feminist clinic to home birth — a natural progression (part I)

In my mid-20s, when I decided to consider a future in nursing, birth wasn’t on my radar at all. In my queer community in the San Francisco Bay Area, I didn’t know anyone having babies or talking about birth. But I had long been involved in reproductive rights advocacy and had worked in coalition with the folks that ran the feminist abortion clinic in Oakland — so that is where I looked to get my first clinical experiences — to see if I really wanted to be a nurse.

Mostly volunteer-run with just a couple of paid staff, the Women’s Choice Clinic (WCC) (back before fake clinics had popped up with deceiving names like this; and before intersectional feminists adopted more inclusive language when supporting abortion rights) was a small outfit in downtown Oakland. On the second floor of what I remember as a somewhat dingy building, it was the homiest clinic setting I’ve ever encountered. Clearly run on a shoestring budget, WCC relied heavily on state Medicaid funding for most client care — but WCC also oozed an ethic of feminist care that was too committed to decolonizing “gynecology” (I hate that word) to try to be “clinical.”

I wish I had pictures to share. The best way I could describe it is that when I eventually watched the 1996 documentary about the legendary underground abortion service Jane, I understood in my body how WCC was situated exactly in the same history — borne of the women’s health movement. This is, of course, why I first learned about Jane from my time at WCC.

The footage from that film showed rooms that reminded me exactly of the recovery room at WCC — horizontal lighting and colorful blankets on the very non-medical-feeling recovery beds — blankets that looked like they came out of a quilting grandmother’s guest room.

The first job you would do as a volunteer was to observe procedures; then you would move on to provide doula support (though I don’t think we actually called it that) during abortions. This being the mid-2000s, the now-commonly used quiet MVA was not yet in use. The vacuum was loud, and I nearly passed out seeing blood and products of conception in the machine the first time. The gravity of witnessing and supporting someone through the transformation of an unwanted pregnancy in one moment to a blessedly empty uterus the next felt huge, sacred. The palpable relief, sometimes mixed with grief, was hard for my highly sensitive spirit to not catch.

Other than provide support during procedures, volunteers such as myself had to learn every aspect of running the clinic, though some specialized in certain roles like scheduling, staffing the phones, and billing. On clinic nights, we would take turns doing health history screenings, pre-procedure education and consenting, in-room support, processing labs (I loved the centrifuge!), recovery room nursing, and counseling about family planning options.

Similar to how I think Jane operated, all education about procedures happened in a group setting. We volunteers would learn the spiel about the abortion procedure, and review it with the incoming clients in the prep and recovery room, using as props some of the equipment that would be used during the procedures to demystify what would happen and ensure true informed consent. More senior volunteers were in charge of studying the products of conception to confirm the abortions had been complete, and ruling out problems like ectopic pregnancy or molar pregnancies.

A seasoned traditional midwife came in on “gyne days” to do “well woman” (using the language of the times) visits. I once saw her for an annual exam and received one of the most memorable, holistic checkups I have ever experienced. Long before I understood anything about midwifery or its historic ties to abortion, I knew that her approach to health was something I wanted to learn.

Other professionals that provided services included a family practice nurse practitioner who came several times a month to run a reproductive health clinic. Several kindly (and some grumpy) physicians came through to provide the procedural abortion services.

But what struck me over and over was that we were “just regular people” (mostly young women-shaped and genderqueer folks) making it all happen. Aside from the legendary elder queer who oversaw the place, the vast majority of volunteers were younger queers and feminists whose only clinical training had been under this roof.

There was no pretension, no hierarchy, no gatekeeping of knowledge. The idea that people who can get pregnant are the best experts on our bodies, rather than (white, male) physicians was revolutionary because of the women’s liberation movement and the women’s health movement that came out of it, and clinics like WCC. And though I had read about these movements prior to volunteering at WCC, that couldn’t compare to the empowerment of actually participating in that model of care as a volunteer that year.

The next time I felt that kind of revolutionary buzz happened when I attended my first home birth as a midwife over 10 years later and thousands of miles away, in Chicago. It was so familiar — that feeling of “Wait!? I get to just do this, and there’s no doctor watching over me? It’s just us, the midwifery team, with our client at the center?!” It was unsettling in a way, as I had become sadly accustomed to working in the patriarchal birth world by then with OBs overseeing me.

But the flash of embodied memory of intimate health care being something that (now, much more trained, but still—) “just regular people” (not under the watchful eye of the medical industrial system) could do has stayed with me and kept me tied to home birth and other decolonized models of reproductive care all these years.

If you had asked me 20 years ago if I would believe that I would end up a midwife — let alone a home birth midwife like that soft, grandmotherly woman who did my annual exam at WCC, I probably would have laughed! But when I look back now — it just looks like another full circle, and as natural of a transition as any midwife would embrace.

disability pride month: on celebrating disability as diversity, and centering the needs of disabled folks

It’s July! On the heels of Queer Pride Month, I’m excited to be marking Disability Pride Month this year.

There are so many reasons to celebrate Disability Pride Month any year, but this year, it feels even more important. In this moment, knowing that at least 17 million folks will be losing Medicaid coverage after recent legislation passed, it’s all too clear that the lives of pregnant people, low income folks, and disabled folks aren’t valued. We’ve heard too many (and one=too many) horrific things from the current administration devaluing the lives of disabled folks, and that’s not ok.

Birth justice requires supporting all birthing people, including folks with all kinds of disabilities. Everyone deserves accessible, supportive health care — and too often, reproductive and birth care does not meet the needs of people with disabilities.

As a small midwifery practice, I don’t always have the resources I’d like for making my services more accessible. But I have been learning over the years that there are some aspects of the home birth approach that make this model of care more accessible to neurodivergent folks in particular, and it feels like a microcosm of how we can make more people-centered care meaningful across the ability spectrum.

I’d love to share here a few things I’ve learned about accessibility in midwifery. As much as I also understand neurdivergence as a spectrum, and know that I live somewhere along that spectrum, I also wish to submit these items with the utmost humility, as someone who also lives with a tremendous amount of privilege.

guiding principle: trauma-informed approach

As a fundamental principle of trauma-informed care, I start with the understanding that every client I interact with has experienced some amount of trauma in the world. Trauma can be physical, sexual, emotional, spiritual, or medical. It can be related to war, occupation, incarceration, intergenerational dysfunction, weather disasters, borders and migration, poverty, racism, ablism, transphobia, queerphobia, or xenophobia. It’s pretty safe to say that in this current moment, we are all collectively witnessing and experiencing high levels of trauma, especially those of us in communities targeted by the current administration’s policies.

For those of us that have experienced trauma, or those of us that move through a world that makes our lives a bit more precarious, having a safe space to be ourselves, especially in a vulnerable setting like receiving health care, is not always easy.

So the first step in trauma-informed care is to do our best to remove barriers that might make the most vulnerable folks feel unsafe or unsupported. I want to speak a little to how I aim to do this in my practice — again, with the acknowledgement that I know there is always more I can do.

TIME

The biggest opportunity for making a safer space for clients accessing my care is the spaciousness of time. Potential client consultations are booked for a full hour. Initial client intake appointments are a spacious hour and a half. From there, routine prenatal, postpartum, and established client visits are booked for an hour. Only a couple of appointment types (hearing screenings for babies not born in my care; consultations for other midwife clients that need CNM support; and short follow-ups) are 30 minutes.

Contrast this to the standard of care in most clinics and even private practices, where initial consultations with the provider are often not available, or are not offered one-on-one; where routine visits with the provider are maybe 10-15 minutes. The average prenatal visit with an OB in the United States is 11 minutes!

What do we do with all this time? It allows something transformational to occur — a trust-based relationship can unfold between client and clinician. We can focus on what is important to YOU! Time for education and support.

And not being rushed is, I believe, a core aspect of accessibility.

sensory-friendly space

If you’re sensitive or prone to over-stimulation (like me!), thinking about giving birth in a standard hospital room with what I can only describe as oppressive overhead (typically fluorescent) lighting, does not induce a sense of safety. Lots of folks come to community birth out of a desire for a less medical-feeling, and more sensory-sensitive setting for one of the most intense moments of their lives.

I am very intentional about my office space being a place that feels cozy and safe, including with “horizontal” (as opposed to overhead) lighting and natural light. And when I do that 36 week home visit for my home birth clients, I make sure to check in about lighting options if I only notice overhead lighting.

(Note — I have had clients that feel safer with overhead lighting, and for whom low lighting didn’t feel as safe. We can work with that!)

Not only is the space cozy, but for some folks, having only one person to interact with across the spectrum of care — from scheduling to billing to care provision — can make things feel more predictable as well. Like many home birth midwives, I’m the one-stop shop in my practice (though I do work with a professional biller for folks that want to use their insurance), and that can make it simpler to navigate than a large office with several support staff.

transparency

The division between clinician and “patient” is reinforced across our medical system, with providers in “white coats” and “patients” often stripped of their identities and autonomy with patient gowns and being referred to by their medical condition or room number. The provider is the “expert,” and “patients” are expected to “be compliant” with the provider’s plans.

This dynamic is a huge part of why many folks choose home birth. Midwifery as a practice has always been rooted in community (though it’s also been adapted to fill a vital role in service provision in the hospital setting) — and getting back to its roots in home birth allows us to get away from that unsatisfying role.

Here are several ways that I support folks to be partners in their care — and ways that I think are especially helpful for neurodivergent folks navigating their birth journey:

• I provide an outline of what folks can expect during prenatal visits. The topics to be addressed during routine care across pregnancy. When and which labs are typically drawn; when we might discuss ultrasounds or vaccination options; what subjects we make space for during our visits

• I provide access to all my clinical notes from clients’ charts along with a glossary of all the medical abbreviations I use (I love an abbreviation!)

• I made a document that covers in detail the purpose of each clinical assessment offered during care (e.g. fetal heart tones, client vital signs, various uses for ultrasounds and labs, newborn screenings), with a link to evidence-based information about the use of each assessment; along with information about which assessments can be declined

• All appointment reminders come with extensive information on accessing the building, parking, and what to expect on arrival

digital & physical access

I’ll be the first to admit that social media isn’t my strong suit. But I do strive to make the visuals more accessible with neurodiverse-friendly fonts, and alt text. I will say that physical accessibility to my office spaces has been a formidable challenge with my startup budget. While my offices are not ADA compliant, I am more than willing to make alternative arrangements to see clients with access needs that can’t be met at my office. Finally, I am also committed to providing sign language interpreters if needed.

advocacy

There is no birth or reproductive justice without disabled folks. I support movements and advocacy efforts led by disabled folks, for disabled folks, not those organizations that claim to speak for disabled people (such as Autism Speaks). I am in solidarity with the demands of disabled people, because I know that their (and our, in the broadest sense) demands are the most inclusive and beneficial for a liberatory future. I strive to midwife (in community) a world that stops disabling people by leaving out the needs of any people. I celebrate disability as diversity, because diversity is a fundamental need of all living beings and societies.

Happy Disability Pride Month!

birth settings: home vs. birth center

Place of birth is everything. Everyone deserves to give place in a setting and with a team that brings them a sense of safety and support. I love that in the last several years, two private birth centers have opened in the Chicago area; and the community health center-run birth center has reopened. However, with one of the local birth centers temporarily closing in a couple of months, some local birthing families are scrambling to make new arrangements. Folks that may have considered and then decided against home birth (or hospital birth) are now revisiting their options.

Myths surrounding home birth may persist and lead birth center families uncertain whether they should reopen the question of home birth. I want to first bust a couple of myths about the difference between these two models of care, and then go through the main differences between these two choices and provide resources for folks weighing these options in this context.

MYTH #1: BIRTH CENTERS ARE SAFER THAN HOME BIRTHS

Fact: for individuals with comparable low-risk pregnancies, a planned home birth with a qualified attendant is as safe as birth in a free-standing birth center. A recent high-quality, large observational study including data from over 100,000 home and birth center births demonstrated comparable outcomes for the birthing person and the baby.

Both settings include:

• A highly trained and skilled birth attendant (typically an experienced midwife; occasionally physicians attend) and their assistant(s) and student(s)

• Most of the same emergency medications (birth centers may stock a couple of refrigerated medications that home birth midwives do not carry) and equipment

• A model of care that supports physiologic, low-intervention, low-risk birth

Now, while the outcomes are similar, safety is a dynamic concept. For some folks, the systems in place at a freestanding birth center are reassuring, and being in a setting that was built for clinical use feels safer. That can include protocols for hospital transport using the local EMS and a transfer agreement with a local hospital — something that home birth midwives do not navigate in the same way. So it’s important to recognize that, while clinical outcomes may be similar between the two settings, the sense of felt safety that someone might experience with each of these different approaches must be taken into consideration.

MYTH #2: HOME BIRTH IS MESSY! (and its variation: MY HOME IS TOO MESSY)

OK, really? What do you think, we are animals who are going to leave your home covered in birth tub water and blood stains? Haha, maybe that’s not exactly the vision, but I guarantee you someone who knows you’re considering a home birth is worried about the mess.

We’ve done this rodeo a few times, folks. All home birth midwives equip our clients with easy strategies to keep things clean — time-honored traditions to protect your bed, couch, and floors; and efficient clean-up when oopsies happen. We typically leave you with a bag of laundry (with instructions on removing any stains, if needed), a bag (or 2) of garbage, and a baby (duh) — otherwise your home should look about the way it was when we arrived, with all of “our” mess cleaned up!

Or maybe you’re worried you’ll have to clean too much for the birth and don’t want to have to worry about if your home is too messy for birth. We can work with that and help you find a strategy to protect the birth space within your home!

That said, home birth is not suitable in a home that has been afflicted by serious hoarding or that is extremely unhygienic. In those cases, a planned birth center or hospital birth is probably wise (and getting resources to support your home to be a healthier environment is recommended).

KEY DIFFERENCES #1 & 2: LEAVING YOUR HOME (OR NOT) FOR BIRTH & POSTPARTUM CARE

In the most practical sense, having to leave your home for birth vs. the birth team coming to you is the main difference, and evaluating your preferences for this is key.

With a midwife-supported home birth, your team comes to you. You get to labor at home, without the disruption of travel during your labor. Everyone has heard the stories about how labor can shift tremendously when someone leaves home, travels by car in labor, and then arrives to the hospital with bright lights, strangers, tons of questions and paperwork, and interventions like starting an IV. Granted, the transition from home to car to birth center is waaaaay gentler! The birth centers are set up as cozy environments, where you are greeted by a staff that knows you and your family. But you still had to leave, travel, and adjust to a new environment, which can disrupt your labor flow.

With a home birth, it’s all about you — your labor happening in your own space, and the only adjustment to your labor vibe is when your midwife and their team arrive (hopefully, with calm, as our team does). While inviting the team into your home may be more or less comfortable for you (see difference #3 on intimacy for the pros and cons there), avoiding travel while laboring can be soooo much more pleasant.

Part of planning a community (home or birth center) birth is about freedom of movement, right? A physiologic labor literally moves us — and changing positions freely to support our comfort and baby’s positioning is quite tricky on a car ride, whether you’re planning a birth center or a hospital for your birth setting.

Not only that — but because of how the local birth centers operate in the Chicago area, postpartum care after birth center discharge happens back at the birth center (in some other cities, discharge doesn’t even happen until 24 hours postpartum; in others, the postpartum visit may be at home). So you have to go home at 4-5 hours postpartum, get comfy at home (or as comfy as you can, given the needs of a brand-new baby), just to turn around for a 24-36 hour postpartum visit back at the birth center.

I’m just saying…I love seeing my home birth clients cozy in their own beds or couch when I come back for that first home visit, usually a bit better rested than someone who had to do an extra round trip somewhere when they are just getting their postpartum recovery going. Avoiding taking so many steps — especially stairs, depending on the home — and maneuvering in and out of the car makes home birth recovery generally a bit gentler. I also love seeing the continuity and flow of postpartum in the same general space as the birth. (Bonus: seeing my clients in the space where they are body-feeding — it’s their natural environment, and I can see how I can support them with the tools and positioning they are already using, rather than in my office setting, where they are not spending nearly as much time!)

KEY DIFFERENCE #3: INTIMACY

This is a big one. Look, inviting folks into your home is intimate. I respect that. Any midwife attending home births should take this honor very seriously. Not everyone wants to have folks in their home, changing the energy in their space, etc. For some folks, going to a place that is specifically prepared for your birth inspires more confidence and ability to be present than being at home.

But — to really release your mind and body, to be vulnerable as you ride the waves of your labor — for some of us, that’s easier to do in our home, if our home feels like a safe space. And there’s no way around it — your experience is going to be more about you and your process than when you are in a facility, even when that facility is beautiful and home-like.

KEY DIFFERENCE #4: TRANSFER OF CARE PROCESS

In Illinois, and via the standards of the Commission for the Accreditation of Birth Centers, freestanding birth centers have strict protocols for hospital transfer. I mentioned this above, but I’ll elaborate here. It’s a reality of planned community birth that on average, about 10% of individuals planning a home or birth center birth will transfer care to the hospital at some time during birth or the immediate postpartum (that includes transfer for something the baby needs). Transfers are an important safeguard, as even low-risk birth is not without any risk.

Birth Centers count on a system of transport arranged via the local EMS and with a partnering hospital that agrees to accept the birth center’s transfers. Not only that — they do drills and integrate with the hospital’s teams in ways that are impossible for most home birth practices to do, given our geographical spread and lack of a universal perinatal health system.

When choosing a home birth, families must consider their distance to the nearest hospital with labor and delivery, and the quality of NICU care, if any, at the local hospital. Each home birth practice will have their own protocols about how and where to transport and when to call EMS, but sometimes the distance to appropriate care in that setting may be longer than a family is comfortable with. It’s essential to take these factors into account when making an informed choice to plan a home birth.

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I hope this has been helpful for you if you’re trying to decide the right next steps for your care. As ever, I’m happy to meet with you to discuss your specific situation and help you transfer care if you think I might be the right midwife for you.

pride month 2025: On queering midwifery

This Pride Month is really not like any other I’ve celebrated. Pride has always been a protest for me — since my first Pride in 1997, I believe — and this year, as trans people across the US have found ourselves in the crosshairs of more legislation aiming to erase us than ever before, is no different.

As a queer person living in Illinois — and as a healthcare provider for our community — I feel shielded from much of the worst of this. Compared to other states where vicious legal obstacles to gender-affirming education and healthcare (not to mention bathrooms, sheesh), I get to live in a bit of a bubble. I would also be remiss not to mention the tremendous privileges I enjoy as a white person in a city that is still the deadliest place in the country for Black trans women.

All of this is to say that in this context, I have the coolest job! And a heavy one.

This Pride month, I’ve heeded the call to be more out in my professional world, and it feels both scary and powerful.

Queer is beautiful.

Trans is beautiful.

Breaking the gender binary is beautiful.

And saying those things out loud in the home birth world just isn’t done enough — and I’m here to do just that: queer home birth midwifery. I’m not alone in this — so many incredible birth workers are doing this all over the world. But I am here to do it in my way, in my place.

Here’s what it means to me.

• Always, always, always use inclusive language about birth and birth work. Unless you’re a troglodyte that doesn’t believe that women or mothers are people (“feminism is the radical notion that women are people,” duh), referring to the person giving birth/the pregnant person as a person is important!

  • Guess what?! Some babies get two mothers. So which one are you referring to? Get specific.

  • Guess what?! Not all pregnant people are women! Trans guys and trans masc non-binary folks and gender-fluid folks get pregnant too. Recognizing that the gender expression and identity of someone who gets pregnant is real and valid and personal to them is a basic form of respect.

  • Guess what?! Birthing folks have names! I haaaaaate the default of birthing folks being called “mom,” “mama,” “mother” either in a chart, between providers, or when coaching in labor. Yes! Of course we may identify that way (fun fact: I’m a mom — though sometimes prefer to refer to myself as a parent!), but reducing a birthing person to “mama” in the birth space isn’t as personal as referring to them by their name. This is, again, what midwifery (and nursing, since I’m an Advanced Practice Nurse) can do at its best — and especially in community midwifery (outside of the hospital) where we are providing individualized care, we have no excuse for making our clients into generic categories.

    • Example, in the hospital: Room 1 needs a new IV —> Improved: Sarah, in room 1, needs a new IV

    • Example, in any birth: “Come on, mama, you can do it!” —> Improved: “Come on, Drea, you can do it!”

    • Example, in a midwife’s labor chart: “Mom changed position to hands/knees” —> Improved: “Maria changed position to hands/knees”

  • Guess what?! The only thing inherent to the gender of birth or birth work is how that person experiences it. Pregnancy and birth are no more inherently “feminine” than, say, certain hairstyles, clothes, or anything else.

    • Embracing the uniqueness of the experience for each person is essential for individualized and safe care. We know that pregnancy and birth can be very dysphoric experiences for trans folks, but when birth workers generate a gender-open space, we can cultivate gender neutrality and increased safety for trans and gender-diverse pregnant and birthing folks.

    • Yup, there are male, non-binary, trans, and two-spirit, etc. doulas, labor nurses, midwives, and OBs. Celebrate gender diversity in birth work, and more individuals and families can receive care that is appropriate for them. Advocate for inclusive greetings and call-ins in birth work spaces (“hello, wise ones,” vs. “hello, ladies”)

  • Guess what?! People’s relationship with their gender expression or identity can change over time. Signaling gender inclusivity is a way to promote safety for folks on their journey. Isn’t midwifery about meeting folks where they are at? You can’t do that if you only speak about birth and birth work as relevant to women and mothers.

• Be out! As a queer midwife, there are aspects of queer pregnancy, birth, and parenthood that I am uniquely able to understand and relate to that a straight midwife cannot. Queer and trans folks deserve access to care from someone proudly from our community, and I want folks to be able to find me and know that this unique support is available.

• Show up! In all I do, I support the principles of reproductive justice, as elaborated by Black feminists: the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities. Queer and trans people deserve these rights, and birth workers in our communities safeguard these through showing up for all marginalized communities: BIPOC, disabled, immigrant, fat, colonized, etc.

• Keep on meeting people where they are at.

  • I don’t offer blood tests without medical benefit, such as ones to find out if baby has a y chromosome. But I do offer folks the option of adding that information to a medically indicated test such as non-invasive prenatal testing (NIPT/NIPS).

  • I ask clients to let me know what pronouns they will use for their baby, rather than assume based on any information we get during pregnancy or at the birth. I respect parents’ preferences and don’t impose my views.

I love Pride month. There’s nothing like having a month that celebrates the beauty of queerness. And there’s nothing like the privilege of supporting queer and trans birth, health, and birth/health work (and rights!) all year long. Happy Pride, lovelies!