HCDM 32 | Home Birth

 

Home births are increasingly becoming more and more popular, most especially now with the pandemic. Before diving deep into this birthing option, what is there that you need to know? Richard Marn, MD, brings someone who can guide us through it all. He has on the show Certified Nurse Midwife, Kimm Sun. In this episode, they are going to talk about home birth midwifery, how midwifery brings a much more holistic approach to the birthing process of a child while still maintaining a high degree and level of safety. Kimm then breaks down the difference between an OBGYN and a midwife, the benefits of doing a home birth, as well as some challenges midwives have to go through. She also shares what aspiring midwives have to look forward to as they prepare to take on this profession.

Listen to the podcast here:

Home Birth: The Joys & Adventures Of Being A Certified Nurse Midwife With Kimm Sun, CNM

Certified Nurse Midwife – Kimm Sun, CNM

There are two main health professions that are involved in the pregnancy and birthing process of a child. One is an obstetrician, which most of us know, but do you know the second one? That’s what this episode is all about. We’re going to talk with a midwife, one that specializes in home birth midwifery. We’re going to learn how midwifery brings a much more holistic approach to the birthing process of a child while still maintain a high degree and level of safety. You will also learn that this profession is not for the faint of heart.

It does require a high degree and level of commitment and passion for helping moms through the birth of a child. My guest is Kimm Sun. She received her Nursing degree from Hunter-Bellevue School of Nursing, then got her Master’s degree in Midwifery and also a Nurse Practitioner Degree at the University of Pennsylvania. She is a Certified Havening Practitioner and trainer as well. She has been a certified nurse-midwife for many years, and she is extremely passionate about her job. This was an awesome and wonderful interview. I’m excited to share this conversation with you as a reader. Let’s jump into it and meet Kimm.

Welcome, Kimm. Thanks for joining me on this episode.

Thanks for inviting me.

Tell me about what you do and what kind of patients you take care of.

I’m a homebirth midwife.

A lot of people have their birth with a midwife in their home or is that a smaller proportion?

It’s a unique population. It’s under 3% in the US.

Most people that have a midwife do give birth in a hospital setting.

I think about 10% of birth in the hospitals are done by midwives. That’s our little niche, which is home birth.

How do you help these patients out in their delivery? What do you do?

I do everything. I do the doctoring part of it, the part that we got trained in school to do. You run all the labs. If you’re pregnant and you’re going to see an OB-GYN, the expectations are labs and ultrasounds, doing genetic testing, managing anything that comes up. That’s one part of our job. The next part of our job, which is a bigger chunk of it is midwifery. I need to explain that because when I went to school, what we were taught is how to be a doctor. There are many kinds of midwives, but particularly the certified nurse-midwives who have the widest scope of practice that’s legal.

The things we are taught are all those doctoring things, and the midwife part of it is left for us to define what it is. Generally, you have an idea, you didn’t go to a midwife. I don’t know if you feel that way, but people think about midwives as this nice person. It’s a good start, but then it gets into these areas where they go, “What can a nice person do for me?” There is a whole system of this midwifery care and how you approach care.

It’s a different way to approach care. Part of the work is learned especially if you’re doing a home birth, where there aren’t strict guidelines on what your job is. You’re taking care of not only your client but your client’s family, the partner. You’re taking care of their labs, all the ultrasounds. You’re taking care of educating them to make them feel knowledgeable and empowered. A bit part of my work particularly is taking care of their mental health. We’re trying to do a history to assess what trauma they might bring into the pregnancy so you can clear it.

The psychological aspect.

It’s a mind-body approach. That mind-body approach is a little unique to my care in that I have a set protocol. I do incorporate mental health into my care because it does have such a huge impact on birth. If you’re talking about generally homebirth midwives, they do bring their own sensibility into creating trust and helping the woman feel cared for. They’re good listeners and that helps a lot. The care becomes holistic. That’s the thing that you learn after you graduate and you have to figure it out along the way. Unfortunately, it’s not taught very much in school.

You helped to clarify first of all, there’s an OB-GYN and a midwife. Those are the two main types of professions that usually deliver babies. OB-GYN is a bit more medical, but the midwife has some medical components to it. They also are much more hands-on. How do you set the difference between an OB-GYN and a midwife?

The way to think about it is the only thing we don’t do is C-sections. We do the whole series of assessment work and do all the tests. When it comes to a high-risk situation, for example, somebody may have a thyroid issue, we are then going to work collaboratively with a specialist. We work alongside a specialist. A lot of doctors do that too. They also send any high-risk people to MFM, Maternal-Fetal Medicine, which is the medicine that deals with a high-risk pregnancy. If there was somebody needing some extra help, then we collaborate and we work together.

One of the misconceptions is we don’t necessarily risk a woman out of a home birth just because they need special care. Let’s say if somebody has hypothyroidism and they need to take some Synthroid or something. As long as the thyroid levels are normal, the impact is going to be the same as if they don’t have it because we are monitoring that and giving them medication so that their thyroid levels are normal. At the end of the day, they are still eligible for a home birth.

It’s difficult to answer because we spent so much more time with them. The difference is that with doctors, they take more clients. Their business model is different. They have to keep churning because there are a lot of turnovers. A lot of people are coming all the time. The time that they are able to spend with each patient is ten minutes. If you come to see a doctor, you’re mostly going to be sitting in a waiting room and then moving from room to room where a nurse might take your vitals or somebody else might take your lab work or come and do admin work asking you to sign here. When you see the doctor, you have ten minutes to spend with them. We do everything.

You don’t have these intermediaries such as a nurse or an assistant doing the charting. You are holding the hand of soon to be a mother the whole time.

There’s a good reason for it too. It’s not just the fact that we don’t have help taking blood pressure or running labs or sticking a needle in your arm. The idea of having someone you trust to do it, that’s a big plus. For instance, if I’m taking blood, I am examining and thinking about how this woman reacts to a needle. I’m doing that observation as I am doing what seems to be nursing work. That’s what makes this care unique. Spending time with a human being and building their trust and getting to know them changes the paradigm of this care. If you’re coming in and spending ten minutes with somebody, all they do is take a Doppler or ultrasound and listen to the baby, and then you sit there, you go, “Any questions? I’ll see you soon,” and then go, you don’t get to know that person as well.

If anybody wants to choose to be a midwife, they've got to be the kind of people who find that meaningful. Click To Tweet

Even when we do the baby checks or the basic vital signs and palpation, we do a different kind of palpation. We touch and then there’s a lot of that sensory care and we tell them what we’re touching and we teach them to touch too. As part of that work, we begin to connect them with their body and connect them with their process so they could gain control over their own body versus surrendering it to someone else. At the same time, questions will organically come up and there’s someone who might say, “I’m worried. I don’t feel the baby move yet,” because a friend might have said, “My baby is moving.”

That’s an opportunity to educate them and to tell them that movement, depending on how many babies they’ve had and on many things, they may or may not feel movement. It’s up to you to tell them what a baby’s movement can be like in the beginning. You can feel as if you have gas. It’s that little information that we give them and on that level is education, but on a bigger level, it connects them to the process. They become less afraid of their body. They become more intuitive. It’s that complexity that’s different about this work.

In my specialty as anesthesiologist, from my perspective, when a woman is giving birth, we’re called to put an epidural in and they’re there for several hours. Sometimes that patient will give birth in their room in the hospital, or sometimes they’ll give birth because a C-section is necessary in an operating room. That’s the timeline that I see generally in my profession for a woman, how they give birth. How is that different from your perspective?

Time is an important topic. We don’t have a time limit on anything. If you’re looking at a timeline, yes, there’s a timeline of what we expect, but we could give the woman a lot of time to labor. We don’t have a clock. We don’t check them regularly so that we don’t gauge where they’re at. It’s a system. As an anesthesiologist, you’re talking about people who want an epidural. Someone who comes into a home birth believes that she can do it herself.

The birthing process starts before they even come to the hospital for you.

You will see them when they are in active labor. I know that the hospital has changed the protocols a little bit. It used to 4 centimeters. It’s very algorithmic and numbers-driven. If someone comes in and they are less than 4 centimeters, they might be sent back until they are 4 centimeters, and that has to do with time management. The institution, because it is driven by profit, they want to be the most efficient because what can cost the institution the most money is the staff. If someone is in early labor, and they’re spending all that time in the labor room, that’s going to cost the hospital more. They have a system where, unless you are in raging active labor, you have to stay home.

How is that different than as a midwife?

I’m trying to be logical, but it’s hard because this is such a politicized world. Now, people are using 6 centimeters, which is better because you truly are active at around 6 centimeters. One of the problems with this algorithmic care based on numbers is that a woman’s body doesn’t know that. You could have someone 6 centimeters and give birth within 30 minutes. You could have someone at 8 centimeters and it’s going to take her another twelve hours to give birth. In other words, if you’re using numbers and vaginal exams, which are whole different things that we can talk about, vaginal exams are not necessary except for documentation because in the hospital system, because of the way things work, that documentation needs to happen.

You need to have a number in order to determine where she’s at if you’re talking about the timeline, whereas we are looking at her behavior, responses, and what she’s telling us. For instance, if she’s in labor for a day, and then she says, “I feel like pooping.” It tells us a lot and then we watch the way that she’s starting to vocalize differently. It’s that art form that’s a unique thing about our work. We’re able to tell how she’s curving through observation.

The birthing process from when they start to dilate and start having contractions until they give birth to the child could be a few hours, but it could also be more than a day.

My shortest is thirteen minutes.

What is your typical day like?

A day when there’s birth is a different day from when there isn’t. This is one of the most unique things about this job is that you can’t plan a day. You can plan roughly. You can put your prenatal visits in your calendar, but then you have to be prepared to leave because you’re on-call 24/7. The babies don’t care.

You’re on call all the time and you cannot be working by yourself.

Quite a few home birth midwives are solo practitioners. I did that and it’s brutal because there’s no real blueprint for this job. People like me, being able to advise people if you were ever to go into home birth, find someone who will mentor you, and find a way to get into a partnership with someone because it’s brutal if you don’t. This job is so isolating that having a partner or having a community where you can talk about your case studies, exchange ideas, and then build resources for each other, that’s hugely important.

Tell me then what your work-life balance is like.

My daughter understands that at Christmas, at any time, if it’s not vacation period, which once a year I will take an actual solid vacation, I cannot be relied on. I’ve had to run away before dinner starts one time. We had this lovely restaurant that we waited so long to go to. As soon as we sat down, I had to leave or when we were in the middle of Christmas dinner, I had to leave. There was one time I went to see my daughter in Pennsylvania and this is the day before Thanksgiving. I looked at my calendar and it was totally unlikely that someone was going to give birth on that date, but I was ready.

There’s only one person due within that five-week window, which is 37 to 42. There’s this one primi, the first-time mom. On that day, she was going to turn 37 weeks and it starts the window. A first-time mom is highly unlikely to go at 37 weeks. She usually goes at 41 weeks. There wasn’t anyone else in labor. I was quite certain that we were going to make this dinner. We had a nice day before Thanksgiving and at 4:00 in the morning I get a call. I had to drive back from Pennsylvania. I still remember the sun coming up as I’m driving back to New York and I have to leave. These babies are rude.

They don’t start on the right foot.

They don’t care about me at all that I had to have dinner.

When you leave too, it’s not like you’re gone for an hour or two. You’re gone for 6 or 12 hours?

With one birth, we stayed there for 3 to 4 hours because her labor was fast, but sometimes labors could go on for two days and we don’t show up as soon as they go into labor. We monitor it.

HCDM 32 | Home Birth

Home Birth: Home birth midwives bring their own sensibility into creating trust and helping women feel cared for.

 

What do you mean by monitor?

We monitor her labor by phone so we know when to show up.

You explained how you got to pick up and go sometimes. You’re on-call all the time. Sometimes that’s maybe the least part of your job is being on-call at the time.

I don’t resent that at all. It’s in getting used to that. People often ask me how I can be sitting there and enjoying a movie or having dinner, or now I’m not thinking about anything, but I could get a call right now and have to go. You get used to being called anytime. You have everything ready to go and you stop worrying. It’s not a bad thing. It’s a little challenging. You have to get into that mindset and not think about it.

If someone’s reading this, they’re saying, “Why the heck might I even think about this as a career? Midwife, she’s on-call all the time. She has possibly missed Christmas and Thanksgiving dinner. I have evidence because I’m reading as Kimm Sun told me she did miss Christmas and Thanksgiving dinner.” What are the rewarding parts of this job then?

It’s the best thing I’ve ever done. This calling came to me. I didn’t go looking for it because I’m a lazy person. I don’t self-motivate. That’s the truth. It’s hard for me to self-motivate, but when you are taking care of someone and you have this such huge responsibility, that’s motivation. I have to be on the go all the time. Being on-the-go is mentally healthy for people. You have to think on your feet. It’s that part of it. It’s not a terrible thing for me, thinking on your feet and having to work. You have to be clever, get a partner, and be able to arrange it so that you can have time off. That’s all you need. You need a nice break, maybe a month break out of the year to be able to do your things.

You have to get into the mindset when you’re not on a vacation that every dinner or every moment that you have, you enjoy it. You appreciate it more because you don’t know if this is going to happen. I know this is crazy. That part of the work is not the difficult part, and because it’s rewarding. There are a lot of things that are rewarding about this in that you can connect with another human being. You go into this. You go into their bodies, their kitchen, their bathroom physically and mentally. You go into their mental spaces. How do you ever have a job where you get into this intimate place with another human being? If anybody wants to choose this kind of job, they’ve got to be the people who find that meaningful because I know a lot of people do.

You told me at the beginning, you separate yourself as a midwife who does home births only. What’s the difference between having it in the hospital versus at the home? Is it the intimacy aspect of it?

It’s also prenatal care. For a lot of people, the birth is what I like to call the money shot. Everybody is ready for birth. I said, “Your life isn’t about the wedding. It’s about the relationship. It’s about your marriage. The wedding isn’t everything. If your wedding didn’t go well, you can still have an amazing relationship.” When people come to us, we are very clear, “You come to us for good midwifery care.” No matter what happens, the goal is to make you feel cared for that somebody was on your side, to make you feel in control, to make you feel knowledgeable. Somebody didn’t take your autonomy away from you. It’s that whole spectrum. If you’re looking at people looking from the outside, they’re only going to get excited about the birth of it, the moment the baby comes out.

A lot of our clients have said to us during the breastfeeding period, which is quite challenging, “I would do the birth a hundred times over again because breastfeeding is challenging.” I want to put this in perspective that although the birth is incredible, it’s a real Odyssey of its own. It’s a life-changing odyssey that has much potential. It has the potential of healing and bonding with your child. While all of that is there and all of that is important, it’s one aspect of your motherhood. Your mother is rich with different aspects of it. Breastfeeding and bonding is a huge part of this.

When you’re helping these women out with their birth in her home, you’re in their home and often in a bath. Is that true?

There’s always that image of the bath and water birth. We do have a lot of people who want a water birth, but what we recommend is water for laboring. We ask people to be open to whatever happens because as soon as the head is crowning, all of the work is done. The water provides a lot of relief during the labor because women who are untethered move around everywhere. Sometimes they might be sick and tired at the top, and they might feel better on the bed. Sometimes we get women who tell us, “I want a water birth.” We try to make that happen. There was a woman that was in the water and not much was happening until she got out of the water, and we had to do what we call rebozo work to shift her belly and doing all this positional work on the bed. As soon as we did that and the baby starts crowning, then we grabbed her with the head coming out, carried her, and plumped her into the tub because she was so attached to water birth.

For you as a midwife, not all the births occur in the bath, and it can happen anywhere in the home and you assist them through that.

The thing about this work is that you have to be very flexible physically because wherever they are, you have to be able to twist and turn so that they don’t have to move. They get to stay where they want and you have to pretzel your body around.

As a midwife, you’re very hands-on as you describe it way more than OB-GYN. Are there any men?

They are male midwives, but very few that I know that do home births. They mostly work in hospitals. The nature of it is that if you were starting a business as a male midwife, you’re less likely to get clientele.

I would think so, especially the nature of how you describe OB and midwife, just more hands-on and you wouldn’t think that would work so well.

There is something about women and nurturing and what I call the yin energy. It’s feminine energy. Speaking of which, there are a lot of politics around gender and often people insisting on making sure that every language that you use, the pronouns that you use are gender inclusive, which gets to be a little problematic in that. When you say a woman, it’s a surrogate term because we’re accepting. We’re gender inclusive. You can call yourself a man. I don’t care what you call yourself. If you’re going to have a baby, it’s fine. We love to take care of different types of people. The word midwife translates into with women. No matter what you call yourself, the work has this feminine, nurturing, matriarchal energy. That’s why you probably couldn’t get a business. I wouldn’t recommend, Richard, that you start a home birth practice.

It’s not going to be my second career. What kind of people do you find going into this career? What kind of students do you recommend for this career?

By nature, a lot of people are curious about this work because it’s women-centered. By nature, it has to be someone who is moved to do work with women and to be part of the woman’s journey. That is quite a few people. You have to be the person who is comfortable with touch and comfortable with intimacy. We do get quite a few students curious about this profession. My recommendation to people is, if you want to be a midwife, you don’t have to be a home birth midwife. We need midwives. To anybody who wants to be a midwife, I am all there for them.

You can decide to work in a hospital too. There are a lot of classes. I appreciate my hospital midwife colleagues because whenever we transfer someone, then we’re transferring to another midwife. There is a sisterhood where we can collaboratively work together. I do love hospital midwives. It doesn’t matter if you’re looking for midwifery. Whatever kind of midwife you’re looking to be, my recommendation is to do some research. Read their bios or work, and this is important, write a nice email to them. That’s how I found my partner. She was, at that time, still an undergrad and she wrote me this lovely email. Many people write me emails and I don’t know what to do. I don’t have room for a lot of mentorships.

I usually write in a very nice, “Go here, go there. Look for our professional board. They might give you more information.” I could tell from the way she approached, there is somewhat maturity. There’s a lot of humility. I thought, “I’ll talk to her.” Now, she’s my partner. A lot of people are fascinated with birth. Whether or not they were going to choose a midwifery career or anything to do with birth and they want to follow a midwife, my advice is the best way to get in is to write a nice letter. I say that because that craft is a little lost of approaching a total stranger.

Being on the go is actually mentally healthy for sports people. Click To Tweet

Kimm, I want to move to a different segment now. It’s a fun segment I like to call it Dr. Marn’s Lightning Round. You don’t have to make a long answer. It could be short answers. Favorite day of the week?

Saturday.

Favorite city in the US besides the one you live in?

A town called Adams in Massachusetts. It’s not a city. It’s a beautiful town.

What cheers you up?

Being with friends and not having to worry about politics or birth and being able to be myself.

What’s your best childhood memory?

I’d say spending time in a boat with my grandmother in the monsoon season. We had boats under our stilt houses. Every year when the monsoon came, the whole town would be flooded and we’ll pull the boat out, do all our shopping and all our sightseeing.

Is it while raining?

It doesn’t rain all the time. It means that the floods would come.

What accomplishment are you most proud of?

My work. I would like to apologize to my daughter for not saying being a mother. It’s awesome being a mother, but being able to come to where I am now is the answer.

One of your favorite books of all time?

Any book by Amy Tan.

Climb a mountain or jump from a plane?

I flew on a hang glider, so climb a mountain.

Your least favorite word?

Vulnerability.

Do you have any pets?

I have a fur baby, a cat.

If you could ask your pet two questions, what would it be?

It would be like, “What are you thinking all the time?” and two, “Do you love me?”

HCDM 32 | Home Birth

Home Birth: Being on the go is actually mentally healthy for sports people.

 

Where can readers go and reach you or learn more about you?

They can go to my website, HeartScienceMidwifery.com. I also have a website for the mental health work that I do call BirthHavening.com.

We didn’t get the time to talk about that but maybe in the future, we could. Kimm, thank you for being on this show. I appreciate it.

I hope this has been useful for you.

It’s been useful, educational and a lot of fun. Thank you.

Thank you, Richard.

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About Kimm Sun

HCDM 32 | Home Birth

Certified Nurse Midwife, Owner at Sunrising Midwifery