Transcript

SPEAKER_01
0:04

Hi Denise, how are you doing today? Here we are, Ginger, the Popswit Midwives. We're coming. More time. We are happy to share that with our ginger. Maybe today we'll be called Rabbit. Let's do it. Oh, RPM. I like that. I like that. I like that too.

SPEAKER_02
0:25

That seems pertinent. Okay. Um, well, today we're gonna jump straight into the new news. And I love this article because it just came out probably in the last two weeks from um a peer-reviewed article out of the University of Washington. And those folks are doing a lot of research on maternity care, and they always seem to drop in the word midwife in what they're studying, which is really a great, a great thing to know about. But as they should. You know, if folks didn't look at this health systems journal, which I had never heard of before, people are talking about us. And what they did in this article titled Increasing Access to Perinatal Care in Rural Settings, a Washington State Global to Local Scoping Review, is take thousands of articles across the globe focusing on rural care and synthesize them looking for best outcomes. And some of what they found is exactly what we have been talking about related to a hub and spoke model using not just community health workers, but midwives, equipping them with technology that they can be trained to use. And guess what the state of Washington appears to be doing? Okay, bring it. We need all the really thinking about now how to implement some of this in their rural health transformation funds. Okay. This is so exciting. I love this topic. It's thrilling. I mean, I think you've talked about Wisconsin really focusing on this.

SPEAKER_01
2:09

You've got a lot of OB colleagues who would probably love this article. I think so. Um, I think it's worth meditating on for many hours.

SPEAKER_02
2:18

Yeah, you don't have to think about it. So long. I mean, it's really, it's it's it's an enormously long article article to be published in a journal. Uh, but the the data extraction is it's mind-blowing the work that was done and the conclusions that were made that really continue to prove, shall we say? I think all of us on this call today have been around the block a few years with stuff we know.

SPEAKER_01
2:47

Right, right. And I didn't read it yet. Um, but did they, because I've been working so many hours, but did they provide some great conclusions, interventions? Yeah, that's exactly what they do. Let's talk about them. Yeah. But but who do we have with us today, Ginger?

SPEAKER_02
3:02

Well, what's exciting is my partner in crime to start Grow Midwives, Leslie Rathman. We're finally uh thrilled that Leslie's on with us because she brings a wealth of knowledge across a lot of years of doing many types of work. And we describe ourselves as sisters from another mother or something like that, Leslie.

SPEAKER_01
3:23

How many mothers do you need? A lot of them.

SPEAKER_02
3:26

So, Leslie, do you want to share with listeners who may not know who you are a little bit about your background and and what you know, what brought you to your place in the world today? You know, how you see yourself influencing a lot of things that are going on.

SPEAKER_00
3:41

Hello, everybody. I'm happy to join as a participant and not just a listener for um for a change. I've been enjoying these podcasts from the beginning. Great information out there. I'm Leslie Rathbun, and I am the COO and one of the founding partners of Grow Midwives. Prior to that, I started my career way back in the previous century in the 1980s as a nurse in labor and delivery. And I have worked in all areas of maternity care from a freestanding Amish-owned birth center with a barn to a high-level NICU and tertiary care center, and both worked inpatient, outpatient, focusing on the birthing person, focusing on the neonate. Um and what brought all this together was I did uh decide to go back to school in the early 2000s. Um, shout out to Case Western Reserve University and get my um FNP and my CNM. And my intent was to work at that Amish Birth Center. And that did not come to fruition due to a big malpractice crisis that hit the state, and I needed to move. So our family wanted to move back to the South where it was warmer, and I was offered a job near in Charleston, South Carolina, which of course the location, location, location sold it to all of us. Uh, the practice had an interest in opening a birth center, and like many large uh um practices, they kind of went through a reorganization and divorce. And and so at that moment, I decided if I wanted to have my dream job, I needed to create it myself. And so I broke off and started Charleston Birthplace, um, the only accredited freestanding birth center in South Carolina at that time. And I sold it two years ago um to slow down a bit, enjoy life, grandkids, and to be able to have a little more time to put forth through to grow midwives. I'm a strong believer in you climb the ladder and then you put your hand down and you hoist other people up that ladder. Yeah, yes, yes. Thank you, Leslie.

SPEAKER_02
6:08

You know, Leslie, you also are a political warrior. Can I say it? Yes, yes.

SPEAKER_00
6:15

Not willingly. I never thought I'd be in that spot, but yes. But you do it well. You do it well. Yeah, there was another legislative issue crisis that hit the South Carolina concerning freestanding birth centers. And so the next thing I know, I was um being interviewed on the news and hiring an attorney, and um being quoted in newspapers, and we were even mentioned on Stephen Colbert. So um right, it was a big deal, but yeah, the state had threatened um to shut down all the birth centers, and uh we fought back and we're still open. Yeah, it's remarkable.

SPEAKER_02
6:59

And I I think that, you know, would you say, Leslie, that that attack on you was what lit the fire? Or were you always kind of in the advocacy spirit?

SPEAKER_00
7:13

I think I always advocated in my own way, depending on where I was and what position and I held. I from the very beginning of my nursing career, I was singled out to be a leader and I fought that um almost all of my nursing career until I just couldn't fight it anymore and realized, okay, yeah, you know, I somebody's gotta do this, I and I will do it. And I I did not like the policy work that I had to do when I was in grad school, but um I owe that instructor a big apology. It's so important. And I actually came to enjoy the political end lobbying both state, local, national. Um, I've met some very influential, important politicians, and I find it um very enjoyable and not as difficult as I thought it would be.

SPEAKER_02
8:06

Yeah, I I think it scares people more than even imagining it could be fun.

SPEAKER_00
8:12

Right. Yeah. I I would say the key is finding the underground um tunnel to go from building to building in Washington, DC. I didn't do that for several years when I was like, oh, this is so much easier than running around upstairs outside me.

SPEAKER_02
8:28

Yeah.

SPEAKER_00
8:28

Um wear comfy shoes.

SPEAKER_02
8:31

Well, one of the things I don't think you said, which is where I'd love for us to take a dive into, is you were a two-term past president of the American Association of Birth Centers at a time when I think birth centers were really moving up uh in numbers, accredited birth centers. Um, and yet not a lot of conversation in the national media. You mean you were doing the CMS studies and other things to sort of get the attention. In my opinion, and I'm not going to speak for you, Leslie, and I worked in a birth center for 14 years. It's how my career started. A lot of people know that. An accredited birth center. Now, what I think is happening is birth centers are talked about by people who don't know what birth centers are. They're still not being reimbursed equitably, and they're closing week by week by week. Too many, too many aren't closing. Like, what's going on?

SPEAKER_00
9:34

Well, you're yes, you're correct. Um, when I was the president of AABC, it was at the exact same time I was fighting that legislative battle here in my state, which made me take a really hard third-party expert kind of look at the standards and then the indicators from CABC that were attached to those, and brought it back to AABC and CABC and said, we need to, this is outdated. We need to tear it down and start over, and we need to invite all the stakeholders, which is what we did. Yeah. And at that point, I believe it's the first time all of those people ever sat at a table. And um, some of the people that were there were not fans of out-of-hospital birth. The American Academy of Pediatrics sent um the physician that wrote the anti-out-of-hospital birth articles. And yeah, so, but we were all able to sit down, have some collegiate conversations, and make some changes, um, specifically with NRP. Um, and things tend to be going in the right direction. Then we got the strong start study, and that really opened the door and got the attention that this birth center model not only should be an option, that it can be a solution to the maternity care crisis that we have now recognized our United States is currently in. And all of that was based on accredited birth centers. Every birth center that participated in Strong Start, it was part of the um criteria to participate is that you were accredited. And that's so important because safety and standardization is the key to being sure that the when you say birth center, you know what you're talking about. The term birth center is not a protected title. Anybody who you know asked their neighbor to come over and give birth in their guest bedroom can call themselves a birth center, right? But they can't call themselves a C A B C accredited birth center. So that that is the big distinction that um we need to know. We do have organizations and physicians and people that have jumped on the bandwagon, which is great. But then when you have conversations with them about our model, there's assumptions and confusions that that occur because they don't understand it. And they're busy providers just like we are. And you know, I'm not interested in reading step by step of how to do a laparoscopic robotic hysterectomy. You know, I just want to refer that mom patient um over to the gynecologist who can do that procedure. They need to refer the patient who fits a low-risk birth center model that is asking for it and say, go see those medwives over at the birth center. I know nothing about that, but they do good work. I can assure you you'll be in great hands. And then that's it. Yeah, that's it. Yeah, when we see issues and problems is when we get too many cooks in the kitchen. Yeah, we know the birth center model works, it's been proven. Over and over and over. Yeah, $40 million strong start study, which should have been the explanation point, move on. However, then there, you know, you can have recently we've been helping a hospital open a freestanding birth center, and it's hard. There's a reason that a lot of hospital-owned birth centers um either don't exist or they'll exist for a little while and then close down, and it's because the model is so different, and trying to fit it in to this big organization that has um much more um details and um uh people at the table that needs to for a big organization to function that you don't need in the birth center that complicates it. I say it's like, you know, too many cooks in the kitchen. You're gonna have it's like saying, okay, we're gonna have a Sunday dinner and we're gonna invite the best chefs in the world. And you invite Asian cuisine, Spanish cuisine, French cuisine, all these expert chefs, and tell them they got to come together and cook one meal. Are they gonna agree on the ingredients and what would no great suggestions? They have different culture, different background. Doesn't make them that they're not experts in what they do. But if you want an uh just an American family Sunday dinner, invite your grandma, right? She can fix a Sunday dinner for you.

SPEAKER_02
14:35

I love it, Leslie.

SPEAKER_00
14:36

Keep the spice out.

SPEAKER_02
14:37

So the evidence exists ad nauseum. We talk about this all the time. A A B C C A B everybody who knows talks about it all the time. We don't need any more studies. However, the insurance industry could give a shit less.

SPEAKER_00
14:52

Yeah.

SPEAKER_02
14:53

Yeah.

SPEAKER_00
14:55

That's right, Ginger. The answer we have. We know the answer, right? We don't need to do any more studies. The next piece is you have to financially support that model so that it is sustainable. And birth centers back when I started in 2008 were fairly squeaked by, and they only squeaked by by the staff, the midwives, agreeing to work harder for less money. Their passion led it to them.

SPEAKER_03
15:28

Yeah.

SPEAKER_00
15:29

And that is not sustainable in the long run. To if you want a birth center available for everybody, and birth centers got popular, you know, everybody wanted an open birth center, and everybody's looking at an open birth center. And then suddenly we start seeing birth centers shutting down, shutting down, shutting down. Since the pandemic, we went from barely squeaking by to okay, now we are completely not sustainable. Part of it is the cost of providing care went up and reimbursement went down. The other part is people took a hard look at their lives after COVID. All of us did. The entire world, and said, How do I want to live my life? I'm on this world for in on this earth for a short amount of time. What what do I want out of life? And part of that was family, free time, less stress, ability to raise my children and support my children. So they came back saying, I want less hours and more money. Yeah. And you can't, they're not wrong. They're absolutely not wrong. Birth center midwives should be paid and have the same benefits as hospital midwives.

SPEAKER_01
16:43

Yes. And in order to do that, you have to reimbursement.

SPEAKER_00
16:48

But our entire healthcare system is based on reimbursing for illness, trauma, and interventions. Not on keeping people healthy, right? Well, and out of the hospital. Right. I mean, during that pandemic, what did they do? They looked to the birth centers and said, How can we keep healthy pregnant women out of the hospital? If it's okay for a pandemic, it's okay when we don't have a pandemic.

SPEAKER_02
17:17

Well, because of that, and I'm sure many of the listeners we have no practices are closing all the time, right? And we'll just focus on birth centers for now because I want to pivot to your thoughts about alongside midwifery units and how that could be a bridge to what's possible to allow a community birth-like model owned by someone with more money than midwives. And and be able to have similar criteria and that are protective for the families that want low intervention.

SPEAKER_00
17:55

Yes. Um, when we looked at our standards um way back, uh the the discussion came up is what about these hospital birth centers? Right. And some of them were a few were freestanding, not many. Most of them were a unit within the hospital, but it was separate from labor and delivery. What are we going to do about them? Because it's not fair to the freestanding birth centers, right? Because these guys are getting reimbursed at an in-hospital rate. Yep. And are able to provide um a tray for the patient, you know, whereas our patients have to bring their own food, or we have to have little frozen dinners in our freezer or whatever it is to, you know, make this happen. And it works, but they are we're at an advantage. So we knew we already had that model. It's in the UK with the alongside midwifery unit. So um AABC said, let's embrace it. Let's embrace alongside midwifery units and directed CABC. You guys need to look at accrediting them separately and encouraging these hospital birth centers to call themselves what they are, an alongside midwifery unit. And there's a lot of advantages to that alongside midwifery unit. I don't think it replaces the freestanding birth center, and I hope it doesn't completely replace a freestanding birth center. I think there's room for both, just like there is in the UK. Um, but I think it can be a solution for um being able to not just protect the family's right to have a low intervention birth, but it also exposes the other players, the physician groups, the pediatricians, neo, OB, anesthesia, all these people to that model within the area that they feel most comfortable in practicing. Also gives way for midwives to get that training and experience and embrace that midwife model. Unfortunately, midwives come out of school gung-ho for their midwife model of care, get a job in a hospital, uh, and many times they're leaving it all behind. Yep. You know, anything they learned about the newborn, gone. Anything they learned about autonomy, gone. It's you know, I follow the recipe that the hospital has decided I am going to follow. And many times it is not the midwife model of care. It's a bottle of care, and it's not necessarily good or bad, it's just not our model. Right. I can vouch for that one, Leslie.

SPEAKER_02
20:45

So these AMUs, these AMUs are accredited entities. Leslie, at last I looked, there were five or six that were accredited, not very many.

SPEAKER_00
20:56

Right. Yes, there are not very many. Um I would like to see that change. I really thought that the TEMA grants would help push that forward. And uh been working here locally trying to get one going. Um, and you know, you get it's it's a roller coaster. Good news, we're going forward. Oh, new CEO, bad news, we're backing up, you know. It's very frustrating that we can't seem to get the ball moving down the road when when it's a very clear answer. And many hospitals have pared down. You know, they're they're closing their psych units, they're closing their PG units, they're closing their labor and delivery units, you know. Um, but these services are still needing to be provided. Right. And this is certainly a way to fill the needs. And I love that spoken wheel model that they use in Europe. Why are we not doing it here in the United States? I know we feel like here in the US, if you do not have a you know high-level teaching tertiary care center then you're deficient right and we're holding hostage what is attainable for the ideal yeah and if you know the military does a good job of this um they do brain surgery in a tent in Afghanistan but they don't think you know the United States system healthcare system doesn't think a uh normal healthy woman could give birth outside of a hospital a labor and delivery intensive care unit which is what labor and delivery is you got titrated drugs one-on-one nursing care monitored beds what about that in an ICU but it's a woman who just wants to give birth on her own and eat a sandwich when she's hungry and drink water when she's thirsty. Okay so Leslie so just for everybody to understand really well so you have the freestanding birth centers you have birth centers which are really labor and delivery units with the name of birth centers can you just give a really good picture of what an AMU looks like um like it's it's in the hospital it's next door to the hospital tell us really what that looks like for for the patients the moms the birthing persons and for the staff like who's there it is a unit within the hospital so it can be you can because you don't have monitored beds you can utilize a space that's not necessarily um a monitored area like a um a wing of the hospital that is currently not being used a med surge or peds or whatever it was because it's not monitored beds you don't need inline oxygen you don't need inline suction you don't need any of that you just need a room yeah with a bed preferably a birthing tub um the and then you would hire the midwives ideally the midwives would take care of their own babies for that first 28 days of life just like we're trained to do and then turn them over to the primary pediatric provider of the family's choice the key to this model we know is the time and education the midwife spends with this family. So it's not ideal for every family it's not for every family you're not gonna be able to provide this for all but about 80% of families in America would qualify for this type of model. So it's going to start with the prenatal care where you're gonna have extended prenatal visits. You can do it individually you can do it in a group there's different ways of getting that done but here's a good example car seats right before a family leaves the hospital it's usually a nurse has to verify bring your car seat up to the unit right let me look at it it's not broken it's not outdated it hasn't been recalled you know etc well in the midwife amu model that would be done early in the third trimester I like a rodeo you have a a staff member nurse whoever whoever who has an interest in car seats and has their car seat certification and the partners really like this this is the part it's like oh this is my job I'm bringing you home and they show up with their cars their car seat everybody straps them into the car they're verified and checked and there's a little um snacks you know we've got some popcorn we may have a you know a food truck vendor make it fun have fun stuff for the kids uh coloring books on car seat safety and then it's done when you go to take the baby out after it's born that has been in that person's car now for weeks ready to go and it's been installed correctly and checked by a certified car seat person. You don't have time to do that in the 24 to 48 hours that that family is in the hospital. But it's a much more effective way of getting it done.

SPEAKER_02
26:24

So in essence I think Denise it's it's you and I worked at the birth center in Topeka a lot of prenatal education combined with postpartum education and awareness. So those early discharge experiences include families ready understand how to monitor the mom and baby understand the follow-up model and um highly engaged in their care highly engaged. But an AMU, I mean there's some new ones emerging I mean the one in St. Louis through Mercy has been there a while. Mercy opened another one in Oklahoma City in the last year. They're they're beginning to be talked about as Leslie and I know around the country but not necessarily accrediting them which leaves the door open to not have a truly midwife led model of care. And that's the midwifery model once again it it it it creates a crack I think Leslie do you oh yes yeah because we learned that the birth center title was never protected so anybody can call themselves a birth center.

SPEAKER_00
27:42

Anybody can call themselves alongside midwifery and it you know that that needs to be trademarked and owned um so that if you call yourself an AMU you are an AMU um the I feel like midwives and the birth center organizations and the uh CABC who credit AMUs now um need to step up and take ownership of that and our consumers need to support us the consumers need to demand if you're going to a alongside midwifery unit you or a freestanding birth center you ask are you accredited if not why not?

SPEAKER_01
28:20

So Leslie why is it that an AMU might be from a financial aspect you know more sustainable?

SPEAKER_00
28:28

Like why that versus a freestanding birth center are they at the same risk of not being sustainable and staying open so you're um still an inpatient in the hospital in the facility you're you're providing care in a hospital facility so you can bill a hospital facility fee. That's a huge difference. Hospitals hospitals are big and influential and they can negotiate payment with these payers that the small birth centers you know if you're talking 300 birth centers in the entire United States and a giant birth center does 300 births a year that's such a drop in the bucket to these big insurance companies they're not interested. So um you got the clout and the power of the hospital behind you but you also got the support. But midwives don't have to clean the rooms you know you've got janitorial services you've got food services and you have that button on the wall that you can push and you call a a a neonatal code or you call for an obstetrical code with a prolapse cord or shoulders or whatever that emergency is and your team comes running down and together you get that mom and baby into the NICU or the OR or wherever they need to be to get that done and the amount of stress that that lowers from those the midwives for the midwives yeah I'm telling you when you're practicing out there on an island by yourself and you're everything you know you're resuscitating the baby you're the pediatrician you're the janitor you fixed the broken air conditioner you cook their meal the meal you know you do everything laundry yeah you just don't want to clean a room out nobody wants to do the laundry it just piles up in the laundry room till somebody finally says we need to wash some sheets right well yeah the skill level to that so it all comes to money Denise your bill comes to money yeah you're billing for the mom and the baby both what are you what does it look like for um I mean you're in a hospital what does it look like as far as um pharmacological relief measures are we looking at more like what a birth center offers a freestanding birth center okay right if that mother baby family needs or wants pitocin or an epidural or a vacuum they get transferred to labor and delivery. Okay so you have the benefits of a birth center within a hospital setting it seems like a serious win-win it is a serious win-win on so many levels it's no we need more of those we need more in ambulatory surgery centers that are part of a hospital right they have their little wing of their ambulatory surgery center and sometimes that patient that's having their gallbladder out or whatever develops a complication or a problem they get admitted that and they can call a code to the ambulatory surgery center if needed and then they stabilize that patient and get them to the ICU get them to the steptown whatever unit they need to be on same thing as if this mother is just had an unusually hard difficult birth and she wants her birth center birth with her midwife but she's not ready to go home early. One example that I think of is we had a patient whose husband died the day before she went into labor. She needed she needed to be in the hospital in the hospital so you know we ended up transferring her and admitting her postpartum with her baby because she needed that extra support and that mom should be able to have that that choice so what is right provider right place right time. How could that work for maternity shortage areas um how could that be a solution or could it it could it because um we're we rely on telehealth but there are right now um hospitals out in rural areas who the physician running the code is on the computer okay they may not be in the same city you know um they're trained to run the code the staff but the team leader is actually on the computer now yeah you're gonna have to have you're gonna physically have to move these people some of them so instead of transferring them down the hall you're gonna have a helicopter fly in just like you did at the Amish birth center which was an hour away from a level one hospital and there's not a whole lot more level one hospital can do that the birth center couldn't do right right and several hours by by ambulance from that tertiary care center. So they had a barn in the back for the horses and a helicopter pad which is basically a field with an orange sock you know marked off for the helicopter to land it doesn't have to be super fancy so that when that mother patient baby whomever it is that needs to get to that higher level of care is going to be able to safely get there. But in the meantime you're preventing a lot of complications and problems that's the key that's let's not go down that road to complications and problems. Right, right you're recognizing it yeah yeah recognizing early so that you know you can provide the care for that higher risk person in her backyard. Let's say she is um a chronic hypertensive she can get her prenatal care with the midwife in her backyard at that rural hospital and then she's gonna have a planned induction most likely unless she goes into labor earlier right right right so she's gonna have her you know 37 to 39 week depending on how things are going induction. So she can still have that induction at that higher level hospital right but she's getting her care and you're you're co-managing she's she doesn't have to drive the three hours to where she's gonna end up delivering for every visit.

SPEAKER_02
34:50

But she's gonna go she's gonna get I'm gonna I'm gonna interject this article that we said was new news and intervention 4.1 spotlight is birth centers and community birth and rurings. Yeah it's all there Denise everything we're talking about is in this article that is so well evidence based it's the resistance to people like who who control the money TMAH and rural health transformation funds that every state got at least the rural health transformation money only the other 16 Tima states those people talk the words midwife do labur centers and have no idea what they mean no idea what they mean. So we need to move into that discussion how do we how do we get there? Well Leslie's in the middle of Tima in South Carolina we cannot get Kansas to respond to us yet and you know Tara Stroda has reached out now to the medical chief medical officer of the Department of Health I think we have a meeting coming up because nobody knows what the blank is going on and what they're supposed to be doing related to midwives birth centers and doulas well in Wisconsin I reached out and they asked if I would just be like to be put on an email of notification of what happens yeah thanks one more email of doing nothing.

SPEAKER_00
36:25

Oh sorry um I mean we talked a lot with Liz um yeah Munos about that right so Leslie just got off a call this afternoon what happened Leslie so um Tima here does have medwaves three of us um on you know we had to kind of bang on the door to get invited but we did get invited on um but they're not you looking at medwives as the solution they're looking at more um education and um using sim training and other kind of things technology but they you you you know you know let's send the team the sim wagon out to the rural hospitals and train them on um the postpartum hemorrhage bundles you know right um not a bad idea but it's not was the attended focus of that grant which was to increase access to the midwife model of care and and doulas when we bring up midwives we'll say oh we'll ask the midwives opinion we're definitely gonna we we we want to hear from them and when we send these surveys provider surveys out they'll go to the midwives too and they they're welcome to give their opinion and um so it's just basically getting brushed aside and not being used the way I feel the Tima Grant was intended to be used.

SPEAKER_02
38:02

Well you're at the table you can be a thorn in their side oh yeah you know that I am most of the most of the most of the states the midwives can't get in the door leslie um Liz Munoz just put out yesterday and I don't know if you knew about that group Leslie she's trying to get all the states who have funding for TIMA into a group every other month call if you haven't you haven't gotten that email I'm gonna send it to you leslie so you can join the next call I think I did yeah you did or didn't I did not yeah so if there are other midwives listening that are in TIMA funded states Liz Munyos from the University of Alabama is the coordinator informal coordinator of this think tank of how do we raise our voices collectively as Yuri would say build a coalition to get louder which may include screaming at the federal government.

SPEAKER_00
39:05

Yep and it's not just um midwives and midwife organizations it's our consumers yes when I had that political issue here in South Carolina it was the consumers that got the news media out yep and I you know opened the door and to the birth center one day and there's our congressman with five news cameramen you know with their cameras pointed at me and I'm hello um and I've invited you know politicians to the birth center and they don't show up until there is a crisis and people are I mean this was um around Thanksgiving and so it was Thanksgiving weekend that hundreds of our consumers showed up with their little two-year-old in pigtails saying don't take my midwife away that really got attention and um I I feel like right now is very important because you know we have women dying from childbirth we have women afraid to give birth in a hospital so we've never been in a position to be able to make these strides forwards but we really need some celebrities and consumers and people that can get the attention we'll do the talk and just get the attention for yeah I think the stories that that Yuri shares about the community the third side I think is so evident in the stories you've experienced Leslie and how the people story moves these listeners.

SPEAKER_02
40:42

And Ellen Breslin who's speaking at our conference next Thursday I've looked at her PowerPoint deck who's offering a playbook it is so thick in that the power of the human voice who's experienced the issue is the leading voice.

SPEAKER_00
41:02

The leading voice and it's this is an easy one this is a bipartisan issue. It should be you know it it's it it's an easy sell to politicians you know here I I'm in South Carolina I was talking to Lindsey Graham and Tim Scott and they they were like you are a hundred percent right how can I help you um you know and then you can Jim Clyburn's office same thing but he's more of the liberal democrat you know um because they all agree this is birth this is the future of our country yeah we we have to come together on this and it's a it's a super easy sale on both sides. Well we've had another I think we're gonna start wrapping it up another really powerful conversation about how midwives are key to the solution beyond working every day beyond the patients you see every day so let's just let's just go do do our call to action who shall we start with you Leslie what would you like the listeners to sort of resonate with or go do or take away from this conversation so I I'm assuming a lot of your listeners are primarily midwives um if you are not aware of the strong start study download it it's free read it it does apply to you regardless of where you work because it supports our model and if you want to truly be a midwife and be able to practice as a midwife and provide this care to your families you need to be able to cite that article forwards backwards and sideways so and then there are a bunch of articles I I think um you're gonna have one of my favorite researchers Diane Jollis if you just Google her yeah if you get her research article she's taken the same data that Strongstart used through the AABC's data set and done on obesity and BMI and how does that affect birth centers or midwife care. It's everything that you would want to be able to um support your argument when you want to make a change at your facility it's been done for you.

SPEAKER_01
43:32

Yep she's cited many times in the new news article as well Denise um quick one I'm gonna just be knocking on Tima's door again see if I can get back in doing more than just in just an email uh notification and I'm gonna just ask our our new affiliate president to to really spread the news and try to stir up some stuff.

SPEAKER_02
43:54

Ginger I I think you you guys should uh contact the state Medicaid office and your governor you gotta go high gotta go high I I am going to encourage people who who like this conversation about non-clinical issues sort of the business and leadership savvy to look into our conference next Thursday July 23rd um I'm not sure when we're gonna air this podcast but I will say that um there are a lot of experts outside of midwifery who are there to help us. We just don't know who they are if we're not out there um networking. So it's been great Leslie having you on we really appreciate your time and we'll have you back. Thanks for having me. Have a good day everyone

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