What it’s like to be a home-birth midwife: A transcript of Slate’s Working Podcast conversation with Karen Jefferson.

What It’s Like to Be a Midwife: Working Podcast Transcript

What It’s Like to Be a Midwife: Working Podcast Transcript

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May 5 2015 11:26 AM

The “How Does a Home-Birth Midwife Work?” Transcript

Read what Adam Davidson asked Karen Jefferson about her workday.

Karen Jefferson.
Karen Jefferson.

Photo illustration by Slate. Photo by Adam Davidson.

We’re posting weekly transcripts of Season 2 of Slate’s Working podcast for Slate Plus members. What follows is the transcript for Episode 7, which features Karen Jefferson, a New York-based home-birth midwife. To learn more about Working, click here.

In addition to the transcripts, we’ve added some other Slate Plus perks for Season 2 of Working. The members-only version of each podcast will feature a short Slate Plus extra, and we’re also allowing members early access to the podcast—look for it to publish on Sundays. The nonmember version will publish on Mondays.

We’re a little delayed in posting this episode’s transcript—apologies. This is a lightly edited transcript and may differ slightly from the edited podcast.

Adam Davidson: So, we’re just going to start. So, tell me your name and what do you do all day?

Karen Jefferson: My name is Karen Jefferson, and I’m a midwife in New York state.

So, I start my day usually by getting in a car and driving all over the five boroughs to see pregnant women in their homes for prenatal care.

Davidson: And I should just say, you mentioned right away when I came in that your phone is by your side, you can’t turn it off, and there’s a chance in the next hour that we won’t be able to finish this interview because you’re going to have run off.

Jefferson: Right, because I have somebody due a few days ago. She lives quite a ways away, so she’s been instructed to call early, call when she really thinks it’s happening, so that we can get there and take care of her.

Davidson: Got you. So, can we roughly divide your days into delivery days and non-delivery days?

Jefferson: The delivery thing is hard to predict. I have a small private practice with a partner—my partner’s name is Martine Jean-Baptiste—and we’ve been practicing midwifery together in business for 13 years. And it’s a small practice because we attend women’s births in their homes. So, we can’t have too many women because we’re spread too thinly across the city.

So, we have women in all boroughs. We usually take four to six families a month. And the births are funny. I mean, one week you can have no births and the next week you can give three in two days. It’s very unpredictable.

Davidson: Let’s just start with the non-birth days. You told me today, you were driving around Brooklyn and other places visiting women in their homes. What are those prenatal test days like?

Jefferson: They’re more visits than tests.

Today I first stopped in Williamsburg and I saw this lovely couple who are getting—they are about 37 weeks pregnant. So, it would be fine. She’s term, what‘s called “term.” It would be fine for her to go into labor today and have her baby. It probably won’t happen today. We sat in her living room. And we talked about issues relating to her labor, how she was feeling physically, how well the baby was moving, what she could expect to feel, lots of different issues around her upcoming labor and birth.

And then after a while I took her blood pressure and she reclined on her sofa, and I sat next to her and I felt her baby, I felt her belly all over externally and found out where the baby’s behind was, and where the baby’s back is, and where the baby’s head was, and where the baby’s feet are, to just get some idea of where that baby’s positioned in utero.

Davidson: If I remember correctly, around 37 weeks you’re beginning to worry about breech birth, where the baby’s positioned to come out butt-first, which is a high-risk pregnancy.

Jefferson: So, yeah, 37 weeks, we really better know if it’s the head coming first, because you’re absolutely right. Breech is a high-risk birth.

Breech is—in this metropolitan area your options for a breech birth are limited mostly to Caesarean section. There is one physician in one hospital who might do a vaginal breech, but definitely, definitely not for planned home birth.

Davidson: And these are women who—will they not be getting ultrasound and not going to doctors at all during this period?

Jefferson: Well, in New York state, midwives are licensed, independent providers. Entry to practice is a master’s degree, and we have a very wide scope of practice. We take care of girls from the time they get their period to women after menopause, for well woman, problem care, and family planning, as well as focusing on maternity care.

And we prescribe medication and we have hospital privileges. And being a home-birth midwife, I’m very much in the minority. Of about 950 practicing midwives in New York state, maybe there are about 70 of us who are attending women at home. The rest are in hospitals spread all over the state. Certainly all over New York City, the hospitals are filled with practicing midwives.

Davidson: Oh, I didn’t know that—so, there are many midwives where it’s not a pregnancy practice.

Jefferson: Yeah, I mean, there are midwives who work for Planned Parenthood, who do family planning and treat sexually transmitted infection, and, you know, work with women who are not pregnant. In some other countries, the midwifery scope is limited to maternity care, but we’re very lucky here in the U.S. and in New York state that we can do quite a bit.

And it‘s our job to identify when a problem needs a higher level of care.

Davidson: Tell me about the pregnancy days. So, let’s say that phone call was this woman, she’s in contractions. I’ve been through this myself—you don’t, especially if you’re a first-time parent—you don’t really know. Those contractions might last a day and a half, they might last an hour or so. How do you evaluate when it’s time to leave the house, and then what is that like?

Jefferson: OK, so, it’s a bit tricky. We triage by phone, and that can be really tricky because sometimes it’s hard for a woman to adequately assess for herself how strong the contractions are or what’s happening in labor.

So, we ask a lot of questions. How long have you been feeling these things? What do they feel like? How long do they last? How are they spaced? Do they change when you stand up or sit down? Is it possible you’ve broken your water? How’s the baby moving?

There are a bunch of questions we run through. And very often, even in moms who’ve had babies before, we’ll say, “See what happens in the next 30 minutes or hour, and call us back and give us an update, unless something changes that you need to call sooner, like your contractions are longer or stronger or closer together. Your water breaks. You feel a lot of pressure.” And people will often call us back.

It’s very rare to run on the first call. It has happened.

The shortest labor I have ever attended—thankfully, I was on call that day, not Martine, who lives in Manhattan—the woman woke up in the morning—I don’t know how appropriate this is for radio—but she saw a little blood when she went to the bathroom. Wasn’t feeling a thing. She called me up. She said, “Something’s happening.”

I ran over to her house in downtown Brooklyn, and she gave birth to a 10-pound baby in 45 minutes. It was so fast.

So, it’s a bit difficult to judge, and that’s not just for home-birth midwives, that’s for any pregnant woman who’s going into labor. Because you hear a lot of stories: baby born in the cab; baby born on the bridge; you know, baby born in the vestibule. Because it’s really hard to judge how quickly it’s happening.

Davidson: OK, so walk me through the birth.

You’ve now decided, OK, it’s time, I’m leaving the house. This can happen, I’m assuming, at anytime, day or night. And you don’t actually know, right, if you’re going to be home in two hours or 20 hours?

Jefferson: Yeah, and so the first thing that happens to me, or that I do, when I know that I’ve got to leave now for a birth, if I’m not running out the door, I get dressed in my birth clothes. And I always bring an extra pair of clothes in case I get messy or have a second birth to go to after that. And then I have to gather some things that are inside of the house.

Davidson: Wait, what are your birth clothes?

Jefferson: Ha—Uniqlo lounge pants and a T-shirt. It’s nothing fancy.

Every once in a while I’ll wear hospital scrub-type pants because they wash out well, but usually I like these stretchy Uniqlo things that are very, very comfortable, especially if I’m going out of the house. Well, even in the daytime—a lot of the work involves watchful waiting, and I really like to be comfortable. So, I kind of go to work in pajamas.

I put my work pajamas on and then I have stuff to gather in the house.

I have to throw my computer in the bag. I throw a little machine that we use to monitor the baby in prenatal visits and during labor. And sometimes I’ll throw a snack in. Sometimes I have time to make a cup of coffee. Often I do not.

I keep my birth supplies in the car so I don’t have to drag them all to the car. So, I just need to go to my car and start it and go.

Before I leave the house, I call my birth assistant. Because she needs to get up, get out of bed, and throw her clothes on, if it’s the middle of the night, and meet me at the client’s house.

Davidson: For some reason I immediately think, because of where you and I both live—parking, that must be a hassle in this area when you’re desperate to just get to a place.

Jefferson: I have to say, it is one of the cruel injustices of the world that the New York state government will not, nor will New York City, issue us midwife license plates.

And so we have no official way to not be towed. There are some births where I have had to dump the car and run, and I have been towed. And there’s nothing worse than coming out from a birth, not necessarily clean, dragging a backpack, a shoulder bag, the equipment we bringthere’s a lot of equipmentand not finding the car there.

It’s awful.

Davidson: What do you bring? I mean, I’ve never been to a home birth. My wife gave birth in a hospital, so there’s all the stuff there. How much are you setting up when you get there?

Jefferson: OK, well, we bring a lot more equipment than we pull out of the bags.

Our usual setup involves sterile gloves, nonsterile gloves, gauze, little lubrication packets, olive oil, sterile equipment to use when we cut the cord or if the mother needs a repair after birth. So, the setup is pretty minimal.

We have whole other instruments and suture and local anesthesia for numbing someone should she need stiches.

Davidson: And typically does the family having the baby, they put out a sheet or something? And it’s just happening in their regular space otherwise?

Jefferson: It happens in their space. The funny thing is, we’ve had toilet births, shower births, couch births, floor births, water births, bed births, standing births. I mean, it can happen absolutely anywhere.

And we give the family a list of supplies that they have to get. And we ask them to get a couple of shower curtain liners: One to protect the bed and another to follow them around with. We are housekeeping, so it doesn’t really get very messy and we clean it all up.

Davidson: OK, so you get into the house. Walk me through the next steps. What happens when you first get there?

Jefferson: Well, first we assess—we take a breath, put our stuff down, take a look at the scene, and then we’ll take out the Doppler—

Davidson: And is this another moment where before you walk through the door you just catch yourself for a second?

Jefferson: Oh, absolutely, because sometimes if we think the labor’s going quickly and/or there’s traffic, it can get a little anxious in the car.

So, yes, it’s take a breath, put the things down, and then listen to the baby. Because that’s one of the first things we want to make sure: How’s the baby doing right now? No matter where the mom is in labor.

And then we’ll do vital signs, blood pressure, temperature, pulse, just to make sure everybody’s in really good shape. And then it’s a matter of supporting the family however they want to be supported, because every family is different.

So, once we’ve realized that everybody’s healthy and fine, baby sounds good, everything’s fine, we really just are watchful. It’s a matter of trying to figure out where the mom is in labor and whether it really was the best time to move in with the stuff.

Because some women feel like a watched pot, and if we end up coming to their house too soon, they feel like they’re on a stage and that they’ve got to produce.

Davidson:  Sometimes you show up and there’s another 17 hours to go, and sometimes you show up and it’swell, you said, there was the one where it basically happened immediately?

Jefferson: Yeah, it really varies.

Sometimes the mom will think she’s further along than she is. Like, the moms who go into the hospital and get sent home, “No, you’re 1 cm. Come back later or come back tomorrow.” Well, that also can happen at a home birth.

And we do very, very few vaginal exams, but if it becomes apparent to us that the mom really feels like she might be further along and we’re pretty sure she’s really early, we might check her. And depending on what we find, and her comfort level, go home for a while and then come back later.

Davidson: And I think I’m right, that every family who’s had that happen to themwe had that happen to usit feels like, oh, God, they must be so annoyed at us. Are you annoyed?

Jefferson: Actually, I’m not annoyed at all. Because it’s—if you get annoyed with that, you can’t do this job, you just can’t do this job.

You have to have tremendous patience to do the job. Because in the times when the mom is early but the family really wants you to stay, you really could be in for quite a while at their home.

A lot of midwives knit, but Martine and I don’t knit. We don’t knit.

Davidson: So, what do you do? You wouldn’t just like, pull out a book and read a book or watch a movie on your computer?

Jefferson: No, you’re just present in the room. You’re not necessarily talking to the family, but I just kind of sit there and pay attention, yeah.

Davidson: I mean, it seems almost like a Zen practice.

Jefferson: I guess it is, although I’m not that kind of gal. But yeah, I guess it is.

You just need to be present and observant. And I think one of the benefits for people who choose to work with a midwife is that you often get this continuous care with your care provider present with you throughout the labor. Just, you know, aware of the scene.

Because of course, most people choose hospital birth. Ninety-nine percent of the women giving birth in New York state give birth in a hospital—it’s not the norm to have a home birth.

But I hear of a lot of doula strategies and childbirth educator strategies and mommy strategies, “Oh, stay home as long as you can. If you want to avoid all the hospital, come in as late as you can.”

And then women will show up to the hospital at 6, 7, 8 cm—but nobody’s been monitoring that baby. How has that baby been doing through the labor? So, one of the benefits of home birth is this continuous care and monitoring which usually happens.

Davidson: What would be an average amount of time between getting there, assessing the situation, and then getting to work?

Jefferson: It varies so much. And it can be several days when you have a very challenging, long labor, and not all of our births end up successful at home. About 10 percent of the people who attempt a home birth in our practice end up needing to move location to a hospital birth. Because it is no longer appropriate for home. The baby wasn’t coming out, or the baby didn’t tolerate labor, or the mother was exhausted. There are a bunch of reasons you could risk out-of-home birth. So, those births, you could have been with somebody a day and a half, and then end up in the hospital with them, and spend another day and a half.

It can be quite a long commitment to attend someone’s labor.

Davidson: Wow, and those must be tough moments when you make the call—“OK, this isn’t going to happen at home.”

Jefferson: It’s really tough for the family, although most families understand the situation. I don’t have a poker face, so if I’m concerned, we’re talking about it as it’s developing. And so it’s not a shock to them when I say, “You know, we’re done here. We really need to go in. Let’s get up and go.”

And my assistant will help them gather their things while I’ll call ahead to the hospital that we’re going to and give them a report that we’re coming in.

Davidson: And was that set up ahead of time? Or do you always have a hospital on standby, sort of?

Jefferson: Depending on what the situation is, and the neighborhood the woman lives in, we identify the best places to transport to. So, it’s not a two-way relationship in that the hospital knows that we’re in the community planning a home birth, but they are obligated to receive us and provide care for any laboring woman that comes in.

We do have preferred hospitals identified all over the city that we’ve had great experiences in, and most of these hospitals are staffed with midwives 24/7. So that even though the mom had developed a complication that risked her out of home, unless she immediately needs a Cesarean, she can still receive midwifery care inside those hospitals, with a physician available should we need her or him for a surgical birth.

Davidson: And you can stay with the mom, too?

Jefferson: Oh, yeah, and up until a few months ago, Martine and I had admitting privileges in a hospital. So, we were able to be the midwife that took the family into the hospital, admitted them, and continued their care in the hospitals.

Right now we don’t have that because we haven’t found a hospital in New York City that has wanted to have a home-birth midwife on staff like that, or as a voluntary attending like that.

Davidson: Let’s get to the big event. This baby’s coming, but even that can still be hours. So what happens then, when you’re not just watchfully waiting, but you’re in?

Jefferson: A lot of moms will need absolutely no direction. They’ll feel it. They’ll start pushing. We’ll start checking the baby more frequently, because the situation changes as the baby goes down the birth canal. There can be some head compression or cord compression, and we just want to make sure that if that’s happening the baby recovers fine.

And we make sure everything’s set up. We have towels, we have always a hard surface with a heating pad on it in case we need to resuscitate a baby, and we have everything we need ready. And often the mom will just push and we’ll start to see a little bit of head, and nowyou attended a birth, right? You know it?

And then little by little the baby starts coming, and then the midwife has the gloves on and supports the mom so she stays intact, hopefully. And the baby comes out.

And once the baby births itself, we always—well, not 100 percent of the time—if the baby needs assistance with transition or needs a resuscitation, we’ll do that immediately. But mostly we can hand the baby over to the mom, and we dry the baby. And at that point, the family is usually just so excited because they have their baby on them.

And the baby’s crying, and we get to take a breath, and like, “Oh, yay! You know, great!” They’ve given birth. The kid’s OK. Mommy’s OK. And at that point our job is to assess them, make sure the baby really has made a good transition, and is breathing well and is pinking up, and everything is good, and that the mom is OK. We’re watching for bleeding from the mom, because the birth isn’t really over until the mom gives birth to the placenta and her uterus clamps down.

So, again, we’re watchful waiting. We’re watchful waiting. Some vital signs taking, but watchful waiting.

Davidson: And letting them have this moment where you’re not the center of that moment.

Jefferson: We try never to be the center of the moment. And actually in some of my appointments today, I was really encouraging the moms that when they go into labor and they are pushing their baby out, that they should put their own hands on the baby’s head to help guide the baby out, because they feel what’s going on better than I can guide the baby.

So, we hope never to be the center of attention. If the baby has made a great transition, it really is just hanging back, either waiting for signs that the placenta’s ready to be born, and making sure Mommy’s not bleeding too much.

Davidson: I’ve seen one birth, which is the birth of my son, and it—you know, of course was the most important of my life, and it’s hard to think of without my eyes tearing up.

But you’ve seen hundreds of births. Where are they on the scale of sort of “routine day at the office” to “greatest miracle in human history”?

Jefferson: Some births cause me to be more emotional and joyful than others.

I never know which ones and I never know why. The one constant is that after every single birth, even the easiest, smoothest, no-problems, everything-perfect births, I’m depleted. So that I know it’s really affected me.

There’s a variation in how I respond. But boy, am I hungry and tired afterward.

Davidson: I can imagine! And now the baby’s stable and everything’s good. Now what happens? You’re just cleaning up and leaving?

Jefferson:  Well, first the mom has to birth her placenta. And then after a while we’ll have the father or the partner cut the cord, and put the little cord band on. And then we help the mom get cleaned up, and then we help them breast-feed if they need any help. A lot of babies just bounce themselves onto their mom’s breasts and do a great job with breast-feeding.

And we make sure the mom eats and drinks and pees and is cleaned up. And then we clean up the house.

As everything is stable, time is passing, and we will do a full newborn exam. We function in the pediatric role, so we do a full physical evaluation of the baby, and we weigh and we measure the baby.

The weighing is always really fun because we use a fish scale with a sling. So, we’re hanging this child above the bed and, you know, we ask people to guess. The physical exam is really fun.

And at a certain point, if everything’s been great, usually a couple of hours after the birth, everybody’s stable, their vital signs have been great, blood pressure is good, everything’s good, we wrap them up and they go to bed. And we go home. And we come back 24 to 48 hours later. We do several postpartum visits.

Davidson: I’ve got to say, it was after the birth that we really wanted the professional help. I mean, you’re suddenly at home and there’s this thing, and you don’t know what to do.

Do you have that conversation? Do you give them guidance on the next few days?

Jefferson: Yeah, we really do. We want every person to have another adult in the house to be available to help them with the newborn. I mean, a lot of people have family come in, so they get some modeling of how to take care of a baby.

And we encourage everybody to take childbirth education classes, including a newborn care class. Because unless you were a baby sitter for a newborn, how would you know what to do with this little floppy thing?

And we check in by phone and do our visits. But people need more support than is traditionally provided here in the U.S.

Davidson: And so, and then every once in a while, you then have to go from there to another birth?

Jefferson: Yes. That’s no fun. It’s really not fun. Not that often, thankfully. It happens. People never know when they’re going to go into labor, and you just have to do it.

Davidson: How does this interact with the rest of your life? I imagine every time you make dinner plans with friends or you think about going on a vacation, you have to have this asterisk: “unless there’s a birth.”

Jefferson: I’m lucky to work with another midwife, because we alternate calls.

So there are actually some days and evenings and vacation times and other times where I’m not responsible for the women in labor. I was just in Albany for two days, so Martine was the person on call for labors. I mean, on the days I’m on call, there’s a little “Oh, I might have to run.” But I try to plan things for days when I’m not on call.

And the special things that come up in my life, like my other son’s college graduation is coming up, I took the day off. I mean, I’m off, so I don’t have to run. There are a lot of solo practitioners in home birth; I don’t know how they do it. Because I wouldn’t like being pulled away from important events all the time. I mean, it still happens to me a little. I can’t have everything off that I would like. But in general, working with a partner has solved that.

Davidson:  Have you ever lost a baby?

Jefferson: One time, and I have to say that it sent me into—I wanted to stop practicing.

And I ended up seeing a therapist for, I guess I would call it, like, a post-traumatic thing. Because every birth after that, I would have a panic attack and the sweat would fall in my eyes, and I couldn’t—I really needed to get some help with that.

And the one thing I can say about that is, it was something that we’ll never know the reason why. The family investigated, we investigated, and there was really no known cause. But it was also a situation that even rushing her to the hospital, if we had identified that, you know, 15 minutes later the baby would pass away, wouldn’t have saved that baby.

So, this baby was stillborn—and died in labor. It was a horrific experience for the family, of course. And for us as well.

Davidson: Yeah, I mean, it sounds awful. But knowing the statistics, I mean, if you’re going to attend hundreds of births, statistically you’re probably going to have that happen.

Jefferson: And I have a friend who is in practice, and she hasn’t lost a baby. And when people come for consults with her and they ask that question “Have you ever lost any babies?” her answer is “Not yet.”

So, it happens. We don’t talk about it too much. It’s often unexplained and terrible.

So, yeah, talk to any midwifery or obstetric provider, and they’ve had to get through these things in their life.

Davidson: How did you get into being a midwife? Why did you decide to leave the glamorous world of radio reporting for midwifery?

Jefferson:  For me, that young man that you saw come in who’s visiting us was born in Rogers Park in Chicago in 1985 with a family practice doctor and a midwife, at home in our apartment. I was already getting care from midwives at Illinois Masonic, but I learned—I was in my mid-20s, and I learned, wow, people can have a baby at home with professionals attending them!

And we made the switch to that choice for a home birth late in care, at about 30 or 32 weeks in the pregnancy, and went on to have a great experience. To the point where when we moved to New York and we wanted to have more children, I actually sought out a midwife who attended births at home prior to pregnancy, because I knew I wanted to repeat that experience.

The second birth was very funny, because that was such a quick birth that the midwife missed it. And my husband caught the baby, and it was an amazing experience for us.

And I was thinking, “Wow, more women should have the option of doing this if they choose to,” because at the time there were only three midwives attending births at home.

Davidson: In New York—

Jefferson: In New York City. And I got a little spark of “Wow, this is so interesting and it could be great.” And I thought about it for several years. We had another baby.

And then I just bit it and went back for my education. It took me about five years to retrain.

And it also coincided with being a grant-funded radio producer. It was a good time to make a shift. And when I first started working at Bellevue Hospital, which was my first job out of school, I spent the first three months in absolute terror and questioning, what was I ever thinking about becoming a midwife? Because it’s a tough job.

Davidson: And I am an economics reporter. I always like to understand the economics, the business strategy. It’s clear to me you did not pick this in a profit-maximizing business strategy kind of way, this career.

But how—it does seem like there’s some tradeoffs to be made. For example, having more clients, but that would mean not being able to attend as many. Having two midwifes, or five midwives, or 10 midwives in a practice. How do you sort of keep the lights on and keep it a viable business, but also make it so that you can be available in the way you want to be for your patients?

My hunch is you’re maybe making some choices that leave some money on the table.

Jefferson: Well, by not having a busier practice, we’re choosing to leave some money on the table. But both Martine and I are very, very involved in some projects outside of our practices. Me, in advocacy at the state and federal level on behalf of women, families, and midwives. And Martine with a foundation that she’s—well, I’m part of that, too—but that we and some other people have started called the Foundation for the Advancement of Haitian Midwives.

So, we are content to earn what we earn and not be busier, because we have these other important things in our lives. But midwives, people who take care of birthing families aren’t really rolling in money. Because insurance payment for global maternity care—and that’s either provided by the midwife home, the midwife birth center, the midwife in the hospital, the physician in the hospital—the usual reimbursement, especially if you’re in-network for global maternity care is an embarrassment.

And I’m not sure how practices survive on such a low reimbursement, and why our insurance system is structured to pay such a low fee for such an important process and care. For instance, Medicaid in New York state, which 50 percent of the births in New York state are Medicaid: $1,720 for prenatal care, labor, birth, postpartum. So, naturally in a small private practice, we really have to limit Medicaid clients because of that, because we can’t survive on that with a few clients. You have to have a big practice with lots of clients to make that work.

I don’t understand the economics of why this is paid so poorly when surgeries are—can be paid very well by insurance.

Davidson: That is nuts. And I guess that does explain why the practice we chose, which was identical in this way to all the practices we looked at, had a whole lot of doctors and saw us for seconds, not minutes, not hours—and they were all very nice, we liked them a lotbut still, it was clearly a volume business. It had to be.

Jefferson: Right, and we—obviously we can’t work for $1,720 in general, and so we have a—we’re out-of-network, which enables us to charge a fee, and our clients are responsible for the fee. And most of the insurances will pay a portion of that, but it’s a cost-sharing experience these days for families to choose us. Because we’re out-of-network.

Davidson: My wife and I did have a couple of bad experiences where we talked to some people who, it almost seemed like an ideology, that natural home birth is the only valid way. That if you take any pain meds at all, that if doctors intervene at all, it will destroy the bonding experience with the child. And it was so off-putting, it was so frustrating.

What is your philosophy and what do you think about the politics of birth?

Jefferson: I think that each woman should feel free to choose what works best for her.

It’s funny, I’m not really an advocate of home birth because it’s not for everyone. It’s really peculiar in our society to do it in our culture. So I wouldn’t say that when I do my advocacy it’s for home birth. I’m really an advocate for women’s choice.

One thing I can advocate for is the midwifery model of care, which can occur in all settings. And I think there’s a drive to reduce the incidents of Cesarean section, and midwives generally have a lower Cesarean section rate than physician practices.

So, in terms of philosophy, that is one that I do buy into, that with observation, monitoring, patience, individualized care, looking at the whole person, and using intervention as needed, you have great outcomes.

There are physicians who practiced that way. There are physicians who use the midwifery model of care, and there are midwives who are quick to intervene. So, it isn’t even which provider you use, but it is this idea that you can expect labor to start on its own; you hope labor starts on its own, because the outcomes are best for that, unless there’s a medical indication to get the labor started. And there never has been any evidence to support continuous IV fluids and no food during labor.

So, I can’t sit around and say everybody should have a home birth, but I do wish more people would know about midwifery hospital birth. And that in most of the hospitals in New York City, there are midwifery practices that give wonderful, wonderful hospital care.

Davidson: Is there anything about your job that I haven’t asked that people often misunderstand, or you’d want them to know?

Jefferson: People are so—if you look at research on home birth, it’s all over the place. And depending on your slant and your bias, you can find studies to support everything.

But one thing about my job that I really would like to have changed—and I think we are now in a possibility of change—is that there are other countries, for instance Canada, where the women have a choice, all through their pregnancy, of what setting they would like to deliver in: home, birth center, or hospital.

And the midwives are completely integrated into the system, meaning it would be the same midwife who would attend her at home if she wanted it, or in a birth center, or in the hospital. And I wish that we would stop arguing about whether home birth is safe or not, because honestly birth isn’t safe until it’s over. And have a discussion about what is the safest way that we can all work together to take care of families choosing whatever way they want to be cared for.