Inside Midwifery: The Miracle of Birth and the Midwife’s Role

It's so magical.
It's such a magic, spiritual, special moment in a person's life to give birth, and intensity is so strong, such empowerment.
Hi, I'm Ravozeri and welcome to How Much Can I Make.
I am a curious journalist, fascinated by what people do for a living, what their jobs are really like, and how much they can earn.
Join me as we dive into stories behind careers, uncovering insights and details, which I hope you'll find as intriguing as I do.
So let's get started.
If you ever wanted to work in the magical world of birth, this is the segment for you.
And by the way, next week we'll have a segment featuring a birth doula, so you definitely do not want to miss either podcast.
Today we're going to talk with Connie about being a midwife.
Connie, thank you very much, first of all.
You're welcome.
My honor.
Thank you.
And you are doing the oldest job in the world.
Midwives are mentioned in the Bibles a few times, if I recall correctly, right?
Yeah, somebody had to take care of the mamas.
From time immemorial.
So, what I want to know, we were just talking about you being a recording engineer.
So, how do you get from that to being a midwife?
Well, I was very fortunate when I was young, in in some ways, in other ways not.
But when I was a teen, I was interested in in both sound engineering because my brother was a musician, and we thought we might go touring together.
So I learned how to do sound engineering.
I bought a little, you know, Porta Studio.
And as far as midwifery, um, my mother had passed away in a hospital at a very young age.
She was 40 while she was pregnant and had a heart attack in labor and died.
Her and the baby.
And that got me very interested in wanting to help people have safe birth.
Were you aware at the time that there was such a thing as midwives?
No.
There wasn't much talk about midwives at that time that was only eleven, so I don't I wasn't that aware.
Were you thinking of becoming a doctor or no, I just missed her, so I wanted other people not to have to suffer the same fate.
So I thought, well, I'm really interested in helping women have babies in a safe way as well as and to be there a hundred percent for them.
Wow.
So between those two things, I decided to do some studying about midwifery.
And when I did, I found out that you really have to be around in one stationary place in midwifery.
What do you mean?
Because someone's pregnant for nine months.
So you have to be taking care of them for that nine months plus another two months afterwards postpartum.
So it's a long trek to take care of a person, you know, if you're want to be with them th throughout the whole time.
So you can't be traveling and going here and there.
You have to be pretty in a stable position and be willing to to be home as a home birth midwife.
A hospital midwife, you have a schedule and hours and time off, but and I was that for a while, but mostly I wanted to be a home birth midwife.
Um, I didn't trust hospitals after my mom died in one.
Right.
So I s found other ways of having babies, and that was through home birth.
And that was one-on-one care.
You knew your provider and you trusted them.
And if there was an emergency, of course, then we go to a hospital.
Which as a midwife I have had many transfers.
I want to back up a second.
What does a midwife do?
So a midwife is basically like an obstetrician, except we don't do surgery.
But we can diagnose, we can do all lab tests, we can order ultrasounds or whatever scans we need.
And of course, we work with the MFMs, which are the master family medicine, like the highest up doctors in family medicine.
Okay.
So we can consult with other doctors and MFMs.
In the hospital, you get the the women from the hospital, from the doctors, the nurses.
How did you get your your first person, your first couple?
Well, first I worked as a doula, which is not a medically trained birth worker, but a support person for birth.
And I studied with an indigenous midwife when I lived upstate near the Canadian border and found out about what it meant to be a home birth midwife.
That's how I got introduced to it.
And this was after I did a career for 10 years as a sound engineer and got to travel all over the world and not be at at home.
Right.
But then when I was ready to be at home, this I started doing these other trainings or teachings.
So you had to go and study after you did the doula.
Oh, yeah, I got a master's degree.
First, I there's a couple of ways in New York to become a midwife.
The way I chose to do it was to become a CNM, which is certified nurse midwife.
So first I had to become a nurse and get a nursing degree, then a bachelor's and then a master's in midwives.
How many years in total did you have to study?
Well, I also had two young children and I was working part-time, so I did it over 13 years.
But you can do it much faster if you don't have a family to take care of and sleep.
How how much faster can you do it?
How many years do you think?
Maybe six, five.
Wow, that's quite a lot.
And there's other ways you can enter without being a midwife.
You can be a midwife with a bachelor's in another field and then get a master's in midwifery as well.
This is what I want to ask you.
Are there different kinds of midwives?
Yes, and then there's CPMs, which isn't necessarily going to school, but it's practicing with other midwives and doing book work and taking tests us as well.
And those are not allowed to practice in New York State yet, which is really silly because most other states allow CPMs to work, but New York State doesn't.
New York State is very harsh on medical regulations.
Right.
So there's three different avenues of and ways to become a midwife.
And I chose the CNM one because I got a lot of experience as a nurse in labor and delivery while I was in school.
Oh no.
Getting my bachelor's and my master's.
And does you have to file this with the state or the federal?
Yeah, state.
And especially if you're going to use insurance companies, which, you know, people who are having babies, of course, are young.
They're not all career people and they can't afford pay out of pocket for birth.
Right.
So it's convenient to be able to use insurance companies, but not all insurance companies will even pay a home birth midwife.
It's crazy.
So what kind of people come to you and ask you to be their midwife?
People who want to be at home for their birth.
Well, let me just back up one second.
I will say I worked as a nurse in the hospitals for a while while my kids were in school.
So I had a schedule.
And then I worked as a midwife in the hospital for several years.
So that also I wanted to keep the schedule.
And and I you know, and I got a paycheck.
And they it was you were asking how much.
Right.
And you can make between a hundred to a hundred and fifty thousand as a midwife in a hospital.
Really?
In the hospital, really?
Mm-hmm.
Depends on what?
Oh, it depends on where you what where you're located, like in New York City or pay more than Rochester or something.
Yeah.
Right.
And I'm somewhere in between.
That's a very nice salary.
Yeah.
With benefits, of course, and everything.
That is if you work for the hospital.
Okay.
If you're on your own, then you regulate how many clients you want to take per month.
I try to stay in the same realm as Medicaid would pay for a birth.
Okay.
So when I first started, I got four thousand dollars for the whole shebang.
For your year's worth of work, because you follow up with a couple for a year.
Nine months.
Yeah, but I'm not seeing them every day.
Right.
Okay.
You know.
Oh, not too bad then.
Yeah.
It's not too bad, right?
But then by the time I ended, I was getting six to ten thousand dollars a birth.
For Medicare or from private?
Both.
Yeah.
How much does the insurance pay you for each couple?
It depends on the insurance company.
Some insurance companies, and I'm not gonna name names at this moment, but some refuse to pay a home birth midwife anything.
Really?
Yeah.
And they have that right if they're not a New York State insurance company.
And so then the person would have to pay out of pocket.
And then some will pay ten thousand doll up to ten thousand dollars or so.
Wow.
For a home birth.
Because that's what you would pay at a hospital or more at a hospital for a birth.
Ten thousand dollars.
At least at a hospital.
As far as I know.
Wow.
So the insurance companies will some of them are very respectful and they will pay us what we deserve.
And that's for all the prenatal care.
And again, it's nine months.
You see a client every we call them client at patients because we're working together.
And the you would see the client for in the beginning once a month, and then once they get to be thirty weeks, you see them every two weeks.
So what do you physically check them or you just sit and talk?
Both.
Yeah.
And home birth is really different than a hospital midwife.
How is it different?
Because unfortunately, and I know this because I worked in hospitals as a midwife as well.
You only have so much time to be with a client.
15, 20 minutes per session.
In a hospital.
In a hospital prenatals, we're talking about.
Maybe some could could do a half hour.
But uh it's very for them to get enough money from the insurance companies, it's all coming to money, right?
For them to make enough money, you have to see so many patients per day.
So you don't have as much time to get into all you do the physical, but you don't always have enough time to get into the emotional and spiritual aspects of what they want for the birth.
Right.
So home birth, we spend about an hour for each prenatal visit because it's our own time.
Right.
And we're not being regulated by that.
At least that's what I did.
Right.
And I do, yes, all the physical.
I do I drew the labs here in my office.
Um, I ordered ultrasounds, and but then we talk a lot about diet, because diet is so important in pregnancy and nutrition.
We try to work with very healthy people at home.
If they have uh I don't want to call diabetes a disease necessarily, but something outside of the norm, sometimes we need to refer them to a hospital midwife where there's more tests, etc.
And when you do home birth and you run into, I mean, this is it's a very touchy situation, birth.
And you run into a problem, do you go to the hospital?
How do yes, if there's a problem, we go to the hospital.
Did it happen to you that uh oh many times I've had you know, where a labor just would not progress or someone would choose, okay, I've had enough.
I want to go to the hospital and get some pain medicine.
But I wouldn't supply pain medicine?
Well, I supply herbs and sleep and different body movements, and I usually also work with doolas who can do you know, massage or we do massage or different positions, and it's just a different atmosphere because it's not full of fear, it's full of trust.
I would say out of fifty births a year, I might have transferred four people.
But it happens, and you also have to be careful in in choosing your clientele and saying, you know, I don't think it's such a good idea for you to have this baby at home for this, this, and this reason, or because you live very far away from the hospital, and if we do have an emergency, it's a problem.
So and depends on the people's fear factor.
Like if you're really scared of birth and scared of the discomfort or pain that you would feel in childbirth, then maybe you would want to go to a hospital and get medication.
But at home, we don't do epidurals or you know, you need an anesthesiologist to do that kind of work, and that's a hospital.
And I'm not against it at all.
If people want that, that's that's what they should have.
But if they want to have a natural birth and learn about birth and not fear it, uh a home birth midwife is a really great answer for that.
And that's the type of people that I generally worked with.
So when you left the hospital, how did you get your first uh client?
I think another group of midwives, there's not a whole lot of home birth midwives up up here in the Hudson Valley, but there are some.
And they were overbooked, and they had a woman that wanted a home birth and asked me if I was interested in taking them.
So I said yes.
That was my very first.
Were you scared?
No, and I had a a really good assistant with me who was a nurse and a friend.
So no, I wasn't scared, and it was a beautiful birth.
Were you ever scared in any of your uh births?
The funniest thing is that I have a friend that's a midwife, and she said the only time I saw Connie really scared at a at a home birth was when her dog was having puppies and the placenta wasn't coming.
And she got really nervous because the placenta wasn't coming.
But there's an herb called Angelica that we use when a placenta is taking its time.
And so I just started chanting, Angelica, Angelica, Angelica, and the placenta came.
She always loves telling that story because you said I never really saw her.
I mean, if if inside I was scared, I was I I have the kind of demeanor that I wouldn't show it.
Right.
I and the more you breathe and not take chances with something if something doesn't seem appropriate, then you transfer.
Is there a birth that stayed with you that you when you think about is like, wow, that's the first one you think about?
Well, my own home birth experiences were really great.
The birth of your children?
Mm-hmm.
Yeah, my first son is 35 now, and my second son is 31.
Did you have a midwife for them?
Oh yeah, yeah, yeah.
Yeah, I had midwife.
Did you have a doula also?
Uh the first birth I did, the second birth I didn't.
Do most people come to you for first birth or not necessarily?
Yeah, all different.
Some first, some sixth.
What?
Yeah.
It's yeah.
And first births are normally you would have more fears.
Like the first time you get on a bicycle, you're scared.
Right.
But once you're doing it, you're okay.
And birth is similar in that way, is you know, you're scared the first time.
So it's a lot about letting go of the fear and not believing all the tales of that you see on TV of this is an emergency.
They always seem to make birth so scary in America.
Did you have emergencies in your birth?
Uh uh in my career.
In your career?
I've had one or two.
How many years have you been uh midwife?
Well, starting from a doula to a nurse to a midwife, I would say about 33 years.
Wow.
So you have lots of experience?
Yeah.
Before that I was the sound engineer traveling.
Do you love being in the birth business?
Yes, I do.
You do?
Yes.
Why?
But I am retired now.
I don't know.
You just retired.
Yeah, just recently, because the schedule for a home birth midwife is intense.
First of all, you have to really schedule your time off.
Like you can't take a client or you have to have another midwife back you up.
If you're a single midwife.
If you're in a group, it's a little different.
I was in a single midwifery practice for myself.
And then you're on call all the time.
Like you can't really say, Oh yeah, I can climb this mountain today or go kayaking because you don't know if you're gonna get called in.
So you have to schedule things around who's due when, and you know, you miss some parties that you would have liked to go to, like your kid's birthday or something like this.
Or So that was the challenge.
What is the reward of the job?
It's so magical.
It's such a magic, spiritual, special moment in a person's life to give birth, and for them to receive their baby into their hands, either they catching the baby themselves or us giving them their baby for the first time, and and that's what I miss about not doing birth right now as retired.
Those magical, magical moments that are every time.
Yeah, every time.
And every time it's different.
Every woman, every partner is very different at a birth.
Uh but it's always just magical.
It's just like you'll see a woman be so intense at I don't know, seven, eight centimeters where she's like, Okay, there's a dilated, yeah.
And this is really getting hard, and ten centimeters is fully dilated.
Okay.
And she's like, I you know, wanting to give up.
And then she gets into a warm tub of water and or she gets some sleep.
She gets through that point, and then she gets to the point of pushing out her baby, and it's so intense and such hard work, but she does it.
For most people.
Some people are lucky and it's not so hard, but for the first babies, usually second babies tend to slide out easier.
Anyway, the intensity is so strong, just helping her to breathe through it and get through it, and then she has get the baby is born and in her arms and on her chest, and it's just as smiles and peacefulness and gratitude that her body was able to do this.
Right.
And like such empowerment.
And for the partner too to be such a supportive partner throughout is it's just so beautiful.
So when a woman starts uh feeling contraction or feels that it's she's close to that, she comes and stays with you in the office.
I mean, how does that Oh no?
I go to her house.
Oh, first we first we talk on the phone and she calls me when things are just starting.
So if I am somewhere galvanti and that I come back home and um get my proper rest if I can so that I can be ready for her when things pick up.
So if her water breaks, but she's not having contractions, or she's starting to feel some contractions, or she has some something called bloody show, which is mucus that's got a little blood in it.
These things she would let me know so that I could be on standby.
And then we would talk on the phone, and either when she needs me, or when I think, oh, I think I should come over and see what's going on, or if it continues for quite a while, I'll go to her home and check it out.
And during the prenatal visits, we have a whole list of things that she should have available at her house, like some chucks pads and some other things.
And then I bring a lot a lot of equipment.
Okay.
Including oxygen, IVs, fluids, herbs, a lot of a lot of things.
I don't come empty-handed.
Okay.
I w it's not like all the midwives where you can just get there on a bike.
You got a whole car trunk full of stuff.
And that's why it's good to have an assistant not only for support during the birth and uh you know, four pairs of hands or two pairs of hands, four hands.
It's also really good because they can help you pack up your equipment and carry it in and out.
Right.
Because it's a lot of stuff.
Uh and some people even want a tub at their birth, so we supply them a birth tub.
Portable tubs that you take with you?
Yeah, that's we in a pump that fills it up like a air, like an air mattress kind of pump.
Right.
I so I spoke to the doula yesterday and she says some some women love to have a birth in the tub.
Oh yeah.
Does that scare you that the baby something will happen to it?
Are you totally cool with that?
Yeah, I'm usually very cool with it.
Because if you think of it, the baby's inside, it's getting oxygen from the mom and the placenta.
And so if the baby's born into water before the head comes out of the water, it's it's still getting oxygen from the mom and the placenta.
And then the baby is brought up out of the water and put onto the mom's chest and it takes its first breath.
So some people think that it uh cuts down the trauma of the baby.
Baby coming out to the world by doing into the tub yet, right?
Well, it is very gentle.
But it also is very calming for the mom.
Like I said, seven, eight centimeters is when it's really intense and you're feeling like, wow, I need some help.
Sometimes getting in a warm tub of water will just make you feel ha relief.
Uh-huh.
Wow.
And interesting.
And it softens all the tissues, so that's what helps it easier on the baby coming out too.
Right.
Is it physically strenuous, Job?
Oh yeah.
It is.
You have to be in good shape.
Yeah.
Why?
Well, because you're helping carrying the equipment.
Okay.
You're physically not getting eight hours of sleep a night for sure.
You're always on call, so your adrenaline is always up.
When am I gonna get this call?
And then the birth is so exciting that also increases your adrenaline, so then you don't go to sleep.
And then you you know, you have the responsibility of two human lives.
So that is very intense to have that responsibility at home and to be able to put in an IV if you need, if someone is bleeding or someone is or to give them a medication.
We do carry medications for emergencies.
It's um very hard on the body physically, and like sometimes the person is in a very strange position.
They don't have to be in a bed.
Sometimes they're sitting on the toilet or and pushing there.
So you have to sit nearby.
Right.
And or and you know, get them off of the toilet when the baby starts.
And then sometimes if someone does have uh a tear and you have to repair the tear in the vaginal tissue, we have to suture them.
You do that too?
Oh, of course.
Oi, oy.
Yeah.
Okay.
There are only women in this job, right?
No, there's a few men midwives, but I've only met one in my life and he was more in the international midwife community.
Oh, okay.
But I have heard that there are some.
Okay but it's mostly women.
What advice would you give somebody that wants to get into midwifery?
Maybe to try to assist at some births first, or if a sister or a friend is having a baby to ask if you can be a quiet person in the background just listening, or if you want to do massage on them or whatever, you know, or or w offer your talents that you will do the cooking and cleaning for them for or can they do something because it's an honor to be at someone's birth.
Right.
And and it's also at home, it's a very private personal experience.
Trying to witness some births before you To see that you really like it because it could sound good and then be a disaster.
Yeah.
Right.
What kind of skill do you need to have in order to be a good midwife?
You need to be patient, you need to have your medical skills so that treat an emergency if it came up.
And to know that it's a dedication and it has to come from your heart that you want to do this.
It's really a service to w women giving birth.
What is the trend regarding home birth?
Is it like growing?
Where do you see mm midwifery growing?
It goes up and down, and it's a lot dictated by insurance companies if they'll pay for the birth or not, or if the person has money or not.
But it seems to be going up in America, but it's very low.
One to two percent of babies, I think, are born at home.
But during COVID, husbands or partners were not always allowed in the room with the mother when she was giving birth.
So a lot of people wanted home birth so that they could have a family birth and not so the during COVID I was extremely busy.
I would think that uh people, because there's so much less trust of hospitals now, that people would want to do home birth, but also women want to schedule C-section.
That's another thing.
Yeah, you have both sides of the coin.
Is there something that uh midwife can do above just this kind of service over the nine months to increase the income?
I don't know.
When I had Olive Bridgemid referee, I was just into supporting the client through the pregnancy, the birth, and the postpartum.
In fact, we do three postpartum cares visits at home.
Okay, that's what my next question.
What does that entail?
They come to me at six weeks postpartum, but if they have any problems in between, we go see them.
Or any breastfeeding problems, either we help them or we have a breastfeeding specialist go see them.
What's the most common problem after birth?
Exhaustion.
Because babies don't have a clue what day and night is like.
Right.
But you can't help with that, right?
Yeah, we could during the whole prenatal period we try to prepare people to have support, to have food cooked and put it in the freezer.
If they have a relative or can afford a postpartum doula to come and give them a hand sometimes.
And if they have more than one child, try to ask other friends if they can arrange some play dates for after the birth.
So we do a lot of preparation before the baby's even born.
So it's a total support system.
You mentioned before the miracle of birth every time.
You said every time.
Did you ever get jaded?
I mean, you've been doing it for 30 years.
I mean, it's like God knows how many.
How many births you would assume?
2,000, 2500?
Oh, I don't know.
I lost count after a thousand.
Right.
Okay, so I didn't even keep track, but you know.
Did you ever get jaded?
You mean as far as insurance companies not paying me?
No, but it's oh it's another birth.
Nope.
Never happened to me.
Never felt like, oh, just another birth.
Nope.
I have gotten exhausted.
And I think by the time I had figured out I needed to retire, uh it was time because I think sometimes sometimes you go to a birth and the baby comes right away.
Sometimes it takes two or three days.
And like we sleep in weird places on the couch, on the floor, you know, waiting patiently um for this person labor to continue, but they need the support, so we're there.
We know how to do it.
You have to have trust birth and that the babies really know how to be born.
They've been born for thousands of years, and we know how to come out if people don't intervene so much.
Right.
All right, Connie.
Thank you so much.
You're welcome.
That was so interesting.
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