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Welcome to the Midwifery Wisdom Podcast
This podcast is your go-to resource for practical education, thoughtful insights, and relevant conversations tailored to modern midwives.
Each week, we bring fresh content and engaging guest speakers to explore key themes in midwifery, including:
Advocacy, business, and clinical skills
Self-care and professional growth
Current issues shaping midwifery today
Listen to meaningful stories and essential advice from leading midwives working to elevate care for families across the globe. Gain clarity, encouragement, and actionable guidance to support your business, practice, and personal life.
Wherever you are in your journey, the Midwifery Wisdom Podcast is here to empower you. Together, we strive to make midwifery the gold standard of care worldwide.
Podcast | Season 6 Finale | - Emmelia
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[00:00:00]
Welcome back to the Midwifery Wisdom Podcast. I'm your host, Augustine, and today's episode is a very, very special one. It's a real conversation, one-on-one between me and one of the midwives from our very special first Midwifery Wisdom Fellowship cohort. For those of you who haven't heard of it yet, the Midwifery Wisdom Fellowship is a six-month graduate to midwife bridge program that fills the gaps left by school and apprenticeship, combining mentorship, business mastery, and trauma-informed resilience training so that you can step into practice without burnout, poverty, isolation. And, if you wanna learn more, I invite you to head to our website, midwiferywisdom.com. Part of the fellowship experience is that students get one-on-one consults with both me and my co-teacher, Christie Davis. And what you're about to hear is actually one of those [00:01:00] consults. Emmelia graciously gave us permission to share this with you because there's so much in here that I think you'll resonate with, whether you're a student, an apprentice, a newly graduated midwife, or even a midwife further along who's still asking questions.
Questions of like, "How do I get through this?" In this conversation, we talk about what it feels like to hit the wall in your training. That moment when you go from feeling really confident to suddenly questioning everything you know. We talk about the Dunning-Kruger effect and why that crash is actually a sign of growth, not failure.
We talk about betrayal by a preceptor and how to process without letting it curdle into something worse. And we get into the bigger questions that a lot of midwives eventually face. Do you have to choose between being a hands-on provider or building something sustainable? A business, a birth center, a [00:02:00] legacy, or is there a way to actually do both?
It's honest, it's a little raw, so be gentle with both of us, please. But I think it's exactly, worth, you know, this time, this effort. I think you'll really enjoy it. I think it's worth listening to, I think it's worth sharing. And so without further ado, this is my conversation with Emmelia. Thank you so much.
What should we start with? Man, I don't know. I... There's so many things that I could pick your brain about.
I think right now I am trying to figure out my direction. I have loved doing all of the assessments and everything that you've done with the fellowship. But I find it really challenging for me to do some of the things as far as business and billing and those kinds of things because I don't really know the direction I wanna go in.
And so it's been really hard for me to narrow down or even answer some of the questions because of that, right? I [00:03:00] really don't wanna be solo practicing. I'm not opposed to a home birth practice, but I definitely don't wanna be by myself. But I feel like I really vibe a lot more with the birth center setup.
And so yeah, I'm still just really trying to figure out how this is gonna look for me. Yeah. And with everything that's happened recently with my apprenticeship and all of that I feel like I'm probably gonna be a student for another year. It's like... yeah ... which isn't necessarily a bad thing.
I was really feeling just over it and really sick of being a student, so ready to be done. I was really excited that I had all my births and I was just so ready to just be done. Yeah. And now I'm almost thinking maybe it wouldn't hurt, to be a student for another year. I am... Just because the more I work for other people, the more I'm wondering how checked out my preceptor was towards the end of her career, and there were so many things that I think she thought [00:04:00] in her mind that she taught me that never actually came across. And so anyway because I have to now get all my skills signed off, I'm gonna have to be a student at least for a little bit longer. Yeah. Maybe just reframe it.
I feel like a student, so maybe just I'm gonna be a lifelong student- Yeah ... because I'm always gonna learn, and there's always people and situations I can learn from. And instead, just name this period of time "I have another year to get my signatures," so that you don't vilify the concept of being a student in your mind.
Yeah. Because it's such a skill to be a student. Yeah. The midwives who get set in their way and decide they know what's best actually are terrible. Totally. Yeah, it's definitely not so much that. I am the kind of person that's a lifelong learner, and I... that's how I ended up starting a whole nother career
I think for me, it has been such a hardship to my family- yes ... being a student. Yes. Okay, so then let's talk about the difference. So then let's name it and say, I [00:05:00] only have one more year without an income.
Yeah. Or with a marginalized income. Instead of vilifying the student role- Yeah ... because you do ascribe to being a lifelong learner. And the things we say in our mind, they carry a lot of weight, right? And they influence- Yeah ... a lot of things. So I would just invite you to reframe that so that you work towards the actual goal, which is not to not be a student, but is to become making money at this work that you do, right?
And to feel super competent, not wondering if I was ready, right? I wanna feel- Yes ... like I know there's gonna be. Yes ... that scary feeling of being out on your own, no matter- Yes ... when I do it. Yes. But I would like to go into it... six months ago, I was feeling like so excited, so ready, and actually very competent and very secure.
And then like so much transition happened and craziness happened, to where all of a sudden I felt like I actually don't know anything. You know- Yeah ... I just got totally rocked by that. Yeah. So I'd like to [00:06:00] be closer back to where I was emotionally. Yes. But I want to... I know now that might have been a false sense of competency, and I would like to arrive at that place with a secure sense of competency where I actually feel like I'm feeling this way because I do actually know, and not- Yeah
be always wondering, do I know? Do I know? Yeah. Have you ever heard of the Dunning-Kruger effect? You know this phrase? Maybe. Okay. So the Dunning-Kruger effect is basically the description of how you only know what you know. If that makes sense. Yes. And so if you don't know, you could imagine that you have the full knowledge when you don't.
So the Dunning-Kruger effect is a bias where you're limited by knowledge. So basically people who know very little about a topic are often blissfully unaware [00:07:00] of their own ignorance. And so this thing happens where you're learning, and you're like la la, I'm learning. I'm going up the curve of learning.
I know. Oh, I know so much. Oh, I know so much more. I know so much more." But meanwhile, the mountain that's way above you, you can't even see because of your limited knowledge of the subject. And so this happens to all people learning all things, but it's particularly salient in midwifery because my perception and my belief for a long time has been that we send people out into midwifery before they have crossed over this first Dunning-Kruger effect mountain.
Because what happens if you follow this trajectory in business, in birth work, in anything, you ... I, oh, I know a little bit. Oh, I know a little bit more. Oh, I know a lot. Oh, wow, I know so much. And then, like what usually happens, oh, God, I know nothing. I know nothing at all, right? Yes. And you do a few of these cycles [00:08:00] before you come out the other end with some level of actual competence.
And so what you're describing is so normal and appropriate that the clouds have parted, and now you can see more that you feel like you need to know- Yeah ... before you call yourself a full-fledged midwife. And I just wanna validate that. I just wanna hold this mirror up and say that's so healthy.
I'm so proud of you. That shows real growth. It doesn't show the opposite. It doesn't mean, "Oh, I didn't learn very much." It means that you've learned enough to now have the perspective necessary to climb the mountain. And so I just wanted to share that with you because I think a lot of midwives do graduate on that high you were on six months ago.
And then they experience this crash in their first three years of practice, and they leave midwifery forever because it's so much harder than they thought it was. Yeah, for sure it is. Yeah. Yeah. And this is true of everything. You can... let's just take it out of [00:09:00] midwifery, which is very personal for all of us, and just look at it in business.
Lots of people are like, "I'm gonna start a business," and they go out there, and they buy some equipment, and maybe they rent some space, and they set it up, and they go and go, and they're like, "Shit, I'm not making money," or, "Oh, my God, there's so many people that have so many questions I don't know how to answer."
And they're like, "Ah." And they leave the practice, or they leave the business. Or they sell the business or the business fails or whatever. They're like, "Okay, I'll go start another business," and they never actually go back and learn what they didn't learn about balancing- ... the books and about proper hires and about paying taxes.
They never go back and learn what they were missing- Yes ... they just do the- Yes ... serial whoop. Yeah. It's "That's a problem." My kids just went through that with their business. They had to file taxes. So I had been doing it for them, and then finally I was like, "Guys, I've got my own life here.
I wanna help you, but I've got my own things going on. You guys have s- got to start keeping track." And I showed them how to use a spreadsheet and stuff. And then we had to do our quarterly taxes, and I was trying to explain to them, and my daughter was like, "Oh, forget this. I'm [00:10:00] gonna pay somebody to do that."
And I'm like, "That's great, but for now, you've got to learn-" You don't have that money. Yes. You can't right now. And you... And guess what? I'm not doing it for you, so you've gotta do- Yeah ... Anyway, she was just like- Yeah, that's great ... "What is taxes? What does this mean?" Yes. Learning to adult is very painful.
But yes- Yes ... I feel like I just wanna validate it for a second, is that you have climbed one of many vistas, and now you can see out, and that's a really good thing. Yeah ... the frustration you feel at wanting to move forward faster, that's really normal. The need to make money to support your family, super real and normal.
But so is this experience of realizing there's so much more to learn. That's a really healthy thing. Yeah. Yeah. Yeah. You almost can't... You can't wait till you know everything, because that would never happen, right? So at some point, you have to feel secure enough that you know enough to- Yes
keep people safe, keep yourself safe. Yes. Yes. And I wanna reach that point to where I will [00:11:00] feel safe working for somebody else or myself and do a good job.
Yeah. Yeah. I just wish you a lot of grace to yourself during this process, because it is a lot to have to reset. I know that there's also some grief in this process because you've had to circle back and redo stuff because you had a preceptor- Yeah ... that was honestly not very conscious from what you've told me.
And- Yeah ... unfortunately, that happens a lot. Yeah. Because so many midwives don't go back and learn what they need to learn about nervous system regulation. And they burn out, right? And so you had a burned-out preceptor who could not meet your needs and could not effectively teach, and you got to what felt like the end and had to start over, and that sucks so bad.
Yes. And so there's some grief in there, too, but don't let the grief taint the learning process for you. Let yourself- I feel like I had to take- ... be open to it ... I had to take two months to [00:12:00] just be angry, you might need to take more, for sure. I might. I feel- Yeah ... less angry now, but I really felt so angry for a little while, and
I think most of it was because I thought I had hit a roadblock that I was not gonna be able to get past with her not signing my skills. Yeah ... because there's no midwives near me. Yeah ... but I had a couple of people reach out to me on Facebook, some other midwives, that they were like, "Hey, if you can get to where I am, I'm happy to sign for you."
And so I've traveled. I went to Bella Vie, and I went to another midwife up north in Seattle. And, they're just willing to sit with me and sign seven pages if that's all we have time to do. But they've just made me realize it's not the end of the road even though I felt so betrayed by her and angry that she would keep me there for three years with just the amount of sacrifice that I and my family was making, and then just leave me hanging like that.
I was so furious. Yeah. Yeah ... that's- Yeah ... unfair. That's betrayal, for [00:13:00] sure. It was betrayal, and, It's deception, really. You were unpaid labor in some ways, and that's just I literally told NARM I had, I reported her to NARM, and of course they did nothing, but so I reported her and I was like, "What are my options here?
What can I do? Can I force her to sign? Can I do this or that?" And they basically said, "We don't hold anybody accountable for that type of thing." And I was like, "Okay can I take her to small claims? Can I sue her for three years of back wages?" Like 'cause I might. I was so angry at that time.
Now I'm just like it's really not worth it, but at the same time it was like that's how mad I was, yeah. I get it. I was willing to almost go get a lawyer to- Yeah ... deal with it. But, Yeah. I get it ... now that I know there's other good people out there who are willing to help me, I feel a lot better and I've processed.
What she did isn't less bad, but I've just realized this doesn't mean it's over for me. It just means I have to go a different, a little bit different path, and that's okay 'cause I probably need it, there's probably things that other midwives can teach me that I don't know yet, That's very generous and [00:14:00] egalitarian of you. And I can see you turning the other cheek and doing your best to see the grace in the situation. That's beautiful. That speaks to your personal growth mindset and who you are as a person. And also, God damn it, it hurts so bad. I totally get it.
No, it seriously- Yeah ... does. It seriously does. Yeah. I, yeah. Yeah. But, I mean- Yeah ... what am I gonna do, just wallow in it, you are an adult. You are adulting yourself through this, and that is beautiful. Yeah. It is. It is beautiful, and it speaks to your character, and I'm just, I'm impressed to know you and cheer you on.
Aw. You're so nice. Thank you. And also, I'm just gonna speak to the wounded part of you and be like, that sucked so bad. That was so unfair that you got deceived like that, taken advantage of that, and then dropped like a hot potato. That sucks. Yeah. And that won't stop sucking for a very long time, and the worst thing that you can do for your nervous system is shove that under the carpet.
Definitely. [00:15:00] So I'm glad you're talking about it. I'm glad that you're expressing your emotions, you're exploring your resources, that you're- Yeah ... processing this trauma. It's, it was a trauma. And you go through the five stages of grief. Yeah. And then if you don't clear it out of your body, it will become PTSD.
And we've talked about this a lot in the group. Yeah. And the and the PTSD is simply trauma that is unprocessed. Okay? So this is why I'm just so cheering for you that you are giving yourself the time, the space, and the permission to have these and probably many other conversations about- Yes
what happened to you. Yep. So Gabor Maté is one of my favorite mentors, and he says that trauma is really only trauma because a bad thing happened to you in isolation. Absolutely. Yeah. A bad thing that happens to you with other people [00:16:00] automatically gets to be shared and released.
Right? I totally agree with that. A bad thing that happens to you in isolation is something that feels like it fills up your heart, and you are all alone for it, and that's, that is what feels like trauma. And so you are doing the right thing in what you're doing, and I just wanna encourage you to keep doing it even though it sometimes hurts.
But it hurts now in the moment as opposed to 10 years from now when you're snapping at your students and potentially, bleeding on them from pain that was never processed. And I know you've seen that before, so you know, Yeah, for sure. Thanks for being the cycle breaker here. Thank you.
Absolutely. Absolutely. Yeah. I totally agree. I feel like the more you hold something in, the worse that it is for you, yes. And also by speaking, and probably publicly as well, you are allowing other students who may be younger or less mature in their journey or less [00:17:00] of a exterior processor or just more traumatized, you're allowing them to be like, "Oh, that happened to me, too."
"This is okay for me to talk about? This is okay for me to share?" And then their burden gets lighter, right? Yes. So it's, you're doing everyone a favor here, actually. Yeah, I totally agree. And I- Including yourself, which is the most important right now. Yeah. And I just think the... I haven't done the Boundaries for Birth Workers class yet.
I definitely will. But I've been doing so many other classes. I'm sure. We bombarded you this year. Yeah. No, but I just wanna say I haven't even done that class yet, and I still feel like I have grown so much from the work that we have done in the group in my boundaries. And being able to say...
i'm going to visit a new midwife tomorrow. She invited me to come potentially be her student, and right off the bat she was like, "I require this, and this." And I already, I told her I will come check it out, but my plan is already to not [00:18:00] be her student because she's too demanding for what I am able to give right now.
And in the past I feel like I would've been like I have to just make this opportunity work. It might be the only one." on whatever. And I'm going into it with the mindset of if I do like it and I enjoy her clinic and I enjoy her as a person I'm gonna ask her for what I want, and if she says no- Okay
then that's fine. I am okay- Okay ... with saying that this isn't the time for the amount of commitment in my life that she's asking for. But I talked to a past student of hers asking, like, how was it working with her or whatever, and she said she really needs a student right now, so maybe you're, you will get what you want," and I'm like, I it's worth it for me at this point to ask. I can't get any worse right now, totally. Totally. But you understand that you do not have to self-erase in order to- Yes ... get your needs met. And also it's okay for me to put my life and my family first, and that's where we're at right now as a family. I've been putting midwifery not [00:19:00] before them, but it was my top priority while it could be in the moment that it could be, and it came to a point where it had to stop being the number one thing. Yeah. I needed to- Yeah ... reset some things. And so I'm taking a step back, unless somebody can offer me something that will fit in with my life, and that's fine.
I'm prepared- That's beautiful ... to not do it. That's so beautiful, and I just wanna say how ironic it is how much you can learn from burnout. Yes. Somebody else's- And in a lot of ways, you can even circle around to being grateful to your preceptor in some weird way- Yeah
because through her example of what not to do- Yes ... you very early are learning what not to do. Yes. I felt that from the very beginning when I started working with her. That's right. I was like, "Oh, Lord have mercy, I never wanna be like that." Yeah. Never. I don't wanna have- Yeah ... relationships just go on the, yeah. Yeah. And because you're a mature adult learner, you were able to see that, and [00:20:00] sidestep, and do the best you could, and eventually extract yourself, what have you. But so many younger students, newer students, that don't have the life experience that you do, and don't have the life responsibilities that require you to take these deep looks, they get sucked in and- Yes, absolutely
spit, spit out 10 years later, and it's just such a disaster. And so I just wanna tell you again, I know you will be a leader in your community. You've just done the leadership module, and I just, I really want to champion you stepping into that role. You have so much to teach and so much to share. And yeah.
This is part of that initiation to become the leader- Yes ... that you will become. Yeah. That kinda leads me into my question for you, is I'm really curious about birth centers, but I after my experience opening my little clinic that was almost nothing for a very short time I'm very gun-shy now.
And I, like, when you [00:21:00] say you're gonna be a leader in the community, I feel like yes, and also that comes with such a trepidation of... as the midwifery world is so competitive, and I don't mean with clientele, I mean between midwives. Yeah. That's not actually competition ... It's actually scarcity.
Everyone's functioning in a scarcity mindset. And my solution to that has always been to actively and aggressively walk in the abundance mindset. Even if everyone around you doesn't get you, keep giving Keep believing that there's more. Let that client go. It's hard to describe, but once you have the abundance mindset installed in your brain, and it's not codependence, which is giving with no limit.
It's abundance that gives from capacity, gives honestly. But it also believes the best of other [00:22:00] people, and I teach from this abundance concept. But when you're in practice, it means that you like open palm your experience of life, right? So it's like walking through life with open palm instead of closed palm, is the best visual that I can give around the mindset that this requires. And I have built several birth centers, and I have assisted in 20 five others building them and structuring them.
I have been a leader in the community. I have planned conferences and workshops and classes and all kinds of things, and it always has been from this place of, I know what I have to offer
And If you come, you are welcome, and if you don't, I wish you well. I'm not gonna coerce you to do what I'm doing. I'm not gonna browbeat anyone. I'm not gonna talk behind anyone's back. I'm not gonna talk about people that aren't in the room Let's just do the best we [00:23:00] can. Yeah.
I'm similar to you, and I feel like I can do a lot. I can go start 100 businesses right now. But, probably not 100, but I don't know. We might. We might. But how do you get people to go along the journey with you? Because a birth center- Yeah ... is not something you can do- that's what I struggled the hardest with.
Yes. If I'm truly honest, that's what I struggled the hardest with. Because most people do not- I terrify people ... do not work from abundance. Yeah. I terrify people. You're welcome. Welcome to the club, girlfriend. Yes. And I think that is, you, I have come to love that quality in me because of what it means behind that.
Yeah. Behind that it means that, I have the power to move people. Yeah. And I've heard this said before that there's only three responses to you. People can love you, people can hate you, or people can be ambivalent. Yeah. And you generally inspire people in two ways And of the options, of those three options, [00:24:00] I would say I have come to understand that I would much prefer to be loved and hated than to be loved and have people ambivalent about me.
Or to be hated and have people be ambivalent about me. Because ambivalence means they don't care. They're not invested. You don't stir anything in them. You don't move them. It doesn't matter. You don't matter. Your cause doesn't matter. The situation doesn't matter, whatever. And if I'm loved and hated, then at least I know that I am on the pulse, the nerve of what needs to move in the world.
And because ... I am a world builder, I am a change maker, then- I just saw a podcast that you posted- Yeah ... a clip of you talking to this woman about marketing, and like she... I wanna go back and find it now. I only saw a little clip of it that you shared. Do you know which one I'm talking about?
It was just a couple days ago. I do a lot of podcasts. I don't know. You, it was specifically she- Was she in a sari? Was she in a sari? Maybe. She was talking about "Why wouldn't you wanna, why wouldn't [00:25:00] you wanna donate money to our cause?" Yes. It like makes you feel good. Yes. I can't remember what it was.
Yes. I wanna go find it now. That is a very recent podcast, Yeah ... she's amazing. And it is about nonprofits specifically. Yeah. But yeah there's so much mindset shifting that can happen, and so many midwives have not made the mindset away from scarcity.
And so what happens is they close, they tight, they grip, they, "I don't wanna let go. This is mine, my territory, my clients, my whatever," right? And you can't work with those people. You just can't. I've tried for years. I have tried to change that mindset from inside and outside, and it's not possible. They have to do it on their own.
Like everything else, people can only change for their own free will. So there's nothing, literally nothing near me. Yeah. The closest birth centers are an hour and 20 minutes, an hour and 10 minutes, and two-plus hours away. There's only one- So if you have any kind of population around you- Yeah ... then it would probably go really well.[00:26:00]
It would, but my thought process is the OBs are gonna hate me. Yes. The CNM at the hospital- Yes ... is gonna hate me. Maybe. And I want these, and I don't want them to hate me. I don't want them to... I don't care if they love me, but I don't want them to hate me because then they're gonna either try to stop it from happening.
No you don't get these options. But think about ambivalence. Think about ambivalence. Yeah. Do you really wanna be met with ambivalence? No, but I'm saying- So then the only other option- you need the support ... is love and hate. Yes and no. We're talking about several things here. Yeah. But let's just try to narrow in on the important piece, which is you and how you feel doing your life's work.
Okay. Do you believe that your life energy, your life force energy, would be well spent serving in midwifery?
Maybe ... regardless of the outcome Maybe, I'm not sure Okay, so pin on that Still figuring it out. Do you believe that your life force energy would be [00:27:00] beautifully spent by building opportunities for midwifery to exist in your community? I could say yes to that. Okay. Yeah So from what I'm taking from this, just from this very simple test, you could be a fantastic entrepreneur and business owner where you may not be the primary provider. Right. And that is a great discovery.
That is a freedom level discovery Yeah, I'm still deciding about that. Because most- But yes ... most students who I ask this will say yes to the first and maybe to the second that's interesting. And so what you have there is basically a ready-made workforce who doesn't wanna do the thing that you already know.
You just said, "I could start 100 businesses." Yeah So like you, you actually already have the skillset. The problem that you did before, and is the model that we've seen so dysfunctionally applied, is trying to do both now, it totally [00:28:00] makes sense for a midwife to own a birth center because you have so much knowledge that you can't acquire any other way.
But I think what midwives don't know is that you don't have to be the sole provider. You don't have to be a provider at all. You can be the owner, and you can employ providers. Yeah. Yeah. And I think that I was getting so much backlash about that because people were saying how could you do this or that?
You're not even a midwife. You're not even licensed." And I'm like I hired two midwives to work for me. I don't understand what the problem is." Totally. You know this. You know this model. Yeah. Exactly. The problem is that you tried to be in all the clinic, in all the birth rooms, in all the prenatals.
And this is what I'm saying. You could actually finish your training, as you should- Yeah ... and at the same time, build the mindset that allows you to be the boss, the leader, the entrepreneur, without the sleepless nights. Yeah. I definitely don't wanna do it on my own. I have a huge family that is- You said that
my- Yeah. Yeah. You said that. I mean- Yeah ... I feel like there [00:29:00] isn't a way for me to be the mother that I want to be, and also the midwife that I want to be if it is a sole proprietor- 100%. 100% ... or co- It just doesn't, it doesn't work for me. So let's, since we're narrowing in on this let me ask you a few more questions.
Sure. Would you rather work a shift where there's defined start and end hours in the day or the week? Or would you rather be the boss that doesn't have a shift, but also has no clinic hours?
So like you take calls all the time potentially? Is that what you mean, like any time of the day? No, because you have no clinic hours. You're just the boss. So you just... I don't know how that would work. Just run the business, but you don't do the births. I see. So would I rather have a timeframe in which I work, or I always work but I'm not in, at the births?
And not on call. Yeah. I feel like both of those are the same to me because if I [00:30:00] have set hours, then I have hours that I'm also not there. So that to me is fine. But then the other way is also fine because you're not on call, so you're able to set hours, right? So it's I don't know. Okay. This is things to ponder over.
Yeah. This is the intersection. I think I'm not distinguishing the two very well, those two options. Okay. So if you were somebody's employee at a birth center- ... there would likely be a shift. Yeah. Some birth centers do week on, week off. Sure. Some do day on, day off. Some do 12-hour shifts, what have you.
There's lots- Yeah ... of different just call schedules. But you would have to, at some point, based on the schedule you're handed, put midwifery ahead of everything. Sure. In the other scenario, there is no midwifery. There's just your business. Okay Then I pick the first one. Which, you would like to be at births?
I think I would like to be at births, but if the second scenario means I don't have anything to do with midwifery and I'm only running a [00:31:00] business. You have lots to do with midwifery Yeah. You just don't do midwifery. You just don't have to, you know- Yeah ... deal with the clients face-to-face most times in their moment of pain.
Ooh, I like both of those options. I like both of those options equally. Okay. Yeah. So the third option is the one I don't recommend, which is where you're running a business and seeing clients, and you're always on. Always on call. Always available. Yeah. Always needed. That would be, yeah, that would be like a home birth practice.
And that's what- ... home birth center, doesn't matter. That's the, that's what most midwives do. And so you're very clear about not wanting that, and that's excellent. Don't want that. Yeah. Don't do that. It's not sustainable. Yeah. That's why everyone's burnt out. Even if I owned the business and was a provider at a birth center that I opened, I would not be on call all the time 'cause I would not open a business by or I wouldn't be the only one.
I hear you, and at the same time unless you put in very strong boundaries, it still happens. Yeah. And let me give you a little scenario. So because you're a startup and [00:32:00] midwifery oftentimes people try to get deals, and insurance doesn't pay all the way, and Medicaid is a joke, and on.
Unless you put very inspiring business practices at work a lot of midwives will complain of poverty wages. So what happens then is in order to save money, you start doing labor. And/or you hire newer midwives that don't have as much competence and call you for everything. And/or because you care so much about your business being successful, you show up a lot and smile a lot, and clients choose you because you're smiling so much.
And so it's this three chains around your neck dragging you back into being on call and available all the time. And so even though you may not attend all of them, you certainly are aware of all of them. You certainly are on call for your senior midwives. You certainly are waiting for the shoe to drop, right?
So [00:33:00] this is that dangerous slippery slope that if you- I see that ... do not actively prepare for how to not be a clinician, if you own the business and you're a clinician, you very oftentimes end up having two or three jobs concurrently. I know owners of birth centers who chart stock while people are in labor, while their midwives are working how many jobs can we do simultaneously? One. Ridiculous. Burnout central, right? I'm like, "Do you trust your midwives that you hired? Why are you watching the charts? Why are you calling us to see why we're doing this or that?" Systems are not in place. It's a systems game. So I know that you're a systems-level thinker, and I know that will not be a problem for you unless you don't get really clear about this distinction, which is why I'm trying to paint the picture that there are only two options really- in sustainable midwifery. One, work a shift, go home, be off. Yeah. Two, own the business, do not be a provider, at least for [00:34:00] huge chunks of time. That would be so hard. Only initially. And it depends on your goals and your motivations, right? So let's put this aside, the time and energy and sort of- Yeah
thought process of how, what role you're in, and let's think from a very high level, 30,000-foot view. Zoom way up, look down at your life. Five years, 10 years from now. Yeah. What do you want midwifery to have done for you, or the the accompanying businesses of midwifery to have done for you?
What do you wish that it has done for you? What is the outcome of all this energy you've put in to your knowledge base in this profession?
That's a really good question. If I'm in my 60s, let's say, 'cause I'm 40 now, I would love to say that I opened a birth center that's still going, right? Okay, longevity ... yes, and where I don't have to be there anymore. I would like it to be running itself. And financial independence.
Yes. [00:35:00] That being said, I feel like this is where you're the expert. I am seeing literally every day this week another birth center announcing that they are closing. Yeah, girl. We gotta always talk about this within context, and right now the political, social, financial context is bad. What is going on?
In Portland alone we had one or two birth centers close. I saw, three others on the East Coast, another one somewhere in Washington. Like- Every single week a birth center closes in the US. Yeah, and then we've got multiple up north of me opening. We had two this month open. Every single week a birth center opens in the US.
So what distinguishes the difference between, a birth center staying open for 20 years You can answer this. Yes Come on, you can answer this. So- I really don't know ... you do. Okay. Let's take any birth center. There are lots of examples of birth centers run by owners. [00:36:00] Yeah ... that do not practice in the building, and oftentimes do not even work there.
They export even the executive leadership. So how can I enjoy birth and enjoy midwifery and potentially have to, because there is no one here in my area, like potentially I would have to be the one to start. So hold on one second. Yeah. You're going into how, and that's a natural human reaction is to try to figure out how.
But stay at the what and the why with me- Okay ... because defining this first is so important. Okay. How comes last, actually. Sure. What, why, who, where, how much, and then finally how. Okay? I like how you put how much. That's funny. You do. You gotta run- Yeah ... the numbers before- Yeah ... you can actually figure out if it's even possible, which is the how, right?
Sure. So- ... these examples of birth centers, there's one in California that's run by a chiropractor. There's several birth centers in Texas run by venture capitalist firms. [00:37:00] There's a midwife turned entrepreneur in Minnesota who does all kinds of lobbying work now and does not practice at all.
And the difference is partly that. So one of the major reasons that we have longevity in some of these birth centers is that their founders are not their providers. The owners are not their providers. Another reason is that the owners have either outsourced or learned it themselves proper financial management.
Because so many birth centers run like a hobby. Yeah. And I think the third reason is that the ones that are, have longevity and are sustainable have also cracked the ancillary income. So they earn from multiple streams of revenue, not just ... birth income. Yeah. There's a birth center that has a lactation café connected to the birth center.
Yeah. And the lactation cafe pays the full [00:38:00] birth center rent every month, plus its salaries, plus its, its operations costs. Yeah. I know one in Texas that has a boutique ultrasound clinic next to it- ... that's owned by that, right? Or even just doula, childbirth education, placenta encapsulation, photograph, blah, blah, blah.
Like, all the ancillary things that circle around birth. They've- Yeah ... figured out a way to have multiple streams of revenue. They understand proper financial management and planning, and the owner does not attend births. That's truly the sustainability trifecta, if you ask me. So birth center that I'm, birth assisting for right now that is, was started by a midwife.
It was at one point just her solo practice long time ago. It's been open a really long time, and she now just owns it, just does all of the, paperwork side of things. She does not do births anymore, but it is still open, and she for a long time did it herself, [00:39:00] then hired multiple midwives on, and now just those midwives are doing that.
I'm very curious how she managed to keep it open for so long 'cause now she's nearing retirement age, there's ... Yeah. There's really two options. One is leverage the resources around you, and two is, hook up an IV and drain your own blood. The only two options, right?
Yeah. So either she's the walking dead because she drained her life force into a business, or her community has stepped up to support the thing that they say they want. So all of this is to say, again, we're in how. Come back to the what and why. Yes. And I've heard you say, "I want to have sustainability, financial independence, longevity- Yes ... and joy." I heard joy in there. Yes. So write those four down- Okay ... because I think that's really important foundational leadership there in your own [00:40:00] brain of what you know you want on the other side of all this work. What was the third one? Sustainability, financial independence.
Longevity. Longevity. And joy. I didn't say that. Yeah, you did say that. Yeah. I was joking with my family about this. Hey, even if I just become a midwife so I can catch my grand babies, like that would be enough for me. Like just having that skill that I can participate in their births, if they want.
Obviously, I'm not gonna be like, "I'm your midwife," but- But my 17-year-old- You, you're- ... is already like, "You're gonna be my midwife." I'm like, "We'll see if you still feel that way." That's really sweet, and also you're at a really important growth trajectory in your evolution here. Yeah. Yes, exactly.
Thinking in this long-term goal to this place of "I could be fulfilled actually if I didn't rank up the numbers, because I have these other goals." Yeah. I have these other things. And really getting clear [00:41:00] about the pathway in front of you, having seen so many midwives burn out. Yeah. Being convicted that midwifery needs to grow, but realizing that you might actually lose your family if you were one of the frontline health workers, because it requires so much of you.
We've oftentimes joked in Midwifery Wisdom, it's like midwifery is a young man's game. It's a young woman's game. This w- we can't keep doing this. You're up all night, blood and all kinds of gunk on you, and funk, and exhaustion and trauma. It's we can't keep doing this.
Yeah. So you know, just being real about the fact that you have a large and growing family, that you have small people that depend on you, that you need to make an income, and that might be more important. That's why I was so frustrated when- Yeah ... the, a lot of the w- a lot of my frustration was coming from with my previous preceptor.
My husband was saying NARM gives you 10 years to finish." And I said, "In 10 years I'll be 50. I'm not gonna start a career-" "... [00:42:00] doing midwifery at 50 years old." No. "It's either gonna be now, and I get a good 10 years and that's it, or I'm not gonna do this, 'cause I'm not gonna be 50 with grandkids running around and then be like, 'Yeah, okay, I'm going off to a birth.'"
I... No. Yeah. I feel like 10, 10 years from now I wanna see something that I can actually take a step back from and feel like I made a huge impact in my community. Okay, so listen to these words. This is very important. What you're saying is not actually very congruent with being on call 24/7 as a new midwife.
Like being on call 24/7 as a new midwife does not create sustainability. It does not create income. It does not make a large impact on your community. It definitely makes a large impact on the families that you serve. It's a beautiful offering, but it does not scale. And you, like you said, are an adult learner, and you came to this needing to have something to scale.[00:43:00]
You have a family. You need to be sustainable. Yeah.
I do feel though, most people have to start somewhere. Definitely and I don't know that it would be possible for me to just start a birth center without first being a midwife in the community. I think you're at how again, and I would say I disagree entirely, number one. Okay. And number two it's really not always up to us to determine the how.
Sure. I guess what I'm trying to- It's up to us to determine what and why ... what I'm trying to uncover here within myself- Okay ... within this conversation is do I have to give up the desire to actually be at births? That's what I'm trying to uncover here. Because that's what I'm hearing from you is it sounds like you would want to be the entrepreneur and open the birth center, and yes, I agree, that totally is my personality.
But there is a strong desire within me, too, to also be at births. And so what I'm asking and trying to figure out [00:44:00] is not necessarily how, but in the realm of this, does that mean I have to choose, right? Does it mean that I have to decide now whether I want to not attend birth?
Or is this some- These are really good questions. Yeah. These are really good questions. Yeah. Only you have the answer. But I think you're on the right path, and I think instead of making it black or white or either/or or negative, do I have to stop doing this, try to reframe it into going back to that what do I want, where do I want my life in five years?
What do I want this to say about me? All the things. What do I want this work to mean? Yeah. But can it be both? Can it be, like, I want to be in this world for a little while, and then I know where my goal is? Yeah. Anything's possible. Sure. There are also midwives who do it all. Yeah.
But as we've already discussed what are you gonna give up for that to happen? And that's not something I'm willing to give up. Yeah. There you go. So when you go lean into what do I [00:45:00] really want, and what am I unwilling to let go of ... sometimes it gets clearer. Yeah. And you discover that thing that you've been chasing is not exactly what you want.
And there's a bigger want. Wanting to build a lasting, impactful
service in your community is not a small thing. Yeah. That's a beautiful thing, actually.
Some people just wanna go to 200 births in their career and help those 200 families, and that's enough. Yeah. And that's beautiful, and those families benefit. And that quiet community midwife life is beautiful. Yeah. But if you have a higher, more elaborate calling- Amen ... that says, "I'm gonna not only do that for 200 families.
I'm gonna do that for 200 families a year for 20 years, and build jobs for my community," that's very different
And [00:46:00] I think one of the most powerful things that we can acknowledge as women, mothers, midwives, adults, is that when you say No to the things that don't light you up, you actually are getting to say yes to the things that do. So that question of do I have to give this up? Maybe. But maybe that is a really good trade-off because it brings you closer to the things that light you up long term.
Now, you undoubtedly have more births to attend. Undoubtedly. Yeah. You have this license to get and I'm sure you've got friends and immediate people in your community who are depending on you and there's more births for you to attend. This is not something you have to decide right this minute.
Yeah. But when you come from the perspective of your 60-year-old self looking back over this work- Yeah ... you can sometimes get a little more ruthless about charting the course of your life instead of letting it [00:47:00] happen to you. Yeah, absolutely. You can get a little clearer about what you're willing to sacrifice as opposed to what you really want to build with the precious time that we have.
Because it is small, actually. Life just goes by in the blink of an eye. Yeah. You see how fast your kids grow, right? Yeah. It's crazy. Yeah, so true. And so this is finite time. Do with it what you really want to do. Yeah. That's helpful. I'd love to keep discussing this and ... I think it's very helpful to kinda ... I'm a external processor, so just even hearing you bounce things back off me, it's bringing to light more, like, where my direction's going. So it's really helpful. Every fellow gets two calls, perfect. Yes. We got space. We got time to do this. And next Sunday is our final group call. Oh, I'm so sad. I know. It's gonna be a celebration, though. It'll be a celebration. Yes. I am so pleased to support you. It's been such a [00:48:00] pleasure. Yes, I really loved it. I feel like it's been what got me through this last year, it was a rough year. It was. I'm glad we were there for you, and look forward to to watching your trajectory. And as you keep asking and answering yourself these very important questions, just keep hold of that concept that if you decide to put your energy into building a functional, sustainable institution of birth, that in itself is a birth.
And that maybe you're called to midwife things into existence that doesn't necessarily require being up all night at other births. I like that. Yeah. I like that. I've been midwifing for a decade even though I'm not really practicing, because I get to midwife students and entrepreneurs.
Yeah. And that's really inspiring to me. It's the same light bulb moment, yeah. It's funny that you say that, because last night I was at a birth, and I was talking to the birth assistant, and she said, " [00:49:00] Do you really love this? Do you wanna be a midwife?"
And I said, "I'm still figuring that out." And then I said, "I can't tell if I love birth or if I love giving birth." And so then when you said, "Maybe I'll be a midwife that brings to life other things," I'm just like that's really interesting." ' Cause that's how I feel. I feel like I love creating, and when you're the midwife, you're watching someone else doing the creating. It's not- True ... the same thing as being the person giving birth. True. True, friend. True. Yeah. Naming a truth there. Yeah. I have a midwife definition shirt that I wear a lot I wrote years and years ago, and it has meaning to me.
And when I boil down the definition of midwife to its most simplest possible common denominator, it is change agent.
Yes. So you can be a change agent outside the birth room with tremendous effect, and that creative, generative quality that you're talking about. [00:50:00] Yeah. That's so interesting. I've never thought of it that way. All right. I look forward to our next call. Lots of love, honey. All right, have a good day over there. Thank you. Bye. Bye.