Spokane midwives share experiences, advice after years of helping create new mothers

Moms like to say they brought you into this world, but they often neglect to share that they had some help in that endeavor.

The centuries-old profession of midwifery has seen a resurgence in America in recent decades. In 2021, 12% of all births nationwide were attended by a midwife, compared to just more than 1% in 1980, according to federal data. While the number of students in midwifery education programs is also climbing, the U.S. still lags behind its international peers. In countries like Sweden, France or Japan, more than 75% of births are attended by midwives.

The rise in popularity is likely the result of a few factors: Midwifery can be more cost effective; there are often fewer complications in midwife-assisted births; and the practice allows patients to have more agency over the experience than the medical model of yesteryear.

“Generally speaking, I think women, over time, are becoming more and more invested in their personal health and their choices when it comes to their health care, and seeking to be empowered through that experience,” said Shelley Northern, a certified nurse midwife, nurse practitioner and nursing professor at Eastern Washington University.

Northern, who practices through the midwife-led Quilted Health clinic, said midwifery can look different from practitioner to practitioner .Some lay midwives learned through traditional means; licensed midwives have more formal training but are limited in scope; and nurse midwives like her come from a medical background. Northern spent years as a labor and delivery nurse before going back to school, eventually working her way up to a doctorate of nursing practice.

“I think clients like that we offer the best of both worlds, where we are called to it and kind of embody the spirit of the profession and place high value on women’s health, women’s choice and walking along with them through whatever they’re going through, which is very midwifery model,” Northern said. “And yet we also have high value and respect for what medicine brings to the table.”

Safety is the profession’s number one priority, Northern said, but they also strive to make the journey a positive experience for expecting mothers. That doesn’t mean everything goes smoothly or pain-free, but ensuring that “no matter what goes on, she felt like she was listened to, that she was included in decision making, and that we care for her.”

Northern said midwifery goes well beyond just pregnancy care, highlighting that they strive to provide reproductive health care throughout the span of a patient’s life, often in a much more intimate, attentive and empowering form than a typical obstetrics and gynecology office.

Ensuring patients feel listened to can make an impact well beyond a patient’s pregnancy and postpartum care, said Lisa Larkin, a certified nurse midwife, nurse practitioner and clinical lead for Quilted Health.

Larkin said midwives often have to acknowledge the harm patients may have experienced in the past in order to build a strong relationship, and “not just assume that people come to us with a clean, blank slate.”

“A lot of people come with a whole history of trauma, and even trauma related to their previous health care interactions, and so being a place that’s safe, where you can take time and listen and get to know people and meet their needs – it matters,” Larkin said. “It matters a lot. It can be really transformative for a person.”

Larkin became a midwife and received a doctorate of nursing practice in 2014, after working as a yoga instructor, massage therapist and doula in the Spokane area as a young adult.

She credits her mother for sparking her interest in the field. Her mom was never shy about sharing the “empowering stories” of the births of Larkin and her three siblings and “what a woman’s body can do and how exciting and empowering it can be to grow a baby and give birth and be a mom,” Larkin said.

Larkin said her passion for women’s health care has only grown since the days when her mother would take her to visit the maternity ward at her hometown hospital in north central Washington.

“It’s been since I was very, very little that I was interested in pregnancy, birth, babies, but then learning the state of maternal health care in the United States as I was sort of coming of age, and recognizing the need for patient-centered, humane, trauma-informed care, and that midwifery could help meet that need, that really sparked an interest in me,” Larkin said.

Larkin had her first of two children while already five years into her career. She said she’s always been of the mind that “true empathy is gained with personal life experience,” but was still surprised about how her own childbirth helped her to become a better caregiver.

“The postpartum time, like the immediate after the baby’s born time, was the biggest surprise for me,” Larkin said. “The way that you’re, I call it hijacked, with love and concern for your little person, and how that feels just all-encompassing and huge, overwhelming your system, was a foreign feeling that I don’t know that I could have really, truly empathized with before having had babies.”

At Quilted Health, which recently became a subsidiary of MultiCare, Larkin is able to provide care well beyond a patient’s pregnancy, which she said is one of her favorite aspects of the clinic. She loves the “richness of the relationships” formed in providing obstetrics care and then following up with annual checkups or problem-focused visits.

Quilted also provides resources for a network of midwives throughout the state to help support and develop the field, and Larkin said she’s enjoyed getting to mentor others and advocate for her peers.

“Making midwifery more sustainable and achievable for the midwives on my team, and then more broadly, is really important to me,” Larkin said. “I love doing direct patient care, but also supporting the transition in our health care system of midwifery care becoming the norm is really a passion of mine.”

Like Larkin and Northern, Dani Whitmore, a certified nurse midwife at MultiCare’s Rockwood Clinic, found the profession after working in related fields for years. Inspired by the birth of her first child, Whitmore became a doula first, then went back to school to earn a nursing degree, which she used to work in labor and delivery wards for a decade.

“Honestly, childbirth was always something that I expected I would do, but I never really thought much more about it until I had my own baby,” Whitmore said. “I realized what a transformative experience it was for a woman to become a mother, and that really inspired me to dig deeper.”

Whitmore became a midwife and received her masters a little over five years ago. She said she’s built relationships with her patients that carry on for years, rather than just the 12 hours or so she’d care for them as a labor and delivery nurse. She’s able to care for patients throughout their lives, whatever comes their way.

“That is kind of what the work is about: not just through the good, but also through the bad,” Whitmore said. “You have to support them through whatever it is that they’re going through, whether it’s wonderful and happy or not. I think that that’s really where I find the joy in all of it.”

The more than 1,000 babies Larkin has helped deliver, and the more than 300 births Whitmore has attended, have been in hospital settings, but a growing number of expecting families seeking midwifery care are doing so in less traditional medical settings. More than 46,000 home births occurred nationwide in 2022, the most recent year for which data is available. That’s a 56% increase since 2016, according to the U.S. Centers for Disease Control and Prevention.

Rebekah Alice, a certified professional midwife licensed in Washington and Idaho, has offered home birth services to Inland Northwest residents through her practice Lilac City Midwifery since 2015. Like others in the field, she said she prioritizes a family’s sense of agency over the process.

Alice said that she’s noticed a stark rise in home birth popularity following the COVID-19 pandemic. At the time, expecting women may have worried about catching the virus in a medical setting, or didn’t want to go through labor alone while restrictions on visitors were in place.

“I think that speaks a lot to the fact that families are finding a lot of value there and understanding that pregnancy and birth, they’re not some pathologic event, they’re not a sickness,” Alice said. “It’s really this extremely spiritual, emotional and deeply human experience, and as these families have reached for alternative ways to experience their pregnancy, they’ve just found more power in their lives, and in their journeys as parents.”

Alice said she felt a spiritual calling to enter the field, despite having an aversion to blood and related elements of working in medicine. But while attending midwifery school in the Philippines with the intention to provide missionary care to disadvantaged communities, Alice said she found a sense of purpose.

“It’s evolved into this thing where I see so much power and purpose in giving women back their choices in health care,” Alice said. “And I think we really live in a society that tells us to look to others outside of ourselves for the answers to what is best for us, but my model of practice really empowers the mother and the family.”

Alice recognizes the value and importance of medical intervention when needed, and she and Larkin said relationships between hospital and clinical providers and home-birth practices have improved greatly in recent years.

Regardless of the differences in their certification, where they do the “catching,” the long hours and challenging moments in patient care, the work itself is what keeps them coming back.

“This is not the most easy career path to take; there are heart-heavy things that happen on a fairly regular basis, and if not heart-heavy, there are sacrifices that midwives make that are not usually seen,” Larkin said. “It’s worth it because of the hugs and the kind words and, you know, seeing a mama tell her 6-year-old, ‘This is the person that caught you, this is the person that saw you first,’ that sort of thing.”

There’s nothing like seeing a child open its eyes for the first time, or the first time a mom holds their child, and then running into that same family at the grocery store years later, Whitmore said.

“It’s so fun to see them, and it’s fun to interact with them as well,” Whitmore said. “I always tease them, and I always say, ‘Do you remember me?’ And they always kind of look at me like, ‘I don’t know who you are.’ ”

It’s also an extremely rewarding experience to help a family through multiple pregnancies, and to develop a base knowledge that can prove invaluable in caring for that family, Alice noted.

“That just makes all the difference in health care, to have a provider that kind of knows you on a personal note and remembers you too,” Alice said.

Northern said making a positive difference in the lives of others is what sustains her through the hard aspects of the career. She believes strongly in the ripple effect supporting young mothers and children can have within a family and the broader community, and said nothing truly compares to the responsibility and “incredible honor” of caring for and providing a safe space for women to become mothers.

Watching the mix of joy, excitement, surprise, love and exhaustion sweep over a mother as she holds her child for the first time never gets old, she added.

“That to me, is just so profound,” Northern said.

With more than 40 years of experience between them, Northern, Larkin, Whitmore and Alice offered some advice for expecting mothers and those supporting them through the journey. Alice advised women to trust themselves, that their intuition “is the most powerful guide they have in their motherhood journey,” and they should surround themselves with supporters who remind them of their strength.

Northern stressed that it’s important for new families to do their own research to find the model of care that works best for them. She recommended looking at all available options, talking with friends and family about their experiences and echoed Alice’s recommendation to listen to their gut.

“We all want the best for our clients, whether you’re a nurse midwife or an OB, but we all have different personalities and different cultures and clinics,” Northern said. “So it’s just about finding that right match.”

As for those supporting fresh new parents and moms, Larkin and Whitmore said showing up can go a long way.

“I think new families just need that,” Whitmore said. “They kind of don’t know what they need. Sometimes you’re just overwhelmed with your lack of sleep and all of that that’s happening that sometimes it’s hard to even identify what those stressors are to you, those external stressors.”

Actions like mowing the lawn, bringing a meal over or watching the baby while mom grabs a glass of water can help alleviate some of the pressures that surround a family immediately after welcoming a new member, she said.

“It’s being present, emotionally and physically present; it doesn’t have to be that you have all the answers,” Larkin said. “It’s showing up and caring and encouraging the person to reach out for support if something doesn’t seem quite right.”

“There are no perfect parents, but there are a lot of good ones, and often we’re harder on ourselves than we should be,” she added.