and time to aid in a healthy birth.  They look very, very different than a baby who is just born a big healthy baby.  None of those babies are included in this observation** [also, I love you for the work you do educating mothers about how to use their bodies to birth their babies and demanding that providers get with the program written so many thousands of years ago]

Back to the blog…

The model of healthcare delivery I offer is wrapped in listening and free from standard time constraints.  And still, I almost missed it.  It took listening, observing, and participation in the lives of the families I serve to find this connection.  It took nothing at all for me to apply the lesson to every pregnant woman who came through the door.

If we want to use our privilege as healthcare providers to launch families onto a platform where they can begin to see that opportunity funded by energy, vitality, and good health is different than opportunity funded by the massive domino effects of refined foods and stress without recovery–the disability of diabetes, cardiovascular failure, endocrine implosions, adrenal fatigue–well, we are in the perfect position to do so.

What do you do to offer healthcare that promotes justice?  Do you want to learn more about offering this kind of healthcare?  Are you a healthcare consumer who has or has not received personalized care?  Share your story!