Ep 168: All About Midwifery with Certified Nurse-Midwife (CNM) Gianna Fay


I have been wanting to have a midwife on the show for a long time. It’s a big topic and I knew I had to get it right. That’s why I’m so thrilled to have Gianna Fay on the show today. Gianna Fay is a Certified Nurse-Midwife (CNM) and Women's Health Nurse Practitioner (WHNP-BC). She has been a part of 600+ births and has worked in a variety of settings including out of hospital birth centers, large hospital teaching facilities, smaller community hospitals and private practice.

Throughout her career, she has seen pregnant families struggle with navigating the maternity care system. Race and socioeconomic status impact every part of the delivery process and that can make getting the help of a midwife inaccessible for some. After having worked in many different birthing settings, Gianna has decided to work within the hospital system so that she can make her skills and expertise available to everyone.

This episode is being brought to you by Ellement prenatal supplements.

In this Episode, You’ll Learn About:

  • Why Gianna felt called to become a midwife
  • What types of practice models she has worked in
  • What people can expect when working with a midwife who is hospital based
  • How midwives and physicians work together
  • What the difference is between a midwife and a doula

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Ep 168: All About Midwifery with Certified Nurse-Midwife (CNM) Gianna Fay

Nicole: If you are wondering what it is like to work with a midwife, this episode is for you. You are going to love this conversation with certified nurse midwife Gianna Fay. This episode is being brought to you by Ellement prenatal supplements. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Nicole: Hello. Hello. Welcome to another episode of the podcast. This is episode number 168. Thank you for being here with me today. On today's episode of the podcast, we have Gianna Fay. Gianna is a certified nurse midwife and women's health nurse practitioner. She lives and works in the Metro Detroit area. She has been a birth worker since 2011 and has worked in a variety of settings, including out of hospital birth centers, large hospital teaching facilities, smaller community hospitals, as well as private practice. Throughout her career and the over 600 births that she has had the honor of being a part of, she has often seen pregnant families really struggle with navigating the complex maternity system and really feeling confident to make the best decisions for their care. She's super passionate about educating and empowering you to know your options and ultimately feel prepared to make the decision that is best for you.

Nicole: And I am so thrilled to chat with her today about the different types of practice models she's been in. She really, really brings a wealth of experience to her work that I think is so important. We also chat about what people can expect when working with a midwife who is in the hospital, how she as a midwife works with physicians, who's a good candidate for working with a midwife who isn't a good candidate, her thoughts on the term med wives, three things she wishes everyone knew about working with midwives and much, much more. This is a fantastic episode jam packed with such great information. You are truly going to enjoy it. Now, before we get into the episode, let's chat for a minute about prenatal supplements and vitamins. You know, OB GYNs, we all recommend prenatal vitamins. You should really start taking them three months before you get pregnant, but it can be so confusing to figure out which one to take which product is right for you.

Nicole: And that's why I really love this week's episode sponsor Ellement. They have created the first ever personalized prenatal supplement. It takes the stress out of this process. Ellement is a twice daily packet and was designed by maternal fetal medicine specialist. And it is customized not only for each person, but it also changes over time, depending on where you are in your pregnancy journey from preconception to postpartum, every pregnancy is unique and really your prenatal should be too visit helloellement.com that's Ellement with two L's. Hello, H E L L O E L L E M E N t.com and join their wait list today. All right, let's get into the conversation with certified nurse midwife, Gianna Fay. Gianna. I am so excited to have you on the podcast. I have been dying to have a midwife come on the podcast, so I'm so excited to have you here.

Gianna: Oh, thank you. I'm excited to be here.

Nicole: Yes. So why don't you tell us a bit about yourself, your work and your family, if you like.

Gianna: Sure. So my name is Gianna Fay. I am a certified nurse midwife, um, living in Detroit, Michigan. I am originally from Southern California, um, which is where I did nursing school and midwifery school. Um, because I'm a certified nurse midwife. That means I've got training as a, a registered nurse. Um, and then got my master's in nursing to become a certified nurse midwife. So I did all of that in Southern California. Um, and then since then I've lived in Alaska and practiced there as a midwife. And now I'm in, so yeah, I've, I've been, um, been doing midwifery and birth and pregnancy in a couple of different states.

Nicole: Nice.

Gianna: Yes, that's me professionally. And then I'm married to, I guess I'll say my college sweetheart. We've known each other for a very long time, but I guess we started dating in college and we've got, um, three kids three and under two boys and a girl. So we are busy, busy,

Nicole: Busy, busy, busy. Yes,

Gianna: Exactly.

Nicole: Alrighty. So what made you decide to become a midwife?

Gianna: Gosh, so, you know, growing up, I will say like in high school, I really liked watching. I don't know if you ever heard this show birthday on TLC and discovery health. They had this show called birthday and like special delivery. I think those are the names. Um, and it was like a little docu-series that talked about birth. And of course it was always like emergency C-section, you know, this is the labor delivery unit, this is how busy it is. And I would watch that every day. And I was like, you know, I wanna be an OB GYN and going through high school and starting college. I was like, I don't really know if I wanna commit to med school. And like, that doesn't feel right. Like I'm gonna, you know, I like moms and babies. I'm gonna do psychology, I'm gonna do sociology and just do something with that. And, um, during my junior year I took a medical sociology course and there was a women's health section and we watched the business of being born by Ricky Lake. And that is kind of, I like to say like a gateway drug for a lot of birth junkies, that documentary.

Nicole: That is, that is very true.

Gianna: Um, if you haven't seen it, you gotta watch it. Um, and I think that's the first time that I had heard of what, like a modern midwife was, you know, of course I'd heard the term midwife, I guess, like in life, but knowing what it actually was and that it still existed and what it looked like and what maternity care looks like in the Western world. And I was just like, oh my gosh, whatever that midwife is, that's what I gotta do. Like, that's the thing I gotta do. So I'm in my junior year with my psychology sociology degree, finished that, and immediately went back for nursing prereqs to go to nursing school to become a nurse midwife. So, um, in that time I really reached out to be mentored by some nurse midwives in my area. Um, and I worked at out of hospital birth centers and was a birth assistant and worked in the office there while I was doing my nursing prereqs and nursing school, which I think was a really, really good, um, foundation, um, before going into the hospital as a labor and delivery nurse as well. So

Nicole: Yeah, 100%. So how long were you a labor and delivery nurse?

Gianna: Um, just about two years. So honestly I really did my labor and delivery nursing concurrent essentially with the second two thirds of my midwifery program. Um, because I had the experience, I worked at the birth center again, total out of hospital birth center under CNMs for three years prior to becoming a nurse. They accepted that experience that I had as a birth assistant. Um, so I did that and then I was a labor nurse for about eight months prior to starting the master's portion, um, for the midwifery. And honestly, you know, I, again, I'm so grateful now that I had that foundation of totally normal birth outside of the hospital setting. And then I got to labor and delivery and I realized what labor and delivery nursing is and what labor and delivery birth is. Um, and that's really important to know, especially being that I was gonna become a nurse midwife and, and I, you know, wanted to work in a hospital setting. So, you know, I felt like I knew so much and I did about birth, but I knew nothing about the running of a labor and delivery floor, you know, um, until I became a labor nurse. So that was really, really eye opening.

Nicole: Yeah. That's really great and unique experience that most people don't have that gives you an incredible amount of insight into this work.

Gianna: Yeah. And it was difficult cuz I started with like a new grad cohort at a very busy facility that did seven hundred births a month and you know, just very busy labor and delivery and the way that they taught us as new grads, you know, the steps that you do in labor. And then all of my colleagues are learning this and you know, I'm like, well that's not always necessary. Do we have to do that? Do we actually, you know, I'm questioning all these things because of the births that I've seen for the past three years in a total different setting. So, you know, it was interesting and frustrating, but also humbling. I hadn't seen true emergencies. I hadn't seen a lot of things that can go wrong, uh, because I was dealing with a lower risk population out of the hospital, you know? So, um, yeah, it was a really good foundation. It really was.

Nicole: Yeah, for sure. For sure. Yeah. So you were, you said 700 births a month. That is very busy. Um, and I, you were probably being taught away essentially just trying to get people through so to speak. Oh

Gianna: Exactly. Yes. Two patients on Pitocin all the time, continuous monitoring, lots of epidurals, lots of, you know, artificial breaking water, you know, just lots of keep it moving, keep it moving.

Nicole: So yeah, yeah, yeah, yeah. So what type of practice model do you have now? Oh, actually let me back up and say you, did you ever consider wanting to practice out of hospital birth or did you always know you wanted to be in the hospital?

Gianna: Yeah, really, really good question. And it's something I still struggle with every year, right? I'm like, what is my purpose as a midwife? Um, yes. I always knew I wanted to work in the hospital, um, because you know, over 94% of babies, even over 96, some stats say in America still are born in the hospital setting. And so I wanted to meet women where they are. That's where most people giving birth are in the hospital. More personally I'm a Black woman and most Black and Brown people giving birth are doing it in a hospital setting. There is definitely out of hospital birth growing in all demographics. Um, but specifically when looking at Black and Brown people, you know, um, and again, that's, that's what I am, what I represent. Most of us are giving birth in the hospital setting. And so I found it really important to be able to offer midwifery care in a hospital.

Gianna: I also think that it's able to get to people that don't necessarily know the benefit they're getting versus at the out of hospital birth center in Orange County, California, that I loved and, and worked at, you know, these women have lots of access and means to a lot of different things. Um, versus you just encounter a midwife in the hospital and you didn't know that she may have, you know, saved you from unnecessary interventions or things like that. Um, so I like that idea about working in the hospital setting. Yeah. I, I will, I do want to be out of the hospital again at some point in my career. Absolutely. But, um, for now I'm enjoying my time in the hospital.

Nicole: Gotcha. Gotcha. Gotcha. So what type of practice model do you have now? What types have you done in the past?

Gianna: Yeah, so now I, um, I work as a laborist, um, which, you know, I believe that's what you do too, you know, the, um, yep. Right? Yes. So I support a labor and delivery unit. Um, I don't have my own private patients. I care for patients from other OBs, um, and a few other midwives and I work really closely with residents that manage the labor. Um, and so I do that, um, I am enjoying doing that. I enjoy educating the residents. I enjoy the shift work. That's what my family needs right now. Um, so, you know, I'm enjoying getting exposure to a lot of different practices. We also are pretty busy facility, um, not quite as 650 to 700 births a month, but pretty busy. Um, so that's what I do now. But before this, you know, again, I did the out of hospital birth center while still a nurse in a nursing school. And then I have done group practice. So in Alaska I worked in, in like a big group practice where, um, I don't know, I, I guess a group model, it's not a private practice. I don't know. How can you help me describe what that's like versus a private practice?

Nicole: Yeah. I just, I feel like, I don't know. Yeah. Group practice feels like the best, the best way to put it. Yeah. It's like the best

Gianna: Everyone's patients is everyone's patients, everyone, um, works together. It's kind of a one stop shop. The hospital's at the same place. The clinic is same place where the blood draw is. It's kind of same place where the ultrasound is. Um, we refer within to other specialties like chiropractic and it's all kind of, you know, within the same organization. Um, I guess, I don't know, that's kind of the best way to explain it. Um, yep. And I did that for three years in Alaska and I loved it. Um, that was my new grad midwife experience. And I worked uniquely with the Alaska native population, which was also really, really rewarding. Um, lots of good stories there as well. And then when we moved to Michigan before this job, I worked in private practice, which I also really enjoyed. Um, and in the private practice setting, I, I found it very challenging, um, the work life balance aspect with the small kid one at the time, um, soon to be two at the time that I left, um, that was really difficult, but I enjoyed the relationships I developed with my patients through prenatal care. I enjoyed the relationships with my collaborating physicians and the hospitals. Um, I just couldn't be on call and be up all night and then come home and have a six month old baby that I also had to care for. Uh, that was, that was proving too difficult at the time.

Nicole: Yeah, absolutely. That, that totally makes sense. But you have had like a wealth of experience that I'm sure helps you in the hospital as well, in terms of forming those quick relationships. As hospitalists, we have to connect with people very quickly. Yes. And, um, also knowing like what happens on the other side in prenatal care. So I'm sure you, you know, all of those experiences together really, really help you be great at what you do.

Gianna: Thank you. Yes. I do feel, I feel like I have a perspective, you know, from, from a lot of different backgrounds, I, I have a different perspective. Absolutely. And, um sure. In my role now.

Nicole: Yeah. So let's talk about what can people expect when working with a midwife who is hospital hospital based? Because I feel like this is becoming more common. I too work side by side with certified nurse midwife hospitalist as well or laborist. So what can people expect when working with a midwife who is just in the hospital?

Gianna: Um, you know, I think the biggest emphasis that I like to place in a lot of my colleagues is on physiologic birth. And I think that's what you can expect is someone who's gonna advocate for that. Um, I wanna get rid of this whole natural birth, you know, term, like, what does that mean? Does that mean no medication? Does that mean vaginal? What does that mean? Right. I just wanna say physiologic birth, which is a whole podcast episode in itself. But, um, you know, just like promoting and standing by normal, healthy pregnancy and birth and looking out for when pathology, when something does go wrong. Um, and I think that's what a midwife whose hospital base should be and is, is, is uniquely equipped at doing instead of routinely applying all interventions or things to every person it's looking at the physiology of the specific person and trying to advocate for that.

Gianna: Um, that might, you know, again, I kind of alluded to it earlier, how we can protect people from things they don't even necessarily, they know they need to be protected from when they're in the inpatient setting. Um, I often educate a lot about certain interventions and things that we do, you know, to empower power patients, to make their own decisions that may be better suited for them as a low risk, you know, normal, normal person or even moderate risk, right. Um, person. Um, and then I think one of the things that people expect from us, which is true is we do have more of a knowledge of non-pharmacologic pain control methods. It's part of our training. We're required to attend a certain number of births that are unmedicated. Um, so, you know, and most of us, you know, in our CEU continuing education time, attend different workshops and things like that to, uh, expand that body of knowledge. So I do think you can expect a little bit more, um, support from a non-pharmacological standpoint in terms of labor support, um, in the hospital.

Nicole: Gotcha. Gotcha. So who is a good candidate for working with a midwife and who is not

Gianna: There's this quote? Um, that was from one of these studies. I believe the person who Nate did the study, her name is Jane Sandal, and I love it. It says every woman needs a midwife and some women need a doctor too. And I like that because, um, I really feel like almost everyone is a great candidate for midwife. Um, the term midwife means with woman. And that just means that we pride ourselves on a continuity of care and an established, personalized plan of care for every person. Um, so during the prenatal care and well women care, which a lot of midwives can do, um, you know, that's a great fit for majority of women. Now it's interpartum risk factors, um, mainly that are gonna risk someone out of midwifery care because there's certain things that I cannot do specifically during the birth.

Gianna: I cannot do surgical births. I cannot do cesareans. I cannot do vacuum or forceps assisted deliveries. I cannot do very, very preterm babies. Um, you know, twins multiples can be complicated. And so I think it's a really important thing to look when you say, well, I'm too high risk. Is it your risk in, in the birth itself? I think that's the biggest thing to look for. Um, when risking out of a midwife care in the hospital setting, um, I think a lot of the stuff that happens in prenatal care, diabetes, high blood pressure, whatever it might be also may need the attention of a physician. Um, and that can be done in collaboration with a midwife. Would you agree with that?

Nicole: 1000%. Yes. Um, and I've also found through the course of my career, cuz I've worked with lots of different midwives at different hospitals. Some midwives are more comfortable with doing, like taking a patient who has hypertension or diabetes or, and, and co-managing, so I may be managing the blood pressure part and the midwife is doing all of the birth issues of the diabetes or, or that kind of thing. But I, I have a, a time or two come across the midwives who don't wanna touch anybody with a 10 foot pole who is, is not like very explicitly low risk without any issues at all. I would say the majority tend to fall towards being comfortable with co-managing things if they're working in the hospital. But occasionally you may find a midwife who doesn't want to, um, manage or be, you know, deal, deal with anything that that could be considered higher risk.

Gianna: Sure. Yeah. And I understand that. Right. And that's where, and that's the beauty of, one of the beauties of the hospital system is where my expertise ends, someone else's starts and where their expertise ends, someone else's starts. Right. And so there's that layers of support, um, within the hospital setting. Um, that's unique versus if you are an out of hospital practicing, um, provider, for sure. Yeah. So that's why I say every woman can have one in the hospital setting cuz you know, likely, um, there's a physician available as well if need be.

Nicole: Yep. Absolutely. And, and more and more practices are going to, um, having midwives manage all of labor and the physicians only come for operative births, um, you know, vacuum forceps or C-sections so I agree that and it, and actually that's the way that it is in terms of every woman having a midwife, um, internationally that's very much so kind of the foundation of, of, of birth it's a little different in the US.

Gianna: Yeah, absolutely.

Nicole: So how do you work with physicians? Obviously I know the answer to that question, but, but some folks may not understand exactly how midwives work with physicians. So how do you work with physicians?

Gianna: You know, I'll, I'll talk about it in the role, in a full scope role. I think that that is more commonly how the question is asked, um, versus in my current role, you know, as a full scope practicing provider, you know, I have my patients that I see for their prenatal care. They come to me for their visits, they go get their ultrasound done, get their labs done. They come to me, we talk about it, we interpret them, we discuss. Um, and if during the course of their prenatal care, something arises, say they're elevated glucose screen in a diagnosis of gestational diabetes or elevated blood pressures or anything like that or something abnormal with an ultrasound, something that is leading us to think that this pregnancy course might be more complicated. Then I would collaborate with one of my physicians. Um, at all the places I've worked, it's been a pretty easy process of, you know, through the computer or in person, depending on where I worked, you know, Hey, I think this person needs a physician appointment for this reason.

Gianna: I've already talked with her about this. She's gonna see you in two weeks. You guys can talk about it. And then, you know, either they see me for a visit and back to the physician for a visit on and off, if it's diabetes say that needs to be managed with medication or um, or one visit with a doctor might be enough and everything is going well and they might not need to see the physician again throughout their care. So it just depends, you know, in the prenatal setting, what risk factors may arrive, um, how I work with the physicians in the hospital setting, um, that's been very different depending on where you work, what role you work and your practice setting. Um, and so, you know, I think that needs some attention, um, cuz it can be frustrating if you come from a mid, you know, in my group setting, it was very supportive.

Gianna: Um, I was able to manage and do a lot. And then when I moved to private practice, it was like, if I have anyone who's for, for instance, um, attempting a TOLAC a trial of labor after cesarean, my physician has to be in house the whole time. So that was a big change for me. Um, and my physicians were supportive, but I just had to remember to call them and have them in there to be there, quote, just in case, you know. So I think the working with physicians during the labor part really is depends on the practitioner with the facility you're in and what their policies might be. Um, and it's all relationally based, you know, once they've started working with me and knowing what I'm comfortable with and vice versa, um, it, it kind of helps that relationship flourish a little bit more. So it's not so hands on hands and more, I'm here to support if need be.

Nicole: Yeah. I, I agree. Um, it can be, um, um, chuckling, because I can maybe hear a little bit in your voice that it really depends on the doctor cuz some of y'all wanna be all up in our business. You said that, who said that? Uh, because I know, I, I know some of my colleagues just don't feel as comfortable working with midwifes. So that is something that you need to be, um, aware of for the listeners. If you're, you know, working with a midwife and a practice, some physicians just, they, they, you know, may be newer for them and they may not feel as comfortable and they may, you know, uh, interfere some places where they don't necessarily need to be until they get that comfort level. I think most people come around, but for some people, for some doctors, it is, they just have a hard time with it. And then you have other doctors like at me who are like, if, if the midwife is calling me, then they need me cuz they're not calling me unless, you know, we don't have talk unless you really need me kind of thing. So I think it really does. Does, um, depend on the, on the physician.

Gianna: Yeah. And that's, what's beautiful about working in different roles and getting different experience. You know, I, I think when I come to a job, a lot of people can see that I've had a variety of experiences, like you said. And, and I think I am approached mostly with a lot of respect and, and feeling that, you know, I can handle things and if I can't, I will come to you at the appropriate time, you know? But sometimes again, it takes more relationships times to grow and or if you've had a bad event or bad outcome and that's gonna obviously stick out in your mind for a long time. So, you know, sometimes battling against that is a frustration, um, with the collaboration of care.

Nicole: Yeah. 100% and 100%. So what do you think about the term midwives?

Gianna: My gosh, I think a lot about this term. Um, I, I, midwife is usually the way I look at it. It's, it's a term intended to cast the negative light on hospital based midwives, um, who practice more of like a medical model of care, you know, including lots of interventions and recommendations that aren't necessarily in line with physiologic birth. And you know, what I'd like to add is that the practice setting is more important for the way a midwife for any practitioner really develops his or her skills. Um, so if all someone's ever known and trained in is the hospital system, you know, in America, AGA the medical industrial complex, um, there's a lot of rules and policies that, you know, get ingrained in them. And so again, I think my foundation's unique in that I've seen out of hospital birth prior, um, and I'm open to it and wanna work in it again.

Gianna: Um, so I'm not, as my perspective is broader. I'm not as confined to those things. So I hope I'm quote, not a med wife. However, I am also obligated to follow the policy procedures of my hospital. I can lose my job. I can, you know, be reported or whatever, if I'm not doing what the policy says, that doesn't mean that I don't educate people to refuse certain things. Um, but you know, I think it just gets, it's a gray area because to say that all midwives in hospitals are practicing as midwives because they're doing continuous EFM or IVs on everyone or whatever it is, you know, it's hard, it's, it's, it's, those are the policies. And we know it takes, you know, 12, 15 years sometimes for policies to get updated to evidence. And so I'm there, I'm sitting at those meetings every third Thursday of the month or whatever it is, you know, it just might take some time for those policies to be changed.

Nicole: Yeah, yeah, yeah. For sure. Yeah. I think your point about you're so highly influenced by where you train is really, really important. The culture of the environment makes a big difference. Like for me it has never been a problem for me working with midwives, cuz I work with midwives since I was a resident. So it, you know, 15, almost 20 years ago. So, um, that was never an issue for me. And I can totally see how, if you are, uh, in a midwifery school or your training is in a very highly medicalized system, that it can be hard for you to know more of what I, I, you know, I guess for lack of a better way to put it like more true, like midwifery roots and, and, and care. Sure. Um, so I can, I, I, I see your point that it's where you're trained and, and can, can make a huge, a huge difference for sure. Yeah.

Gianna: And you know, on the contrary and a lot less common, but again, I think it's practice setting. There are community based OBs you know, Dr. Stewart Fishbine. Um, uh, there's another one that I follow and I I'm forgetting her name right now like that our community based OBs he only does homebirth and supports midwives in Southern California and does, um, things like twins home birth and vaginal breach home birth, which however you wanna feel about it, it's how you feel about it. But he basically practices midwifery, but he's a board certified OB GYN. Um, you know, so I think it's, it's like you're saying it's, um, kind of, he was trained obviously in the traditional obstetric system and then for the last years, 20 years has been doing birth in that setting. So I think it's the setting, um, and the training that cultivate you over time yeah. To turn you into the provider that you are

Nicole: Definitely. Definitely. Yeah. I, I, one of the best compliments I got from a midwife was that I was very midwifery in my practice, so oh, I, I try to, um, you know, I don't look at that as a negative thing because the foundations of midwifery care are really, um, important and they, they save lives and, and help women have a great experience. So, um, we should all be adopting some more midwifery style practices for sure.

Gianna: Oh, thank you.

Nicole: Yeah. So what are three things you wish everyone knew about working with a midwife?

Gianna: Um, I guess first, like what my role is, you know, like what a midwife is versus a doula, I think comes up a lot. Um, doulas are amazing. I am not one. You need one, if you have a midwife.

Gianna: You know, just basically knowing what I do, that I'm a, I'm a provider, I of care I'm in charge of the medical care for yourself and the baby. Yes. I am often, you know, I love to be supportive and I can do that, but I am not a doula whose job it is, is to solely dedicate time to support you and your partner in labor. I may have three people in labor that means six patients that I have to care for, you know? So, um, kind of just knowing what I am, what my role is versus a doula versus the nurse. Um, so I think that's one thing that I definitely wish everyone knew. Um, I wish everyone knew you could have an epidural if you have a midwife. Um, I think people think midwife means that I'm saying I want an unmedicated birth and I wanna eat Michaels and I wanna, you know, sing kumbaya or whatever the stereotypes are.

Gianna: And Hey, kumbaya with you, if that's what you want. Um, but that's not what I went to school for. That would be in addition to, you know, so, um, I just think that knowing that you can have epidural and, or whatever pharmacologic modes are available in a hospital setting, um, cause that's what we're talking about. Hospital based midwifery can have that yeah. With a midwife. Um, and then lastly, I guess just that you can have a midwife in the hospital setting. Um, I think a lot of people don't know that or, or they're just starting to learn about it, you know, seeking out the practices in your area that have midwives or the hospitals that have midwives as laborists even calling your insurance company to ask if there are any, you know, covered, um, facilities that have midwives. Um, I just, I do, I wish more people knew that they could have midwife in the hospital setting.

Nicole: Yeah. Those are all, all great points. I think, uh, the first one, for sure, so many people confuse, um, doulas and, and midwives and, uh, I, I, I appreciate that. You're being honest. Like I, I, you're probably not gonna be my only patient in the hospital, so I, I, I literally can't be at your bedside doing continuous support all the time. It's just not the structure of how hospital based midwifery works. So I'm definitely having a good doula in addition to a midwife is like, um, for sure. A great thing.

Gianna: Yeah. Yeah. I'm taking a class, a comprehensive class and then you have a great one, you know, just cause you have a midwife doesn't mean that you don't need to educate yourself. Um, you know, so yes, absolutely.

Nicole: Yes. For sure. For sure. Um, and then what are three things you wish everyone knew about having a, like everyone having a baby, knew about birth in particular?

Gianna: Um, that gosh, that it will come on its own if we just let it um,

Gianna: Towards how many inductions happen, it's crazy. Um, but yes, that your body is, is often wiser than we are and it will birth will happen. Um, and that really surrenders the most important part, not control. Um, and I, and I know that's really hard in our busy Western society and all the information we have or think we have and access to. And, you know, I think the average person giving birth for the first time in America now is about 30 years old. So likely that person's gone through schooling, and is very successful, you know, and everything has gone the way they wanted and you know, but control when we do too much about controlling and trying to research everything that is the opposite of birth's rhythm, rhythm births, rhythm is surrender. And so I really, um, try to talk to, to people about that as they're approaching birth. Um, and then just in general, what's normal and what's red flags, you know, it surprises me how many people don't know how much bleeding might happen, you know, with birth. And then of course they're concerned cuz all pregnancy, you don't wanna bleed. And now I'm like yay bleeding and they're freaked out, you know? And I'm like, I wish you knew what was normal, you know, versus red flags. So

Nicole: All great points for sure. I really love like the surrender piece. Um, and that's not to be misinterpreted, like you said, with the lack of preparation, those are, it's not the same thing. Surrender doesn't mean just like, you know, throw caution to the wind. Yeah. Um, and just like forget everything. That's not what surrender means. Surrender means you just, you have to be in tune with your body and the process you can't fighting. It just makes it longer and potentially like more painful.

Gianna: Absolutely.

Nicole: And then, um, the final question that I didn't, uh, you know, I didn't prep you about this ahead of time, but I, I, or didn't put it in my list of questions. So I'm sort of putting you on the spot here. What are your thoughts about like midwifery in general is very much so a white woman dominated profession, there are more Black and midwives and, and, and midwives of color. So what do you think about that in terms of how the field is, how, how that is, um, in terms of, for caring women now, because honestly I've seen some stories unfortunately, of, of Black women and they were with them like a White midwife and experienced some really racist, um, behavior, um, or on the flip side, you know, they, they felt like they were very well cared for. So what are your thoughts about like the overall makeup of the profession and how that affects the ability to care for, for women?

Gianna: Gosh, of all the questions to not have me.

Nicole: I know, I know, I know, I know, I know part of it just came back because, you know, midwifery was like there Black women were a huge part of midwifery, um, in the pack. Huge, huge. And then we're essentially driven out of the profession.

Gianna: Yeah. You know, historically we've always been doing this. The granny midwives is what you're referring to, you know, um, years ago it was Black women that took care of women, White and Black women, um, giving birth in home settings. Um, and then with the development of obstetrics and a lot of things that happened kind of pushed, you know, the granny midwives out and kind of painted, why would you wanna have care by this, you know, Black woman, when you can come into a hospital with this man and have no pain and have a have your birth, you know? So, that was a very simplistic way of explaining what happened. But, um, now with so much that's going on in this country in regards to just race relations and people doing their own work, um, I think it's important, no matter what you identify as to recognize your own implicit biases. I think all of us have sadly, you know, the, um, we've all had experiences where we've treated someone differently because of an implicit bias we have. I know I have, um,

Nicole: I have two, I have two for

Gianna: Sure. And we all need to do that work. I do think though that my being Black and interacting with Black and Brown people during birth, the cultural competency that comes with that, um, is crucial and really important. Um, and is recognized. There's been several times only in these last two years, I'd say where I've walked in a room and people have literally said, oh my God, you're Black, like Black women saying to me, oh, I'm so happy. You're Black. It's never happened to me before these last couple of years. Um, and just small nuances of like, I don't know, and our hair, you know, Black hair is a big thing and yes, you know, this one patient was gone about, she had to be induced, but she wasn't ready cuz her hair appointment was on this day and she wasn't ready yet. And I was just able that wasn't an emergency, you know, but I was able to like see her where she was and understand that. Um, I don't know. I think, I think there's just so much more to be said there. Um, and especially with the, you know, Black maternal health crisis and the rates and all of that. Um, there's just so much to unpack here that I'm just glad to be a representative, to be one of the Black midwives that someone might see, um, you know, during their, during their care,

Nicole: There are not very many of you all, you all are kind of unicorns in a respect

Gianna: Yeah. And, um, and I, I guess I didn't know that as much, although again, I just, I trained in Orange County, California. Like I, and I know of two other Black midwives that, uh, went through the same program I did, um, in the same place. So I guess I did know I was in unicorn, but it's, it is a really unique experience when someone looks at you and thanks you for your unicorn, this, you know, um, thanks you for being there and showing up as you are and is grateful that you're there. Um, that's been a really rewarding and new experience for me in these last couple of years.

Nicole: Yeah. I, I have that similar experience as well as a, as a Black female physician where folks, literally, you walk in the room and they're like, oh my God, thank God you're here. Or, you know, you can see them visibly relax. Um, because they just, you know, they feel more comfortable. So I totally totally get what you're feeling from that. And I didn't mean to put you on the spot. I just felt like was something we had to touch upon. I agree.

Gianna: Yeah. I agree.

Nicole: Yeah. So what is, as we wrap up, what is the most frustrating part of your work?

Gianna: Um, I would say the most frustrating part is explaining to people again, what I do, what midwives do or can't do. Um, and that has to do with, you know, the certification process and the differences in types of midwives and all of that. So it kind of muddies the waters, but that's really frustrating to explain, no, no, no. Like I'm a nurse midwife. I work in the hospital, this is what I do. Um, and, and also, you know, I'm, I am getting growingly frustrated with this, just the system and the system saying we wanna lower C-section rates. We wanna improve different outcomes and people's satisfaction to me, the answer is just so simple. You know, it's more midwives, it's less interventions. It's training residents with, with physiologic birth, you know, tendencies. Um, so it's just frustrating. Like, okay, this is the answer. Why aren't we doing this? Then if these are all the things that you're throwing all this money at, like let's do these things.

Nicole: Yeah. It, again, I'm chuckling because you're right. It's really not actually that difficult of a concept. We just have to like center the person giving birth, right. And the process and listen to them and meet their needs, like focus on what they need. Um, and if we did that, like things would be a lot, a lot different, but somehow it's seems to be difficult for us to do.

Gianna: Yeah. I don't think it's just us. I think a lot of patients now don't trust themselves, aren't empowered. And so they're not even looking for it to be revolving around them and their needs, you know, they're very like whatever the doctor says and whatever I need to do. And you know, there's a lot of fear and anxiety. Um, and that just, you know, saddens me, that people aren't asking for that type of care, they're kind of just whatever you think is best. And that just filled with fear, um, in, in regards to the whole thing.

Nicole: Yeah, I agree. I agree. So on the flip side, what is the most rewarding part of your work?

Gianna: Uh, there's just that look on a person's face when they're done and they birth their baby and they look at you and they just say, thank you so much. And you can tell that you and it's not catching the baby. Um, that's fun. Um, but it's, it is just knowing that you helped them at one of their most difficult physically, emotionally, spiritually transitions ever. And that you were there with them. I think that thank you so much genuine eye to eye contact. That moment is worth everything.

Nicole: Yeah, it really is. It really is. So what's your favorite piece of advice that you would give to expectant moms, expectant families?

Gianna: Um, educate yourself, educate yourself, educate yourself. It's my number one. Um, take a comprehensive class. Do not just take your hospital's labor and delivery tour class. Um, you know, just really educate yourself, um, on what you don't know, especially the first time around, um, because there's a lot that you don't know, um, get a doula if possible. Um, I do think that that is makes a world of difference for people in terms of outcomes and experience. And then also like, you know, for you guys, you and your partner, your support person come together first and decide what's most important for you. Um, and drown out all the other noise. It's kind of your first exercise in parenting. You're gonna have to do that for the rest of the time. So through your pregnancy and childbirth decisions, really making sure that you're in line with your values, with your partner's values, your support person's values. That's what matters first, not what everybody else is saying or thinking or doing. Um, those are the biggest things that I tell people,

Nicole: All excellent advice, all excellent advice. So where can people find you?

Gianna: I am on Instagram, um, at, @midwifefay. Um, I am again with my three littles. I have been a little less active in the social media space right now, but I am on there. I also have a YouTube channel as well that I'm growing. Um, my mid, my YouTube channel. You can search midwife Fay or GI Fay either way.

Nicole: Okay, awesome. Yeah, we will link that in the show notes and less social media probably is a, is a good thing or at least using it, you know, as effectively as possible. Oh, something I'm trying to work on myself. All right. Well, thank you so much Gianna for agreeing to come onto the podcast. I'm so excited that you were here. We'll have to have you come back and, and talk about something else, midwifery.

Gianna: I would love to anytime. Thank you for what you do. I tell everyone to listen to you. I just, um, really appreciate your just all around good wholehearted evidence based just all the perspectives that I think patients need to hear. So thank you for what you do

Nicole: Well, thank you. Thank you.

Nicole: Wasn't that a great conversation? I really, really enjoyed chatting with Gianna. She's so passionate about her work now, you know, after every episode where I have a guest on, I do something called Dr. Nicole's Notes, where I talk about my top three or four takeaways or thoughts from the episode. And before I get into Dr. Nicole's Notes, let me tell you a quick word about this week's podcast episode sponsor Ellement. I have the pleasure of chatting with the founder of Ellement. And can I tell you she is so incredibly passionate as well about her work and they take a very serious approach to this. Ellement provides a tailored prenatal supplement for each person, whether you have certain dietary preferences, a high risk pregnancy or nutritional deficiencies, like low iron or vitamin D levels. And every 30 days they can adjust your prenatal protocol to make sure it is the perfect fit for you based on where you are in your journey. Ellement has really exceptional ingredient quality, no fillers, no additives.

Nicole: And the packaging is eco-friendly as well visit helloellement.com that's Ellement with two L's. Join their wait list today. Okay. Let's get into Dr. Nicole's Notes. So I wanna talk for a minute about the different types of midwives. We briefly touched upon that, but I just wanna give you a quick overview of the different types. The big two types are certified nurse midwives and then certified professional midwives in the hospital. You are always going to encounter certified nurse midwives and a certified nurse midwife. Uh, her minimum education requirement is that she has to have a bachelor's bachelor's degree or higher, and also has to have an RN license. And these days, many programs also require, um, doctorate level, um, thesis work in order to be a certified nurse midwife as well. So in the hospital, you're only gonna see certified nurse midwives in the community.

Nicole: So in birth centers or home births, you will most often encounter certified professional midwives certification. As a, as a certified professional midwife does not require an academic degree. It's more based on demonstrating a certain level of competency. Competency in specific areas of knowledge and skills, and that varies by state. So those are the differences between certified nurse midwives and certified professional. In episode 120 of the podcast, I talk in more detail about the overview of midwifery care. That is drnicolerankins.com/episode120- 1 2 0. Okay. Number two, I want to reiterate Gianna's point of surrender, not control. You cannot control birth. I can't control birth. Your doctor can't control birth. The only person who controls birth is the baby, and they don't tell us our plans. Birth is an unpredictable process that cannot be controlled. And in order to go with the flow of the birth process, you really need to surrender to it and be in the moment of your birth.

Nicole: Now surrender doesn't mean like you throw caution to the win. I was gonna say another expression but I don't think I can say that when the podcast, cuz this is family friendly, but anyway, um, you, you can't just like throw caution to the wind, but you can be prepared. That's where childbirth education is so important. Listening to this podcast is so important. Of course you can join me in the Birth Preparation Course, my online childbirth education class that gets you calm, confident, and empowered for your birth. That is a great, great next step from this podcast. And you can check that out at drnicolerankins.com/enroll. Okay. The last Dr. Nicole's Notes is I just wanna give a shout out to all of the midwives that I have worked with throughout my career. I have worked with some really fantastic ones, learned from some really fantastic ones and the experiences have helped me to be a better doctor.

Nicole: I really wanted a midwife on the podcast for a long time, but I couldn't bring myself to, to ask any of the midwives I work with. Cause I didn't wanna like seem like I was doing favorites. I couldn't bring myself to choose. So I just wanna tell you all that. I love you all. I appreciate working side by side with you to take fantastic care of women during their pregnancy and birth. All right. So there you have it. Do me a couple solids, share this episode with a friend. Also subscribe to the podcast where I be listening to me right now and leave a review, in Apple Podcast. I love those reviews. I love to hear what you think about the show and from time to time, I do shoutouts from those reviews. So definitely do that there also, if you wanna connect with me after the podcast, I have another resource for you.

Nicole: It's called the Inner Circle Membership. It is a really great place to get additional content and information from me. At the time this is airing the inner circle is probably, um, closed for membership cuz we've just had an opening and it's probably closed, but you can head to my website, drnicolerankins.com/email. Join my email list to get on the wait list for when the Inner Circle opens again. It's a great community where you connect with other like-minded folks. And I do monthly classes about birth. Um, I do monthly office hours where you can ask me anything about pregnancy and birth. So head to drnicolerankins.com/email, or if you're listening to this and it's later on, um, after the episode is air, the Inner Circle may be open again. So you can go to drnicolerankins.com/inner circle and join actually just head there cuz, if you're interested, because even if it's closed, it'll direct you to join the wait list. All right. So that is it for this episode, do come on back next week and remember that you deserve a beautiful pregnancy and birth.

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