Community Midwives Tending to Low-Risk Families and Adapting to Changes in Hospital Resources

In this time of the COVID-19 pandemic, there is so much that feels uncertain for families, especially families that are expecting a child in the coming weeks and month(s) and planning to birth in hospitals.

Some of the questions that families are coming to me and my colleagues with are:

  1. Is it safe for me to birth in the hospital if there are potentially infected or exposed people in the same environment? Does this put me and my baby at risk?
  2. Will there be enough beds, space, and medical personnel to attend my birth? What if my OB, CNM, or RN is exposed?
  3. Will I be able to have my support team with me in the hospital, or will they restrict the number of people who can tend to me to limit potential exposures?
  4. What happens if the current hospital resources prioritize people who are exposed to or infected with COVID-19?
  5. What are my options as a low-risk pregnant or birthing person in terms of alternate birth providers and places?

Jen Segadelli JD, MSM and I are Co-Presidents of the Midwives’ Association of WA State and are joined by an incredible Coalition of midwives, educators, and activists who are working quickly and intensively in collaboration with hospital-based providers, the WA State Department of Health, the WA State Hospital Association, and the Health Care Authority to answer some of these questions for you.

Most importantly, this work is inspired by and springboards from the incredible Rainier Valley Community Clinic who has developed and piloted many of the models being proposed, and also Master’s Candidate Emily Jones, who is nearing completion of her thesis specifically investigating the role of Community Midwives in disaster management.

As a team, we are engaged in a multi-tiered plan to determine the various roles that Community Midwives can play in providing adjunctive and/or prenatal, postpartum, and lactation care with hospital-based providers, to assume care for low-risk families in the event of strained hospital resources, and the development of a network of alternate care settings (including accredited birth centers) to absorb low-risk families as the need arises in the healthcare community.

In addition to developing this collaborative plan with our hospital-based colleagues, we are also developing educational resources for families to learn more about Community Midwives and the role they can play in their care and well-being.

And, as always, we are tending to the professional needs of Community Midwives including securing PPE (personal protective equipment), developing COVID-19-specific Clinical Practice Guidlines to protect families and midwives alike, addressing financial and liability concerns, and attempting to support and protect Community Midwives’ well-being, who are often vulnerable solo or small practice operations.

Needless to say it has been a busy month this week! And, more importantly, I am very proud of the work of the Midwives’ Association of WA State.

Our COVID19 Response Materials:

If you want to learn more, you can also take a look at our relatively on-the-fly webinar for member midwives: And try not to be too distracted by the fact that we are in lockdown attire 🙂

And I also had the opportunity to participate in a nation-wide conversation with over 500 midwives on a panel for the ACNM and their reponse to COVID-19. (I join the conversation aroundn 56 minutes in).

Here is the recording to that webinar:

Being Born Isn’t the Only Thing That Hurts…

In the last two years I have changed my work-life balance. One may look at my 4 or 5 spinning plates and not find a shred of balance…It’s a practice; not a destination. At least that’s what I tell myself. One of the ways that I have radically shifted my life is not being on call anymore.

I started being on call nearly 20 years ago, working with adolescents who were becoming young parents or were already parenting. And then I shifted into being on call as a midwife attending births 13 years ago. Pagers and phones have accessorized my outfits and my social life for the majority of the last 20 years. Literally everyone in my life knows the drill…sometimes I am here…and then I am gone.

It was a good run while it lasted. I loved that work. I loved that liminal space in a person’s and family’s labor and birth where so many things were happening that were unseen, but so incredibly palpable. It was so rich. Like everything you can think of when you imagine abundance, fullness, and the most beautiful things in life. Not everything was hands-on; in fact, there was a lot of hands-off. But my heart and my mind were always on. Always. On.

It was powerful, thrilling, and exhausting. Like my own birth. And at some point my strength diminished. I needed sleep. I needed to not be Always. On. I needed to not be feeling like I was slipping away and becoming less and less myself. I felt like I was dying and didn’t even know it.

My heart and mind were in constant demand by everyone around me; everyone except me.

That’s kind of what postpartum feels like. You’re not just tired; that is an oversimplification x 1,000. It’s more like you have disintegrated. Slipped away. Sometimes completely unnoticed by everyone, including yourself. You feel like you are dying sometimes.

There’s a video making the rounds about the dim and raw reality of those postpartum moments, and the decision to keep it out of a mainstream television event. Keep the postpartum experience unnoticed by everyone. Can’t help but reflect upon that irony.

If you haven’t checked it out, take the 90+ seconds to notice:

I still provide midwifery care in a very different way now. I midwife students, newly postpartum families, growing docs. And finally, I am midwifing myself. I have to say, I am really mesmerized by this rich, liminal space. It’s a little scary, really hard, and mostly powerful and thrilling.

Being born hurts…

I mean they don’t call it labor for nothing…
 It’s been a awhile.  I have been taking my own advice that Winter is For Sleeping (you can check out the Muse-letter archives to read that one from last year).  I have been sleeping, thinking, reading, writing, and hibernating within myself quite a bit in the last 2 months.   And then all of a sudden it was Rohan’s 9th birthday and I realized it was time to step back out.  Time to stop growing on the inside and get born already.  If you remember those last weeks of pregnancy, you know what I’m talking about…Let’s get this party started!   

So here’s a little chronicle that I created on IG about what it was like to be born those 9 years ago… 

9 years ago I was in labor with this cherub (below). It started in the middle of the night after a long, fast hike the day before

I was at home, hanging out in my robe (that I wore for weeks after), my friends all came by at different times to distract me. I remember Michelle bringing me candy

My dog doulas walked around with me eating all the food I dropped but was too lazy and crampy to pick up

I didn’t even know yet I was going to meet the most incredible human I have ever known in all my life. And that I had done and I was going to do the coolest most fantastic thing I have ever done in all my life

Today’s not his birthday…it’s not for 2 more days. I’ll tell you a little more about Day 2 tomorrow…😜 But this day 9 years ago things were in motion that couldn’t be stopped, things that were so, so hard, that I thought could break us. We ain’t broken, that’s for sure ❤ 🔥 

Today was Day 2. Crossing the threshold into the Nether

At this point 9 years ago, I had been working my ASS off for many, many hours. It wasn’t being handed to me; it was kind of being blown apart

Labor is a lot of things. Fucking intense. Hard. Thrilling cuz every time you do a contraction, you never have to do that one again. Powerful cuz holy shit you just did that. I had hundreds of contractions at this point. I was thrilled, powerful, exhausted

And as a midwife who had helped hundreds of babies and parents enter into this world safe and loved, I knew…it was time

Time to go get more help cuz even thrilled, powerful, strong people need help. Sometimes we need the most.
Stay tuned for Day 3 ❤ 

Today was Day 3 and our birth. Before you get your knickers in an knot about “OMG! 3 days!” know that he was great. I was great. We were both healthy and well

In a country where we heavily pathologize birth, know that our beliefs about what is ‘normal,’ is very much a cultural construct. And that countries that witness low risk healthy people’s births as just that (and utilize midwives as primary maternity care) have FAR better outcomes than we do in our system for parents and babies. Hands down

Now… back to our regularly scheduled program

By this morning, I had a tube coming out of my back that was bathing the nerves of my pelvis in pain meds. This meant I had to stay in bed. And couldn’t get up to pee. I had a tube in my urethra to my bladder because #peehappens . I had a tube in my vagina measuring pressure of my contractions to make sure my baby was getting squeezed hard enough but not too hard. I had a tube in my arm connected to another tube that brought fluids and meds into my blood

Sounds pretty healthy and normal, huh?

The most annoying tube though was the one that was connected to the blood pressure cuff that squeezed the fuck out of my arm every few minutes. For hours

But the parts that I always look back on with deep pride are these: that he kicked like mad all the way out, that I pushed him out like a motherfucking queen even while strapped down like a wild animal, and that my community of friends were all there smiling, loving, and protecting us all the way

And…that when he was coming out, *I* got to bring him out and up to me. I’m pretty sure I told my friend and colleague to give me *my* fucking baby. She let me get him

I didn’t even know that this magical human who arrived, who I already loved more fiercely than I had or have loved anything, was going to get more magical

They say kids are gifts. They teach us more than we teach them. What isn’t always said is that each day they are alive and with us, those gifts and lessons multiply. Like exponentially

I don’t just feel lucky to be his mom. I feel mesmerized. And aware of the deep honor I have received cuz we have also lived as people pass on or life changes. This dude 💗 

Measles and Immune System Function: A Closer Look on NDs For Vaccines

My collegue Les Witherspoon ND has written a really nice piece grappling with the concepts and conversation around Measles infection and the Immune System response.

I also invite you to read, learn, and enjoy other articles here at: NDs For Vaccines.


Can you love your little self?

I have an eight year-old so I think a lot about what they are doing right now at this time in their lives. Sure, they are growing and farting a lot. But mostly, I am curious about their inner lives and how that plays out into adolescence and adulthood. Is he going to be OK? Will he always know his worth and how loved he is? Will he hold himself as dearly to himself as I see, appreciate, and love him? Will he know that he deserves to?

If you are reading this and wondering about self-love, self-worth, and self-care, I don’t mean, “Will he take himself out for pedicures and PSLs?” I mean- will he look himself dead in the eye in the morning and be able to respond with irrepressible kindness? Will he fill his well with deep, enduring love all on his own so that when life gets really shitty and rough (which it will), he has something to draw from? That’s the kind of self-care I’m about.

Many of you know that I teach, and one of my favorite classes is Lifespan Development and Psychology. But I don’t really teach the books (no shocker); I love for us to think about why some aspects of development and behavior are normal and what that says about us. Because whether we were “normal,” or seen and loved, kind affects everything, right?

I don’t really see anyone overdosing from too much love, too much irrepressible kindness, or being seen and acknowledged for who we are. Which means, we could always have more. We could do that all that time for ourselves; you don’t even have to wait for someone else to love or see you for yourself.

You could look your own self dead in the eye, see yourself, and say, “I love you.” And mean it.

Try that out today. Let me know how it goes.

PS- If you need a little inspo to start talking to your littler self, check out this Ted Talk

Here it is…conversations on Vaccinations…check it out!

Image result for vaccinations

It’s never an easy thing to decide to put your thoughts and ideas out into the world. And sometimes it’s just the right moment to expand the conversation beyond the one-on-one dynamic or the usual echo chambers.

Thanks to @BBrozy and @keoniteta for inviting me to come chat with them, share some thoughts, and contribute to the ongoing conversation on #vaccinations.

Check it out and let me know what you think!

Click here to listen: Vaccinations with Dr. Sunita Iyer ND


Stay tuned for two new episodes coming up on The Well Man’s Podcast this Fall!

What kind of loss is harder?

If you have been following along for a little while, you know that one of the things I have been ruminating and writing about is loss. We all know it in some way. And we will certainly know more. To live is to love, and also to lose.

It’s not uncommon for us to ‘rank’ loss. Which kind of loss is worse, changes us more deeply, is more worthy of grieving, or warrants talking about at all. Is the loss of an aging parent worthy of years of sadness? Can you be devastated by the way divorce changes your life? Are you allowed to grieve a welcome change like the birth of your healthy and living child?

A friend shared this article written by Camille Hawkins LCSW: Miscarriage or Stillbirth: Which Is Harder? It is a powerfully written perspective on just this thing: attempting to rank our grief. She shares some interesting insights into why some griefs may be shrouded in darkness, and why some may feel more survivable.

Reading this article allowed me to realize that one element of my storytelling has not surfaced, yet. I have waded through the grieving process, felt its depth, and received its tangible gifts. But what still lurks is: are the losses I (and our family) have experienced these past few years worthy of this much grief? And when should this story end?

Another thread that I have been grasping at for some time in my clinical work is shaping postpartum depression as a grief process. Not just that grief can be normal after birth, but that the true baseline IS grief. Postpartum wouldn’t just be worthy of grief, it would BE grief. Perhaps we could surround, hold, and integrate our grieving loved ones as if they had suffered loss.

Witness that they had suffered loss.

What would we do differently? When would we feel as if that story should end?

#neverendingstory #griefworkislifework #griefworkismywork


For more thoughts and storytelling, check out my Muse-letter. You can join the conversation by subscribing here

So Maybe I Did Write One or Two…

If you recently read my Muse-letter that I sent out this week, you know that these last few days have been a celebration of life and loss. Maybe it seems weird to celebrate loss, but if you have been reading along with me these last few months, it’s really not so strange.

Loss, death, disappointment, or not getting what we want (even when we work really, really hard for it) shreds a layer or two. We feel raw and grated. Exposed and vulnerable. But what settles in its place are new cells, new skin, new life. The last three years have felt like an onslaught of loss, death, and disappointment. I won’t lie; even with my super intact ego, it’s been really hard.

One of the things that has been especially tricky for me is to not let the hard make me hard. I am actually a pretty trusting and loyal person. A ride-or-die sort. But when things keep coming at you, sometimes it feels like the best way to survive is to make a shield. A thick, crusty layer that I can see out of, but keeps the world’s badness out. Like my friend here, the Indian Star Tortoise. She’s got it down.

But those layers can get old, grizzled, weak, and are shed too. And underneath, strength still has to be built and sustained. Like muscle; well-formed but pliable.

So #whattodo? How do I stay protected and strong without getting hardened? These are my goals this year: to be strong and pliable. And here are the few simple things that I am going to work into my daily life more often than I do:

  • Water: to have force alongside fluidity, take it from the master. Literally, drink it in. That’s my plan.
  • Stretch: muscles are only as useful as they are mobile. And it also happens that I am aging, and so is my fascia. What isn’t softened can become brittle.

To make resolutions, we have to be resolved. RE-solved. Look closely at our problems, errors, misfortunes, or disappointments and be dedicated to the solution. Again. What are you resolved to work on this time around?


To join the Muse-letter conversation, subscribe here. It’s pretty low-stakes. I tell stories, you get to read them. Join in!