The student studies textbooks and shadows their preceptor to births as well as pre-natal and postpartum appointments. The preceptor decides when the apprentice had learned enough to become certified. To become officially certified, the student must pass a 300-question exam, which is taken in 2 4-hour segments.

Mason stated that she was fortunate to have a great support system during her training so that she could work and study. However, it was often difficult to connect with physicians who would treat her clients well and were willing to work with a midwife. 

“You don’t want somebody to be treated badly just because they made a choice to have a baby at home,” Mason said. “I’ve actually had some people who, maybe they wanted a circumcision for their child after postpartum, and they were calling up pediatricians in different places, and they actually said, we don’t take home-birth babies. Because sometimes they’re considered dirty babies.”

It can also be difficult to connect with preceptors according to Fletcher. In the early stages of her apprenticeship, she had to train with a preceptor three hours away because there aren’t many midwives, and some midwives don’t want to train new midwives due to competition for business.

Doulas have similar problems in how it can be difficult to find clients who will trust them and to compete with medical providers who don’t want to work with doulas, according to Wisdom, Harvey-Williams, and McGinnis.

A further complication is that in Arkansas, patients legally must have a risk assessment in the beginning and near the end of their pregnancy if they plan to work with a midwife for a home birth. They have to see a third party, either the health department or a nurse-midwife, that will look over their history to make sure that they won’t have any complications.

“It’s just like a routine prenatal that’s not needed,” Mason said. “It’s like an extra step that our patients have to do that they don’t really need because we are the ones that are assessing care. Most states don’t require that, but Arkansas does.”

“It’s just like a routine prenatal that’s not needed. It’s like an extra step that our patients have to do that they don’t really need because we are the ones that are assessing care. Most states don’t require that, but Arkansas does.”

– Cassi Mason

Midwives and doulas offer many types of care, and they can overlap sometimes, but the two are very different. Doulas focus on emotional support and typically don’t offer medical advice or treatments, while midwives focus more on physical and medical services.

Both midwives and doulas typically offer some form of preconception, pregnancy, birth, and postpartum support. During preconception care, Mason focuses on detoxing the body, cleansing the lymphatic system, and making sure the patient’s body has the best start possible.

McGinnis offers a similar service. She does fertility support, which means she goes with her clients to fertility appointments and helps them learn how to track their cycles. Fletcher does fertility and nutrition coaching. 

Mason also offers regular prenatal appointments with the patient. She does all of her patients’ labs, knows what their diet is like, knows what their family and home is like, knows if they have good support or not, knows how they react to different medications, etc. She tailors her services individually for each person.

“It’s kind of like if you have a whole team of people—the doctor, the nurses, the APRNs, the billing, all of those things—and you wrap it all into one person,” Mason said. “Also, we don’t take as many people as OBs do…whereas you would go to an OB and spend fifteen to twenty minutes in their office, we spend an hour doing our prenatals, educating and making sure that they’re not afraid and whatever their fears are, we can address…we can really tailor that to each individual person.”

Fletcher, McGinnis, Harvey-Williams, and Wisdom also offer prenatal appointments. As doulas, they provide comfort, guidance, and education regarding pregnancy and birth.

“Doulas are huge advocates,” Fletcher said. “I am having conversations that are empowering you to understand what is your baseline, what is normal for you…then you can have a leg up, and you have information, so any time you have information, you have power…the truth is, this is your body…that’s where the midwifery model of care and doula support separates from the medical model of care because it’s individualized.”

Towards the end of a patient’s pregnancy, Mason listens to the baby more, does nonstress testing to make sure the baby sounds good and blood flow is sufficient, and sends off biophysical profiles to analyze amniotic fluid levels and make sure the placenta is still doing what it should. 

Mason’s clients get unlimited postpartum support, so she helps with whatever they need regarding the baby. She checks up on them to make sure they’re doing well emotionally and can get them support from a lactation specialist if need be.

McGinnis, Harvey-Williams, and Fletcher also provide postpartum support. For a certain amount of time, McGinnis and Harvey-Williams will cook small meals, care for children and pets, do household chores, or run errands to let the new mother recuperate. Fletcher is also a lactation specialist.

According to Mason, the difference between traditional maternal care and conventional maternal is choice. She makes sure to educate her patients about their body, but she doesn’t force them to do something they don’t want to do, like STD testing for example.

“A lot of my patients have said, They [doctors] made me feel stupid for my choices or they made me feel like I didn’t know what I was doing. When you are instilling fear upon somebody, fear can do a lot of different things to the brain,” Mason said. “If you think about animals, they want to go the most secluded place where they can protect their baby…if they don’t feel safe, they just won’t [go into labor] or things will not happen the way it needs to happen.”

“A lot of my patients have said, They [doctors] made me feel stupid for my choices or they made me feel like I didn’t know what I was doing. When you are instilling fear upon somebody, fear can do a lot of different things to the brain.”

– Cassi Mason

In addition, Arkansas is almost 50% maternal health care deserts according to Fletcher. What this means is there are several areas where maternal health care isn’t offered, and so a patient has to drive hours away into a bigger town. For some, this isn’t possible because they don’t have time outside of work or it’s too expensive.

Fletcher founded Ujima to address this issue and provide more maternal health care options in those areas, focusing specifically on black mothers. Midwives used to be prolific before the advent of modern medicine, especially in black communities where the “grand midwives”—mostly grandmothers—were professionals of birth, medicine, and counseling, and all of this was done in the home. 

Since the shift from this mindset, the rate of black maternal mortalities has increased significantly. However, according to Fletcher, 90% of maternal mortalities—not just for black mothers but for everyone—are preventable. 

The cause of higher maternal mortality rates for black women are often due to systemic racism, lower socioeconomic status, and lack of education. Within the healthcare system, the mother’s problems and preexisting conditions are sometimes brushed off because of falsities spread about black people, like they supposedly have a higher pain tolerance.

According to Wisdom, it’s been statistically proven that mothers who hire a birth worker are less likely to need a caesarean and rate their birth experiences higher. Additionally, Mason stated that birth is 80% mental, 20% medical. In other words, the more educated and emotionally prepared a mother is for birth, the smoother the birth will go. That’s where midwives and doulas come in.

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Note: Feature photo by Anna Civolani on Unsplash