Maternal Wealth Podcast - Own Your Birth

Anissa Sartini: Journey as a Certified Professional Midwife and Advocate for Inclusive Maternal Care

• Stephanie Theriault • Season 1 • Episode 11

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Discover the inspiring journey of Anissa Sartini, a certified professional midwife from Texas, who navigates the world of midwifery with resilience and dedication. Despite facing challenges as a hard-of-hearing individual in a demanding field, Anissa has created a successful practice that champions inclusive care for BIPOC and LGBTQ families. In this episode, we unpack Anissa's path from education to practice, highlighting the hurdles of finding clinical apprenticeships and the importance of embracing diversity in maternal health.

Our conversation expands into the significant contributions of certified professional midwives (CPMs) and certified nurse midwives (CNMs) in improving maternal and infant outcomes, especially in home birth settings. We explore the critical distinctions between CNMs and CPMs, their training, and their legal challenges. Addressing criticisms about equitable certification, we emphasize the need for accessible education for marginalized communities. By examining how midwives handle common birth emergencies and the importance of choosing hospital care when necessary, we underline midwives' essential role in supporting varied birthing experiences.

This episode also provides a deep dive into the complexities of vaginal breech delivery, sharing stories of resilience amidst restrictive reproductive policies and personal childbirth experiences. We shed light on the emotional and physical journeys of home births, the significance of supportive midwifery care, and navigating the disparities in hospital practices. With invaluable insights on choosing the right birth path and the impact of hospital influences on outcomes, this episode is a must-listen for anyone interested in understanding the multifaceted world of maternal health and midwifery.

Do you want to reach out to Anissa personally? Find out how at
www.metroplexmidwifery.com
www.instagram.com/metroplexmidwifery
https://www.facebook.com/MetroplexMidwifery

Music Credit
https://uppbeat.io/t/danijel-zambo/azteca
https://uppbeat.io/t/fass/electric-tides
https://uppbeat.io/t/vocalista/esta-noche
https://uppbeat.io/t/corals/lanterns
https://uppbeat.io/t/jonny-boyle/sunrise-samba

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Stephanie Theriault:

Welcome to the Maternal Wealth Podcast, a space for all things related to maternal health pregnancy, birth and beyond. I'm your host, stephanie Terult. I'm a labor and delivery nurse and a mother to three beautiful boys. Each week, we dive into inspiring stories and expert insights to remind us of the power that you hold in childbirth and motherhood. We are here to explore the joys, the challenges and the complexities of maternal health. Every mother's journey is unique and every story deserves to be told. Please note that this podcast is for entertainment purposes only. It is not intended to replace professional medical advice, diagnosis or treatment. Always consult with your healthcare provider for medical guidance tailored to your specific needs. At Maternal Wealth, we aim to ensure that you have access to the best and the most appropriate care. That's why we created a maternal healthcare provider database. Maternal health providers can easily create profiles to promote their services and business, helping to increase access for those seeking their care. This is a one-of-a-kind database that offers a new and exciting way for women to search for and find maternal health providers near them and tailored to their specific needs. Profiles feature badges that highlight various services, such as TOLEC-friendly practices, all-female practices, lgbtqai plus inclusivity, language options, access to vaginal breach services and, more Additionally, be sure to check out our Not your Average Birth course. In this course, I discuss the variations that exist in hospital practices based on policies, staffing and budgets, all of which can directly affect your birth experience and outcome. Are you ready? Let's get into it Today, we welcome Anissa Sartini.

Stephanie Theriault:

They are a certified professional midwife and a licensed midwife based in Texas. Anissa earned a Bachelor of Art degree from Smith College, where they studied biology, herbalism and various topics related to midwifery practice. Since 2009, Anissa has attended over 450 births, including in the home birth center and hospital. Their experience encompasses VBAC, which is vaginal birth after cesarean, vaginal breach deliveries, induced labors, medicated labors and cesarean deliveries. Anissa is passionate about serving families in the BIPOC and LGBTQ community, working to increase access to safe and compassionate care. They live in Ivering, texas, with their partner and two children who were born at home in their bathtub. They have two cats and a flock of chickens. Anissa have both of their children through IVF. In their free time, anissa enjoys spending time with her friends and family, creating art and contributing to activist causes. Let's welcome Anissa Sartini.

Anissa Sartini:

Hello, thank you for having me here today.

Stephanie Theriault:

Thank you for being here. First I would like to start off by learning about your journey into midwifery.

Anissa Sartini:

Sure, my journey to midwifery was a little circuitous. I suppose it is for lots of folks. When I graduated high school, or was about to graduate, I was trying to figure out you know what was next for me. You know, honestly, I don't even remember how I came about learning about midwifery. It kind of came to me as this thought, like oh, I should be a midwife. And I'm like, okay, well, what does a midwife do? What does that entail? How do I become one? And so I started looking up about how one becomes a midwife and found the certified professional midwife route, the CPM route.

Anissa Sartini:

So basically, the steps that I took were to attend an academic school. It was not an accredited one, which at the time was a lot more common. Now there's an accreditation called Meek. That's becoming more common, but at the time it was not very much heard of. And so I did this schooling and sought out clinical apprenticeships and also obtained my bachelor's degree at Smith in a mostly unrelated subject, but also again, like you said in your intro, took classes about biology, mostly unrelated subject, but also again, like you said in your intro, took classes about, you know, biology, herbalism, pertinent topics that helped me out.

Anissa Sartini:

I did all that. Finding clinical apprenticeships was definitely a challenge, just because there are more hopeful midwives than there are midwives taking students. In addition to some personal challenges I'm hard of hearing, so that was an issue for some midwives that were precepting me. Just philosophical differences, like when I moved back to Texas. Being non-religious, being queer, was kind of something that had to be in the closet briefly to be even able to find that kind of placement and so eventually got through it, finished out, opened my own practice where I can be out as whoever I want to be and take care of the people I want to take care of, and that has been hugely rewarding and I think a needed voice in the community.

Stephanie Theriault:

Why is the role of a certified professional midwife so necessary in our society today?

Anissa Sartini:

There's so many good answers to that question Most of us know about. Like 99% of births in the United States take place in the hospital and the vast majority of those under the oversight of an obstetrician. And an obstetrician for those of you who don't know is actually considered a surgical specialty, which is great when we need a cesarean birth and we need a hysterectomy and we need the variousarean birth, when we need a hysterectomy, when we need the various gynecological surgeries that could be necessary in one's life. But for a normal physiological childbirth, maybe hiring a surgeon for physiological birth is not the most logical choice, right? So in many other countries, having a midwife is the default for normal, low-risk pregnancy, and those countries tend to have better outcomes for maternal and infant mortality and morbidity, while decreasing costs, increasing access. It's really a great model of care.

Anissa Sartini:

In the United States, as far as midwifery goes, there's a movement towards having more certified nurse midwives, which is a route in which you get your RN and then you go to a specialty in midwifery which is, I think, an additional year or two of training after your RN, which is also a pretty interesting route. You know CNMs certified nurse midwives can practice at home hospital birth centers, depending on the state laws. Laws by state vary quite a bit as far as what CNMs and CPMs are and are not allowed to do, and so I feel like that's kind of the more popular route to go now because CNMs tend to be covered more by insurance. They can work more in the hospital, so it's a little bit more of this like accepted route. They know what a nurse is, you know, they know they're comfortable with hospital births, things like that. So it's a really interesting route to go that way. Now a criticism of that route and why the CPM is still important I believe with CNMs typically they are under physician oversight in the hospital, so they still have to function according to the protocols of the hospital. And as far as like their training, you know it's kind of in between. It varies vastly on where you get your training. So I've met CNMs who are very comfortable with natural birth, very, you know, skilled and out of hospital, and others that are like what the heck is that? That's scary, I only want to be in the hospital with my medications and they don't really know much about herbs, positioning kind of the more physiological things that we focus on out of hospital. So there's quite a bit of a range in that.

Anissa Sartini:

So the certified professional midwife certification arose in the 70s and 80s and then didn't really gain a lot of traction maybe until the 90s and 2000s. The idea is to have kind of a little bit more of the traditional practices of a midwife, so to have that close client midwife relationship is a big part of it. To be skilled in being able to manage emergencies outside of a medical setting, whether that means with various maneuvers with mother's positioning, with herbs, with dietary changes for movement patterns for the mom, things like that and so to have that. Then the certification was developed kind of for two reasons First of all to try to show to other providers hey, this is a legitimate thing, we're not just showing up and catching babies without knowing anything and also to show that to the public.

Anissa Sartini:

Even still today it's a lot of misunderstanding about what midwives are and are not able to do so, especially by, I think, men in particular. There's a lot of like what midwives are and are not able to do so, especially by, I think, men in particular. There's a lot of like a midwife like isn't that dangerous? You know what is that and you know they don't know that. We know how to interpret lab tests and do clinical tasks and to maintain safety, while also honoring the birthing parent, while honoring the baby in a way that doesn't really happen in an industrialized hospital setting.

Anissa Sartini:

And while we talked about the CNM, there is a criticism of the CPM too, in as much as questioning whether it's an equitable certification. It's recently come out that Black midwives fail the CPM exam at higher rates than their white counterparts. There's not as much access to funding for schooling as there is with CNMs, so it can be harder for marginalized communities to become CPMs as opposed to CNMs, where you might be able to get grants to attend nursing school or scholarships, for example, and so that's been kind of an issue that's come to light more recently. That's a big topic of conversation in the community currently.

Stephanie Theriault:

I'm curious to hear as a labor and delivery nurse. A lot of the patients bring up the idea thank goodness they're in a hospital, because if there's an emergency I'm in a hospital and midwives or the doctors can handle it. Common emergencies would be like a postpartum hemorrhage or a shoulder dystocia, fetal intolerance to labor. What are the skills that you have in your hands to help women who might be presented with these emergencies in the home?

Anissa Sartini:

in who might be presented with these emergencies in the home? That's such a good question. Obviously, these things do happen in any setting that birth is happening. So whether you give birth at home, birth center, hospital, these things happen. So postpartum hemorrhage, fetal distress, surgical shoulder dystocia, etc. So we are trained to handle emergencies that can come up, the vast majority of which we can handle at home and those we can't. Crucial part of our training is knowing when we need to change plans. For example, with postpartum hemorrhage it's a pretty common obstetric emergency. Depending on state laws and physicians, that might provide standing orders for midwives.

Anissa Sartini:

Most midwives in the United States do carry anti-hemorrhagic medications like Pitocin, misoprostol. Mostly do carry things like oxygen. If there's, you know, neonatal resuscitation that requires that, then we also have training in maneuvers herbal medicines to help with that as well. Going back to hemorrhage, things like bimanual compression, uterine massage. Going back to hemorrhage, things like bimanual compression, uterine massage, using the uterine tamponade if needed. We do have methods to be able to control hemorrhage at home. For the most part. A lot of us have IV skills. Let's say shoulder dystocia next. That's where a baby's shoulders can get caught coming out of the pelvis during birth, and so one big advantage that we have in an unmedicated labor and as midwives with training to physiological birth, with freedom of movement for the person giving birth, is that the person can move, whereas in the hospital, I think, the rates are about like 90%. 80% of births have an epidural, and so there's not a lot of movement that's available.

Anissa Sartini:

If there is a shoulder dystocia, you know, guess what? The obstetrician has to go in and be the hero and kind of like, do all the maneuvering themselves, whereas for us we can say, hey, mom, you know, your baby's shoulders aren't coming, I need you to get up right now. So let's say, if they are sitting, we can get them on their hands and knees, if they're in the birth pool, we'll have them stand up, and that movement, the mobility of the pelvis, can help dislodge the baby's shoulders. So movement and knowledge of the physiological mechanisms of labor is not only a great treatment for dystocia but a great prevention. So same with, if we think about osteoposterior babies that's where you know the back of a baby's head is against the mom's back make for a harder delivery oftentimes. And so you know we're able to suggest hey, why don't we try this position? Let's try this position, and we have that power of movement to be able to help the parents get baby into a more normal labor pattern.

Anissa Sartini:

And as far as fetal distress and labor, that does happen from time to time but I would say it's honestly pretty rare in an unmedicated, low-risk population. Again, it does happen, but we're not doing Pitocin during labor which can cause fetal heart rate to be under distress. We're not using narcotic medications that can cause a low heart rate in mom or baby. It's fairly rare to see fetal distress and when we do, we know it. So we're so used to normal. We know normal like the back of our hand. So as soon as we see a baby that's even a little bit off of what we're used to, we're like, hey, I think we need to go to the hospital where there's baby can be monitored continuously. Or, hey, this baby's really in trouble and we're going to go to the hospital and get it out right now.

Anissa Sartini:

And I think a big benefit because we do hear one of the biggest questions for potential clients is well, what if there's an emergency? You know what do we do. You know what do we do you know? Again, I tell them that most of the time we're able to handle it at home and we always have two backup plans. So backup plan number one is most transports are not emergencies and I think that's a big thing people need to understand.

Anissa Sartini:

About home birth, the most common reason is first time mom that's tired and wants an epidural, for example. So not an emergency. For other things that are emergencies we go to just the closest hospital. So if we're non-emergent at least in our area we're lucky enough to have a hospital or two that are fairly midwife friendly. So we prefer to go to those hospitals If it's non-emergent. If it is an emergency, we just go to whatever is closest to the client's house, according to their needs. For example, if it's a labor and delivery emergency, we need to go to the closest hospital with an L&D unit, whereas if it's, say, a need for blood, that can happen at pretty much any hospital. If it's an emergency with a baby, we try to transport somewhere with a NICU. We always have backup plans.

Stephanie Theriault:

I like how you talk about your management of labor focuses on preventing shoulder dystocia, postpartum hemorrhage, not using the Pitocin, a healthy and stable labor course and delivery.

Anissa Sartini:

That's nice to hear thank you, and we focus on that a lot in prenatal care as well. So, whereas in the hospital, you know, I hear a lot about clients who've had past hospital births and they're like, yeah, they didn't even really tell me how serious this prenatal complication was and because they knew that they could handle it like, let's say, with anemia, so they don't do much as far as treatment other than just talking about like, okay, well, here's an iron supplement. Or you know they talk about, yeah, you should exercise, but they don't really tell you what kind of exercise you should do. What kind of daily movements should you be doing to ideally promote healthy body mechanics, to promote a good position of the baby, to make for a smoother birth.

Anissa Sartini:

We do try to do a lot of prevention in pregnancy care as well, because we know that we don't have immediate access to those things, not only wanting to set up the client for success and the kind of birth they want, or, conversely, if things don't go the way they want, they can know hey, you know what I really did, everything I could have done, and if it still didn't go that way that I wanted, you know it's not my fault. So I think that's a huge comfort to a lot of clients as well as knowing that, hey, I was really well supported. Even if they do have to transport, they know, okay, if we did everything we could, it was truly necessary, versus the trauma of questioning Like, did I really need that? Was my baby really in danger? You know, is the OB just getting impatient? So they don't have to have that questioning, which I think is a huge comfort to a lot of people.

Stephanie Theriault:

In modern day obstetrics, vaginal breech delivery is looked down upon. It's not even offered. You offer vaginal breech delivery services. How were you trained to provide this service to women?

Anissa Sartini:

Yeah, so I think I would add in there in the introduction that vaginal breach delivery in the United States is not very common.

Anissa Sartini:

Vaginal breach delivery in Europe and other countries again, where they mostly utilize midwives and the health care system is not like a for-profit liability-driven system, vaginal breach delivery is actually quite a bit more common. As far as my own personal training with breach delivery, I was lucky enough to have preceptors that viewed breach delivery as, somewhere between you know, a variation of normal and well, this isn't normal but it's still something we can support. Which is kind of the view that the organization Breach Without Borders takes is that maybe this isn't so normal, you know, only being four to five percent pregnancies at term, but it's still something that can be perfectly safe, beautiful, natural. We did have, again, I had preceptors that had that attitude of this is something that we can do, our bodies can give birth to breech babies vaginally, and so I had the training from preceptors and I still do continuing education on breech birth at regular intervals. So I take breech without borders trainings done other you know breech classes just to keep it fresh, cause you know, as a home birth midwife I have a pretty small practice.

Anissa Sartini:

It's not every day that anyone sees a breech birth, even at a busy hospital. So I think training frequently is really important to maintain safety and vaginal breech Again, mentioning hemorrhage, for example. That's something we see I don't want to say all the time but frequently enough that you're going to come across it, whereas you don't see a breech baby every day. So I think that frequent training and getting very confident and comfortable with the skills needed to maintain safety is crucial. And going back to the unmedicated thing, you know our clients don't have epidurals. They can move, and so if we have a breech baby that does need some help coming out, you know we are trained to do the maneuvers that we need to do, but we also know how positioning can help. You know being upright with breach delivery, for example, is not only a thing that can be helpful, but I consider it a safety feature to be able to have the birther participate in the process of getting them out.

Stephanie Theriault:

What is the main concern when women are presented with a breach?

Anissa Sartini:

delivery. So there are several real risks that come with breech delivery and we do talk about those, you know we call them any process of discussion, you know we refer to that as informed consent. So what that means is that we give the client the information saying, hey, these are the risks of delivering a breech baby vaginally and these are the risks of delivering any baby via C-section. So there's risks and benefits to any kind of birth you choose, but here's what they are, and so you get to make that decision for your own body, for your own baby. So the reason that a lot of providers are very afraid of vaginal breech birth is there's a risk of what's called head entrapment. So that's basically where the head can get caught in the cervix before it's fully dilated and that can be an emergency because it can cut off circulation to the baby. Cord. Prolapse is another potential emergency, which is where the umbilical cord can fall through the lap of the baby, since it's not that solid diameter of the head, and that also can, you know, cut off oxygenation, you know, and causing damage, death, to the baby. So those are the main two things that are concerned and there are other things that can happen, like fractured humerus, you know the arm bone, fractured clavicle is similar to a head down shoulder dystocia, things like that that are partially, you know, a risk of a provider. That's being really rough but can happen just with like a regular delivery as well. Studied that.

Anissa Sartini:

So the hip dysplasia happens in similar rates in both breech babies delivered by cesarean and vaginally.

Anissa Sartini:

So it's not so much about having been born vaginally, it's just about the position of having been splinted like that in utero for however long amount of time.

Anissa Sartini:

If you go back and talking again about cord prolapse, for example, it's more common with what's called an incomplete or complete breech birth. So that's where the baby is sitting with the feet kind of folded together, as if you were sitting cross-legged on the floor because the baby's got the lap that can kind of fall through. So it's more common. So it's more common. The good news is that it's less of a dire emergency than it would be with a cord prolapse, with a head down baby or even with a frank breech baby. And a frank breech baby is where the baby is sitting in utero with the legs butt down, legs up together, feet up by the head, and that's considered a safer method of breech birth, just because the it's called the bitrocanteric diameter. So that means the diameter around the booty and the thighs is bigger, more like a head. It's often about the same size or even bigger than the head diameter.

Anissa Sartini:

So, if it's a cord prolapse with a frank breach. Yes, that is dangerous, but it's also less common. It has more similar rates to a vertex, a head down delivery. Again, knowing if you're a provider that's interested in attending breach births, then knowing the difference between those rates of risk. When is this an emergency, when is this a? Hey, this is an emergency, but we've got a few minutes right. Yeah, just knowing the difference between those types of emergencies, you know when are they more likely, when are they less likely. I think that's very important.

Stephanie Theriault:

You, as a midwife, can anticipate when labor is going on the right path, and most of the time there's subtle signs, right, that, okay, something is going away. It's not dramatic that, okay, all of a sudden, like there's, we need to have a stat C-section. Generally, you can see that this is going in a way that it might mean to go to the hospital.

Anissa Sartini:

And we definitely try to not wait until it's a dire emergency. One complaint that, especially when I was first starting out, before anyone even knew what midwives were, is very unaccepted is that midwives would wait until it was a train wreck and bring them in. And now, thankfully at least in Meijer it's not so much like that.

Anissa Sartini:

know, there's more acceptance we can bring in a client earlier in labor and you would be treated with a modicum of respect at least, because one thing that ob's don't like is they hate being brought those train wrecks like why did you wait so long? Why are you showing up and all of a sudden giving us your problem? So we try not to do that. We try to, like you said, watch for those subtle signs and say hey something's not quite right here.

Anissa Sartini:

Like we do as midwives, we give report to the hospital that we're bringing the client to and saying, hey, here's what's going on, here's what I think needs to happen. What do you think? Here's the client's preferences? We'll be heading in at this time and, yes, almost always when there is a transport that needs to happen, I will have the conversation with the clients and say hey, for example, your baby's heart rate is looking a little concerning and I would like to go now, rather than waiting until your baby's really in danger and having to have this be an ambulance ride. So let's go ahead and make this happen now, before it is a dire emergency.

Stephanie Theriault:

I want to talk about maternal health care in Texas post the reversal of Roe v Wade In your practice, what changes have you seen with the patients in your care?

Anissa Sartini:

It's been really sad, it's been difficult. So, as I said earlier in the interview, I have a small practice, so you wouldn't think that I would be seeing the repercussions of this very much, but we already are. I would say the main way that I have seen this affecting folks. You know two things A if you have a fetal malformation where you're choosing to terminate because the baby's, for example, not compatible with life, then having to go jump through all these hoops, leave the state, have providers that are afraid to even tell you what to do because of the laws about anyone the wording is aiding and abetting an abortion left vague on purpose. I would recommend that you terminate or you have the option even to terminate based on health reasons, all the way up to actually performing an abortion. All of that is illegal. Now it's been really sad to have to see clients suffer not only through the loss of this wanted pregnancies again either from fetal malformation and choosing to have an abortion, either from fetal malformation and choosing to have an abortion, or clients that have miscarried and everyone's afraid to treat them, or in the process of miscarrying because well, if I do D&C, if I prescribe mesoprostol, am I going to be charged with performing an abortion. And again, in my practice I'm largely seeing clients that these are wanted pregnancies, even planned pregnancies, and so it is so tragic to see them going through this process of being refused to be treated you know, having to travel for care, being treated like they're lying by hospital staff.

Anissa Sartini:

Like I had one lady who actually didn't IUI for her on intrauterine insemination Very wanted, very planned pregnancy. She miscarried and just had the hardest time finding anyone to help her because you know she went for an ultrasound no heartbeat and they're like, well, you could just be not as far along as you thought. And she's like, no, like I know the day I got pregnant, I have the documentation, you know the baby's died and just no one would help her. So, okay, well, you can get an appointment for, you know, another two or three weeks. And she's like I don't want to sit here with my dead embryo inside me for another two or three weeks. Like I want to, you know, be able to process and move on with this situation.

Anissa Sartini:

Yeah, it's been really sad. Yeah, I mean, and you know, as midwives we don't do abortions, even though historically that's been part of midwifery care, and I do believe that CNMs we talk about nurse midwives. A lot of them, I think, can receive abortion training, at least in other states it's. I'll just say it's been difficult and sad trying to help these folks going through this already difficult process.

Stephanie Theriault:

It's hard to hear. I'm all the way up in Massachusetts so I'm in this little bubble and I know what's going on, but hearing it from somebody who's seeing it, on the front lines with your patients, it's hard to hear.

Anissa Sartini:

Yeah, Another issue that's coming up is that Texas in particular has already had pretty poor infant and maternal mortality rates for a variety of reasons Racism, poverty, lack of access to care and with these new restrictions, you know, research is showing that a lot of clinicians don't want to be here because of things like that, and new doctors don't want to move to Texas because they want to be able to provide care for their patients. They want to be able to save their lives. If they're having, for example, sepsis from a pregnancy who technically still has a heartbeat, so they have to wait until the embryo has passed before they can do anything to save this adult woman's life. And people don't want to do that, and so the scarcity of providers is getting worse. You know, as far as midwives, out-of-hospital midwifery is not covered by Medicaid. Most insurance does not cover it.

Anissa Sartini:

So even providing again like normal pregnancy care to people is hard. They call them maternity deserts. It's I don't want to be, you know, depressing, but it is, it's very depressing, and it does not look like it's going to be getting better anytime soon. There is advocacy work trying to make things better, but your maternal mortality review board was even just shut down in light of these changes. So it's kind of like, okay, look away and it's not happening. So yeah, it's uh, it's hard it's real hard.

Stephanie Theriault:

Talk about getting septic and waiting. I just can't even imagine being in the hospital and seeing somebody actively dying who does not need to be actively dying, not being able to save her what that would do to me as a person.

Anissa Sartini:

Yeah, yeah, same. I mean, I'm not a hospital provider so I'm not usually in that circumstance, but I can imagine that if I were, it's like, oh my gosh, I mean you would almost rather lose your license and let somebody die, right? Yeah, it's a terrible, you know, unfair position to put physicians in Absolutely. I mean as much like criticisms as we have of the obstetric system and everything like obviously they're there for a reason. When there's complications boy, howdy are they great, right, right reason when there's complications boy, howdy are they great, right?

Stephanie Theriault:

And so putting them in that position is completely unethical and unfair want to take a little turn and talk about something that brings me joy and I'm sure it brings you joy. I would love to hear the birth story for your two children yeah, I could talk about that all day.

Anissa Sartini:

Okay, definitely a much happier topic. So let's see, yeah, pregnancy, you can start with that, because that was certainly a journey. So I have a wife, you know. That's uh makes things a little more complicated to get pregnant. Yes, she is trans. We do have the material, so to speak, and so basically we kind of tried, you know that, home methods for a while, being a midwife, being super familiar with fertility awareness and everything, I was like, okay, you know, after you know six months or so, I'm like this is not working and it should be. So I knew when it was time, just like in pregnancy and birth, like we know when it's time to seek higher care.

Anissa Sartini:

So at that point I was like, okay, I think we need to see a fertility specialist, and sure enough found out that we both had some fertility issues Her with even before any HRT or anything had like low sperm parameters. I had low egg reserves for my age, and so there just wasn't a lot of chance of them getting together. And so you know, again, after discussing the risks and benefits with our provider, we decided to go ahead and do IVF so we would have embryos for the future. We always thought we wanted more than one child.

Anissa Sartini:

I think it helped too that our provider was a gay man, so having that cultural competence is really nice. And so, yeah, we decided to go through with the IVF process and thankfully we're successful on the first try. For those of you who are not familiar with the IVF process, you know, of course they merge the egg and sperm in vitro and then you can do testing to find out, you know, how many survive the development process, how many are normal how many are abnormal? So?

Anissa Sartini:

we were very fortunate. We had about half normal, half abnormal embryos. Thankfully I got pregnant on the first try.

Anissa Sartini:

I did have with both of my pregnancies. It's called a subchorionic hematoma, so that means basically bleeding that happens behind the site of implantation. It was a scary process, especially the first time. I mean, even knowing what I know, I know there's like a 70% survival rate of pregnancy with subchorionic hematomas, for example. But as awful as it is to say like if you've gone through fertility treatments, that pregnancy is so precious Not that every pregnancy is not, but it's not just like a okay, you can go have sex again. If you miscarry, it's like okay, there's another. You know $4,000 out the window and work so hard, plan so hard. So it's a really big emotional impact when you're scared for those pregnancies and again, big financial impact Again. Thankfully everything ended up fine. But yeah, both of my pregnancies were pretty uneventful, healthy up until the very end. With both of them I did develop some hypertension Nothing terrible Enough to where we were keeping an eye on it.

Anissa Sartini:

With my first I carried to 41 weeks and went into labor spontaneously with her. My midwife was a friend of mine who I actually had been her midwife a few years ago, so it was super, super special to get to reciprocate that relationship with her. I just love her. Yeah, I had her for my first birth. I went to 41 weeks, had done some stuff to stimulate labors I'd had a couple membrane sweeps and doing some herbs and nipple stimulation and stuff like that.

Anissa Sartini:

So anyway, morning of week 41, I went into labor very gently, peacefully, just kind of spent the day doing stuff around the house, hanging out with my wife and our cats and it was great. Took a nap, you know, woke up later on in heavier labor, had a video call with my friend. Just it was great. It was very like nonchalant and peaceful while at the same time being very sacred and sweet. You know, I had a pretty easy labor process with great support from my wife. Let's see, yeah, eventually called back my midwife in the evening when things were getting more intense. So, yeah, she came back and I was like eight or nine centimeters and I'm like woohoo, I'm about to have this baby.

Anissa Sartini:

This is great. This is not as bad as I thought it was going to be. And then pushing was really hard for me, unfortunately. So I had a really prolonged second stage, prolonged pushing stage, like five and a half hours. It was a while. Yeah, for those of you listening, a normal pushing stage for a first time mom is usually like an hour or two. Pushing stage for a first time mom is usually like an hour or two. So, having it be that long and again, knowing what I know, I'm like what the heck is going on? Like why isn't the baby coming down? Why is this taking so long? And going through the things in my head like, oh, I'm just in arrest and descent, like, oh, no, like what are we gonna do? And I mean, I've come so far. There's also may 2020, right, so right in the beginning, middle of covid there, and I'm like I don't want to go to the hospital by myself, but no, I'm staying home, I'm getting this baby out here. So I definitely had that mental resolve of yeah, I'm not changing my plans I'm gonna

Anissa Sartini:

have this baby, but also the desperation of well, what if I can't? You know why isn't this working? And so we try all the different positions water, land, everything. And eventually I remembered I have a massage therapist friend who had offered to come and labor if I needed it. So my wife was like call her. She called her and she didn't answer. And I'm like and she told me so, and I'm like call back. So she called back, massage therapist friend came and did her magic. And then all of a sudden, I felt the baby moving again and I'm like she's coming down. This is great. And so, yeah, yeah, my friend adjusted me when I was in my bathtub and I felt my baby starting to move down and then just got this great, you know, euphoric, blast of energy, like okay, we're really doing it now, and just focused all my power and got them out. I caught my own baby which was so awesome. Yeah, in my own bathtub at my own home. That was so incredible. It was just the best, most blissful experience. There's even a picture of me like smiling as they're crowning. I'm like it's great, it was so amazing.

Anissa Sartini:

Then I did hemorrhage after I gave birth. So after that prolonged pushing stage. I think my uterus was just real tired and we waited for the placenta to deliver. You know they gave me some mesoprestol and I delivered the placenta, gave the baby and the placenta to the wife and it was just, you know, pretty woozy at that point, but yet it felt safe. I knew that I was hemorrhaging, I knew that my baby was with my wife. I knew that I was in good hands, that if it got out of hand I would be taken care of. You know they were treating me in a safe, respectful manner, in a safe, respectful environment, even with there were, you know, two complications with that labor right. So an arrest and dissent and a postpartum hemorrhage. And yet it was such a positive experience. It was so empowering, it was so personal and beautiful that I think it will always be one of my favorite things I've ever done.

Stephanie Theriault:

I love that you were able to have. Even with the complications, you felt safe. You had a competent midwife who was taking care of you and, even with the complications, you were taken care of at home and everything turned out okay.

Anissa Sartini:

Thank you.

Stephanie Theriault:

Yeah, I'm curious about your friend's massage therapist. What areas did she target on your body?

Anissa Sartini:

Oh, man, she wrote it all down for me. It was so funny because I've seen her during pregnancy too. I remember you know she always explains what she does while she's doing it, because I think it's interesting, right. I remember she was doing her stuff and explaining what I was doing. I felt guilty for it because I was like, oh man, I'm usually so interested but I just can't listen right now. She did something with my back, my sacral area and, I think, lumbar spine too, and then also released something near my pubic bone. I remember her saying to my midwife too, like hey, you should feel this. And the midwife was like, wow, because she had felt the pubic bone move and that's what, you know, the baby needed for them to be able to emerge. I'll have to look it up and send it to you. I think she wrote it all down for me.

Stephanie Theriault:

Yeah, no, I'm curious.

Anissa Sartini:

Yeah, and that's another thing that like this is such a pipe dream, like this is never going to happen. But wouldn't it be so great if in labor and delivery units they had like chiropractors and massage therapists and they're starting to at least have nurses that are trained in spinning babies, so that for every arrest in labor, for every failure to progress, rather than then say, okay, well, here's some Pitocin or here's a C-section, that's basically all we got, if they had body aware workers that could help moms get through these things and imagine, like, how much less it costs to hire an LMT than an anesthesiologist. Right, I think it'd be so amazing. But maybe in the future, Maybe in the future.

Stephanie Theriault:

I think the more women learn about these types of services and how it can be beneficial to them in preventing a C-section in the hospital. Women have the voice and collectively they can make change. That's one of the great things about this podcast is to give this kind of information to women before they get into the hospital, so they have resources and they can advocate for themselves.

Anissa Sartini:

Yes, I sure hope so. Yeah, and if you want to, I can tell a little bit of my second birth story.

Stephanie Theriault:

Yeah, no, we're good. I would love to hear it.

Anissa Sartini:

Okay, as most folks, my second birth was a lot quicker and easier than my first Pretty textbook. I mentioned that I had started to develop some hypertension at the very end of both pregnancies and with the second one, you know, I was like I think I'm ready for this to happen. She was, there were 40 weeks on the due date and so I decided to contact my nurse midwife friend and I was like, can you do a balloon catheter on me? And she's like, sure, come on in. So I went to see her and she gave me the cook's catheter and I had done the castor oil burrito in the morning and so when I left from the balloon induction appointment, I started having contractions like every 10 minutes. I'm like, okay, cool. And I was driving home thinking, okay, I hope it doesn't get too much stronger while I'm driving, and thankfully made it back home just fine and dropped into the most beautiful labor Again.

Anissa Sartini:

My midwife was different this time, just because my old midwife had moved. So my midwife this time was actually a former student of mine who had graduated and that was awesome to really see her performing in her prime and knowing I was with someone that practiced similarly the way I do, I was just so full of pride to have her there, so full of joy to have her be my midwife and, yeah, I basically had a really sweet six hour from start to finish, four hours of active labor. It went pretty fast. At some point I did ask to be checked. I was feeling, you know, more pressure and they told me that I had a swollen cervix. And I'm like, no, because we all know that swollen cervixes can sometimes take quite a while to resolve. You know, again I was feeling a lot of pressure. So I'm like, oh my gosh, like I will say, I went into a lot more despair than I think I did with my first labor, even with the arrest and descent, but there was probably like 40 minutes there, according to the chart, you know.

Anissa Sartini:

Of course, it feels like forever where I'm sitting there, like cause it went from this, like you know, bliss, like unity with the universe, like I'm totally in my rhythm, to like, oh my gosh, if I, maybe, how am I going to have this baby? I wish I were dead, but maybe I haven't had the baby by 11 PM I'm going to get an epidural, like all these. You know. You know the irrational thoughts that come in transition and my midwife talked me through it. She's like you're okay, like just wait it out a little bit, you're going to be all right, your baby's fine, you know you're strong, blah, blah, blah and all the things that we say to each other. And so, yeah, I waited it out for again. It felt like forever but turned out it was only like 40 minutes.

Anissa Sartini:

Then at some point I'm like, okay, I gotta do something, like something needs to give, and I don't even remember this. But apparently I asked for another cervical check and she was like, oh well, now you've just got like a little lip and she tried moving it back for me. Then I was like not having it and so I just did it myself. So I just reached in and, you know, grabbed what was left of my cervix and pulled it over my baby's head for a few contractions and then it was gone. Yeah, I was like pushing her beautifully, super strongly, and I definitely did not breathe my baby out, but yeah, it was super strong. And I even had this like image in my head as I was pushing of, like you know, like the old, like Williams of Stetrix textbooks that show like these illustrations in black and white of the cardinal movements of labor. So I'm like picturing them in my head as they're happening. Yeah, then same thing Like she was born in the same bathtub as big sister and I caught the baby and one thing that was different about the second one I pushed, got the head out and I had I wouldn't say a shoulder dystocia, but a little bit of sticky shoulders. So the head came out. I knew to wait a minute. So I waited a minute, felt the urge to push again, push some more. And I was like, hmm, why isn't the baby restituted? Where's my external more? And I was like, hmm, why isn't the baby restituted? Where's my external rotation? And I'm like noticing this and I'm like she's not coming, like get her out, get her out. Things that again, things that people say. And, um, my midwife, it's like you know, can you stand up Like let's, let's get this baby out? And I was like, no, just get her out. And so I knew my midwife had the skills to maneuver the baby out. You know, I talked so much about movement but wouldn't do it when it was my turn.

Anissa Sartini:

For me, that was part of my like emotional process, was like being able to let go and let someone else help me, let someone else I don't want to say be in control, but again, just to help, to feel protected for that moment. And yeah, the midwife reached in and maneuvered the shoulder and the baby was born just fine. Again, I helped, kath brought the baby to my chest and it was super blissful and empowering and great Again, even if there's a slight blip in the process. Yeah, it was wonderful and I did have a bit of a hemorrhage again, but I handled it better than the first one. It wasn't as dramatic because I had asked for what's called active management with this one. So active management means that you get a preventative shot of Pitocin to prevent excessive bleeding after birth.

Anissa Sartini:

So I had asked for that, got that this time and, yeah, they were both super empowering, super sacred, beautiful experiences. They were both super empowering, super sacred, beautiful experiences. I really wish that everyone could have births like that. Maybe they weren't perfect, but they were perfect for me. You know, in retrospect Again, I felt protected, honored, seen and safe. They were beautiful. I wish that everyone could have births like that.

Stephanie Theriault:

Did you have any tearing during your deliveries?

Anissa Sartini:

My first one no, no tearing whatsoever. Somehow I was very, very patient and I felt what words were allowed to say on podcasts. I was like, oh my God, my clit's burning my clit. And like that midwife brain, I'm like, okay, I better push really slowly because those periclitoral and periureus tears are real hard to heal, so you better go slow. So I went like really slow and patient and like delivered her head really smoothly and yeah, no tearing. The first one. The second one I wasn't quite as patient and so I did have a teeny, teeny little, like tiny little mucosal tear.

Stephanie Theriault:

Okay.

Anissa Sartini:

I think I asked for just a tiny little like tiny, like labial scrape type of thing. So had, uh, some surgical glue on the labial tears and, um, then the little vaginal mucosal one. It was so small that we didn't really do much with it and in retrospect I kind of wish we did, but also I think I wasn't patient enough. Healing, because I think it mostly healed. And then, to honest, trying to have sex with a different male partner, like six weeks postpartum, it like opened up again and gave me some trouble for a few months. So that was not the best.

Stephanie Theriault:

Final question what advice would you give to women who are interested in learning more about having a home birth? I would say learn about all your options.

Anissa Sartini:

So, depending on what area you live in, you know you may or may not have a lot of providers to choose from, like in my area, in the Dallas-Fort Worth area God, it's probably over a hundred midwives. There's so many people to choose from. So, you know, don't interview all a hundred. You know, read people's websites, see who you resonate the most with and schedule some interviews. Interviews you know you don't have to hire the first person you talk to unless you just see the one their website just speaks to you. Yeah, like, see what your options are. So find someone who's you know culturally, personally, a good fit for you. Find someone who practices the way that you would want to be treated. So that means different things for different people. Like, for example, me. I wanted somebody who would be willing to push the limits a little bit if there was an unusual situation, if I had a breech birth, if I had with my hypertension. I wanted someone who would be comfortable trying to like treat that naturally then safe limits, and not just immediately transfer me, whereas other people might want to feel more anxious, might be like, hey, I want to be sent to the hospital at the first sign of something going weird. So finding a provider that's going to honor your preferences for treatment, what are reasons that you might transport for would be a good question to ask. And what risks me out would be a good question to ask.

Anissa Sartini:

For a lot of people, you know, these pregnancies are unplanned. Maybe, or maybe you planned it, but all of a sudden there's like all these options. It's like I don't know what I want with all these things. So I think taking a childbirth class is really great. Having a doula is great if you can, but, you know, financially sometimes it's hard to have both a home birth midwife and a doula.

Anissa Sartini:

But yeah, finding someone who really resonates with what you want, how you want to be treated as a person. Even you know we were talking about, like abortion and things like that. I've had a lot of people who specifically do hire me because, if that became necessary, I want a provider who's not going to judge me for that if it comes down to, you know, saving my life or it comes down to having a child, that's not compatible with life and supporting their choice to have an abortion. So, finding someone whose values are the same as yours or, conversely, you know, if there's some people who, let's say, are very religious and don't want that to be part of their care, who want prayer or things like that to be part of their care, and that's fine too. So try to find a provider who can do that for you. Yeah, there's so many options. Yeah, knowing how you would like to be treated as a person and as a patient.

Stephanie Theriault:

Thank you so much for taking time out of your busy schedule, leaving your little newborn to come and chat with us. Thanks for being open and honest with us and, lastly, I want to thank you for doing what you do in creating a safe space for women to come to you and seek reproductive care and maternal health in the way that they see fit for themselves and giving them autonomy over their bodies. So thank you for doing what you do.

Anissa Sartini:

Yes, you're very welcome. It's an honor to be invited into their spaces and to be trusted with someone's care in the perinatal space. So yeah it really is. It's lovely to be able to provide a safe feeling for people that might not feel safe in a standard hospital setting, so it's really an honor.

Stephanie Theriault:

Absolutely. Keep doing what you're doing. We need it.

Anissa Sartini:

Oh yeah, I wanted neither here nor there but one more fun detail about my second verse.

Anissa Sartini:

It was on Leap Day. That's awesome, yeah, so I had this really magical experience on to get my little leap link. Yeah, that's so cool. I love it. Thank you so much for having me here today and I hope that this has been educational for anybody listening and I hope that it inspires you to find the practice and method of birthing that is right for you, whether that be home, birth center, hospital, but someone that you just love, that loves you and cares for you.

Stephanie Theriault:

And if you're interested in learning more about Anissa Sartini, I'll have a link to their website. So if you want to reach out to them directly, you'll be able to do that.

Anissa Sartini:

Thank you. Yes, we're with Metroplex Midwifery, so you can find us MetroplexMidwiferycom or Metroplex Midwifery on Instagram or Facebook. People keep telling me I need to get a TikTok, so I guess I need to, because that's what the kids are into these days.

Stephanie Theriault:

You know they're going to have babies too, so that's right, all right. Well, thank you so much. We'll be in touch.

Anissa Sartini:

All right, you bet have a good one on.

Stephanie Theriault:

At Maternal Wealth, we aim to ensure that you have access to the best and the most appropriate care. That's why we created a maternal healthcare provider database. Maternal health providers can easily create profiles to promote their services and business, helping to increase access for those seeking their care. This is a one-of-a-kind database that offers a new and exciting way for women to search for and find maternal health providers near them and tailored to their specific needs. Profiles feature badges that highlight various services, such as TOLEC-friendly practices, all-female practices, lgbtqai plus inclusivity, language options, access to vaginal breach services and more.

Stephanie Theriault:

Additionally, be sure to check out our Not your Average Birth course. In this course, I discuss the variations that exist in hospital practices based on policies, staffing and budgets, all of which can directly affect your birth experience and outcome. Please follow us on our social media platforms at maternal underscore wealth on Instagram and maternal wealth on Facebook. Visit our website at wwwmaternalwealthcom to sign up as a maternal wealth provider or search for maternal wealth providers near you. Lastly, check out our birth course, where I discuss how hospital staffing, policies and access to medication can affect your birth experience and outcome. Stay strong, stay empowered and remember you got this, thank you.