I am Deborah Smithey, nationally certified by the North American Registry of Midwives as a Certified Professional Midwife (CPM). I maintain certification by the American Heart Association in Neonatal Resuscitation as well as Adult and Infant Basic Life Support (CPR). I am a member of Missouri Midwives Association, Friends of Missouri Midwives and Midwives Alliance of North America. But none of that qualifies me to be your midwife. Only you can choose the right midwife for you.
I rely on my hands and simple tools for most routine examinations, reserving the use of technology to assist only when necessary. I strive to balance modern technology with the ancient midwifery practices of my Native American ancestors. I serve families living south of Kansas City, west of the Lake of the Ozarks, north of Arkansas, and in eastern Kansas. I currently have offices in Springfield, Pierce City, and Stockton, Missouri.
I personally visit with the mother throughout her pregnancy, birth, and postpartum. It takes an hour to complete each prenatal visit because we have a lot to discuss! Prenatal visits aren't just about checking vital signs and measuring the uterus. They are filled with questions about life, activities, food, dreams, fears and storytelling. The mother, her family, and I get to know each other very well during these visits.
During labor, the mother calls me to come whenever she is ready for my help. I physically, emotionally, and spiritually support the mother and her family as she works to give birth. I monitor the well-being of the mother and baby and keep the family informed of my findings and recommendations along the way.
2009 to present: certification from the North American Registry of Midwives (NARM) as a Certified Professional Midwife (CPM).
1996 to present: certification/recertification in Neonatal Resuscitation by American Heart Association.
1995 to present: certification/recertification in CPR/Basic Life Support for Healthcare Providers by American Heart Association.
In 1990 I was at the library to find out what to expect at the hospital if I agreed to labor coach for a friend. I checked out the standard mainstream pregnancy manuals, plus one book that would change my life forever, In Labor: Women and Power in the Birthplace by Barbara Katz Rothman. I couldn't put that book down. The next day, I returned all the main-stream birth books and checked out the homebirth books, including Spiritual Midwifery by Ina May Gaskin and The Birth Book by Raven Lang. I was hooked.
Three years later, I gave birth to our first child, a daughter, "unassisted" in our small camping trailer. We wanted to use a midwife for that birth, but circumstances forced us to choose unassisted homebirth instead. Soon after, I joined Missouri Midwives Association and began to learn everything I could about birth and midwifery. I had a second "unassisted" birth in 1995, because baby came before the midwife arrived! My third baby was born at home with the help of a midwife in 1997. He weighed 10 pounds, 12 ounces, and got stuck at the shoulders (shoulder dystocia). I was so grateful to have a midwife there to free him!
Deborah in front of emergency
entrance of CASA Hospital.
Most of my experience and training is with homebirth. I began my apprenticeship in 1995, carrying my baby with me to prenatal visits and births. As part of my training, my preceptor emphasized continuity of care by having me follow one or two women at a time. I was required to attend every prenatal, birth and postpartum visit for these women. My study assignments consisted of researching the details of everything that happened with these women. After a couple years of this, I filled in the gaps by studying more rare conditions and complications.
In 2007, I volunteered at CASA, a midwifery school and hospital in the state of Guanajuato, Mexico. It is kind of like a birth center, but also has hospital attributes in that the midwives can call in a doctor or surgeon if they need one, but he is not waiting in the next room. The school trains women to become Professional Midwives, so they can return to their communities and serve the women there. While there, I worked with the midwives in the hospital and met many amazing women. One of the students I met will return to her home in Guatemala and become the first Professional Midwife there!
Hablo un poco Español, and I know a little sign language (SEE).
I am a follower of Jesus Christ. I serve Christians, Pagans, Wiccans, Quiverful, Hippies, Rainbow, wealthy, poor, married, partnered, single, and everyone in-between. I am pleased to be able pass on the loving, quality care I received during my pregnancies and births.
What Do Midwives Do?
The following is an outline of typical midwifery care that I provide. Keep in mind that the care I provide will be personalized for each individual woman.
Care During Pregnancy:
• Free consultation (Initial Interview) where the mother and family get to know the midwife.
• Provide clients with disclosure of education, training, years of experience, statistics for the practice and emergency back up plan.
• Support Families and their decisions.
• Screen for complications and consult and refer to another health care provider when indicated.
• Remain available to the family via phone, pager or mobile phone throughout pregnancy.
• One hour prenatal visits, every three weeks until 28 weeks, then every 2 weeks until 36 weeks, then weekly until birth, or more often as needed.
• Childbirth education.
• Nutritional counseling.
• Physical Exam.
• Lab work.
During Labor and Birth:
• Monitor physical well-being of mother & baby.
• Keep Mother well fed and hydrated.
• Let labor progress on Mother's timetable.
• Give encouragement and suggestions as needed.
• Immediate skin to skin contact for Mother & Baby.
• Continue to monitor Mother and Baby's well-being.
• Newborn examination within two hours of birth.
• Stay as long as needed, at least two hours after Mother and Baby are both stable.
• Revisit home for a 1 day, 3 day, 7 day and 3 week postpartum home-visit.
• Help mother and baby establish a successful breastfeeding relationship.
• The final visit is at 6 weeks postpartum.
What Midwives Do Not Do:
• Practice Medicine!
• Prescribe drugs or administer narcotics.
• Perform abortions.
• Interfere with normal labor and birth.
• Attend “high risk” births.
• Use continuous electronic fetal monitoring (EFM). Monitoring often leads to partial or total restriction of movement which can domino into more pain due to lack of freedom to assume a better position and/or trouble with the baby descending properly, which is often aided by movement. Use of continuous EFM during labor has not been shown to improve outcomes when compared with intermittent fetal monitoring with fetoscope or hand held Doppler.
• Offer drugs for pain relief like Epidurals, which can lower the mother's blood pressure too much, decreasing the amount of oxygen for the baby, and increasing the risk of fetal distress.
• Routinely offer internal exams late in pregnancy.
• Routinely cut episiotomies. Episiotomies increase the risk of major tears and usually require many more stitches than a natural tear. Episiotomies have a higher rate of infection and a higher rate of serious complications.
• Tell a Mother where, how and in what position she must push.
• Make Mom lie flat on her back during labor or pushing. This is physically bad for baby because it restricts blood flow to the pelvic region, reducing or cutting off the baby's oxygen supply and has been shown to be associated with fetal distress.
• Use forceps or vacuum extractors.
• Withhold food and drink.
Questions to ask when interviewing a midwife
When interviewing a midwife for a homebirth or birth center birth, come prepared to answer as well as ask questions. Be friendly and inquisitive. Make your questions as specific as possible, non-threatening, and personal to your situation. Notice whether you feel relaxed in conversation and whether there is a spirit of dialogue and “getting to know” one another. Informed disclosure includes receiving current information about the risks and benefits of an action or non-action. Families choosing midwifery care tend to prefer this tool along with co-operative decision making when facing the inevitable questions that arise during pregnancy, labor, birth and beyond. Communication and mutual respect are essential to a successful relationship of this nature. No amount of talking can reveal the answers to all the possible aspects of any birth. Discovering whether enough common truths are shared among you and whether the personalities are such to allow for genuine exchange will guide you in choosing your midwife.
How long have you been practicing?
Where and when did you receive your training?
How many births have you attended as the primary midwife? Do you have a statistics disclosure handout?
Do you have written informed consent or disclosure statements?
Do you have paperwork which you request to be filled out and signed?
What criteria do you use for risking out mothers for your service? … for homebirths?
What is your transport rate? … for first time mothers? … for homebirth after cesarean?
What do you consider valid reasons to transport?
Do you have a specific doctor or hospital backup? Do they have criteria different than yours that dictate your decision making?
If we need/decide to transport, would you go to the hospital with us?
What variations and complications have you seen? Breech? Twins? Hemorrhage? How did you handle each?
Do you teach classes? If yes, is there a separate charge?
What is your fee for service? What is included? (pre/post natal care, lab, classes, supplies…)
Do you carry a pager? … cellular phone?
Are there times when you would not be available for communication?
Do you work with an apprentice or partner? Would they be attending the birth with you? Do you have small children? Will they be accompanying you?
What are your feelings about working with a doula (professional labor coach) in the homebirth setting?
Do you have a backup midwife if you become unavailable for our birth?
Do you do episiotomies?
What percentage of your moms require suturing?
What do you recommend to protect the perineum? … during pregnancy? … during birth?
What equipment do you carry? Do you carry oxygen, drugs, medications, herbs?
Do you use a Doppler to monitor baby’s heartbeat in utero? (Many people are concerned over the prenatal use of ultrasound.) If yes, are you skilled and willing to use a fetoscope to help monitor baby’s well-being?
Why did you enter midwifery?
What do you like best about your work? … least?
What do you require of the couples with whom you choose to work?
Do you have specific weight gain, exercise and nutritional guidelines?
How often will we see each other?
What is involved in a prenatal checkup? How long will it last?
Where do prenatal checkups take place?
Do you do home visits?
Do you do water births?
Do you require any prenatal testing?
What will happen if I am Rh negative?
What is your experience integrating older siblings at a birth? … others?
What do you see as your role during the prenatal period?
When do you come to the birth? How long do you stay?
During labor, what do you feel is your role?
Do you work within time limits for progress of labor? … for rupture of membranes? … for pushing?
If there is a tear, what would you recommend?
How do you facilitate the critical initial period of bonding between mother and baby?
Will you help me and my baby establish breastfeeding before going home?
What is included in your normal postpartum/newborn care?
Will you help develop resources for a smooth post partum period?
Do you keep records of my pregnancy and birth? What happens to them? Are they confidential?
What is your commitment to confidentiality?
Do you participate in state/national peer review? Would I have any input into this?
Do you have references who would be willing to talk to us?
Personal (not all midwives will feel it is appropriate to include these kinds of questions)
Are you married?
Do you have children?
Where did you have your babies?
Did you breastfeed? … for how long?
What religion are you?
Is there anything personal you would like us to know about your life or beliefs?
In conclusion, make sure you have taken notes and received answers to everything that is important to you. Ask her if you may call back with additional questions if they come up. Remember to thank the midwife for her time and commitment to such worthy work.
Notice how you feel upon leaving and the next day.
Globally, in the villages around the world, one does not see an isolated mother with her baby. Despite our mass communication and transportation systems, it is possible for new mothers in the USA to feel quite isolated and overwhelmed by the enormous responsibility of nurturing a tiny being to adjusted adulthood… much less the nightly nursings and daily diapers. Do not indulge in isolation. Network and connect with other mothers; some in all stages of motherhood. Create the community you deserve.
Grannies, aunts, sisters ~ family members are often a wealth of support and information. They often help in practical ways like meals or cleaning.
Friends, neighbors ~ choose people to befriend who love, support and encourage you.
La Leche League ~ these breastfeeding experts offer free meetings and support to pregnant and nursing mothers.
Mother’s groups ~ these can be found in local churches, the calendar section of local newspapers, through neighborhoods or your own initiative.
Libraries ~ watch for children’s reading hours, literature tables and summer programs.
State Parks ~ these folks usually have naturalist programs, nature trails, family focus, etc.
Newspapers/Journals ~ note calendar of events or articles related to family interest.
YMCA/pools/resorts ~ water baby programs provide needed outings for mother/baby.
Health Departments/hospitals ~ the government has made commitments to securing food and shelter for families in need of medical care, and information is also available.
Health spas/clubs ~ consider budgeting for a massage and/or learning infant massage.
Health food stores ~ watch the bulletin boards. Be friendly with other mothers there.
Churches ~ people of like mind and faith can be invaluable resources for spiritual and physical support in times of joy as well as sorrow.
Internet ~ find PEOPLE with whom to share.
Spontaneous meetings ~ chance meetings at restaurants, pools, parks, etc. are common among women who breastfeed and show open affection to their babies. Be open to new connections and unexpected friendships.
Missouri Midwives Association, 1325 W. Sunshine, #132, Springfield, MO 65807, 202-MIDWIF-1 (202-643-9431), MissouriMidwivesAssociation.org
Friends of Missouri Midwives, P.O. Box 1336, St. Charles, MO 63302-1336, FriendsofMOMidwives.org