Advanced Midwifery & Wellness; Interview with Jessica Johnston |Nationally Certified Midwife

What exactly is a midwife?

The word midwife means with woman. As a midwife, my role is to honor and view the child-bearing process and assess risk. I am an advisor of low-risk clientele and my role is to help plan the birth and assist with the decision-making process. I am at her right hand, listening and watching. My role as a midwife is to protect the mother and provide empowerment.

I am a Nationally Certified Professional Midwife and State of Alaska Certified Direct-Entry Midwife. Professional midwives are experts at community births and most importantly understand risk assessment. I serve clients and families that desire holistic and informed maternity care and the sacred experience of home-births. A midwife is a witch that wasn’t burned and is willing to stand up next to a mother and say “I believe in you”.

How long have you been practicing and how many births have you attended?

In the State of Alaska, a certified professional midwife must attend 60 births outside of the hospital setting as an apprentice. A certified professional midwife is an expert at community births and the most valuable tool in their tool belt is risk assessment. I was licensed in the beginning of 2018, so I am coming up on my third year in practice. Before I became licensed, I attended over 90 births during my apprenticeship. I now own Advanced Midwifery and Wellness, which is a boutique home-birth practice. I have attended about 20 deliveries in practice. The reason behind a boutique home-birth practice is sustainability. Inherently, midwifery practices are unsustainable therefore I choose as a provider to only accept limited clientele.

“I focus the majority of my midwifery practice around providing prenatal and postpartum care to clients who desire/require hospital delivery. They deserve personalized midwifery care, no matter how or where they give birth, and I love bringing that care to them and supporting them through their journey, whether they give birth at home or in the hospital.”

I visit mothers everyday in home for the first week postpartum and then follow-up in the clinic at 2, 4, and 6 weeks. I develop a bond with each mother, and support them with their adjustment to motherhood. At postnatal appointments we focus on optimizing latch and breastfeeding, postpartum strengthening and healing, and help to adjust to motherhood. As a midwife, I can provide care for the newborn for the first 28 days of life and provide maternal care for women up to 6-weeks postpartum, but 42 days is not enough time.

Women were never meant to have a baby and raise a baby alone. In a village, when a mother would bring a child into this world, it was a sacred moment. If it was a rough birth and your milk wasn’t coming in, someone else in the village fed your baby. No one was without. There is a sense of interconnectedness that develops during the birthing process and I as a midwife have the opportunity of witnessing this beautiful connection unfold before my eyes.

What is the role of a midwife during labor?

The birthing process is sacred. As a midwife, I do not come to a mom in labor until she is in active labor following the 4-1-1 rule. The mom will be having one minute contractions, four minutes apart, for one hour, however this rule does not apply to mothers with a history of precipitous labors with previous children. When I arrive I do not require a cervical exam. I maintain medical oversight, maternal and fetal surveillance and I am continuously conducting risk assessment.

Much of the time, I help to direct the team but maintain my distance and remain in the hallway on the other side of the wall. I make sure the mother knows where I am, if she absolutely needs me, but I do not infringe on the mother’s area. You know the saying, a watched pot never boils? The same applies to the birthing process. I require all of my first time mothers to have a doula, a sister, a mother, or a friend. I am not a doula. A doula provides emotional and physical support during and after labor, very different from a midwife.

I do not intervene in the birthing process unless absolutely necessary. I do not tell mothers when to push, I allow my clients to position themselves and experience the rawness of labor. Space allows for vulnerability.

What led you to become a midwife?

You know, my goddaughter is a sophomore in high school and she is always telling me, “I have no idea what I want to do with my life” and I tell her, well sweetheart, I didn’t know what a midwife was until I was 26 years old. When I get asked this question I always respond with: What has led me to do anything in life? I have my undergraduate degree in pre-med. Prior to becoming a midwife I was a Kundalini Yoga instructor. I taught prenatal yoga and took lots of pre-pregancy courses before having my first son at a birthing center ten years ago. I had terrible postpartum depression and anxiety with my first and that wasn’t healed until I became a midwife.

I have the privilege to ask myself what I want to do and try it out. I had the opportunity to become a midwife so I took it and ran. I was 32 years old and a server at a restaurant; it’s never too late to say F*** it and try something new. So I would tell you today that everything I have ever done in my life has led me to become a midwife.

What advice would you give to an expecting mother on how to find or choose a midwife?

You know how you go into an ice-cream parlor and there are so many different flavors? You remember how you try them all before you pick one? Somedays you feel like chocolate and other days you love strawberry. Well each midwife has its own flavor, so interview any of them that strike your fancy. Listen to your gut and take note of that feeling. That gut relationship is what you want with your midwife. You are trusting that I am skilled, supporting, and loving throughout the whole journey.

It is never too late to change your method of care. At anytime during your pregnancy you have the ability to change your providers. Choose to change anytime it calls to you. Always listen to yourself and do not worry about what everyone else thinks. If a mother ever says to me, I don’t know why but I have a gut feeling I should go to the hospital, then we go and we treat it like an emergency. I never question a mother’s gut feeling.

What are the benefits of having a midwife?

Midwifery statistically demonstrates a significant reduction in preterm labor, cesarean sections, and higher successes with breastfeeding. A midwife looks at you in your most vulnerable state and says yes you can! A level of trust is established through the bond created between mother and midwife. The benefit of a midwife is you know you are getting the best care from someone who knows you and is walking along side of you during the entire journey.

In the state of Alaska, we have a 94% success rate with home-births as compared to the national average of 89%. 9 out of 10 mothers with plans to deliver at home will deliver at home. 1 out of 10 mothers will transport to a hospital for delivery, but 9 out of 10 of those mothers that transport will have a vaginal delivery in a hospital. The Midwives Alliance of North America (MANA) Home-birth Data from 2004-2009 reports 5.2% result in cesarean deliveries¹. MANA also reports that home-births result in a an high rate, 97.7%, of breastfeeding at 6 weeks postpartum.

How does prenatal care differ with a midwife?

My prenatal care appointments last an hour, sometimes longer. Sometimes it takes the upwards of an hour in our hustle bustle lives to sit down, slow down, and actually talk. Sometimes we will sit for another hour to talk or to just cry. I want a relationship to be created and fostered through time between myself and my clients. I want to educate my clients because education is empowering. I have learned from experience that educating from a culturally matched provider is the greatest way to achieve the best outcomes.

I focus on education and advocacy for midwifery. Prior to COVID-19 shutdowns, I was running a group prenatal care model with another midwife in town. We would bring mothers of similar due dates together to chat, snack, and complete vital checks. We would schedule two hour blocks: the first hour we focused on educating the mothers on newborn and postpartum care and the second hour was dedicated to forming camaraderie.

I work in tandem with many other providers such as occupational therapists for tongue tie and latch issues, chiropractors, dietitians, and pediatricians to provide exceptional care to my clients.

What are some common misconceptions about midwifery and how would you address those?

The most common misconception I hear about midwifery is that midwives are not licensed healthcare providers and that we do not receive enough training. Certifications in Alaska are the most stringent in comparison to the nation. I hear that we are hippies and do not believe in science and evidence, but that is invalid. We are commonly associated with anti-science, but we do believe in science. We apply modern evidence to our practice. We share evidence based information with mothers regarding everything from vaccinations to circumcision, and encourage mothers follow evidence-based practices when making decisions. Home-births are dangerous is another very common misconception. Low-risk births, births that require low-intervention and low-resources have the safest outcomes when attended and delivered in the community by midwives.

What is the best part of what you do?

I love talking to mothers about motherhood and the rawness and directness of midwifery. I help mothers navigate and own their postpartum and understand the beautiful changes that happened in their bodies over the past nine months. I encourage mothers to overcome the expections of motherhood and to help them to reorient themselves in their life with their baby.

“You matter. You are right here and you built this family and it matters. You are the center of the wheel of your family. Your cup is so full and its overflowing with love. You have given so much of yourself for those you love. Love yourself because you matter and you are important.”

Women give so much of themselves to everyone around them, but no one stops and holds them. I stop and hold them and tell them its okay to take a moment of self care. For some people its running until they cry.

Where do your births take place?

In the sacredness of my client’s homes. Most expecting mothers that choose home-births are pregnant with their second child. The odds are that once you have had a home-birth, you’re going to do it again. I do not have hospital privileges.

Can patients bill insurance?

Most insurances in the state of Alaska will cover partial or sometimes more of home-births. Most midwives that practice home-births are not in-network with most insurance companies. I have a fair amount of cash-pay clients. Medicaid covers all midwives in the the state of Alaska. Community based midwives save the state of Alaska roughly a half million per year. Insurance also covers prenatal and postnatal care provided by a midwife.

For more information, visit their website at: https://www.anchoragemidwife.com

Resources:
1. Homebirth Study One-page Fact Sheet. Midwives Alliance of North America.
Published 2021. Accessed February 19, 2021.