Chatting homebirth with midwife & academic, Jessie Johnson-Cash

In today’s episode, as a part of the midwife stories series, I chat with Jessie, mum to 4, including 1 born at home, and midwife and academic from the Sunshine Coast on Gubi Gubi country. Very specially, Jessie was also one of my own tutors as a student midwife. In this episode, we chat about how Jessie found midwifery, her work as a midwife and birth culture in Australia. It was amazing to speak with jessie after all these years and learn more about her. This episode will be great for student midwives and midwives alike, so please share it! 


CHAPTERS

00:54
Background and Work as a Midwife

04:27
Influence of Spiritual Midwifery

05:52
Shift to Pursuing Midwifery as a Career

06:18
Challenges in the Maternity System

07:44
The Transformative Power of Home Birth

08:09
Entering Midwifery Before Home Birth

09:34
First Birth and Transfer to Hospital

10:30
Second Birth and Home Birth Experience

12:20
Transition to Academia

14:12
Working in Private Practice and Hospital

17:58
Challenges Faced by Home Birth Midwives

18:28
Self-Care and Burnout

19:55
Transition to Academia

21:42
Insurance Challenges for Home Birth Midwives

24:30
Student Midwife Society and Attending Home Births

29:08
Publicly Funded Home Births in Queensland

32:15
Challenges and Opportunities in Maternity Care

36:27
The Magic of Home Birth

Transcript

0:00

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, on country, for tens of thousands of years prior to the British invasion and acknowledge that sovereignty has never been ceded. In today's episode, as a part of the Midwife Stories series, I chat with Jessie, mom to four, including one born at home and midwife and academic from the Sunshine Coast on Gubbi Gubbi Country. Very specifically, Jessie was also one of my own tutors as a student midwife. In this episode, we chat about how Jessie found midwifery, her work as a midwife and birth culture in Australia. It was amazing to speak with Jessie after all of these years and learn more about her. This episode will be great for student midwives and midwives alike. So please share it. Enjoy. Welcome, Jessie, to Birthing at Home, a podcast. Thanks for having me. So wonderful to be here. Thank you. We were just catching up listeners. So you might've seen that I put a shout out to midwives in particular on my Instagram who might want to come on the podcast and chat. And Jessie reached out and said that she would like to be on the podcast and chat with me. And it's very full circle as I've been saying, because it's like 10 years ago that I started midwifery. And Jesse was one of my tutors, lecturers. So it's just amazing. And I guess, Jesse, we haven't spoken for many, many years. Do you want to give like a little bit of a background to like who you are, where you live kind of thing? Yeah, of course. So yeah, my name is Jesse Johnson Cash. I am a midwife. I am a mom of four kids. I have had a home birth, I've planned a few at home that didn't all go to plan, but I'm working currently as a midwifery academic. I live here on Gubbi Gubbi country up on the Sunshine Coast. And yeah, I have not been working in the clinical space for the last few years and working kind of full time in this more academic arena, but home birth is what brought me to midwifery and is a really. deep passion and love of mine. So yeah, I jumped at the chance to be able to have a chat. Yeah, amazing. I guess like one of the first questions to ask then is like, how did you learn about home birth? Like when did home birth appear in your life? So home birth has always been in my life. From whenever I can remember really, I grew up with friends and cousins that had been born at home. I'm the oldest of four kids. I've always been, you know, pretty obsessed with babies and birth and things and was always surprised that we hadn't been born at home. And so that was kind of a conversation I remember having with my mum very early on. So it was just kind of all a part of my kind of community and experience. I attended my first birth accidentally when I was about four. Oh what? We were having a sleepover at um you know some friend's place with mom and dad and um yeah she not as a plan to be there at birth but she went into labor and I woke up in the early hours of the morning and I just remember walking out into the lounge room and just that warm dim light and just knowing that something really special was happening and that. you know, whatever I'd woken up for was not reason to disturb what was happening in that room. And so I watched and put myself back to bed and yeah, so Humbert has always been there. Yeah, wow. And is that what led you to Midwifery? Yeah, I found an old book that had belonged to my aunt in our bookshelves at home when I was about 12 called Spiritual Midwifery. And it was one of the original editions that had this beautiful psychedelic centerfold of a woman giving birth. And I kept that under my bed and I would read it religiously. It just gave me these feelings of love and excitement and hope and that there was also a mix of kind of shame and secrecy there that I was confused about at that time. I was, you know, just entering puberty and there's all these, of naked women in this book. And so what does that mean about me when I'm having all these feelings? And so there was almost something that that was kind of, yeah, to be kept secret. But I knew from then that, yeah, just hearing the way that those women described their births, that just really spoke to me. And I knew at that point that I would give birth to any of my children at home. I was studying health sociology and lots of different subjects. And thought that I came up with this idea that if we can support women to have healthy, positive births and feel connected with their babies and with their intuition and with their biology, that we will have healthy, well humans that are loved and connected with each other and the world. And so that's what really shifted me into pursuing this as a career. Yeah. a lot of those issues around social justice and societal challenges that I thought, you know, if we get birthright, then everything else is going to be okay. Yeah, yeah, absolutely. I have reflected a lot on that particular thing as well. Like in society right now, it's so much about instant gratification and so much about birth could be, you know, tied in with that. You know, we don't want... don't want to wait. I mean, it's quite normal at the end of your pregnancy to be anxiously excited about the arrival of new life. But I guess, especially in the maternity system, it goes one step further where it's like, oh, well, you want your baby now? You can have your baby now. And for so many women, I guess there's sort of a disconnect that, OK, you do get your baby right now. But like what, you know, other risks or consequences possibly like right now and like into the future of, you know, that particular decision because yeah, I like Frankie, my second baby, he's almost eight months and like his birth, I had a home birth with Murphy as well in April 2020. But with Frankie, like I'm still riding that high, you know, like my whole world is changed because of that birth experience, you know, and I just like imagine if all or most women got to have a birth that they felt like that about, you know? Absolutely. Yeah, so yeah, I'm really on board with that as well. So did you enter midwifery then before you had a home birth or after? Before. So I had this incredible kind of period where every day I would just see someone or meet someone or something would happen that just reinforced that I meant to be a midwife. And. I was really conflicted about what path to take at that time. So if I was to become a registered midwife, there was no direct entry programs unless I moved to Melbourne and I'd just fallen in love so I didn't want to move away. So I would have had to pursue nursing first and then go and do midwifery afterwards. But there was also something called the home program that was being run out of Brisbane at the time that was... run by, and I may not get all the details, but it was run by kind of an organization like Home Birth Queensland, I think, of local birthing mothers and midwives. And it was really kind of an apprenticeship model to work as a lay midwife. And I decided at the time that I have an academic brain and that I would change the system by trying to get in there and fuck it up from the inside. And so I pursued that path. And I reluctantly did nursing with the goal of being a home birth midwife. That's all I wanted to do. I didn't want to work in a hospital at all. I would have liked to have had my first baby after I finished nursing and before I became a midwife, I decided. And to my surprise, I found out I was pregnant with my first baby the week I started midwifery. Oh my goodness. Well, so yes. Wow, that's like stars aligning. Yeah, she she heard my wish. Yeah. Well, and was she born at home? She wasn't, which was a real challenge for me. There was a lot of pressure and expectation that I had on myself. Yeah. And I learnt a lot, actually, through that initiation around. handing over power and responsibility to somebody else. Yeah. I had booked in, you know, the quote unquote best home birth midwife around who was good at managing difficult things. And I found it very hard to take my midwifery hat off and to be a birthing mother. And so, yeah, I transferred into hospital and I ended up having an emergency cesarean baby. Yeah. Wow. I spoke to another midwife who shared her home birth story recently and she worked within the hospital system and she was really emphasizing that, you know, like I had to request to be taken out of that birth space because I knew like how it would impact me and having that midwifery hat on. like thinking like, oh my gosh, that could be me. Like that just was not helpful for her. So yeah, I mean, even to some extent with the birth of Murphy in 2020, like I finished, as we were saying before, finished up my, well, I didn't finish. I quit my studies of midwifery in 2017 at the end of 2017. And so yeah, just a couple of years later, I had Murphy and like, I remember. in labor with Murphy, I was thinking about like what like I had my student midwife hat on, you know, and it was really difficult to escape that. And so, you know, reflecting like right in this moment, maybe that's why Frankie's birth was quite different because, you know, more time had passed since, you know, being in that world and being exposed to the stuff that you might see in the minority system in Australia. But. Yeah. And did you return to academia or midwifery like after you, well you obviously finished your midwifery studies with that after that baby. I did. Yeah. So as I was being wheeled out of theatre, being told by the obstetrician that I had a pelvis that babies would have fit through, I said to myself, I will show you and. Oh my gosh. was quite surprised when I found out I was pregnant with baby number two, when baby number one was only eight months old. Wow. Wow. So I was still a midwifery student at this time and it was only a 12 month masters of midwifery, but it did end up taking me four years with two babies that I had. That's still pretty impressive. Yeah. But I had a very different experience that time around. I've had really pertinent dreams in both of my, well in all my pregnancies really. And there was a dream that I had not long after I realized I was pregnant with him where I was all alone in a room and I was just kneeling down and I realized I was about to birth a baby and I was like, oh shit, I'm on my own. And then I realized I actually don't need anybody. And I gave birth to this beautiful big baby on my own. And I carried that with me. I chose a really different midwife. Um, I was very conscious my preparation. I was planning a VBAC at home for that second birth was, um, to be a mother and to not be a midwife, to just really keep my head out of that space and to, um, try and de -intellectualize that experience as much as I could. And I had a really beautiful, slow, gentle, um, birth of him at home. I. never went into labor according to all the textbook definitions. Hilarious. Yeah, he didn't read that book and he was gone and home. Wow. Wow. That's amazing. How old is he now? He will be 15 in a couple of months. Wow. So you've been a midwife for how long now? So I became a... I finally qualified in 2011 and I went straight into private practice. I did all of my clinical placement at a private hospital up here that was really at the time supportive of physiological birth. So I had a lot of experience in the system supporting physiological placental birth and women planning VBACs. A lot of water birth was really common. There was lots of women that traveled from around the country to come and birth there because that wasn't available to them locally at the time. But yeah, I was mentored straight into private practice by some wonderful local midwives that had taught me and percepted me. And it was a really wonderful experience of trust for them to know. where I was at in terms of my knowledge and my skills and to feel really aligned, you know, philosophically, I guess. And yeah, so I think I attended my first birth as a registered midwife at home a couple of months after I graduated. Wow. So yeah, that was great. Wow. And did you ever attend apart from, you know, like, I guess, the like sometimes home birth doesn't occur in the like you like you had an experience of doesn't occur in the way that you had hoped or planned. Did you get to transfer into hospital with women you know after that? I did so that first birth was quite a long labor for a first time mom and we did actually need to transfer him with that baby post birth. was having just some ongoing breathing challenges. So that was really scary being a new grad, transferring into hospital with a baby that needed support and being brave enough to, yeah, to, I guess, face some of that criticism and scrutiny from some colleagues and peers around that. But yeah, there was a good outcome. with that baby and we absolutely made the right call. Yeah. Hospitals exist for a reason. They do. They do. So yeah, I've had a few, you know, not too many, but a few transfers in and I've actually found them to be quite positive experiences. Yeah, cool. The staff are often, yeah, I think relationships can be really helpful. Like, when that has occurred subsequently. There's been real support for me to kind of be there and keep acting as the quote unquote midwife to support that woman. Even though I never got visiting rights, I didn't have to do any documentation, but I could be there providing all of that physical, emotional, spiritual support. And that was really respected and women's choices were respected. So that's been a pleasant surprise over the years because I am very aware that that's not the case in a lot of places and for a lot of women. Yeah, yeah, absolutely. I have heard before that, you know, that relationship building and kind of trying to bridge that gap in a way with that relationship is really helpful for those scenarios. I have like heard so many stories, of course, though, of how private practicing home birth midwives, you know, it's like called a failed home birth, you know, that there's been a failure of some sort. But you know, if you fall down the stairs, is it called like you failed to like go up the stairs? No, you just fell down the stairs and you went to hospital. That's it. Is there something that I struggled with as a student midwife was that I was so passionate. I felt that I was so passionate. And what ultimately happened is I burnt myself out. Like from your experiences, are there things that you know, you engaged in with self care to make sure that, you know, you could like fill others cups, you know, like by keeping your cup full. Yeah, I guess like when I was working in private practice, I did have two little kids. So, you know, my youngest was, I don't know, one and a half, I guess, when I finished. And so I didn't take on a huge client load. The way that I worked, you know, it was very much not a hierarchical, first midwife, second midwife, kind of work together in partnership. One of us would be the primary on paper, but you know, I would share information and we'd talk about things. So yeah, I guess not taking on too many women was, was a good way for me to negotiate and balance all of that. It was more the hospital that I ended up going in that really burnt me out and shifted things. So, Yeah, I guess I got to that point where finally I was able to work, you know, as a home both midwife that I had wanted to be doing for so long. It had taken me about 10 years to kind of get to that point from when I decided that that's what, you know, my calling was to get to that place. And the reality of, yeah, I think juggling that with a small family and providing the type of care that I wanted to with the women I was working with was tricky. Yeah. you know, some women midwives that, you know, are happy to take little kids along to births. And occasionally I'd have a toddler at an antenatal or a postnatal appointment, but I find, you know, I want to be really present when I'm there. So I did end up going to work in a hospital for a little bit and doing that alongside my private practice. And I just... Yeah, I just, I just started having panic attacks essentially. It felt so incredibly unsafe to me. Working, you know, on a poorly staffed birth suite with bad skill mix with lots of women with complex social and physical needs. I was working in quite a low socioeconomic area and really seeing how that impact of smoking and poor nutrition. Yeah. kind of plays out in the health of, you know, of these women and babies. That felt really, really scary to me. I just, and so I had to stop doing that. And that's really, I guess, what triggered my initial transition into academia. I was continuing to work in private practice and was starting to do teaching at the university at the same time. But yeah, then there was some big changes that happened in terms of insurance. And that's essentially what really pushed me out of working in the home birth space. Yeah. Wow. Wow. Was that like a common experience for midwives at that time for you? It was. Yeah, you know, there were a few of us. And a couple of people that I know have taken different pathways with that where we had gone straight into private practice. And the idea was that people worry, they think that you're just going to go out and we love to use the word cowboys to describe rogue, quote unquote, midwife. But none of the women that I know of were doing anything other than. you know, supporting women in evidence-based ways, you know? Yeah. Yeah. Um, but yeah, basically I was at a point where if I was going to continue, I would have had to go and, um, go back into the hospital for a significant number of hours to have collected those 5 ,000 hours that are now required to become, um, endorsed back then it was an eligible midwife. Um, and I was just completely unprepared to do that. Yeah. Um, I can't believe I didn't actually know that. Like if you didn't have those hours that they sent were telling you that you had to go back that. Yeah. So it was in this messy in between space where I hadn't been working for long enough as a private practice midwife to have met those requirements. Whereas there are a few people I know, I think Melanie Jackson is one who comes to mind to probably graduated a few years before me. But she was able to kind of continue on. Um, but yeah, I hadn't met that. So I had been insured. There was an insurer called Vero that was fairly cheap and accessible. And we met those registration requirements that came in with national registration with APRA. Um, but yeah, and I just ideologically was really cross at the idea that, yeah, women then needed a GP referral. What many of us were actually wanting at the time. Um, was to be able to just, you know, order routine. Bloods and ultrasounds and administer basic medications, you know, on emergencies if we needed without having to have scripts for that. Yeah. Um, kind of what we got is, is very different. So, yeah. Yeah. Yeah. It's a very different, um, landscape from where it was when I gave birth to my eldest children and when I was working. Yeah. Yeah. Wow. And so then you transitioned into, that's obviously how then we met up is that you were teaching. And we were talking briefly about this before as well, about the student midwife society. Is that what you called it? Yeah. So, yeah, our students a number of years ago now, I guess, maybe. probably just after you left. Yeah, that's such a shame. Maybe 2018 or 2019. It was a student driven and it's a student run organization. Yeah. The Midwifery Society of Uni SC as we are now. Yeah. And yeah, they're an incredible group of women that kind of come together to just really support each other and are really aligned with the midwifery philosophy. Yeah. They put on lots of events and do other kind of education sessions and it's a beautiful way to build support and connection with each other. Do you find like in your you know the bits and pieces or you know whatever you hear that student midwives are wanting to go into private practice? Yeah, yeah a lot are and you know what I hear from a lot of people and what I really see you know my personal opinion is that that 5 ,000 hours. that you need to complete post -graduating to be able to work as a private practice midwife and get insurance is a huge barrier. It is so different working in a hospital setting than it is working at home. There's the way that you manage emergencies, the way the expectations of you in that space. Birth at home and birth as a midwife in a hospital. is so different. People would say, oh, but aren't you worried there's nobody else there to help you? Like, we work with another midwife. But no, because my entire focus is on that woman. I'm not being pulled into other rooms. Yeah, there's not things like beeping and like, I know her intimately. I know her history, you know. Yeah. I know her family, I know her children. And it's just a really different space. I think you almost work in an altered state of consciousness in that space. Yeah. Yeah. Everything else is quiet. Yeah. And you kind of enter this birth space in a similar way as well. Yeah. Yeah, absolutely. I was listening to an episode of Birthing Instincts last night. And there was a midwife somewhere in America and she was talking about maternity care deserts and how, you know, she and maybe like one other midwife or like, you know, there's all there's so many problems in America, which is like, you think, oh my gosh, that's America. But it's like, oh, watch out because like, when next. Um, but you know, even, uh, like I've started doing a lot of advocacy, um, and trying to set up home birth Victoria. Um, and like there's women like in rural areas of Victoria, they're like, Oh, I want to have a home birth. And, you know, there's just, there's not enough midwives because you don't need one, you need two. And like, what are the chances that you can get two private midwives when you're hours away from places like. It just doesn't make sense. Regardless of what lens you try and look through, you know, even coming from like a health economy point of view, or even coming from a risk assessment perspective, you know, within that biomedical model, it just it doesn't make sense to deny care providers to women. Women have absolutely the right to choose where and with whom they give birth. And it's just criminal to not have that. accessible and available to women. Yeah. You know, as midwives, it is, you know, within our scope of practice, we are autonomous practitioners that are able to support women across all settings. And we don't see that. Yeah. And yeah, I think there is, yeah, there's so many factors that are, you know, are at play there. But it's, you know, really a mistrust of women and this trust of. midwives and just absolute coercion and control. Yeah. You know, through that mainstream biomedical model, it's really deeply entrenched. Yeah. Yeah. I see things. Yeah. Yeah. Not improving. Oh, there's not a lot of good stuff. What was I going to ask? Oh, the students allowed to attend home births. I feel like it. Is that different between universities or? It is, it is and it is a huge issue of contention and something that we're really working hard to address here. So yes, some student midwives and some universities are able to attend Home Births. Currently, as it has been at our university, the University Insurer. has not been supportive of that because midwives themselves are not insured for intrapartum care at home. And so their policy is that students are able to only go on placement with an insured healthcare provider. The fact that we've got publicly funded home births starting at our local hospital has come at a really good time for us. We've been working to... you know, change that across the board, you know, that students absolutely should be going out with private practice midwives. But yeah, you know, those midwives that are working in the hospital providing home birth, or working for the hospital, sorry, will be insured. So yeah, we're really fingers crossed, hoping that that will change. And yeah, collectively, there's a lot of other universities that are in a similar situation to us. In the past, their insurers have not supported that, but change has been happening in a few different places. So feeling positive and optimistic. Yeah. Yeah. Yeah. Because it's really difficult to, um, to, to understand or to practice in a way that you've never seen or experienced. Yeah. A hundred percent. Yeah. Well, all the births I saw were in a hospital and like, yeah, the, the, The way that I ended up choosing Home Birth was because I knew that I wanted a private midwife and it was kind of, you know, I knew, I knew all the stuff behind it. And when it was proposed to me, well, do you want to have a Home Birth? Like you can have a Home Birth. I was like, Oh, I can't believe like this has been giving an option to me, but yeah, of course. Um, but yeah, like if you don't. Yeah, that's why I love the podcast so much. I love listening to other podcasts. I love my podcast. I love listening to stories is because most most women and like most midwifery students are, you know, women that have never seen birth before. And so if the only thing you're being exposed to and learning from is medicalized intervention, heavy birth, like. How do you even know that something else exists or that it can look different, it can sound different, you know? Yeah. Yeah. Yeah. But that is very exciting that you're getting publicly funded home birth. Is that the first hospital in Queensland? It is. So yes, we are the only state slash territory that hasn't had publicly funded home birth. And, you know, I think there are some challenges with. that model of care in terms of limitations for women. And it'll be really interesting to see how those risk assessments get played out here and how many women are supported because we're all either too fat, too old, too young, too thin, too scarred. Absolutely. Yeah. Whatever. And if they don't risk it at the start, they could at 36 weeks or whatever. So at least the ones in Victoria, that's the rule. But yeah, but I think, yeah, for a number of women, It'll be a fantastic opportunity. And, you know, really great for a lot of midwives as well to see a different way of working and being very different, that power dynamic from when you're invited as a guest into somebody's home, compared to the hospital where it's your turf. Yeah. Yeah, totally. Totally. Yeah. Well, maybe the tides will turn. Maybe, maybe. But that's really exciting. I am an eternal optimist. Yeah. I do think. But on the other side too, like I think, you know, there's a real, while there are a number of women I know and friends and people that, you know, that were having, you know, free births back then, you know, that's really grown and shifted and changed as well. And I just, I do think we're seeing a lot more women just, you know. regained that knowledge and that wisdom and shift that ownership and that responsibility that has been gate kept by us as midwives and professionals. I think, you know, the internet and social media has been really fantastic and it's really beautiful seeing that. And, you know, makes me think sometimes about what our role is as midwives and where do we fit in what capacity we needed. Yeah. Because most of the time, um, birth just works beautifully. Yeah. And we don't need to do anything. Yeah. Yeah. Well, certainly at my most recent home birth, um, from what I remember, the midwives just sat on the couch and, you know, at the end they were there to, you know, hold, like not me physically, but like, you know, in a way, hold the space and like, I wanted that and I felt like ethically, I deserved that as a birthing woman. And so, you know, I might not have needed a midwife to do like physical stuff. But you know, I still really valued having a midwife there and yeah, yeah, yeah. I hope things change. I am worried about the public. There's going to be five in Victoria by the end of the year. Yeah. And I do worry that like, you know, a woman might not know much about home birth and might be like, Oh, I might give that a go. And then they'll be like, Oh, no, you're too fat, too old to this to that, you know, and then they could potentially discount home birth altogether because, you know, all the hospital has said that I'm too high risk for home birth when that's not actually the case. Yeah. Yeah, I think, you know, having a really kind of, you know, rich tapestry of options to women is really great. You know, I think that, you know, home birth with a private practice midwife is, you know, an option that is only available often to women with certain amount of privilege. Yeah. And I have found that really challenging at times. Um, but yeah, I totally understand what you're saying. And then even on the flip side of that too, you know, for some women that will be almost, you know, the gateway to, um, to, to home birth with, with a private practice midwife of, you know, I had that experience where I was risked out of that. And so here's this other option that maybe I can explore instead. So, yeah. Yeah. Yeah. lots to think about. Thank you so, so much for like, reconducting with me. Yeah, it's been lovely. Do you have any, anything that you'd like to add or? Oh, just there's nothing like birthing your baby at home. It's incredible. You know, after my son's birth, I'm You know, the midwives made me food and tucked me up into bed. And I remember coming out through the lounge room in the early hours of the morning and everything had been put back together. And I just thought no one would know what magic has happened here today. Yeah. And yeah, I'm incredibly grateful for that experience. Yeah. Oh, it's made me all nostalgic. Yeah. Yeah. Yeah. Absolutely. I, yeah, I. I find listening to all these stories, I'm like, oh my gosh, I want to give birth again. I don't want to be pregnant again, but I would like to give birth again. And there's, yeah, even just doing the podcast since Frankie was born, I've learned so much stuff. And I think, oh my gosh, if I have like the past 10 years of my life has been the way that it has, you know, so like associated with the birth world. Imagine somebody that has, never been in the birth world, gone to have their baby. Like there's so much lost knowledge that we've got to like find and share and yeah, home birth is magic. Yeah. Yeah. Beautiful.