What you should know about midwifery in Texas: An Introduction

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3AM. My cell phone rang. “Coll, it’s time” was all I recalled hearing as I rolled my body out of the bed. My heart was pounding. Was it the hellish August heat or the fear of the unknown? I pushed my thoughts aside as I pulled on black scrub pants and a shirt that read “Meconium Happens.” I tipped toed down the hall, passed my children’s rooms and grabbed my keys off the hook by the door. I paused. “Watch, phone, keys… Come on, Baby.” I headed to my car. 3 minutes flat from roll to engine start. Damn, I’m getting good at this.

The growing need for midwifery

Texas is one of the greatest States to practice out of hospital midwifery in the US. From the flexibility of training, the resources available to midwives such as the option of standing orders and continuing education options, Texas struts. But with all its flair, Texas has some of the worst outcomes for birthing mothers and babies, with black women twice as likely to die in childbirth. Nationwide, planned home births have increased 56% since 2016. Midwives are in high demand as women across the country are becoming more informed, empowered, and educated on their options and returning to the roots of women lead maternity care. And it is changing the country.

The growing needs of midwifery

It’s not surprising that since the pandemic, there is a general lack of trust in hospital care and dissatisfaction in our medical system. More families desire autonomy, safety and responsibility for their health care and thus more women are seeking midwifery services. The total number of Texas midwives is on the rise, but not quite fast enough for the increasing demand for out-of-hospital care. And with rural areas of the State still lacking even basic OB/GYN options, the pressure is on. 46% of counties in Texas are defined as maternity care deserts with women driving more than an hour to the nearest birthing hospital. East Texas is not immune to this statistic with many women having to drive greater distances to find general health care. The distance increases for those seeking a hospital that provides VBAC, twin delivery, breech delivery, or even the Baby-Friendly initiatives in place.

Holistic midwifery care is different

As the demand continues to climb, so does the need for skilled midwives to enter the force and with the ease of entry in Texas, getting trained, licensed and boots on the ground may be going at a quicker pace than ever before. Thus, no two midwives are the same. From training, experience, beliefs, education, comfort levels, community trust, compassion, and fortitude, the seeking family should interview carefully and choose wisely. With the influx of beautifully curated Instagram posts touting to the medically confused population that home birth is where it’s at, (don’t get me confused, it is) it fails to show the months of physical, spiritual, and mental preparation and mutual trust built prior. The hospital-informed consumer seeking out-of hospital services often comes with a lack of understanding of the limitations, personal responsibilities, and laws surrounding midwives. This ain’t yo mama’s hospital birth. Buckle up, butter cup.

As a midwife, it is not uncommon to sit in a consultation with a family and hear OB/GYN horror stories from parents seeking a better experience. Some women come in with horror stories about midwives – heck, you may have even heard some about me. (Oh yes, please see the rants and raves Facebook pages for my most famous moments in midwifery history…) But no matter how we sugar coat this, birth, in all its beauty, peace, and empowerment, can be messy, dangerous, and painful. Emotionally and physically. And no provider - midwife, doctor, or nurse - can guarantee a pain-free, perfectly safe outcome. So… what’s a girl got to do to have a great birth? And how can you make the best decision for YOU?

What I’m trying to do

It got me thinking how much work it is to keep up with the midwifery laws and regulations and I do this for a living! So here I am, writing to you my spring series: Birth in Texas – What you should know.

As I update my protocols, I will be sharing with you Texas midwifery laws and regulations, questions to ask, and information on local resources to help you have the safest and best birth for you and your baby. I hope this helps you:

As I pulled up to the birth center, the laboring mother was making her way tenderly up the front steps, her husband loaded up like a pack mule was carefully guiding her. I parked my car in the middle of the drive and ran to her side. “She’s coming!” She moaned as another contraction took her full attention. We made it just inside the threshold before an audible “POP!” was heard and her bag of waters exploded to the floor. She screamed and then laughed! “Oh my god! I told you! I told you!” I looked up the stairs. There is no way we were going to make it. But by George if she didn’t grab that railing and thrust her whole body up that first step and then the next. The other midwife appeared at the top of the stairs and threw me a pair of gloves.

“It’s so HOT IN HERE!” the woman bellowed.

“I got the air on up here!” the midwife called down. If that didn’t inspire her.

We made it to the top when the first urge to push came down quickly. “Let’s make it off the stairs so we don’t lose the baby.” I offered.

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