Alright – so today we’ve got the honor of introducing you to P Fadwah Halaby. We think you’ll enjoy our conversation, we’ve shared it below.
Fadwah, thanks for joining us, excited to have you contributing your stories and insights. Can you recount a time when the advice you provided to a client was really spot on? (Please note this response is for education/entertainment purposes only and shouldn’t be construed as advice for the reader)
The best advice I have ever and will ever continue to give to my clients is to consider their home as the best place to birth if they are healthy and relatively low risk. For the past 10 years, I have assisted over 500 families to birth in the comfort and intimacy of their home – with a few birth center and AirBNB births here and there. Prior to that, I assisted over 1600 families to birth in the hospital.
I have to say that planned community birth is hands down much more satisfying for clients and midwives alike. [Community birth refers to any birth that occurs outside of the hospital. We prefer this term to ‘Out of Hospital’ birth as the latter implies that the Hospital is the normal place for birth. Normal, low risk birth (which comprises 90-95%of all births worldwide) does not require the high tech bells and whistles that comes with being in the hospital.]
What really stands out to me is the behavior of the babies. They are quiet, content, seemingly happy when born outside of the hospital. They sleep better, breastfeed better, and overall exhibit a more relaxed, contented attitude than their hospital born counterparts. If you really think about it, birth is a really big deal on an emotional and spiritual level. As a human being, you are only born once into this world. And as a birthing person, you may only birth a handful of times, if that. Does it make sense that we have turned it into a medical event with bright lights, rough handling, and absolutely no acknowledgement of the spiritual aspects? Of course the babies are going to shut down, close their eyes against the bright lights, ball up their fists in defensive gestures against what must be perceived as violence against them. And birthing people are more and more beginning to speak up about the physical and emotional trauma that they experience during the episode. The medical professionals in the hospital mean well, but in the name of medical safety, they are missing the point.
The most important decision that a pregnant person and family can make is in choosing their provider. It is possible (difficult, but possible) to achieve an emotionally and physically satisfying birth experience within the confines of the hospital institution. One of the biggest problems is that even your amazing midwife or doctor is not with you the entire time you are there. Therefore, they cannot protect you from the institutional procedures that you may be subject to – from the paper signing during potentially painful contractions, to potentially unnecessary vaginal exams and other institutionally mandated actions like continuous monitoring, IVs, and restricted positioning. You can hire a doula to help advocate for you, but even she is limited in her abilities to protect you.
The answer to this is to choose to birth in a place where you have the control over the environment and the people you invite into that environment. This means that you need to choose well when picking a provider to assist you – someone with a lot of experience in identifying risk factors all along the way.
Awesome – so before we get into the rest of our questions, can you briefly introduce yourself to our readers.
I am a midwife. [MIDWIFE means ‘with women’ (and in 2023 it means ‘with a person who has a womb’]. I am a home birth mama x6. I have assisted over 2000 babies into the world. I am a business owner, a mentor, an educator and a change maker. All of these define me and also don’t fully define me.
I started my practice, Midwife360, LLC, nearly 10 years ago, after working for 8 years as a hospital midwife. My body had begun breaking down from the stress and disconnection of assisting normal birth in the hospital environment. I had considered it my duty to protect women from getting unnecessary cesareans and it was clear that I was swimming against the tide. I also realized that people make their choices and it’s not my job to protect them from the consequences of those choices. Rather, I could create an alternative choice. Midwife360 is that alternative choice.
Now the time has come to circle back and reintegrate with the hospital system to make the transfer from the community setting into the hospital smoother and more satisfying for all involved. There are times (about 10% of the time) when there is a reason to access the next higher level of care during a community labor and birth. Most of these situations are related to long labors, maternal exhaustion, and failure of the baby to descend and the cervix to dilate. It is typically related to the positioning of the baby in the mother’s body, but sometimes we never know the reason it happens. Often we have tricks and tools we can use like Spinning Babies postures and circuits, but occasionally we employ everything we know and we still cannot cross the finish line at home. In these cases, we transfer to the hospital with varying degrees of welcoming from the hospital staff.
We have had OBs refuse to take a report from us stating they are ACOG Fellows and don’t believe in home birth – this has absolutely no bearing on their duty to participate in a hand-off from one level of care to another. We have had OBs simply refuse to speak to us. We get asked all the time – “Who is your back up doctor?” – an entirely irrelevant question in light of the EMTALA law that requires a hospital labor and delivery unit to accept and treat any laboring person who crosses their threshold.
Rarely are we welcomed in with smiles and statements of “We’re so glad you’re here! We will take good care of you and do our best to honor your birthing plans. We know this wasn’t your first choice.” Why is this? Perhaps it’s because most hospital birth providers (nurses, midwives and doctors alike) have never witnessed a normal birth in the community setting. All they know of community birth are the transfers. They may have been traumatized by receiving a transfer that should have come in hours earlier, but didn’t because of fear of the hospital by either the birthing family or the midwife. These are referred to as ‘train wrecks’ and perceived as a situation that was created by someone else that they now have to clean up.
As the Chairperson of the ACNM (American College of Nurse Midwives) Home and Birth Center Committee, I have made it a goal to create a National Transfer Policy to commit to paper the duty of the hospital to receive community birth transfers in the same way they perform their duty when moving patients from one level of care to another within the hospital system (from the ER to MedSurg or from MedSurg to the ICU, from the ICU to Rehab, for example). There are a few states that have managed to create a system using the principles of a program called Smooth Transitions which was born out of the Home Birth Summits. The Home Birth Summits brought a cross-section of the maternity care system into one room to discuss improved integration of services for all women and families in the United States. In 2011, 2013, and 2014 the Home Birth Summits convened a multidisciplinary group of leaders, representing all stakeholder perspectives, to address their shared responsibility for care of women who plan home births in the United States. It has been over 10 years since these meetings took place and we have yet to implement the comprehensive solutions they proposed!
All of this is relevant to everyone because of the appalling maternal and infant mortality statistics for our country. The US is the only developed country with high rates of maternal and infant mortality that continue to rise instead of improving. (According to the CDC, the maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019) And for infant mortality, of all countries in 2020, the United States possessed the highest infant mortality rate at 5.4 deaths per 1000 live births, which is markedly higher than the 1.6 deaths per 1000 live births in Norway, which has the the lowest mortality rate. What sets those countries apart with the lowest maternal and infant mortality is the prevalence of midwives. They have an 80/20 ratio of midwives to OBs compared to the US where it is flipped – 80/20 ratio OBs to midwives. As community birth comprises less than 2% of all birth in the US, we are not the reason for these poor statistics, rather I propose that we are one of the solutions. After all, the US has the best medical technology in the world, yet all of this technology seems to be harming some mothers and babies rather than helping them.
How can you help? If you are interested in birth in Florida, look out for updates to the APRN Autonomous Practice Bill. It was Senate Bill 1686 in 2022, not sure if it will still carry the same number moving into 2023. Also, reach out to your local hospital and encourage administration to care about this topic in the interests of improving safety and satisfaction with community birth transfers. Contact Midwife360 for more info.
What do you think helped you build your reputation within your market?
I believe that my work ethic combined with my authenticity and desire for connection with my clients is what has set me apart in the home birth world. My years of experience, especially my hospital experience combined with my personal journey through the midwifery and birth world have also put me in a unique position to offer assistance to folks who (for various reasons) wish to birth in their home rather than take the expected route of hospital birth. I am comfortable with breech and twin birth as well as birth after multiple cesareans. I have cared for women with unique anatomy. There are a number of factors that also need to be present from the pregnant persons’ side of things: There are a number of factors that also need to be present from the pregnant persons’ side of things: – their conviction in the normalcy of birth and the ability of their body to give birth is critical to our success in each situation.
– their intention and commitment to making their successful community birth a priority for that time of their life by focusing on good nutrition, exercise and other healthy lifestyle choices.
These aspects are explored in depth throughout our journey together.
I am a Nurse Midwife/Nurse Practitioner which is rare in the home birth world. This enables me to provide a wider range of services to my clients like medication prescriptions, and comfortability with medical devices and processes (cervical ripening Balloon, IVs, NSTs and Ultrasound).
Learning and unlearning are both critical parts of growth – can you share a story of a time when you had to unlearn a lesson?
The biggest lesson I had to unlearn is the belief that I needed to be able to work with insurance companies by being in network and participating in the filing of claims in order to have clients. Working with insurance has nearly been the death of my practice several times over the years until I finally made the decision to remove us from that game. It has been the best decision ever and I really wish I did not ever get involved in the first place. It is unclear if I would have been able to grow to the point that I am now without offering that benefit to my clients, but the financial cost has been huge.
When I first opened Midwife360 in April of 2014, I believed that getting in network status with all of the insurance companies was the thing to do. I hired a billing service that was supposed to get me the contracts, but I ended up doing all of that work myself. Ultimately, we became in network providers with every major insurance company, Medicare, Medicaid, and many smaller companies. I came to realize that it’s a big game with the insurance companies being the only winners. Clients were paying large premiums and also having to pay deductible and co insurance costs to us. Oftentimes our claims were denied with the appeal process taking as much as a year or longer with no guarantee of payment. And the contracted rates were laughable – requiring us to play a game of adding an additional fee to our clients for things not covered in order to stay in business.
Now we work with clients insurance for their lab work and ultrasounds and can offer a superbill or invoice after the birth so they can submit their own claims. We have a very reasonable rate for our full journey – currently $8000 – which gives them full access 24/7 throughout the pregnancy and birth experience. They get hour long prenatal visits, the birthing tub and some supplies for the birth, as well as many other benefits. When I compare that to a recent incident where I was injured and spent a couple hours in the ER for a final cost of about $7500, I realize just how reasonable our price is! Also, ever since COVID changed the world, more and more folks realize that they don’t want to be in the place where sick people go to birth their normal, healthy baby. It’s my pleasure to offer a safe and satisfying alternative while also supporting my practice and my team financially.
Contact Info:
- Website: https://midwife360.com/
- Instagram: https://instagram.com/midwife360
- Facebook: https://facebook.com/midwife360
- Linkedin: https://www.linkedin.com/company/midwife360/