One of my favourtite episodes, talking to Kristine was incredible. What a woman. Working with some of the highest risk women in the world in refugee camps amongst other very low/impoverished places where c-section rates are only 5% and the whole scope of midwifery care is used. Whilst she is also a registered midwife, former traditional midwife, in the United States where she recently supported her approx. 10th set of triplets at home. Kristine doesn't practice as a primary midwife in the states but she shares her incredible adventures and tales via her instagram and blog.
Additionally, she works with Breech Without Borders, supporting the lost skills of breech vaginal birth to midwifes and doctors.
An incredible episode!!
Links to people/business/resources for this episode:
CHAPTERS
03:00
The Freedom of Practicing Midwifery allegally
06:00
Learning About Home Birth
09:00
Licensing and Regulation of Midwives
13:00
Supporting Physiological Birth in High-Risk Situations
17:00
Attending Triplets and Twins at Home
20:00
Teaching Breech Skills with Breech Without Borders
25:00
Managing Triplets Births
28:00
Postpartum Care for Multiples
35:00
Home Birth in Different Cultures
41:20
Cultural Differences in Home Birth
47:09
Working as the Only Expat Midwife
50:39
High-Risk Factors for Women
53:26
Gratitude and Living in the Moment
56:57
The Medicalization of Birth
58:45
Taking Responsibility for Birth
59:30
Empowering Women to Demand Change
One of my favourtite episodes, talking to Kristine was incredible. What a woman. Working with some of the highest risk women in the world in refugee camps amongst other very low/impoverished places where c-section rates are only 5% and the whole scope of midwifery care is used. Whilst she is also a registered midwife, former traditional midwife, in the United States where she recently supported her approx. 10th set of triplets at home. Kristine doesn't practice as a primary midwife in the states but she shares her incredible adventures and tales via her instagram and blog.
Additionally, she works with Breech Without Borders, supporting the lost skills of breech vaginal birth to midwifes and doctors.
An incredible episode!!
Links to people/business/resources for this episode:
CHAPTERS
03:00
The Freedom of Practicing Midwifery allegally
06:00
Learning About Home Birth
09:00
Licensing and Regulation of Midwives
13:00
Supporting Physiological Birth in High-Risk Situations
17:00
Attending Triplets and Twins at Home
20:00
Teaching Breech Skills with Breech Without Borders
25:00
Managing Triplets Births
28:00
Postpartum Care for Multiples
35:00
Home Birth in Different Cultures
41:20
Cultural Differences in Home Birth
47:09
Working as the Only Expat Midwife
50:39
High-Risk Factors for Women
53:26
Gratitude and Living in the Moment
56:57
The Medicalization of Birth
58:45
Taking Responsibility for Birth
59:30
Empowering Women to Demand Change
Hi, welcome to Birthing at Home, a podcast. I'm Elsie, your host. I'm a home birth mom of two little boys. I'm a mental health nurse, a home birth advocate broadly, but also more specifically in the state of Victoria and I'm an ex -student midwife. Before we begin, I would like to acknowledge the Wurundjeri people who are the traditional custodians of the land I'm recording on in Melbourne, Australia. I would also like to acknowledge the Aboriginal and Torres Strait Islander peoples have been birthing at home. own country for tens of thousands of years prior to the British invasion and acknowledged that sovereignty has never been ceded. Risk women in pregnancy and birth. Our conversation today will make you think, reflect and give you a glimpse inside Christine's work as a midwife and how she works between such contrasting birth cultures whilst respecting the power of physiological birth. Welcome, Christine, to Birthing at Home, a podcast. Thank you. I'm so happy to be here. Can you remind me where you're joining from? Yes, I am in the Upper Peninsula of Michigan here in the US. It's very, very close to Canada. It's super cold up here, so very far north. Yeah, yeah. Amazing. I'm so excited to share with our listeners today a little insight into your life as a midwife, a midwife with Doctors Without Borders. I was just listening to your episode that was almost exactly two years ago released on the birthing instincts podcast. So it's quite fitting. I think we're talking now. Yeah, yeah, wonderful. Yeah, I remember doing that. I was in South Sudan, right? That was the one. Yeah. Yeah. So I guess, do you want to give a bit of background about, you know, who you are, Christine? Sure. So I am a certified professional midwife. That's a designation that we have in the US. But I started out in birth about 35 years ago. And I was a traditional midwife for about 17 years, meaning that I didn't have any kind of licensure, registry or certification. And I also was practicing illegally. So it's really important that I explain that when I'm talking to people, when I'm out teaching or whatever, because I have such a wide spectrum of people that either come and learn when I'm teaching a breach, which I'll get into in a minute, or really just anything, because there are a lot of birth keepers, doulas, people that want unassisted birth, all of that. There's a whole spectrum. So, I don't want to be pigeon -toed into, oh, she's a CPM, she's certified, she's like this big rule follower. I never felt more free practicing midwifery community -based than I did when I was practicing illegally, honestly. And I had my baby, I only have one, he's 24 now, but I had him alone at home. So, you know, just in case the subject of, free birth or unassisted birth comes up, I'm not against any of these things, having your baby at home unassisted, having your baby with somebody who's not certified. None of those things. I really believe in autonomy and I think people should be well -educated and know what their options are, but then also know what that means. what it means to birth by yourself or what it means to birth with somebody who doesn't have certification and how that differs and what it means to birth with somebody who does have certification. Although, yeah, but yeah, so I've worked as a community midwife for many years and I, and then I, I, like I said, I became certified. I have always done breaches and twins from the beginning because I did my apprenticeship in an Amish community with a midwife there and, and the Amish they have. They do everything at home. So, breach and twins were never anything that was shied away from or anything that I learned to fear. So, I've been doing them all along. And now I work for Doctors Without Borders, as you mentioned, MSF, Medecins Sans Frontieres. And I go to, I do humanitarian aid. That's what we do with MSF. And so, I go to remote areas of the globe to refugee camps and and conflict zones, disaster areas. And I provide humanitarian aid in sexual and reproductive health. And so that includes not just maternity care, but also contraceptive care, safe abortion care. And the big one is SGVB, sexual and gender-based violence, which is a huge part of the SRH package in MSF, because there is a lot of sexual violence in in the places where we go. And so that's a big part of what the midwives do. And most of the time I go places where there are no obstetricians. And so I am the one making the decisions. I work with national staff and I'm the team lead. And so the responsibility is on me to make the decisions. And we oftentimes don't have access to a cesarean. And so all of that to say that I've seen an enormous variety of complications and things that I've had to figure out how to manage without sending somebody to a C-section and hopefully getting a good outcome in the end. Yeah. Yeah, of course. Of course. Wow. That's so, so, so incredible. I guess what I often ask the people that I interview is how Do you remember like when you learnt about birth or even birthing at home? Because in Australia, commonly women only find out about, especially men partners only find out like after they're pregnant or often, more often is when they've had a traumatic experience in a hospital setting and then they discover home birth. It's like they haven't even heard of it before. So do you remember when you heard of it? Yeah, actually I do. So I'm the oldest of nine and my mom did not have any of us at home. She was somewhat high risk now that I know about birth. I was the first though. So my mom was eternally pregnant while I was growing up. So I always kind of had a, she made it look easy. She made it seem normal. Yes, she went to the hospital to have her babies, but it was like, oh, it was just no big thing. And so, That's really where I learned about pregnancy and birth being normal. She miscarried twins at home at about 11 or 12 weeks. I remember that very vividly. I was in maybe fifth or sixth grade. And so when I went to paramedic school out of high school and I had to write a report on something and I don't remember how it came up, but the topic. of midwifery came up and I decided to interview a home birth midwife in my hometown where I was living. And that's when I got introduced to home birth midwifery. But I wouldn't see a home birth for several years but I was still very much captivated by it and was kind of... I remember being attracted to birth then even though I didn't go into the birth field for a while. So that was probably the first time I think I learned about homegrown. Wow. And so did you go into tradition? So from what I understand, having listened to the birthing instincts podcast is that there are some states in the United States that just don't license midwives. So that's when like traditional midwifery comes into play. Is that sort of correct? Yes, there are states where it's legal and then that means you have to have some, you have to be a CPM, if you're a CPM, a direct entry midwife, you have to be then licensed through the state. First you're a CPM and then they license you or it's a registry. So it's either registered midwife or licensed midwife depending on the state. But then there are states where it's illegal. or not regulated. And so like, I think Kansas is one of those states. Here in Michigan, it used to be that way up until I think they got the licensure in 2019, if I'm not mistaken. I didn't live here then. But it was illegal for a long, long time. So yeah, it's different depending on where you live and what state you're in. There's different rules and regulations. So in some states, You can't do VBACs, twins, breach, anything. You can just literally, it's got to be somebody who falls in these very narrow parameters like Louisiana as one of those states. And I think Colorado is not a very friendly state either. So yes, so, but Michigan and Wisconsin where I happen to be licensed, but I don't practice here because I work abroad. But I'm licensed because I live right in between these two states and I have friends who work and sometimes I can help them and it helps if I'm licensed. But it's very, we can do twins breach and be back. It's not a problem at all. And so it's more liberal in some of the states than others. Yeah. Here in Australia, like broadly speaking, There are private midwives that will support VBACs within reason. But yeah, twins or multiples, I don't actually think it's like illegal, but there's a lot of toxicity between like the maternity medicalised hospital system and private rogue midwives, you know. and we report them to our registry body called APRA, the Australian Health Professional Registration Association or whatever. And yeah, and also to child protection. So there's still a lot of that toxicity in Australia. And like I was saying before, yeah, less than 1 % of women give birth at home. And that's yeah, you know, partly because it's just not, yeah, midwives aren't allowed to support much variation, I guess. Yeah. But I am so, so interested to hear about, you know, your experience, your experiences with Doctors Without Borders, you know, so many. people's response to home birth is, oh, well, you know, women die and often lower resourced countries are cited as evidence of, see, women die and babies die. I said, that's why we should be birthing in the hospital. But I find it so fascinating that you work in, you know, this very high risk, low resource situation, but you still are able to, appreciate and respect and support physiological birth, you know, in categories that some people do consider very high risk. So I wonder like how do you ever have any conflict in your mind about that? Well, you know, that's an interesting question. No, I really don't have conflict. I will say that, you know, starting out in midwifery, you know, just very never having seen a birth, the first birth I ever saw was at home, it was not in a hospital. And I was learned that birth was normal and natural and, you know, part of nature and the less you mess with it. the more likely it is that you will have a good outcome. And the more we meddle in things and disturb it, then the more we then have to intervene and the worse the outcomes can be. And I learned this coming up through midwifery. And this is how I was taught by the senior midwives that I worked with. And it was just the belief that I exposed. So I always have thought less is more. And the less you do, the better it is. And you know, if something happens, then of course, you know, you're there and then that's when you intervene. That's when you might need to do a vaginal exam or, you know, give medication, whatever it might be. And so, you know, then fast forward all these years, you know, later and I'm working with literally the highest risk mothers and babies in the world and I have seen some just incredible things in the field and I've managed some really incredible situations. And what I have learned from that is that birth is normal and natural physiological process and the less you intervene in it, the better it is unless or until you need to. Even with the highest risk mothers and babies in the world, birth tends to work. It doesn't mean we don't have to tweak some things along the way. But I have seen what other people would say, oh, well, that's impossible. Well, that can't happen. You can't do that. This is not. No, that baby wouldn't survive. That mother can't do that. I have witnessed it. I have managed situations with my own hands and my own skills with the most limited things. And it can still work. And so just one small example would be. a very low lying placenta like a partial previa. So, you go in, somebody's in labor, you do a vaginal exam, you feel the placenta at seven o 'clock. It's not covering the ass, but you feel it, it's there. What are you going to do? You don't section that person in the field because you know, and they're in labor, they're losing some blood and you know, I, what my job is to monitor first, I... take a hemoglobin level on them. And then I, so I find out where we are. I make sure we have some blood products available in case I, when I was in South Sudan, we did have a general surgeon. We don't have an OB, but I would alert the surgeon that I might have somebody that needs to go to OT and they need to be ready in case if she starts to bleed too much. Okay. And so then what happens usually is the cervix starts to dilate, the baby's moving down and the head tends to tamponade. any bleeding and move past that placenta and the baby is born. And I've never once had a low lying placenta that I've had to send somebody to section four. We've had some, some pretty nice blood loss with it, but not nothing that we couldn't manage and nothing that, you know, that we, uh, you know, we weren't, we weren't taking unnecessary risks. So, um, anyway, so I just feel like it's, uh, one of those things where, you you obviously you're not going to take that risk here in the United States. You have a perfectly good operating room and we have very good, you know, we don't have to parse out the cesareans. But I'm just saying I've seen things that should not be possible actually happen. So. Yeah. Yeah, absolutely. Absolutely. I also interviewed a man that lives in Texas and he's actually from Guatemala. And he was talking about, you know, that also in lower resource countries, like the thought of going to hospital to pay, to use resources to have a baby is just like, that just doesn't happen. Like I think in Guatemala, I was reading some rough stats and like 50 % of women technically are birthing at home. But it's, yeah, it's not, I guess, out of choice in the same way that in countries like the States or Australia, it is, you know, some women are, you know, don't really have a choice because yeah, it does cost money. And it does cost resources to be in a hospital. And that is a privilege. But that also doesn't mean that we have to, you know, at the site of every red flag, you know, utilize the full extent, the full toolbox of like what we can just because it's there, of course. Right. Exactly. Yeah. Yep. And so you said that you've always, you know, never shied away from supporting women, birth twins and even like I think I think so when you were on the birthing instincts podcast almost two years ago, you said that you had delivered about nine sets of triplets at home. And now I suspect that's a couple more. Is that right? Yeah, I think it's a total of about not maybe it was at nine or was it seven back then, because I know I've done I've done two here in the US in the last year, one last week and one about 10 months ago. So I think I always I I can't ever remember exactly. I think it's around nine. It could be 10. But the only ones I've ever done in the US were these two. All of the rest have been out of the US. Because it's very rare for somebody here to, as I'm sure it is in your country, to opt to have vaginal triplets at home. And also it's... It can be difficult even to get to term with them. And I really require somebody to be 36 weeks if I'm going to help them at home here in the US. And both of the mamas I've helped have made it to well beyond 36 weeks. So I had no problem helping them. But that's not usually the case. So. Yeah. Yeah. And. I think you said that you also work with Breach Without Borders. Is it called Breach Without Borders? Yes, yes. They're a nonprofit and they teach breach skills. We have an online portion of the course and then people can sign up and do simulations. I was in last, at the end of December, 2023, I was in Sydney and Tasmania. teaching the simulation workshops. So providers could come and practice breach maneuvers on the simulations. Dr. Bissets was there in Sydney teaching with me. I love him. So yeah, and so it's really wonderful. I love teaching breach and I've attended hundreds of breach births. So they're just really a passion of mine. just, I just think that they're, again, it's nothing to be feared, but it is something that you really have to know about. I think if you're not skilled in breach, then it is something that you do need to learn if you're going to be attending women in birth. So, because it's very, it's not difficult to learn, but you have to learn what's normal before you know how to, you know, be able to notice if something is not normal with breach and that's - where the problems come in, like not knowing what to do and when. Yeah, yeah, yeah, absolutely. And I know that, you know, twins is quite special at home, but triplets, like we've said, is almost unheard of in recent history in more resourced countries. But. Like, you know, the first, so the first time you supported a woman to give birth to triplets that was overseas somewhere. Yes. Uh huh. Probably about, who, about 20 years ago, at least. Yeah. Wow. And, um, you know, do you remember what, you know, some basic things about, you know, what that was like, you know, because it's a whole, It's a whole extra baby that you have to be considering about. So it's like, you know, do you have any comments on that? Yeah, I would say that it's, we always have to be prepared for a baby with triplets with baby C being kind of a wild card. You just never know what's gonna, what's gonna happen with that baby. And you have to be prepared to. to go in after it if you need to. And you have to be prepared for a lot of blood and figuring out ways to mitigate that. So yeah, I mean, just always just assume you're going to have a lot of bleeding. And honestly, as hands off as I am, you know, if somebody is given birth to three babies, they usually handle the first two quite well. by the time they have the third one, it's just, that's a lot on their body. And then to lose blood or, you know, of course they're going to lose some blood, but to have to lose extra blood, I am all about, let's not see if she hemorrhages because I can pretty much guarantee she probably will. And so why not have a managed third stage? Normally I don't do that. In the field, I absolutely do because we're required to. because those women do bleed and they come in with very low hemoglobins to start out with even with singletons for various reasons. So, but here I would say, you know, in the US that it is not, I think it is not at all a foolish thing to do a managed third stage. And I normally would not do that. And so, but I think that, you have somebody that is going to need to take care of and feed three babies from her body. If you can do something to help her not feel really awful afterwards, then why not when we know, when we can almost bet on the fact that she's going to lose a fair amount of blood, why not try to minimize that? So that's what I would say is the kind of the biggest thing. Yeah. Is the third baby sort of a wild card because there's now, you know, so much more space, do you think? Yeah, part of it that and part of it is oftentimes those babies are on an oblique or on a oblique is actually better than transverse, but they'll be transverse and look fine. And they usually will go down. to a breach or vertex, whatever, you know, they're going to go one way or another. But oftentimes, if they're slow at doing it, then that's when they may need a little bit of guidance getting down there. So, the birth I had last year, the babies were cephalic breach -breach, and they all came out just fine. And the biggest space was between babies A and B and then B and C there was only like the seven to 10 minutes, something like that. So it was rather easy and they were born in the water, all three of them. And then this most recent one, I did do an extraction for baby C. So, but I wasn't surprised. did see that on your amazing Instagram this morning actually. Yeah. That's so fascinating. And, Um, forgive my like ignorance, but what is, you know, especially in triplets, like the placenta, like when are the placentas born? Is it, you know, a baby A's comes or baby B's come? Like, how does that, how does that work? Yeah, no, with multiples, um, uh, all the placentas usually come with the, whether it's twins or triplets, um, after. all of the babies are out and it is problematic if they... I mean, every once in a while, if you have like a set of di -di twins, a baby will come out and that placenta will come out. That just that one for that baby because they're separate. But oftentimes they're sort of fused together or they kind of grow together. And so they usually will come out after the fact because we don't want all that bleeding in between. But that's always a risk and it can always happen. And I think baby C's placenta started to detach before baby C was ready to make his way down. He was making his way down to the pelvis, but he wasn't quite in it yet. And so he needed a little bit of help because he broke his water bag and then there was more, there was blood along with the amniotic fluid. And I'm like, well, this is the time to do this because his heart rate also went down to the, 70. And so I'm like, Oh, let's just go in and get him. And the mama knew, I told her, you know, I might have to, because he's transverse and I don't know how quickly he's going to come or how, how easily he's going to cooperate with us to turn. I may need to go up and get him. So I got informed consent from her when, well beforehand. So she understood that when I actually needed to do it, I said, okay, I need to do it. I said I was going to maybe need to do. And she's like, okay. So then there was no. There's no time to answer those questions and it's far less traumatic for them if they understand. Oh, yeah This has been explained to me. I get it and she knew she prepared herself mentally She said and she she did and it's you know, it's something that you do together with the mother It's not something you do to her or with the baby. It's like you're working together So I needed her cooperation to push and we we did it together so amazing and like in terms of duration of, you know, from the start of labor to, you know, until I guess until baby C is born. Like, is there, you know, in terms of like labor duration, is it similar to, you know, Singleton labors or is it longer? Is it shorter? Is there sort of a rhyme or reason to it? Yeah, you know, it sort of depends on the person's previous history. If they're a primip, that's going to be a different situation because we don't know. We don't have any, we can assume that she's going to have a primip labor. I know somebody who's waiting on primip twins right now. So, that's what made me think of that. But in the case of, for example, like these two triplet moms that I helped, one was a... a G5 and this one was a G7. So they already had histories of what they did with their births and they both followed their histories. The one had fairly quick births, especially the last few. So I thought she was gonna birth quickly and she did. And then this one, she usually, her last birth was about eight hours before pushing and she did just about that. maybe slightly under, but I think pretty much from when she started contracting, even though it wasn't active labor, to when she, the first baby that she pushed out, it was about eight. And then it was an hour or a little over an hour between each baby. So there was a little rest period. So yeah. And I was thinking about this morning before we chatted as well. So, It looks like from the pictures there was three midwives, you and two other midwives. Yeah, she had a midwife following her. So I traveled for this birth and she had a midwife following her throughout her pregnancy and her triplets were, they were tri tri triplets. So they had their own amnions, their own chorions, they were all in their own little bags. So literally the most, the easiest type of of birth to death, it's like die die twins, you know? Like it's just two babies and one uterus. In this case, it's three babies, one uterus. Nobody was sharing anything. So they were just siblings. There was no identical anything once they were born also. So she had her midwife and she was following her throughout the pregnancy. And then I went down at 36 weeks to sit and wait. And then that midwife had... gotten together a team. So she got another experienced midwife, which I required. And then that midwife had a student who was fairly advanced because she was also a registered nurse. So she had skills, you know, she had good skills and I knew that she, she worked in the ICU. This woman was going to be calm. And this is what I want somebody that was going to be calm. Yeah. And so, and then the student, the other two students belong, so three midwives and three students, the other two students belong to the midwife that had been following her throughout her pregnancy. And she said that they were going to be calm and respectful. And really, they just needed to stay in the corner, do the charting and then hand over blankets and clean up between the babies and go get... water or what juice or something for the mama, whatever, we needed those things done. And then afterwards, and that's where all the more of the work was, because then they were able to, they did the newborn exams under supervision because they're getting signed off on their skills. So of course, so then they each get a baby and they get to be signed off on their, their newborn exam skills and all of that. And yeah. So it was, it was very nice. It was really, um, There is video of all three births and it's really beautiful and you would never guess there were so many people in the room because it was really quite lovely. And it was a daytime birth actually. She labored in the night and then it was a morning birth, but not early morning. Like eight, nine, 10 is when the babies came in those hours. So, yeah, so kind of unusual, but it was really quite lovely. And we had just the right amount of people. and everybody worked together really quite well. There was not a lot to do, you know, for the most part. And it was the grandma that received babies A and B. A couple of people said, oh, I like how you coach that midwife. I said, oh, that wasn't a midwife, that was a grandma. That's so beautiful. Yeah. And the first baby came in the call and the membranes released right when the head and shoulders were coming out. And then the second baby was born completely in the call and then it was great. And then splashed, you know, kind of right into the grandma's hands. So she got to catch the two little girls and I got the baby boy. Amazing. Wow. And you know, is the postpartum care, you know, somewhat similar like, you know, as it would be for a singleton. Yeah, it's just kind of postpartum care on steroids. You have to, you know, you do have three babies and a mom who just went through a lot. So generally, I, you know, I like to recommend that for the first few days at least, a visit every day and the babies being, you know, closely monitored and weighed and making sure that nursing is going well, because we know that they're going to be a little bit small to begin with and we want them to keep up their weight, right? So, we want to monitor that rather closely. And then as long as everything's going well, it's okay. With experienced moms like this one was, she had had several babies. So, she knows if something's not right, she's on top of it. She knows she needs to stay down. She goes downstairs once a day and then back up. you know, up the stairs. She's not going to go up and down, up and down, all of that. It'll just exhaust her. So, but her full time job is before her full time job was gestating and now her full time job is breastfeeding. And so far she's, uh, she is getting some donor milk for her freezer for when it might be needed. But right now she's all of them have only the colostrum and the breast milk. And, um, and so that's the normal course. And that would be the same with twins as well. Um, But depending on how the birth went and if they're experienced parents, we might not need to visit every day the first few days, but certainly day one, certainly day three, and I would like day five and day seven. So just up it a little bit. And normally we would do days one, three and seven and then two weeks and then four weeks and six weeks. But it will be a little bit more closely monitored just to make sure everybody's doing okay. Yeah. Yeah, there's so many little people to think about. Yeah, exactly. I wonder if you can share any words about, you know, obviously you've worked with women and babies across so many different cultures, like, I guess, home birth is often... you know, I guess in my personal experience, like, especially for my second home birth, it was somewhat a magical experience. And I really see it as, you know, being like the power behind or the power for, you know, I feel like it's going to propel me in my life. And I wonder, you know, in countries where, you know, like home birth isn't actually really the option sometimes. Like do women like how that initiation into motherhood and, you know, taking on a new life and caring for a new life, like, is it the same or do you have any words to, you know, give an insight to that? Yeah, you know, so if I'm working in a refugee camp, Yes, it's really difficult for those women because of the cramped quarters and the lack of privacy for them to have their babies at home, even if they were to want to, because they're not really in their home. They're in, you know, not very great surroundings. However, I will say it when I was in Bangladesh and working with the Rohingya population, there were a million people in that camp and there were a lot of home births and people could easily, they, People could easily get to us, but they chose to stay home with the Rohingya traditional midwives, the traditional birth attendants that they came, when they came as refugees, all the midwives came with them because they were refugees as well. So they're well respected in their communities. And then oftentimes these women, if they had a problem with the birth, they would bring them in to us. But so they still would birth even though they had access to care and it is free. It's 100 % free and they are treated respectfully. At least, you know, I can say it at least when I'm around, they're treated respectfully. You know, it's, birth in other cultures is really difficult to explain to people in terms of how it, it's not this, it's something that you have to do. and it's a very matter of fact thing. So it's not like, oh, we have to be all like rubbing backs and saying sweet things. That's not the way it is in these other cultures. But what I do notice is when women do come into like the maternities to birth, they come in with a female relative. Men don't come in with them. It's usually their mother, sister, a co-wife, somebody like that. And auntie, someone, it's usually the closest female relative to them. And so they come in and they have that person with them and that person's caring for them, bringing food to them, postpartum, all of that. And so they do, it is that sort of expected thing in most of these cultures. And then they, for example, women give birth, they have to bring all their own supplies with them. Obviously, we have medications, but there's no chucks pads, those disposable under pads, things like that. They birth on their skirts, on their fabric, and then their mothers or co-wives or sisters or whatever, they take the birth laundry away and we have an area where they wash it and hang it out. And so then you see all this beautiful fabric, you know, like blowing in the breeze, all these beautiful African fabrics being washed after the birth and they wash everything out of them. And then they, you know, they help them get dressed afterwards and they care for them. And like I said, bring them food and so forth. And so they're really, it is very, very much a community thing. And, you know, they help with the, with breastfeeding and, you know, it helps support them in that. And it's just, yeah, it's just really how it is. And so it's, you know, again, it's just something that they see that they have to go through and that they know that all of their, you know, friends and family do the same thing. But it's not something that's like super like, oh, we're going to light candles and have fairy lights and you know, like they just, that's foreign to them. And it's actually the staff, the staff, kind of chuckle at me when I'm like really, really sweet to the women and talking and really, because they don't understand, the women don't understand me. They're speaking tribal languages. The staff does because they'll usually speak English or French or whatever the national language is in that country. But the people coming in, because they've been educated, but the people coming in have probably not been educated. And so they have not gone to school and therefore they have not learned the national language and they're speaking. any one of a number of tribal languages, but I'll talk to them anyway. And because you body language and the sound of your voice, you know, it makes a difference. And so I do talk to them and they're like, you're just so nice to them. I'm like, well, why wouldn't I? I'm like, you're supposed to be having a baby. But it's so foreign to them to be like, it's their job. It's their job. Also, as midwife, the midwife job is a job. So then that's seen as it's not like. with us where we're like, oh, it's what an honor to be at your birth and this and this beautiful and I'm going to make this as lovely as possible for you. It's just like, no, it's my job. Okay, get up on the table. All right, push, keep pushing. You know, like it's that's how it is. And so it's very different and it can be very harsh for somebody that's coming from a Western culture to see what these. what it's like with these other cultures, you know? And I rarely, if ever, get to see a home birth because I'm not called out to homes. I did do, I did attend a home birth in Aceh Sumatra when I was there back in 2004 after the earthquake and tsunami. And there was, you know, they called in like a medicine man who came in and said a prayer over the mother's belly and chewed up some, I don't know what kind of herb, but some sort of herb and they chewed it up and then spit it out on the mothers after he chewed it on the belly and then rubbed it all over the belly and was saying in some incantations. It was really quite fascinating. But the family was around for that. The females in the family, they were all around this woman having her baby. So I got this little glimpse of this beautiful magical world. with who would be there with her if I wasn't there, they would be alone at home with her and hopefully her baby would have safe passage. But I happened to be able to be there, which was lovely. And so I got to see that and it was really quite an honor. So it's unfortunate that I... I am not able to see more of that when I'm in the field, but the places I go are dangerous. And I would never get invited. I mean, they don't need some white lady intruding on their birth space, you know? If they need me, they bring somebody in. And it's funny when they bring people in, like in the refugee camp. It's I would walk into maternity and as soon as I saw an empty wheelbarrow sitting outside the door, I'm like, oh, we have an emergency and I'd run in. I'm like, who's in the wheelbarrow? Cause if they're in a wheelbarrow, they can't. Yeah. Yeah. Can you believe it? Can you imagine being in labor and have having some problem in labor and having somebody bring you in a wheelbarrow? I mean, yes. Oh my goodness. I guess, yeah, I work in youth mental health here in Australia and there's lots of refugees, like refugees make up a big portion of or big part of the demographic in that, you know, suffer from youth mental health issues, you know, like from South Sudan and whatnot. But, you know, it is a privilege. It's a privilege to be able to, think about how you feel. And I guess, yeah, when you're when, you know, your first concern is, you know, that your basic needs like shelter and food and feeling, you know, safe. Then yeah, the, the magic or the, you know, of you know, birth, like that's definitely not on your mind because you're like, I need to give birth. It's, you know, I'm in a vulnerable position as it is right now. Yeah, it's just like so fascinating. But yeah, like I wonder, yeah, like if it wasn't for the joys of colonization and war and, you know, all of these things, like how... how would it be? Because yeah, now it is the norm, of course, but yeah, like lots of food for thought. Yeah, absolutely. Yeah, there it's it's really it's really quite complicated when you when you look at it. When I go to these different places, all I can do is see. the damage that colonization has done. And I try to like, like back up and just be as, you know, unassuming and obtrusive as possible and do my job and just kind of like apologize for being a white person who, who, who is, you know, in a long line of white people who have done a lot of damage, especially on the African continent. And I just, you know, I, MSF does not, they're very aware of that sort of perception. And I, that's why the majority of the staff is national staff. And I just go to help support the national staff. And unfortunately I happen to be white. And so it really is a detriment. It's interesting when, you know, there's a lot of talk about white privilege and I will tell you, it is not a privilege to have white skin working in an African country. There's nothing privileged about it. And, and, believe me, they let you know very quickly if you were to behave in such a way that, you know, it's so, you know, I just say it right away. I'm like, I'm sorry, I'm another white old white lady coming in here telling you what to do. I'm not here to tell you what to do. I'm here to support you. You tell me what you need and I'm here to support you. So it's the only thing that I can do. And then I learn about the culture. I learn about what, you know, what are their birthing practices like if we weren't here in this maternity. What would what was birth like for you? And I so I talked to the grandmas. I talked to the oldest lady I can find and I have them tell me stories. Yeah. And I love it. Yeah. Yeah. So much to learn. And yeah. So so fascinating, like your experience, because I believe you're usually like the only midwife like attending the births. Is that correct? Yes. The only expat. attending and then there will be national staff that I'm there to supervise and so yeah and I do capacity building with them but I'm always required to be there for anything that's considered you know higher risk if they have preeclampsia if they're being induced they have breach they have multiples you know just anything that's out of the norm and there's a lot of that so then I'm required to be there for all of those things yeah yeah I guess you know, do you have any words on, obviously there's lots and lots of factors, but like any words on, you know, why some of these women are so high risk? Yeah. So, you know, a lot of it's comorbidities. There's the nutritional component. A lot of them have hemoglobin. They come in with a hemoglobin of eight to start labor. If somebody walked in and their hemoglobin is like nine or 10, we're like, yes, excellent. We're excited. We're excited. Here in my country, we risk somebody out of a home birth if their hemoglobin is not above 10. You know, I mean, because it's like, it's like, we're terrified. So, I mean, there's a lot of malaria. There's a lot of other underlying issues. Malaria is a big one, though. A lot of women miscarry. Um, in the early 20 something, we, you know, around 21, 22 weeks, it's in, undoubtedly they walk through the door. They say, Oh, I'm having contractions. I had bloody show 21, 22 weeks. We do a urine dipstick. They have a UTI. We check them for, we check them for everything, but we do a rapid malaria test and they have malaria. So. Malaria along with a UTI is a death sentence for a baby at about 21 or 22 weeks. We listen to fetal heart tones, great. Fetal heart tones are fine. They just put them into premature labor. And I saw that time and again. And so these things happen. And so a lot of it, yeah, it's just, it's the environment and they have stressful lives. They a lot of them have many children. So then as soon as you get to the grand mall tip status, you know Then then we're talking postpartum hemorrhage. Yeah, and so it's just there's just a lot of these factors that are You know all of these different risk factors and lack of prenatal care lack of access to care Coming in too late like they're too far away and then if I'm not in a refugee camp and I'm in a village somewhere where people have to come to us, then they have to travel and they might have to travel quite a distance. And sometimes it's on foot. Sometimes it's on the back of a motorcycle. Can you imagine? Yeah. Well, I mean, to the man from originally from Guatemala, that's exactly what he said. You know, women sometimes have to walk for hours. Yeah. Like just, yeah, I cannot imagine being in. labor and having yeah. Wow. Wow. So so many incredible and eye opening and I imagine life changing experiences that you've had like, whoa. Wow. How has you know, like, has this work that you do, you know, both like such contrasting work, has it changed like how you live your life or how you think about your own life? 100 % absolutely. Yeah. Yeah. The, the immense gratitude I have on a daily basis, particularly when I'm home. Um, because it's in my home is comfortable. It's just, it's a nice, nice little home. It's nothing fancy, but I swear I get into my bed at night and it's so comfortable and I get in and I'm like, Oh my God, this bed is so comfortable. I love my bed so much. And I'm just, I, because I sleep on these horrible mattresses when I'm away for like three or six months at a time. And I'm like, Oh, but I mean, it's, it's in my back and I'm 60 years old. So it's. So it's these little things and soft toilet paper like like it just like really seriously the littlest things and it's daily daily I have gratitude for these things because I know that you know my next assignment it might not be so cushy and I'm not gonna have these things and and I'm I'm grateful for for people and I see how fragile life is really. I there's there's loss in some of these bigger projects like in South Sudan. I deal with death almost every day, whether it's a miscarriage or, you know, or a stillbirth or a baby that's born too premature or, you know, somebody a baby with an anomaly. We had five maternal deaths when I was there, you know, so it's a lot. And so death is in your face all the time. And so it's what I. think about. Like, this could be any day, could be the day. There's no, tomorrow is not guaranteed to any of us. And so I do tend to live my life in a more like, almost like the whole Buddhist way, you know, living in the moment and not worrying so much about, about tomorrow. I think about it, but I don't, I don't, I'm not as, I'm just trying to enjoy today because tomorrow will. tend to work itself out somehow and I'll deal with it when I get there. So it has, it really has changed the way I view things. Yeah. Yeah. Yeah. Wow. I can't even, I can't even imagine, you know, like obviously, yeah, I work with the young people that have grown up and spent many years in such refugee camps and I just, yeah, life, life is precious. And I guess, you know, some may use that as an argument, you know, against, you know, the risk that you may take in a home birth. But in some cases, like giving birth at home is just as safe, if not safer, in some circumstances, than giving birth in a medical setting. And I guess there's still such differences between, you know, the countries that you've visited and a country like Australia or even America, where the cascade of intervention is just part of the birth culture. As soon as you accept one thing, enjoy the ride. Exactly. That's also not right. Yeah, like lots and lots of things to think about. I am just so grateful for you coming on and chatting with me and sharing some amazing insights into supporting women birth triplets at home. Like that's wow. You know, I see sometimes in comments that people say, oh, I didn't know you were allowed. I didn't know your doctor would allow you to. Nobody has to allow you. It's your know that's, yes. That's what I said to somebody. And then they, they, they took me the wrong way. Like that I was chastising them, but I was not, I was just saying, no, it's not about being allowed. Women can birth under their own power. Nobody is allowing. And you don't have to speak to me that way. And then, and you know, when you're typing something, you don't hear a person's tone. And I said, Oh, I'm sorry. You took offense. It's just that. language matters. And when we start saying, well, my doctor said that he'll let me labor without a, you know, without an IV let you, Oh, how nice of them. Like what, who is he to let you do anything? Like, it's just, we have to stop. And so when I, when I did, I saw some allow comments and I'm like, Oh, it's not about allow or disallow. It's about you taking charge of what you want. And if you want to have your, try to have your babies vaginally in the hospital with triplet, you can do that. But anybody, anyone trying to have a baby in the hospital is you're signing up for a more medicalized version of birth. And this is fine if this is what you want, but you have to understand if you, especially the ones that aren't with midwives in hospitals. If they're with obstetrician you have hired a surgeon to attend your birth. I have been saying this for 35 years Yeah, if you hire a surgeon to attend your birth and you're just Somebody walking in having a baby you you you're it's overkill and Don't be surprised when you end up getting surgery because it's what they do. Yeah, and Birth is not a medical event, no matter how much, you know, the medical establishment likes to make us think that it is, it is not. And first and foremost, it is a physiological process that sometimes might need a little bit of intervention. And that's great. The majority of the time, even with the most high risk people, I have seen they can birth just fine, all on their own. without any problems at all. I had a woman have seven seizures in front of me, walked in in labor, seven seizures. I'm like, we need to get these babies out. Got the seizures under control within a few hours. She birthed her baby. Two days later, her blood pressure back to normal. She and her baby walked out of there, both just totally fine. How is that possible? How is that possible? But it was possible. So, you know, it's not that I didn't intervene. I did. I gave her, you know, I did the whole magnesium protocol, everything. We threw everything at her and we got her baby out and, you she pushed it out. And it, but I'm just saying, you know, you can have good outcomes even with the highest risk people. So, yeah. And we have to know that. The concept is like, you know, being a lifeguard, like, You're not going to let people not swim because, you know, they might drown. Like how many people drown every year in Australia? A lot of people drown, but you don't say, oh, don't get in the water. It's better off if you get in the water, you know, get in the bloody water. And if something happens, let's deal with it. You know? Yeah. Yeah. Amazing. Yeah. We're very, very risk averse and we want guarantees and people think, oh, if I birth in the hospital, I'm safer. There is no guarantee. I tell my clients that all the time. I cannot guarantee you a good outcome. I'm sorry, not every pregnancy ends with a live birth. Not every birth ends with a live baby. I cannot guarantee and neither can any provider on this planet and one that tells you they can is lying to you because nobody can guarantee it. And so I think that's just what's important to know. And it's just a matter of what kind of responsibility we want to take for our own. birth and experiences and so forth. So yeah, yeah. Well, it's been so amazing to chat to you, Christine. I was checking out your blog as well. I'll make sure to link that in because that's got also some amazing stories. Do you have any like last words or anything that you wanted to share? No, I'm just really grateful for the opportunity to, you know, to talk to. everyone in Australia, whoever's listening to you. And I just I know what the birthing culture is like there because I do have friends that are midwives in Australia or who have been and and they tell me and it's you know, it's going to be up to to the the women, the birthing women to continue to stand up for themselves and make the change and demand what they want. And that's the only way we're going to change the culture. You know, it's. And then my part, for me, my part is just standing up for those women, for their autonomy, you know, regardless of what that is. And if that means supporting somebody through something like a triplet birth or multiples when they're told it cannot be done, then I'm gonna do that. So, but no, I'm really grateful for the opportunity. And I... just appreciate it. And I look forward to coming back to Australia to teach next year. I think with Reach Without Borders. Amazing. I'll make sure I link Reach Without Borders as well. Oh yes, do because they can look on the schedule and when we have our 2025 schedule up there, you'll see when we're coming to Australia. Yeah. Thank you so much.