Sarah Foster, Midwife

01/26/2025

I recently came across a discussion among labor and delivery nurses citing ACOG practice bulletins that had been interpreted by clinicians to claim that neither peanut balls nor upright pushing are evidence-based. However, after reviewing the studies cited, it’s clear that they lack the nuanced input of experienced clinicians who truly understand labor dynamics and physiological birth.

Take the peanut ball, for example. It isn’t a magic wand to be shoved between a person’s legs to "simulate an upright position"; it’s a positional tool that requires significant skill to implement effectively. This study mistakenly treats it as a standalone intervention instead of addressing the real question: “Does targeted maternal positioning, applied by a skilled and knowledgeable provider, improve outcomes?” The tool itself is irrelevant. A stack of pillows can achieve the same effect—just with more effort and frustration, in my experience. This study doesn’t prove anything about the peanut ball—only that the researchers didn’t understand its proper use.

And that pushing study, like so many others, focuses on outcomes that don’t reflect meaningful clinical data. Upright pushing reduces episiotomies but increases second-degree tears—so what? How does it impact the overall rate of significant perineal trauma? Bleeding over 500ml (an antiquated threshold) is increased, but what about the rate of symptomatic hypovolemia or blood transfusion? Were the providers skilled in upright pushing, or were they simply uncomfortable with it? Is maternal recovery improved or worsened?

These are the questions that actually matter—yet they’re ignored.

The question has never been, “Is a peanut ball justifiable?” but rather, “Can positioning help labor outcomes when used appropriately?” Similarly, questioning upright pushing—a physiological norm that has existed for millennia—is misplaced. The more relevant question is, “Why do we continue forcing everyone into the same pushing position when evidence and experience both suggest that individualized, responsive care yields better outcomes?”

Finally, many of these studies compare interventions against "standard hospital management," which is already suboptimal for physiological birth. If the baseline is flawed, the findings are meaningless. A peanut ball placed by an obstetric nurse trained to follow rigid protocols will never achieve the same results as when used by a skilled provider in a physiologic birth environment.

Research that excludes experienced insights and fails to account for the full labor ecosystem should not dictate how we care for laboring individuals.

At the end of the day, these studies reflect a persistent problem within obstetric research—an inability to frame the right questions and an unwillingness to acknowledge the complexity of physiologic birth. Without context, applying these studies to clinical practice only perpetuates interventions that fail to serve birthing people effectively.

06/14/2024

🚑 Let's Talk About What Really Happens During Emergency Birth Transfers 🚑

I recently heard about an EMT who expressed concerns about community birth, saying, "That's a long drive during an emergency with no treatment being provided!" The comment made me sad, and highlighted a common misconception about community births, so let's clear the air! 🤔

🚨 If you don't read anything else, read this:

When a licensed midwife calls an ambulance to a birth, it isn't because she doesn't know what to do next—it's because she knows it is the best way to continue providing expert care while on the move. You can't do that in a car! 🚗➡️🚑

Here's a little more about what midwives and emergency responders do during community birth transfers:

Expertise and Training: Who Knows What? 🎓

Midwives are the undisputed experts in managing childbirth emergencies in the field. We're comprehensively trained for all birth-related aspects, from prenatal care to the postpartum period. In any emergency, we know precisely what actions to take to ensure the best outcomes for both mother and baby.

EMTs and Paramedics are incredibly skilled at general emergency response but do not specialize in obstetrics. Their training is crucial for ensuring patients are transported to the hospital swiftly and safely, covering a wide array of general emergencies. Even physicians, while highly skilled in hospital settings, typically receive training focused on managing emergencies within hospital walls, not in community settings.

Equipment: What's in Our Kits? 🧰

Midwives come equipped for the specifics of birth. We've got everything needed for fetal monitoring, neonatal resuscitation, and even special medications for rare but critical situations. Think of us as a mobile mini-birth clinic.

Emergency Responders have the essential tools for general emergency care but aren't typically stocked with the specialized gear for newborn care or specific obstetric issues. They’re the champions of safe and rapid transport.

During the Transport: Who Does What? 🚑💨

Midwives stay hands-on with care during the ride. We monitor, adjust, and manage care continuously, ensuring that both mother and baby get the specialized attention they need. We continue to administer medications, manage hemorrhages, deliver the baby or placenta, and provide newborn support and resuscitation when needed.

Our EMTs and Paramedic partners focus on making the ride smooth and swift. They handle the driving, general medical monitoring, and make sure we can do our job without any bumps—literally and figuratively! They also call ahead and let the receiving providers know what is happening and what we might need when we get there. They assist with care in important ways, like starting IVs, when needed, administering medications they carry on the ambulance, and in the nearly unheard of situation that adult CPR would be needed, they would definitely lead the team. (Thank goodness, they are much more expert at that than we are!)

Why This Teamwork Matters 🤝

This partnership isn't just about filling roles; it's about blending our expertise to ensure the best possible outcomes. While midwives handle the specifics of birth care, our emergency responder teammates make sure we get to where we need to go safely and quickly.

Understanding these roles helps us appreciate how everyone works together seamlessly to look after our community's moms and babies. Let's keep supporting and respecting all our healthcare heroes, folks! 🩺🤝👶

(*AI generated art of a midwife and EMS team caring for a newborn, because usually no one is taking pictures at transports! It did a pretty good job, though.)

06/09/2024

But Are You a Traditional Midwife?

I've noticed a lot of talk about Traditional Midwives (TMs) vs. Licensed Midwives (LMs), often from newcomers who may not know our history. Understandable. Let's clear things up.

The truth is, Oklahoma's Licensed Midwives are traditional midwives who have fought hard to maintain and expand access to safe, direct-entry midwifery in Oklahoma.

I, myself, trained and practiced as an unlicensed, traditional midwife, and our midwifery community dates back well before any licensure laws were in place. Even when there were no laws, we always held ourselves to high standards, voluntarily joining professional organizations to ensure we met rigorous criteria. By 2012, almost all practicing traditional midwives here had earned their CPM (Certified Professional Midwife) credentials voluntarily, well before they were legally required. This credential was our way of proving we meet the basic standards of safe and competent care—assuring our clients that we care enough to demonstrate our qualifications.

We know that midwifery isn't just about "being there" with heart and hands. It has always involved serious academic study and lengthy hands-on apprenticeships to develop the deep knowledge and skills needed to safeguard the well-being of mothers and children. Being a "traditional midwife" means undergoing rigorous, long-term training under experienced practitioners. It's about tradition—passing down wisdom and skills through generations, not just claiming a title.

So, yes, Licensed Midwives in Oklahoma are traditional midwives. We primarily learn and use ancient skills passed down hand-to-hand through our midwifery lineage. We also learn new skills and offer them to birthing families when appropriate. We could have easily decided our "title" would be LTM, Licensed Traditional Midwife, but we chose LM for simplification.

I hope that answers your questions! As always, feel free to inbox me with others.

06/02/2024

Scrolling through social media recently, I came across an ad for a beautiful birthing gown (https://www.wearlila.com/collections/laborwear/lila-gown). The comments section left me disheartened. Women were sharing stories of being discouraged or even prevented from wearing their gown during hospital births, highlighting a concept I've explored for years: how the medical model of maternity care, often unintentionally, chips away at a patient's power and autonomy during childbirth.

I deeply value the necessary interventions made possible by medical advancements and have immense respect for the skill and dedication of OBGYNs. However, it's crucial to acknowledge that the medical model of maternity care is rooted in outdated practices that can undermine the birther.

Standard procedures often widen the power gap between the mother and healthcare providers. Upon arrival, a healthy woman is stripped of her identity, assigned a number, dressed in a hospital gown, and tethered to the bed by monitoring devices. She is then told what she is "allowed" to do, from her diet to her movements and even the positions she may assume while pushing. This protocol, lacking in evidentiary support, systematically strips a woman of her identity, autonomy, and dignity.

Post-delivery practices can further this disempowerment. Newborns are often taken to warmers or nursery rooms with little discussion with the parents. The timing of a mother's discharge is dictated by rigid criteria rather than her needs and preferences, effectively making parents wait for "permission" to take their baby home.

Conversely, the midwifery model of care champions the mother's dignity and autonomy, reducing power imbalances. At a community birth, the mother decides what she wears, what she eats and drinks, and how she moves during labor. She is central to all decisions regarding medical interventions and directly receives her newborn, maintaining decision-making authority post-birth. The support team respects her choices without the word "allowed" ever entering the conversation.

This isn't just about where you give birth. Respecting and supporting women's natural birthing processes and their right to make informed decisions about their bodies and babies should be the foundation of all maternity care.

While progress has been made, it’s not enough. We must redesign our system to celebrate all birthing choices and truly support the empowerment of all mothers. We need to demand the midwifery model of care in all settings, increase access to midwifery care for healthy women, and continue the shift towards shared decision-making models in hospitals, ensuring mothers feel informed, respected, and in control throughout their birthing journey.

Together, we can create a maternity care system that truly honors and empowers every mother. Let’s make this change happen.

05/27/2024

Welcome, everyone! Thank you so much for making the switch!

I’m thrilled to have you join me here, where we dive deep into the world of midwifery, birth work, and holistic health care. This page is designed to foster a community of learning, support, and growth for all those interested in these vital areas.

As we continue on this journey together, you can expect regular updates, insights, and stories from the field of midwifery. Whether you are a fellow healthcare professional, a student of midwifery, or simply a friend or family member interested in learning more about midwifery and surrounding issues, there is something here for you.

Feel free to engage, ask questions, and share your own experiences. This is a place for open dialogue and mutual enrichment.

Thank you for your support and for choosing to be a part of this community. Let's make it a positive and enlightening experience for everyone involved.

With love and dedication,

Sarah ❤

Send a message to learn more

05/15/2024

Oops, I forgot to tell people to go vote for me. This is the last day to vote so it's probably too late, but you can go vote for me, for "Favorite Midwife" if you would like to.

It's time for the TulsaKids Family Favorites contest! Vote for your Family Favorites May 1-15. Winners will be announced in July.

04/08/2024

Sadly, the CPM vs CNM debate has come up, again. Specifically whether or not direct-entry midwives need a "nursing education."

I am a licensed CPM in both Oklahoma and Texas, with a master's degree in maternal-child health systems. I trained under CPMs and under CNMs, and now mentor CNMs and precept for student FNPs. Through my work in the policy and legislative arena I am considered by some to be an expert in the credentialing and integration of midwives into our health systems. All of which is only to say why I feel qualified to speak to this topic.

In most industrialized nations midwives don't get a nursing degree, because they are not nurses. Like doctors, who don't go to nursing school because they learn the skills they need in medical school, direct entry midwives don't go to nursing school because they learn the skills they need in midwifery school, including those things that overlap between midwifery and nursing.

CPMs are highly specialized with a deep but narrow scope, which they generally spend 3-5 years perfecting before credentialing. That's 3-5 years of intense focus on the precise skillset of their actual job. Admittedly, they would be lost on a peds or geriatric ward, but that isn't ever going to be part of their duties.

The CPM credential has been evaluated for completeness, and accredited, by the National Commission for Certifying Agencies (NCCA) which also accredits the Certified Nurse-Midwife credential, and the statistics show that community CPMs and CNMs have virtually identical safety profiles. Shortly put, NARM and the direct-entry midwifery educators aren't accidently forgetting to teach CPMs some vital midwifery skill or competency. We all learn from exactly the same textbooks.

We know from observation that no amount of education can fully w**d out bad providers, from any profession, but as far as making sure each applicant has demonstrated the knowledge and skillset appropriate for their job, all things look pretty equal. So, my suggestion is that we stop trying to pit one brand of midwife against another and start focusing our energy on increasing access to midwifery care. That’s what I’ll be doing.

I'm happy to answer any further inquiries through messenger.

05/09/2022

04/28/2022

11/27/2021

Obstetrics developed backwards from the other branches of medicine, preemptively applying interventions without any evidence of their safety or efficacy and now requiring that we “prove” the natural, physiological process should be left intact. Midwifery, on the other hand, holds the unaltered physiological function as ideal and embraces intervention only when there is a clear indication for it.

08/17/2021

“Real Midwives”

The idea that midwifery is a relic of the past, and that its practices should stay stranded in the past, is exhausting to me. The midwives of old practiced in “old-fashioned” ways only to our modern sensibilities. It is clear to me, from their works, that midwives throughout time have been dedicated to determining and utilizing the BEST available treatments for their communities.

Isn’t that still our job?

As new data is uncovered, and new methods are developed, isn’t it up to us to evaluate them all through the lens of midwifery - keeping normal, physiological birth in the forefront - to determine for OURSELVES what their application to our profession should be?
New techniques, drugs, and treatments are not “anti-midwifery!” Carrying every tool possible does not make one a "medwife." It does, however, show the wisdom to hope that if an appropriate technique, drug, or treatment exist for a given situation, we will have it ready.

Our forebears (at least mine) would have shaken their heads in disgust at the idea that a midwife would reject the best tools available to keep their clients safe in favor of seeming "old fashioned." I suspect they would also reject the idea that midwifery can, or should, be defined by those who literally engaged in a campaign to annihilate it (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582410/). These are just some of the reasons midwives must continue to demand the autonomy to define our profession in the way that WE choose to.

At a time when the world is changing faster than it has ever changed before, I hope we, collectively, will have the insight to hold on to the valuable relics of our beautiful tradition while also steadfastly marching into a sustainable future where midwifery is restored to the self-defining, truey autonomous profession it is meant to be.

03/04/2020

This bill is good for Oklahoma, please call and voice your support!

☎️Time to call *YOUR* Oklahoma State Senator on Wednesday morning!☎️
Senate Bill 1823 will be heard on the floor of the Senate tomorrow afternoon. When you call, please emphasize that you are THEIR constituent and you want them to vote Yes for Shepherd's Law.

Use this link to find your Senator: http://www.oklegislature.gov/FindMyLegislature.aspx

Better yet, give every Senator a call (or a least send an email) and ask them to vote Yes: http://www.oksenate.gov/Senators/Default.aspx?selectedtab=0