Gina Thompson

My name is Jamie Hinton. I am a licensed midwife in the state of Texas in the Dallas-Fort Worth area. I was a CPM as well as LM. I am no longer a CPM. I came into this profession in a very natural way of my own pregnancy and birth of my first baby and then teaching childbirth classes, becoming a doula, and then moving on to becoming a licensed midwife.

My name is Jamie Hinton. I am a licensed midwife in the state of Texas in the Dallas-Fort Worth area. I was a CPM as well as LM. I am no longer a CPM. I came into this profession in a very natural way of my own pregnancy and birth of my first baby and then teaching childbirth classes, becoming a doula, and then moving on to becoming a licensed midwife.

Gina and Caitlin and I were friends before any of us were midwives. Gina was a doula, I was a doula, and Caitlin eventually became a doula as well. We did have a friendship and we worked together. I would teach childbirth classes and refer people to Caitlin as the doula, or Gina would refer people to my classes from her doula clients.

Gina and Caitlin and I were friends before any of us were midwives. Gina was a doula, I was a doula, and Caitlin eventually became a doula as well. We did have a friendship and we worked together. I would teach childbirth classes and refer people to Caitlin as the doula, or Gina would refer people to my classes from her doula clients.

Gina was the first of us to decide that she wanted to become a midwife and become licensed. I was the next, and then Caitlin was the third to start. Gina, when she was almost through her apprenticeship, knew that I was about to start an apprenticeship as well and that I was wanting to do an academic program. She said, let's go to Starbucks and talk.

Gina was the first of us to decide that she wanted to become a midwife and become licensed. I was the next, and then Caitlin was the third to start. Gina, when she was almost through her apprenticeship, knew that I was about to start an apprenticeship as well and that I was wanting to do an academic program. She said, let's go to Starbucks and talk.

She laid out a plan for how to fast track the route to becoming a licensed midwife. She basically said, I know that you want to train with this particular midwife that you used as your own midwife, but that would be really difficult. If you come over to this location and work with these two midwives, it will be much faster. You can come in to births towards the end. You catch a baby.

She laid out a plan for how to fast track the route to becoming a licensed midwife. She basically said, I know that you want to train with this particular midwife that you used as your own midwife, but that would be really difficult. If you come over to this location and work with these two midwives, it will be much faster. You can come in to births towards the end. You catch a baby.

It counts for your numbers. A lot less time, a lot less stress. If you want to just buy the first module for the academic program, you could do that, but you don't actually need to finish it or buy the rest of the modules.

It counts for your numbers. A lot less time, a lot less stress. If you want to just buy the first module for the academic program, you could do that, but you don't actually need to finish it or buy the rest of the modules.

You can say that you're enrolled in the program without finishing it and no one will really know as long as you get your skills signed off on and put a past doula birth as your apprenticeship start date, then you can get done as fast as you can get your 50 births in. That was her outline of how to become a midwife quickly. The minimum requirement is supposed to be two years of an apprenticeship.

You can say that you're enrolled in the program without finishing it and no one will really know as long as you get your skills signed off on and put a past doula birth as your apprenticeship start date, then you can get done as fast as you can get your 50 births in. That was her outline of how to become a midwife quickly. The minimum requirement is supposed to be two years of an apprenticeship.

Some do longer than that. A three-year apprenticeship is pretty common if you're doing academics and a true apprenticeship. My view of that was we are not painting walls where I can go back if I use the wrong color and redo that or touch up the corners because I didn't do it well enough. These are people's lives and this is a very serious thing. You're holding lives in your hands.

Some do longer than that. A three-year apprenticeship is pretty common if you're doing academics and a true apprenticeship. My view of that was we are not painting walls where I can go back if I use the wrong color and redo that or touch up the corners because I didn't do it well enough. These are people's lives and this is a very serious thing. You're holding lives in your hands.

I have a bachelor's degree and I taught for several years before entering the birth world. And so education is very important to me. And I told her that and I said, I understand that this looks like a good plan. But again, like these are people's lives. And so I don't have respect for you in doing this. And I'm not going to do that. And, you know, she was Gina.

I have a bachelor's degree and I taught for several years before entering the birth world. And so education is very important to me. And I told her that and I said, I understand that this looks like a good plan. But again, like these are people's lives. And so I don't have respect for you in doing this. And I'm not going to do that. And, you know, she was Gina.

She was very loving and friendly and like, I just wanted to let you know that this was an option. I mean, it's going to be really hard if you work with the other midwife. We left with it feeling like we were on good terms, but I did not feel good about her and who she was anymore. Within the next day or two, I talked to Caitlin about it and said, I can't believe this.

She was very loving and friendly and like, I just wanted to let you know that this was an option. I mean, it's going to be really hard if you work with the other midwife. We left with it feeling like we were on good terms, but I did not feel good about her and who she was anymore. Within the next day or two, I talked to Caitlin about it and said, I can't believe this.

Why would you even want to do this? And she agreed with me. And then two weeks later, Caitlin was then following her track and going to births with Gina and Gina's preceptor. So it was a pretty natural separation. That was pretty much the end of a friendship with both of them.

Why would you even want to do this? And she agreed with me. And then two weeks later, Caitlin was then following her track and going to births with Gina and Gina's preceptor. So it was a pretty natural separation. That was pretty much the end of a friendship with both of them.

a view of watching Caitlin at that point go through an apprenticeship very quickly, use a start date on her student midwife forms of a doula birth that she went to with me to shadow me as a doula. That was the very first birth she'd ever attended. So I knew the date and I called NARM and asked about that. And they said, oh, that's no problem. She can put that date.

a view of watching Caitlin at that point go through an apprenticeship very quickly, use a start date on her student midwife forms of a doula birth that she went to with me to shadow me as a doula. That was the very first birth she'd ever attended. So I knew the date and I called NARM and asked about that. And they said, oh, that's no problem. She can put that date.

I said, even if I know it was a doula birth and they said,

I said, even if I know it was a doula birth and they said,

yes that's fine even if she gets done in nine months they said yes that's fine so i sat back and went through a three-year apprenticeship and finished academics and it was very difficult she went through that so quickly and is making all this money in the successful birth center that was difficult on a personal level for me but also on the professional level of knowing there are going to be people who suffer from this

yes that's fine even if she gets done in nine months they said yes that's fine so i sat back and went through a three-year apprenticeship and finished academics and it was very difficult she went through that so quickly and is making all this money in the successful birth center that was difficult on a personal level for me but also on the professional level of knowing there are going to be people who suffer from this

I just thought, how long will it take before this can be stopped? And that's really when I started figuring out there were not many places to go to or people to go to. So that was a really hard thing to go through knowing I was becoming a part of that community.

I just thought, how long will it take before this can be stopped? And that's really when I started figuring out there were not many places to go to or people to go to. So that was a really hard thing to go through knowing I was becoming a part of that community.

Yes, very, very hard to see. Became harder as time went on and their birth centers grew and their clientele grew because the seemingly perfect portrayal of births and the herbal baths and the pictures and the videos, very hard knowing that underneath that, if you look behind the pretty, was just a whole undercurrent of not good for anyone.

Yes, very, very hard to see. Became harder as time went on and their birth centers grew and their clientele grew because the seemingly perfect portrayal of births and the herbal baths and the pictures and the videos, very hard knowing that underneath that, if you look behind the pretty, was just a whole undercurrent of not good for anyone.

I do believe that part of Gina's philosophy, the shortcut method that she presented to me on here's how you could become a midwife so quickly, that just from the get go was a lot of you can make a lot of money. While I appreciate that everyone has to make a living and I am my family's only income, you have to value people's lives over the money.

I do believe that part of Gina's philosophy, the shortcut method that she presented to me on here's how you could become a midwife so quickly, that just from the get go was a lot of you can make a lot of money. While I appreciate that everyone has to make a living and I am my family's only income, you have to value people's lives over the money.

I think that a lot of the argument that people have about hospitals being a business, the overwhelming drive for hospitals is to get people in and out, in and out, because that's more money. It can also apply to out of hospital birth with birth centers such as Origins.

I think that a lot of the argument that people have about hospitals being a business, the overwhelming drive for hospitals is to get people in and out, in and out, because that's more money. It can also apply to out of hospital birth with birth centers such as Origins.

you have owners that now are wanting to not practice and just run a business and you have multiple locations that you can't be at but a huge part of midwifery care is the relationship that you have with the client that's what makes it valuable to the client and to the midwife is you're investing a lot of time and care the money becomes more important when you are removed from that

you have owners that now are wanting to not practice and just run a business and you have multiple locations that you can't be at but a huge part of midwifery care is the relationship that you have with the client that's what makes it valuable to the client and to the midwife is you're investing a lot of time and care the money becomes more important when you are removed from that

I think we see that in a lot of businesses, a lot of things in the world that money will take over when you lose the personal connection. I think that's a lot of what has happened here that has led to poor outcomes. Some of it not being the people directly involved with the care of those clients, but from the owners themselves and the way that they ran the business.

I think we see that in a lot of businesses, a lot of things in the world that money will take over when you lose the personal connection. I think that's a lot of what has happened here that has led to poor outcomes. Some of it not being the people directly involved with the care of those clients, but from the owners themselves and the way that they ran the business.

Some of that does come from the monetary aspect. With my practice, I don't bill insurance. People pay a fee and that's it. And then I break it down if they need it prorated, etc. I think when you function as it sounds like Origins functioned with billing insurance and needing clients to continue their growth with more midwives working there, more birth centers,

Some of that does come from the monetary aspect. With my practice, I don't bill insurance. People pay a fee and that's it. And then I break it down if they need it prorated, etc. I think when you function as it sounds like Origins functioned with billing insurance and needing clients to continue their growth with more midwives working there, more birth centers,

It leads to we need to make clients happy. And if a client is unhappy because they transfer, then they're going to want a refund. And I have heard that Origins had a contract where they did not refund past 34 weeks.

It leads to we need to make clients happy. And if a client is unhappy because they transfer, then they're going to want a refund. And I have heard that Origins had a contract where they did not refund past 34 weeks.

Most midwives at that time, back when Origins first started, were saying once you hit 36 or 37 weeks, no refund, because it's difficult at that point to replace on your calendar a due date that you've already been on call for and done work for. So they had theirs on the earlier side of 34 weeks.

Most midwives at that time, back when Origins first started, were saying once you hit 36 or 37 weeks, no refund, because it's difficult at that point to replace on your calendar a due date that you've already been on call for and done work for. So they had theirs on the earlier side of 34 weeks.

I think it may have originated from, A, we're trying to keep people happy and so we don't want to do a lot of transfers. B, we're so busy that we need to use students to care for clients when licensed midwives aren't around. Students haven't yet seen a whole wide range of when you need to transfer a client out.

I think it may have originated from, A, we're trying to keep people happy and so we don't want to do a lot of transfers. B, we're so busy that we need to use students to care for clients when licensed midwives aren't around. Students haven't yet seen a whole wide range of when you need to transfer a client out.

And so I think there's a lack of knowledge there as well that led to a lot of the not transferring until it was a shit show.

And so I think there's a lack of knowledge there as well that led to a lot of the not transferring until it was a shit show.

Yes. Back when all of this first started being an issue, there were discussions within the community of what is a graduate midwife? Like, what qualifies as that? This is not a term that's used by NARM. This is not a term that's used by the state of Texas with licensed midwives. But it overall is a large problem. I think it goes back to we don't have a standard for every CPM, LM.

Yes. Back when all of this first started being an issue, there were discussions within the community of what is a graduate midwife? Like, what qualifies as that? This is not a term that's used by NARM. This is not a term that's used by the state of Texas with licensed midwives. But it overall is a large problem. I think it goes back to we don't have a standard for every CPM, LM.

We know that they do this educational route. And so we know that they know this information. Even if we did have a defined, here's what a graduate midwife is, or they've met all their numbers and completed everything. They're just waiting on their paperwork to be processed. We still don't have the assurance that they've completed these things on their educational route.

We know that they do this educational route. And so we know that they know this information. Even if we did have a defined, here's what a graduate midwife is, or they've met all their numbers and completed everything. They're just waiting on their paperwork to be processed. We still don't have the assurance that they've completed these things on their educational route.

You could have me in the office with you as a student where I haven't done any didactic work, I've just learned by situations that came into the office over the last three years.

You could have me in the office with you as a student where I haven't done any didactic work, I've just learned by situations that came into the office over the last three years.

Versus you could go to somebody else's office and have somebody that completed an outlined academic program with markers throughout of tests and skills reviews and that has been in their apprenticeship for two or three years. Their education level may be different than mine was.

Versus you could go to somebody else's office and have somebody that completed an outlined academic program with markers throughout of tests and skills reviews and that has been in their apprenticeship for two or three years. Their education level may be different than mine was.

She may know how to run the labs, what labs to run to diagnose preeclampsia versus if I never saw that come through the office in my apprenticeship and hadn't decided to pick up the right textbook to read to figure out that, then I may not know that. There's new information that comes out, new research, new standards.

She may know how to run the labs, what labs to run to diagnose preeclampsia versus if I never saw that come through the office in my apprenticeship and hadn't decided to pick up the right textbook to read to figure out that, then I may not know that. There's new information that comes out, new research, new standards.

As someone who's taking care of moms, babies, families, you need to constantly be educating yourself, researching, finding out what the newest recommendations are from reputable evidence-based sources. There's some controversy surrounding what's called the PEP process route to becoming a CPM. You would not have to complete an academic program if you're going through the PEP process.

As someone who's taking care of moms, babies, families, you need to constantly be educating yourself, researching, finding out what the newest recommendations are from reputable evidence-based sources. There's some controversy surrounding what's called the PEP process route to becoming a CPM. You would not have to complete an academic program if you're going through the PEP process.

If you are able to get your skills signed off on by preceptors saying that you are competent and you are skilled in those and you can be a competent test taker and you can pass NARM, then you will become a CPM. And in Texas, that means then you also become a licensed midwife, an LM. So I think that that really needs revisited.

If you are able to get your skills signed off on by preceptors saying that you are competent and you are skilled in those and you can be a competent test taker and you can pass NARM, then you will become a CPM. And in Texas, that means then you also become a licensed midwife, an LM. So I think that that really needs revisited.

There are not many professions where you don't have to complete some sort of coursework outline, especially when you're dealing with healthcare and people's lives. It seems like there are too many loopholes to being able to get through quickly, to being able to lie on paperwork, and too many loopholes for not actually having the skills that you say you have.

There are not many professions where you don't have to complete some sort of coursework outline, especially when you're dealing with healthcare and people's lives. It seems like there are too many loopholes to being able to get through quickly, to being able to lie on paperwork, and too many loopholes for not actually having the skills that you say you have.

So there's actually some guidelines on that and they differ whether it's a first time mom or whether it's someone who's already had vaginal births before. The average time, like if you have someone who has had vaginal births before, if we're getting to two hours of pushing, that's pretty abnormal for someone who's called a Maltip that's had these births before.

So there's actually some guidelines on that and they differ whether it's a first time mom or whether it's someone who's already had vaginal births before. The average time, like if you have someone who has had vaginal births before, if we're getting to two hours of pushing, that's pretty abnormal for someone who's called a Maltip that's had these births before.

For someone who is a primip, if we're getting to the three to four hour mark of not making progress with pushing, we're not having a baby here very soon, using those guidelines, that would be an appropriate time to transport for sure.

For someone who is a primip, if we're getting to the three to four hour mark of not making progress with pushing, we're not having a baby here very soon, using those guidelines, that would be an appropriate time to transport for sure.

Is that typical? I would not say that's typical. Most out-of-hospital midwives don't want it to get to that point. When people plan out-of-hospital births or even just a natural birth without pain medication in a hospital, there is a difference between normal labor pain, normal labor progress, and suffering.

Is that typical? I would not say that's typical. Most out-of-hospital midwives don't want it to get to that point. When people plan out-of-hospital births or even just a natural birth without pain medication in a hospital, there is a difference between normal labor pain, normal labor progress, and suffering.

Whether that suffering is from a problem during the labor with a malpositioned baby or exhaustion or whether it's the mental part of labor. If we've turned our corner into this is not just normal, you're not able to cope with this anymore. Most of us want to transport for that, not get to the point where you're unable to walk and unable to communicate anymore.

Whether that suffering is from a problem during the labor with a malpositioned baby or exhaustion or whether it's the mental part of labor. If we've turned our corner into this is not just normal, you're not able to cope with this anymore. Most of us want to transport for that, not get to the point where you're unable to walk and unable to communicate anymore.

It goes back to we're not just birthing out of hospital to birth out of hospital. If this seems like you're going to have a more positive experience with an epidural, then that's what we're going to do. I don't want suffering to enter the equation.

It goes back to we're not just birthing out of hospital to birth out of hospital. If this seems like you're going to have a more positive experience with an epidural, then that's what we're going to do. I don't want suffering to enter the equation.

I think that a really good place to start is asking them what their apprenticeship was like. What experiences did they have throughout that apprenticeship? How long was the apprenticeship? Did you complete an academic program or do self-study or do no didactic work? how many births have you attended and was your attendance at those births for most of the labor and birth or just towards the end?

I think that a really good place to start is asking them what their apprenticeship was like. What experiences did they have throughout that apprenticeship? How long was the apprenticeship? Did you complete an academic program or do self-study or do no didactic work? how many births have you attended and was your attendance at those births for most of the labor and birth or just towards the end?

I think it's also good to ask any midwife, no matter how long she has been practicing, licensed, tell me the complications that you've seen and how you managed those. Tell me about a time that you had an emergency transport. What was that for? How did that go?

I think it's also good to ask any midwife, no matter how long she has been practicing, licensed, tell me the complications that you've seen and how you managed those. Tell me about a time that you had an emergency transport. What was that for? How did that go?

Do you have clients who have been in that situation that I can speak to so that I know their perspective on how your care was and how the transport was and how their postpartum was? Those are great questions to ask any provider. The normal questions that I get a lot when people are interviewing me to see if they want to hire me as their midwife is, what's your transfer rate?

Do you have clients who have been in that situation that I can speak to so that I know their perspective on how your care was and how the transport was and how their postpartum was? Those are great questions to ask any provider. The normal questions that I get a lot when people are interviewing me to see if they want to hire me as their midwife is, what's your transfer rate?

A lot of midwives will say, well, it's 7%, but most of the time it's a first-time mom who's exhausted and she just needs an epidural. After we've tried everything there is to try at home, we go in, she gets an epidural, sometimes Pitocin, and everything still goes great. But is that true?

A lot of midwives will say, well, it's 7%, but most of the time it's a first-time mom who's exhausted and she just needs an epidural. After we've tried everything there is to try at home, we go in, she gets an epidural, sometimes Pitocin, and everything still goes great. But is that true?

Because over the last nine years of being licensed, I can say that that's not my most common reason for transporting someone in. Digging further to get to the truth of some of those things of why people are transferred is important. Ask more than just what my transport rate is. Ask what I transport for, where I go, what relationships do you have at those places?

Because over the last nine years of being licensed, I can say that that's not my most common reason for transporting someone in. Digging further to get to the truth of some of those things of why people are transferred is important. Ask more than just what my transport rate is. Ask what I transport for, where I go, what relationships do you have at those places?

Can I talk to anyone who's been through this, either someone that takes transports or transfers from you or clients who have been through that? Those things all matter.

Can I talk to anyone who's been through this, either someone that takes transports or transfers from you or clients who have been through that? Those things all matter.

There are a lot of benefits to midwifery care. The relationship that you can develop with your provider and them hearing you and listening to you, providing care based on you as an individual instead of you as one of hundreds can be life-changing. The entrance into motherhood, whether it's your first baby or your 10th baby, really changes you.

There are a lot of benefits to midwifery care. The relationship that you can develop with your provider and them hearing you and listening to you, providing care based on you as an individual instead of you as one of hundreds can be life-changing. The entrance into motherhood, whether it's your first baby or your 10th baby, really changes you.

Having a provider, whether it's your doctor or your midwife or your nurse, who provides respectful, safe care, offers you options, explains things to you, and sometimes when there aren't any options, as in an emergent situation, still cares for you through that, can be life-changing and affect you as a mother and how you parent your baby.

Having a provider, whether it's your doctor or your midwife or your nurse, who provides respectful, safe care, offers you options, explains things to you, and sometimes when there aren't any options, as in an emergent situation, still cares for you through that, can be life-changing and affect you as a mother and how you parent your baby.

Yes, I a thousand percent agree. I very much enjoyed speaking with you.

Yes, I a thousand percent agree. I very much enjoyed speaking with you.

My name is Jamie Hinton. I am a licensed midwife in the state of Texas in the Dallas-Fort Worth area. I was a CPM as well as LM. I am no longer a CPM. I came into this profession in a very natural way of my own pregnancy and birth of my first baby and then teaching childbirth classes, becoming a doula, and then moving on to becoming a licensed midwife.

Gina and Caitlin and I were friends before any of us were midwives. Gina was a doula, I was a doula, and Caitlin eventually became a doula as well. We did have a friendship and we worked together. I would teach childbirth classes and refer people to Caitlin as the doula, or Gina would refer people to my classes from her doula clients.

Gina was the first of us to decide that she wanted to become a midwife and become licensed. I was the next, and then Caitlin was the third to start. Gina, when she was almost through her apprenticeship, knew that I was about to start an apprenticeship as well and that I was wanting to do an academic program. She said, let's go to Starbucks and talk.

She laid out a plan for how to fast track the route to becoming a licensed midwife. She basically said, I know that you want to train with this particular midwife that you used as your own midwife, but that would be really difficult. If you come over to this location and work with these two midwives, it will be much faster. You can come in to births towards the end. You catch a baby.

It counts for your numbers. A lot less time, a lot less stress. If you want to just buy the first module for the academic program, you could do that, but you don't actually need to finish it or buy the rest of the modules.

You can say that you're enrolled in the program without finishing it and no one will really know as long as you get your skills signed off on and put a past doula birth as your apprenticeship start date, then you can get done as fast as you can get your 50 births in. That was her outline of how to become a midwife quickly. The minimum requirement is supposed to be two years of an apprenticeship.

Some do longer than that. A three-year apprenticeship is pretty common if you're doing academics and a true apprenticeship. My view of that was we are not painting walls where I can go back if I use the wrong color and redo that or touch up the corners because I didn't do it well enough. These are people's lives and this is a very serious thing. You're holding lives in your hands.

I have a bachelor's degree and I taught for several years before entering the birth world. And so education is very important to me. And I told her that and I said, I understand that this looks like a good plan. But again, like these are people's lives. And so I don't have respect for you in doing this. And I'm not going to do that. And, you know, she was Gina.

She was very loving and friendly and like, I just wanted to let you know that this was an option. I mean, it's going to be really hard if you work with the other midwife. We left with it feeling like we were on good terms, but I did not feel good about her and who she was anymore. Within the next day or two, I talked to Caitlin about it and said, I can't believe this.

Why would you even want to do this? And she agreed with me. And then two weeks later, Caitlin was then following her track and going to births with Gina and Gina's preceptor. So it was a pretty natural separation. That was pretty much the end of a friendship with both of them.

a view of watching Caitlin at that point go through an apprenticeship very quickly, use a start date on her student midwife forms of a doula birth that she went to with me to shadow me as a doula. That was the very first birth she'd ever attended. So I knew the date and I called NARM and asked about that. And they said, oh, that's no problem. She can put that date.

I said, even if I know it was a doula birth and they said,

yes that's fine even if she gets done in nine months they said yes that's fine so i sat back and went through a three-year apprenticeship and finished academics and it was very difficult she went through that so quickly and is making all this money in the successful birth center that was difficult on a personal level for me but also on the professional level of knowing there are going to be people who suffer from this

I just thought, how long will it take before this can be stopped? And that's really when I started figuring out there were not many places to go to or people to go to. So that was a really hard thing to go through knowing I was becoming a part of that community.

Yes, very, very hard to see. Became harder as time went on and their birth centers grew and their clientele grew because the seemingly perfect portrayal of births and the herbal baths and the pictures and the videos, very hard knowing that underneath that, if you look behind the pretty, was just a whole undercurrent of not good for anyone.

I do believe that part of Gina's philosophy, the shortcut method that she presented to me on here's how you could become a midwife so quickly, that just from the get go was a lot of you can make a lot of money. While I appreciate that everyone has to make a living and I am my family's only income, you have to value people's lives over the money.

I think that a lot of the argument that people have about hospitals being a business, the overwhelming drive for hospitals is to get people in and out, in and out, because that's more money. It can also apply to out of hospital birth with birth centers such as Origins.

you have owners that now are wanting to not practice and just run a business and you have multiple locations that you can't be at but a huge part of midwifery care is the relationship that you have with the client that's what makes it valuable to the client and to the midwife is you're investing a lot of time and care the money becomes more important when you are removed from that

I think we see that in a lot of businesses, a lot of things in the world that money will take over when you lose the personal connection. I think that's a lot of what has happened here that has led to poor outcomes. Some of it not being the people directly involved with the care of those clients, but from the owners themselves and the way that they ran the business.

Some of that does come from the monetary aspect. With my practice, I don't bill insurance. People pay a fee and that's it. And then I break it down if they need it prorated, etc. I think when you function as it sounds like Origins functioned with billing insurance and needing clients to continue their growth with more midwives working there, more birth centers,

It leads to we need to make clients happy. And if a client is unhappy because they transfer, then they're going to want a refund. And I have heard that Origins had a contract where they did not refund past 34 weeks.

Most midwives at that time, back when Origins first started, were saying once you hit 36 or 37 weeks, no refund, because it's difficult at that point to replace on your calendar a due date that you've already been on call for and done work for. So they had theirs on the earlier side of 34 weeks.

I think it may have originated from, A, we're trying to keep people happy and so we don't want to do a lot of transfers. B, we're so busy that we need to use students to care for clients when licensed midwives aren't around. Students haven't yet seen a whole wide range of when you need to transfer a client out.

And so I think there's a lack of knowledge there as well that led to a lot of the not transferring until it was a shit show.

Yes. Back when all of this first started being an issue, there were discussions within the community of what is a graduate midwife? Like, what qualifies as that? This is not a term that's used by NARM. This is not a term that's used by the state of Texas with licensed midwives. But it overall is a large problem. I think it goes back to we don't have a standard for every CPM, LM.

We know that they do this educational route. And so we know that they know this information. Even if we did have a defined, here's what a graduate midwife is, or they've met all their numbers and completed everything. They're just waiting on their paperwork to be processed. We still don't have the assurance that they've completed these things on their educational route.

You could have me in the office with you as a student where I haven't done any didactic work, I've just learned by situations that came into the office over the last three years.

Versus you could go to somebody else's office and have somebody that completed an outlined academic program with markers throughout of tests and skills reviews and that has been in their apprenticeship for two or three years. Their education level may be different than mine was.

She may know how to run the labs, what labs to run to diagnose preeclampsia versus if I never saw that come through the office in my apprenticeship and hadn't decided to pick up the right textbook to read to figure out that, then I may not know that. There's new information that comes out, new research, new standards.

As someone who's taking care of moms, babies, families, you need to constantly be educating yourself, researching, finding out what the newest recommendations are from reputable evidence-based sources. There's some controversy surrounding what's called the PEP process route to becoming a CPM. You would not have to complete an academic program if you're going through the PEP process.

If you are able to get your skills signed off on by preceptors saying that you are competent and you are skilled in those and you can be a competent test taker and you can pass NARM, then you will become a CPM. And in Texas, that means then you also become a licensed midwife, an LM. So I think that that really needs revisited.

There are not many professions where you don't have to complete some sort of coursework outline, especially when you're dealing with healthcare and people's lives. It seems like there are too many loopholes to being able to get through quickly, to being able to lie on paperwork, and too many loopholes for not actually having the skills that you say you have.

So there's actually some guidelines on that and they differ whether it's a first time mom or whether it's someone who's already had vaginal births before. The average time, like if you have someone who has had vaginal births before, if we're getting to two hours of pushing, that's pretty abnormal for someone who's called a Maltip that's had these births before.

For someone who is a primip, if we're getting to the three to four hour mark of not making progress with pushing, we're not having a baby here very soon, using those guidelines, that would be an appropriate time to transport for sure.

Is that typical? I would not say that's typical. Most out-of-hospital midwives don't want it to get to that point. When people plan out-of-hospital births or even just a natural birth without pain medication in a hospital, there is a difference between normal labor pain, normal labor progress, and suffering.

Whether that suffering is from a problem during the labor with a malpositioned baby or exhaustion or whether it's the mental part of labor. If we've turned our corner into this is not just normal, you're not able to cope with this anymore. Most of us want to transport for that, not get to the point where you're unable to walk and unable to communicate anymore.

It goes back to we're not just birthing out of hospital to birth out of hospital. If this seems like you're going to have a more positive experience with an epidural, then that's what we're going to do. I don't want suffering to enter the equation.

I think that a really good place to start is asking them what their apprenticeship was like. What experiences did they have throughout that apprenticeship? How long was the apprenticeship? Did you complete an academic program or do self-study or do no didactic work? how many births have you attended and was your attendance at those births for most of the labor and birth or just towards the end?

I think it's also good to ask any midwife, no matter how long she has been practicing, licensed, tell me the complications that you've seen and how you managed those. Tell me about a time that you had an emergency transport. What was that for? How did that go?

Do you have clients who have been in that situation that I can speak to so that I know their perspective on how your care was and how the transport was and how their postpartum was? Those are great questions to ask any provider. The normal questions that I get a lot when people are interviewing me to see if they want to hire me as their midwife is, what's your transfer rate?

A lot of midwives will say, well, it's 7%, but most of the time it's a first-time mom who's exhausted and she just needs an epidural. After we've tried everything there is to try at home, we go in, she gets an epidural, sometimes Pitocin, and everything still goes great. But is that true?

Because over the last nine years of being licensed, I can say that that's not my most common reason for transporting someone in. Digging further to get to the truth of some of those things of why people are transferred is important. Ask more than just what my transport rate is. Ask what I transport for, where I go, what relationships do you have at those places?

Can I talk to anyone who's been through this, either someone that takes transports or transfers from you or clients who have been through that? Those things all matter.

There are a lot of benefits to midwifery care. The relationship that you can develop with your provider and them hearing you and listening to you, providing care based on you as an individual instead of you as one of hundreds can be life-changing. The entrance into motherhood, whether it's your first baby or your 10th baby, really changes you.

Having a provider, whether it's your doctor or your midwife or your nurse, who provides respectful, safe care, offers you options, explains things to you, and sometimes when there aren't any options, as in an emergent situation, still cares for you through that, can be life-changing and affect you as a mother and how you parent your baby.

Yes, I a thousand percent agree. I very much enjoyed speaking with you.