This is the fifth post in a series of blog posts based on interviews I’m doing with midwives who serve Utah County and the surrounding areas.
Today, I’m honored to introduce you to Katia L’Ecuyer. Katia owns Innate Midwifery with birth centers in Holladay and West Jordan, UT. She also attends home births in Salt Lake County and north Utah County. She is a Certified Professional Midwife (CPM), a Licensed Direct Entry Midwife (LDEM), and a graduate of Midwives College of Utah. She also holds a bachelor’s degree in biology with a minor in chemistry from Utah Valley University. As a midwife for over 10 years, she has attended over 500 births in both Utah and Costa Rica. Katia is also a midwifery preceptor and enjoys mentoring student midwives.
During her time at UVU, Katia was the recipient of the Board of Trustees Scholarship in recognition of the research she has conducted on Group B Streptococcus during pregnancy. Even though she has graduated, she continues her research on Group B Strep with the aim of learning more about whether probiotics can be effective in preventing Group B Strep during pregnancy.
Group B Strep (GBS) is a type of bacteria that lives in the intestines and can sometimes travel to the rectum, vagina, and urinary tract. Because this carries a possibility of leading to infection in the newborn baby if a mother has Group B Strep in her vagina at the time of birth, pregnant women are routinely tested near the end of their pregnancy to determine whether they are currently colonized by Group B Strep. Those who are, are termed “GBS positive,” and (in the U.S.), care providers typically recommend that they be given IV antibiotics during labor to kill the bacteria and prevent it from spreading to the baby during birth and possibly causing an infection. To learn more about the evidence on Group B Strep and its significance in pregnancy and birth, check out this article by Evidence Based Birth.
Katia’s research on Group B Strep stems from a 2016 study conducted by Ho et al. In this study, researchers divided 110 GBS positive women in weeks 35-37 of pregnancy into two groups. To one group, they gave two placebo pills to be taken each night at bedtime. To the other group, they gave two probiotic pills (containing the probiotic strains L. rhamnosus GR-1 and L. reuteri RC-14) to swallow every night. They hypothesized that perhaps taking oral probiotics, which colonize the gut with “good” bacteria, would get rid of “bad” bacteria, like GBS.
When these women gave birth about three weeks later, 43% of the women who had taken the probiotics were then GBS negative, whereas only 14% of the women in the placebo group were GBS negative at the time of birth. These results were significant enough for the researchers to conclude that taking L. rhamnosus GR-1 and L. reuteri RC-14 oral probiotics during pregnancy is helpful to reduce GBS colonization in pregnancy.
This study was significant enough to attract the attention of researchers—like Katia—to dig deeper and get a better idea of what was going on with the use of probiotics to prevent or treat GBS, and whether the results could be generalized for all pregnant women. Subsequent researchers found, however, that the results of the 2016 Ho et al. study can’t be generalized to all populations. For instance, when researchers at Stanford University attempted to replicate the study, they did not find the same results.
There are several shortcomings with the study that Katia is digging into and trying to overcome in her research. For instance, we know that it typically takes 30-60 days for oral probiotics to colonize the vaginal and rectal mucosa, but in the Ho et al. study, participants took the probiotics for just three weeks on average. Katia wonders if that oversight may be one reason the results haven’t been replicable.
We also know that our gut microbiome is very influenced by our diet and lifestyle. Since the Ho et al. studied was conducted in Taiwan, it makes sense that its results may not be generalizable to pregnant women in the U.S., who have a very different diet and lifestyle. Katia’s goal is to further investigate these dietary and lifestyle differences and how they play out in the different bacteria that colonize our bodies during pregnancy, and which specific strains of probiotics would then prove most effective in preventing Group B Strep colonization during pregnancy.
Research in these fields is time-intensive and not for the impatient. As Katia continues to chip away at cracking the GBS code, she spends daily energy to ensure that her midwifery clients are educated and informed decision-makers. On every topic, with every recommendation she offers, Katia makes sure to give her clients lots of information and point them in the direction of more.
“I have informed consent for everything,” Katia says. “I think it’s a big piece of why people choose midwifery care, is to not be dictated what to do, but to feel like they have a say in their care.”
When emergencies come up and long conversation about the pros and cons of a choice aren’t possible, Katia relies on the relationship of trust she has built up with her clients throughout pregnancy. She’ll have as thorough a conversation with her clients as the situation allows. If a client’s birth isn’t going exactly as they’d hoped and they’re needing to make decisions they didn’t want to make to ensure the safety and health of themselves or their baby, giving them a chance to talk about it as much as possible makes a big difference. “The outcome, we can’t change. But how we feel about the outcome…” Katia believes that these conversations can make a big difference in those feelings. “Those conversations are really meaningful, because it does make the women feel like they were part of the decision-making process.”
From my conversation with Katia, I could easily sense her expertise as a midwife and her trust in her clients to be the decision-makers in their pregnancy and birth journey. Whether she’s guiding her clients through the process of making a decision or continuing to research Group B Strep, Katia is thorough, professional, and compassionate in her work.
This is the fourth post in a series of blog posts based on interviews I’m doing with midwives who serve Utah County.
This week, I’m spotlighting Seasons Warner (CPM, LDEM), owner of Four Seasons Midwifery. Seasons has been practicing as a midwife since 2014 and attends home births in the greater Utah County area (especially south of Utah county, extending into Juab, San Pete, and Sevier counties). Fun fact: if you see a car with a Utah license plate the reads MIDWIFE, you’re tailgating Seasons. So give her some space if it seems like she’s in a hurry to get to a birth!
Alongside Melissa Chappell, Seasons also co-owns Utah Birth Suites: a beautiful birth center with locations in Orem and Provo. Both locations are beautifully and thoughtfully designed to give expectant families a feeling of homey comfort with all of the medical tools needed for pregnancy visits and birth. They’re also just minutes from local hospitals, in case a transfer of care is needed.
I spoke with Seasons about the postpartum care she gives her clients. In the US medical model of maternity care, new mothers are typically discharged from the hospital 48 hours after giving birth and then not seen by their care provider until six weeks postpartum. This large gap in care, which comes after weekly prenatal visits at the end of the third trimester, can feel jarring and isolating to new parents who are physically recovering from giving birth and adjusting to caring for a (very sweet and cuddly but very needy!) newborn. Midwives, like Seasons, work to make sure that their clients continue to be monitored and well-cared for in the hours, days, and weeks shortly after birth.
After Seasons’ clients give birth, she closely monitors them and their babies for a few hours to ensure that baby is eating and there are no pressing medical needs. Then, she packs up and leaves them to settle in as a family (if the birth was at home) or sends them on their way home (if they birthed at one of the Utah Birth Suites locations). Within 24-48 hours after the birth, Seasons visits her clients in their home (whether they birthed at home or at the birth center).
Seasons again checks in with her clients via text every couple of days during the first two weeks after birth, and then they come to the birth center for appointments at two, four, and six weeks postpartum. This way, she’s regularly in touch with her clients as they recover from birth, and she’s able to offer ongoing newborn screenings and care. As a midwife, Seasons is licensed to offer well-baby care during the first six weeks of life. If any needs arise for mom or baby in the weeks after birth, Seasons is able to spot the need and care for it—or make recommendations for further care—before it becomes a larger issue.
At her postpartum visits, Seasons offers standard postpartum care. She checks in on how breastfeeding and sleeping are going, bathroom needs, stitches and perineal healing, and cracked or sore nipples. She notes baby’s weight and growth, umbilical cord stump, and does a heart and lung check-up. She provides newborn metabolic screening (PKU) tests. After her check-ups, she’ll refer her clients to other medical care providers if anything looks abnormal.
Another important service Seasons offers is repeated mental health screenings. Seasons asks her clients about how they’re feeling, who’s in their support system, and what their daily habits are. (Are they getting enough to eat and drink? Are they getting dressed, able to do some daily activities, and feeling like themselves?) This sort of screening is especially important at the four- and six-week postpartum visits, when lingering emotional or mental health concerns are an indication that her clients are in need of further care from a mental health professional.
Throughout the days and weeks after birth, Seasons is always available through text or phone call if her clients have questions or needs along the way. She’s also well-connected with a local network of lactation consultants, pelvic floor physical therapists, chiropractors, pediatricians, obstetricians, mental health providers, and other specialists. Utah County has a village of postpartum care specialists, and Seasons connects her clients with the village when they have a specific need!
As we concluded our conversation, Seasons reflected, “I think the thing that sets midwifery apart, really, in the postpartum period—not even just the frequency of our visits—is just the level of intimacy and care that you have with a midwife.” Those who are able to have this sort of connection and care with Seasons certainly count themselves blessed.
This is the third post in a series of blog posts based on interviews I’m doing with midwives who serve Utah County.
For this post, I was honored to interview Amber Adams (DEM) and Teryl Stay (CPM, LDEM), who attend home births in northern Utah County and southern Salt Lake county. Together with student midwife Kirsten, Amber and Teryl are Birth Mind Body, midwifery care that “brings back the village” to care for new parents. Both Amber and Teryl attend all prenatal visits and births together and work as a team.
Teryl and Amber each became midwives after first working as doulas. I loved talking with them about their journeys to midwifery, as my goal is to become a midwife as well! (I’m hoping to attend Vanderbilt’s CNM program. Fingers crossed!) Teryl became a doula at a friend’s suggestion and fell in love with community birth. She started attending Midwives College of Utah when her then-youngest child started kindergarten. For Amber, a series of random events led her to choosing midwifery care for her own first pregnancy and learning more about pregnancy and birth. After three people separately told her that she ought to be a midwife, Amber accepted the call to midwifery and also enrolled at Midwives College of Utah. Both Teryl and Amber had a baby (or two) while in midwifery school, and have personally experienced a range of birth experiences. They agree that the variety among their own births is an invaluable resource they drawn on as they support their clients. “I really believe that every midwifery journey gives you a different perspective to be able to help a client down the road,” Amber reflects.
The main topic I chatted with Teryl and Amber about was how they support their clients through decision-making. Throughout the conversation, they both emphasized that they view their relationship with their clients as a partnership, and that they expect their clients to be involved, active participants in their care.
Whenever their clients are making choices, their role is to teach their clients about benefits and risks of each of their options and respect their informed decisions as they move forward. Anytime screenings, tests, or interventions (such as glucose screening, Strep B testing, etc.) are offered, they provide an informed decision-making document with information about the possible benefits and risks of each option. Together with their clients, they talk through all of the information on the document and offer the chance to discuss any further questions they may have. The document also points them towards other resources they can consult as they make their own informed decisions.
“A lot of it is based on trust,” Amber says. It’s important that their clients trust their midwives to give them the information they need to make decisions about their care, and that they trust themselves enough to confidently make decisions.
Of course, there are times when, as medical care providers, Amber and Teryl sometimes need to hold firm on certain guidelines. They insist that all clients have an ultrasound to determine the placenta’s location during pregnancy, as placenta previa (when the placenta covers the cervix) is a serious complication that needs a higher level of care.
If other complications arise during birth, trust is again key. Teryl explains, “It’s also so important to talk about this prenatally, and even during the interview, that these things can come up… We want to make sure that you have enough trust in us that if we’re telling you, ‘you need to go to the hospital; there’s a higher level of care needed,’ that they will trust us.”
With this relationship of trust, Amber and Teryl strive to honor their client’s autonomy and provide safe, quality care throughout pregnancy, birth, and postpartum.
This is the second post in a series of blog posts based on interviews I’m doing with midwives who serve Utah County.
Today's interview is with Richelle Jolley. Richelle has been a Certified Professional Midwife for 20 years and is one of the few midwives experienced in breech and twin birth deliveries. She lives in Springville, Utah and attends home births in Utah County as well as Salt Lake and San Pete counties. Richelle is passionate about the work she does to strengthen women and families. She is uniquely positioned to do a very specific and powerful work with her clients. Let me introduce you to her!
For Richelle, it’s impossible to separate her work as a midwife from her spirituality. She became a midwife after a very clear spiritual call from a dream, and has never looked back! “I do this work with the intention to glorify God,” Richelle confidently states. From the moment of her call to midwifery, she felt “an unstoppable drive and desire to get myself educated so that I could do what I knew I was meant to do.” Richelle did just that and has now been serving growing families for over 20 years.
And throughout those 20 years, Richelle has found an ever-strengthening connection with Deity. She reflects, “I have been graced with the priceless gift of experiencing opportunity after opportunity to choose faith, trust, hope, inspiration and courage, resulting in amazing triumph and growth for me and my clients.”
Richelle sees herself as far more than a medical care provider for her clients, though she is certainly that. As I heard her speak about her clients, I sensed the great love and respect that she has for each of them and the honor she finds in being their guide through pregnancy and early parenthood. As she is guided by her faith in her work, she also invites and supports her clients to do the same throughout their pregnancy and birth experience. She calls on her clients to cultivate and follow their inner voice. “Whenever there may be fears or concerns that come up I get to call a mother back to her heart, reminding her of the witnesses of Truth she has felt regarding her baby, her pregnancy, her health or her birth.”
Richelle points out that pregnancy is an ideal time for personal growth and development. As there is literal life growing and developing within the woman’s body, there is an inherent energy of growth that is encouraging personal development within the woman herself. So, Richelle says, preparing for a baby is the perfect time to clear issues and overcome obstacles that may be holding the mother-to-be back: fears, traumas, false beliefs, etc. “This inherent energy of growth within is all a part of the natural preparation for parenthood” Richelle says, “it is a kind-of house cleaning and strengthening preparation for entering into parenthood with greater clarity, connection and confidence.”
Acknowledging that there is a process in preparing to give birth, Richelle notes, “It’s not like, ‘Oh here we are at birth, and suddenly, we’re going to have a great experience’. There’s a lot of preparation that goes into that.” Recognizing that birth offers challenge, Richelle invites her clients to take the time they need to prepare for the experience, to ask themselves, “Who do I want on my team?”, “What experience do I want to have?”, “What kind of personal growth do I want to gain from this experience?” Finding and creating the answers to these questions through pregnancy and birth becomes a journey for the woman. Throughout the process, Richelle holds space for each client and honors her unique, individual journey. Sometimes there are plateaus or lulls during the birthing time, and rather than trying to force anything or intervene, Richelle holds space and waits and watches until her client comes to a place herself where she finds the motivation to ask the questions and do the work to create progress in her birth journey. If needed, she’ll ask clients questions along the way that offer opportunities for self-reflection. Often these questions invite the mother to work through whatever may be holding her back.
Richelle firmly believes that this pregnancy and birth journey is perfectly designed to prepare for parenthood. “I love seeing the potential for bringing the couple together and strengthening their bond,” she says. She speaks of observing husbands developing admiration for their wives as they witness them in their powerful maternal expression. And she watches as a birthing woman’s trust in her husband is deepened as he is emotionally present for her. They face the challenge and go through the process together, and “come out on the other side feeling this sense of strength and capability that they take into parenthood.”
Speaking of the woman in particular, Richelle is inspired by the way that pregnancy and birth prepare a woman for motherhood. She says, “hopefully a woman can look back on her birth experience and know that she can do anything for her baby as she raises that child, because she just did it! She knows she can take on any possible challenge encountered in raising her child for whom she just explored the depths of her soul to give birth to.”
Richelle’s greatest fulfillment in her work is to see the growth and strength of character acquired by her clients. She relishes in the conversations she gets to have at their final appointments, as a client may share with her about everything she’s learned and how she’s grown through their time together. As one of her clients once expressed, “You believed in me and fought for me and helped me find the strength inside myself. I am a better mother because of some of the things you taught me, but mostly because of observing you and the way you interact with care for people. I have thought of your courage and fortitude to do things differently and it has helped me be brave when I am afraid.”
This is the first in a series of blog posts based on interviews I’m doing with midwives who serve Utah County.
Today's interview is with Roxanna Maurer of Angel Baby Midwifery. Roxanna has been a midwife since she graduated from Utah School of Midwifery in 1998! She lives in Payson, Utah and attends home births in Utah County. Roxanna is a warm, loving, beautiful person—I hope this post captures some of that for you!
Last month, I chatted with Roxanna as she took a break in the shade from landscaping her backyard. She already has a thriving garden, and is expanding it with fruit trees and other plants. She shared her wisdom about the importance of good nutrition during pregnancy.
When Roxanna takes on new clients, one of the questions she asks them is, Are you willing to take responsibility for yourself and your baby? Roxanna says, “I can talk to you till I'm blue in the face. But it's pointless if you go home and don't do anything about it.” This is especially important to Roxanna and her clients since all of her clients give birth at home. “Part of having home birth means I'm willing to take responsibility for myself,” she says. “That means you prepare for the marathon of birth.” And if you’re preparing for a marathon, you can’t be stocking up on candy bars and Diet Coke. Nutrition is critical.
So Roxanna shares a handy acronym to help her clients remember the critical nutrition components they need every day. The acronym was developed by her good friend and fellow midwife, Nikki Sasser. She says, “if you want to be a birthing queen, you need a WHOPPER every day.” And let me tell you, Nikki and Roxanna do not mean one from Burger King! (It’s also great advice for outside of pregnancy!)
W stands for whole grains. Roxanna’s disclaimer about whole grains? “I don't mean General Mills cereal that says whole grain on it because let's just be honest… it's not.” For those who are able to eat grains, she suggests oats, quinoa, millet, and brown rice as some delicious, nutritious options.
H stands for hydrate. Roxanna recommends drinking half of your weight in ounces of water. So if you weigh 160 pounds, drink 80 ounces of water every day. Coconut water is also a great source of natural electrolytes—like Gatorade, but “with all the good stuff and none of the junk.”
O is for omegas. Roxanna uses the acronym BACON to remember sources of healthy fat and omegas. Butter, Avocado, Coconut, Olive oil, and Nuts.
P stands for proteins. As your blood volume increases during pregnancy, it’s important to have adequate amounts of protein. Iron and B vitamins are also critical in promoting healthy blood quality during pregnancy and having the necessary stamina for labor, birth, and early parenting, Roxanna says. (Vegans or vegetarians may need to take a B-vitamin supplement, as B-vitamins are typically found in animal products.) What sources does Roxanna recommend for protein? Beef, chicken, fish, eggs, lentils, beans and rice, nuts and seeds, protein powder drinks.”Those are a variety of ways of getting proteins in your diet.”
The second P in the WHOPPER acronym is probiotics. Probiotics “colonize the gut and break down the food.” Roxanna recommends Standard Process’s Lactic Acid Yeast as a probiotic supplement.
E stands for enzymes. Probiotics help break down the food, and enzymes continue the process. “That's the purpose of enzymes, to help you digest your food effectively,” Roxanna says. A healthy diet only does you good if your body is able to adequately digest it! Multizyme from Standard Process and TerraZyme from doTerra are options for enzyme supplements.
Lastly, the R in WHOPPER stands for the Rainbow. Eating a rainbow of healthy foods invites lots of beneficial vitamins and minerals into your diet. Go through the rainbow, and try to incorporate foods of every color. Red berries and cherries or beets, orange pumpkin, yellow squash, green salads or smoothies, blueberries, and purple plums or grapes… you get the idea!
And there you have it! Roxanna’s WHOPPER for birthing queens! Changing habits and sticking to a healthy diet can feel overwhelming, but you can do it! Check out my Top 5 Tips for Healthy Eating During Pregnancy. And to encourage yourself, here’s Roxanna’s tip: “Take a picture of success that you've had in your life and hang it in your mind.” Keep going back to that success in your thoughts; refer back to it. As you recognize other successes you’re having, “bring that into your success gallery, and refer to that. I was strong here. I can be strong here. And if I'm strong here, what else can I do?”
Hi, I'm Sara. I'm a birth + postpartum doula serving Utah county. I'm a twin mom (plus one!), natural VBACer, and birth lover!