A Licensed Midwife on the Transformative Power of Birth
Birth is transformative. Not just for the baby, but for the mother who goes through her own transformative “birth” in the process. Hayley Oakes, a licensed midwife based in Los Angeles, has had a front row seat in hundreds of births. Her experiences inspired her to start a blog, which has become a kind of “Humans of New York” for childbirth. At home, at a birthing center, or at the hospital, her stories reveal how unique the birth process can be— and also the universal threads that bind mothers. According to Hayley, she began documenting these stories to lift the veil on childbirth, to make it feel less scary and mysterious to expectant mothers. “My hope is that these stories can better prepare a woman for her own birth experience– in any setting,” she says.
How long have you been working in this field?
I have been officially working in the field of maternal health and infant wellness since 2010. At that time, I completed the DONA doula training with Ana Paula Markel at BINI Birth. Prior to that I was exposed to babies, birth and the option of midwifery care and doulas since 2008, when I worked at the Prenatal Yoga Center in New York City. There I worked at the front desk doing administrate work (I was an undergrad student at the time) and it was then that I knew I wanted to work in this field.
What led you to becoming a midwife?
After I completed my doula training, I sought out a midwife in Ventura, CA to expose myself to everything birth-related. I volunteered at her birth center doing admin work, which led to me sitting in on prenatal visits and then eventually observing births. My experience working for the midwife there were was very hugely instrumental in me becoming a midwife. She basically told me, “You are meant to do this and you should.” That instilled a lot of confidence in me to want to go back to school and take on the responsibilities of being a midwife.
What is a common misconception people have about midwives and out-of-hospital births?
A common misconception about midwives and planned out-of-hospital birth is the kind of care that is provided. Most people think midwives are only there for the birth itself, with only towels in hand and nothing else. Or often confuse the role of a doula with a midwife in thinking they are the same thing.
A doula is someone who has been trained to be an emotional, physical and informational support for a woman and her partner in labor. She is a Sherpa, an advocate, a concierge of birth helping the mother understand her options to help her have a positive experience giving birth. She does not perform any medical procedures i.e. blood pressures, vaginal exams or catch babies.
Midwives are licensed, medical health care professionals. They are trained and certified to care for and manage low-risk, healthy women during the childbearing year. During the pregnancy, they perform lab work and monitor the baby’s growth and development as would an OB-GYN, as well as spend time discussing nutrition, exercise, stress, and ways of staying healthy. During the labor and birth, midwives monitor the baby’s heart rate with a hand-held ultrasound device called a Doppler. They carry medical supplies and medications (IV antibiotics, DeLee suction traps, Amnio-hook, anti-hemorrhagic medications for postpartum, oxygen tank and mask, suturing materials, Erythromycin, Vitamin K, etc.) for both the mother and baby. Essentially, the midwife carries a mini-clinic in her birth bags.
In your experience how common is hospital transfer?
The national statistic is 1 in 4 first-time mothers planning an out-of-hospital birth will transfer to the hospital. In my experience, it depends on the volume of clientele in the practice. I have seen as low as a 7% transfer rate and up to 25%.
However, most of those transfers are non-urgent. This means the reason for leaving the home or birth center setting is usually due to maternal exhaustion, need for pain relief and augmentation of the labor. Both the mother and baby are stable, but a higher level of interventions are needed (i.e. an epidural and Pitocin). The midwife calls the hospital to alert them of the client coming in. The clients get in their car, the midwife gets in her car, and they all drive to the hospital. Less than 1% of transfers are true emergencies.
What is the most difficult part of the job?
The most difficult part of being a midwife is being on call. Your life outside of the lives of your clients is on hold. While the work is fulfilling, you can appear to be pretty flaky and unreliable to friends and loved ones. There will be important events, dinners, celebrations, shows, movies, gatherings, etc. that I will have to leave and/or miss because someone is in labor or I am at a birth. This can put a strain on personal relationships with partners, friends and family.
What is the most rewarding part of the job?
The most rewarding part of the job is seeing the transformation in a woman’s sense of power and confidence after giving birth. There is so much shock, awe, joy, tears, sweat— it’s a beautiful thing to witness and the greatest high in the world. Often times, that sense of accomplishment has a positive effect in her approach to breastfeeding and bonding with her baby. Knowing I was there to help navigate that journey with her is such an honor.
What is one of the greatest lessons you’ve learned in this field?
Birth teaches you to be ever so humble, present and unattached. It forces you to inform yourself, prepare and have intentions, but not expectations. Birth teaches you that it’s not about the setting, the care provider or the mother. There are so many other factors that are at play including the baby. Giving birth is part of a woman’s story to glean wisdom, insight and sometimes healing from. As one of my clients, Sarah, so beautifully put it, birth is ‘so dark and so light and all of it sacred’.
What advice would you give a new mother who wants to have an un-medicated birth?
My advice to a woman wanting to have an un-medicated birth is to familiarize yourself with birth as much as possible. The more you know what it looks and sounds like, the less fear you will have in approaching the birth and experiencing it. People often say, ‘Well, women have been giving birth naturally since the beginning of time, so why can’t I do it?’ My response to this notion is that most of those women supported other women giving birth. Therefore, they saw birth all the time. It was normal. Today, we don’t see birth unless it is in the movies, which is always depicted as a horrific event.
Watch birth videos and read positive birth stories. Get to know laboring women’s behaviors and sounds. In any other context, these signs would seem alarming and unusual, but when giving birth it is exactly right. If you know this, then labor progresses so much more easily when you don’t have to decide or think if is this normal or not.
What are some of the basic health, diet and lifestyle recommendations you give your clients?
Imagine yourself training for a marathon. You would never show up to the start line having spent the last few months eating loads of sugar and not exercising. One has to train physically and mentally.
Eat a high-protein and low carb diet. This will help control blood sugars, satisfy pregnancy cravings and prevent excessive weight gain (which leads to more complications during and after the birth). Exercise regularly. Aim for walking 3-6 miles/day or do an hour of cardio a day. This allows the baby to find the best position in the mother’s pelvis and prepares the mother for the endurance she will need for labor and birth (which can be up to 12-24 hours long). Decrease stress. When there is a constant stream of stress hormones coursing through the mother’s body, this increases the risk of complications for both her and the baby. Find ways of having a daily practice of deep breathing, centering/meditating, yoga, and talking to the baby. This naturally lowers your blood pressure, pulse, breathing rate and allows the body to recover from a constant state of being in the ‘fight or flight’ mode. Bodywork in the form of chiropractic care and acupuncture are key in preventing and/or treating aches, pains, and other issues. Lastly, take a great childbirth preparation series. Knowledge is power!
Do you have a self-care routine?
I am a big fan of self-care. The late nights and long hours of attending births can take a toll on your body. I try to eat well and go for a walk every day. I take a lot of supplements: Chinese herbs, probiotics, omegas, vitamin D, vitamin B complex, and ginkgo bilboa. I drink a lot of wellness shots (turmeric, lemon, garlic, cayenne) if it’s been an especially busy time. I see a chiropractor weekly, not because anything is wrong but just as preventative care. I see a therapist every other week to have a place to touch base emotionally. Periodically, I will do some journaling, coloring or water coloring. I also love a good Korean spa day or at home spa facial steams and masks. I try to practice what I preach.