Hadja

Not all midwives feel they were called to be a midwife! In this episode, Hadja shares her journey from a double major in international studies and nursing to her realization that midwifery was the best profession to be in to accomplish her goals. This episode also features topics such as:

The importance of risk taking in your career

How important diversity is in healthcare

How essential collaboration is for optimal healthcare 

Red flags in job interviews

Transcript

0:00

Hello, and welcome to my podcast, mindful Midwifery Presents, the Labor Behind Labor. My name is Katie O'Brien, and I've been a nurse midwife since 2007. Midwifery is simultaneously one of the most rewarding and also one of the most demanding careers. The goal of my podcast is to highlight this dichotomy and give listeners an insider's view on what it feels like to be a midwife. My guest for this episode is Haja. I knew from Hodge's first interview at the practice we ended up working at together, that she would be someone that would inspire me throughout my career. She embraces change and is always looking to improve midwifery, both on an individual patient level and also on a system level. During this episode, we will talk about some of the difficulties midwifery faces from an education standpoint as well as a systems level standpoint. We will highlight the importance of collaboration and diversity within our industry. Haja has three children, the youngest being her Spitfire daughter, who is sure to follow in her mother's footsteps of changing the world. Her daughter was floating in and out of the room we were at at her house while we were recording. I'm excited to share this episode with you. Let's get started. I.

Katie: 1:10

hi Haja. I'm so glad you are on the show. Essentially I'm vol telling everyone to be on the show right now, but, I am picking people that have inspired me personally and that I think have a great message to share with others. So you were top of my list. So I like to start by just asking why did you become a midwife? What, what led you to this? I think it's a really interesting question because. Midwives share so much of how we end up in this field, but not quite the exact stories. And we do have different journeys, that I think continue with us throughout. tell me that, that part of the story.

Hadja: 1:45

Yeah. I think that's so true They'll tell their stories of how they ended up and oftentimes people will say it's like a calling that they felt like it was almost like a calling. I, and I would say for me, it didn't necessarily feel like a calling, but more like a tool and pathway for helping. Improve outcomes for women, in the US and globally. So when I went to college I was like, I'm gonna be an international studies PoliSci major, and my parents were like, Africa does not need anymore politicians. And they really pushed me to do something that I could take back, if and when I decided to go back to, to help people. So then I was like, okay, nursing seems like, a reasonable easy route to do that. In addition to like continuing to do international studies in poli sci. So I essentially double majored in international studies with a focus in social justice, in college and nursing. And so, took me five years to. Get my bachelor's degree, but, graduated with two degrees, and then really ended up falling in love with nursing and what nursing has to offer, as far as like public health and patient education and improving, public health outcomes for people. The other thing that I realized that, I had these stories from, being born and spending some of my life in Guinea, that really, resonated with me about how midwives do play this role in society, in affecting women's health, gynecologic and reproductive. And realizing that I did, want to improve outcomes so that, nursing ma made, made sense. And so after graduating from nursing school, I thought I wanted to work with like adults and everyone. So worked a little bit, on a general medical surgical floor. And then while I was doing that, I realized that I actually did not wanna work in a hospital and I did not wanna work with everyone At that point, I was already taking some courses for a midwifery degree, But I did like the courses and I realized while working as a nurse that I didn't wanna, do anything else but work with women. I continued on with midwifery school and then just learned a lot about disparities and outcomes for people, here within the US and also globally. I've always had this global attitude about midwifery and nursing, that it's something that's in every society. You know, these are professions that are in every society, and these people function in, every society. And they're really like the first line for improving outcomes for healthcare in a lot of countries. And it was like, this is, this is what I wanna do. And it's also not, something complicated. It's not the cutting edge of like, health or medicine. Right. It's not like, it's not like neuroscience. That's true. Yeah. We're using like really basic tools, mostly our hands to do the work that we do. And then even the knowledge, like even I, I think about this often. I'm like even the most complex medical conditions and. Obstetrics pregnancy, gynecology. There's often like much more knowledge about that than like these other, specialties like neuroscience. And yet we still have really, desperate outcomes when it comes to, maternal health. People die from, from bleeding out after having a baby and it's so preventable and you, you have the tools, medications, and it's a matter of training and having people that are trained, with every person who's giving birth to help, ensure a safe outcome. I've been a midwife since, 2015 and I've been a nurse since 2012 and I don't. Regret it at all, it's Oh, that's

Katie: 5:34

to hear

Hadja: 5:36

No, I mean, I mean, in the sense, I do think about pivoting, not maybe necessarily doing bedside clinical work anymore, but I still will always be a midwife and will always advocate for, for causes that are like for midwifery and nursing and that are really close midwifery and nursing.

Katie: 5:52

That's a big component of what I want people to get from this podcast is what is a midwife, and you just alluded to the fact that I think it looks. Different. You can have this really narrow vision of midwifery where you can have this very broad definition, and I'm trying to lean into the broad definition of mid

Hadja: 6:12

Yeah. Wifeing.

Katie: 6:13

wifeing. Yeah. and right now I want a midwife. The midwife. Yes.

Hadja: 6:17

Yes. There's, yeah. And there's so many things to midwife, right? We midwife parents, moms. Our colleagues, students, we midwife the system through the system. Yeah. Yeah.

Katie: 6:31

that's the tougher one. I, I think. But I'm hoping that we continue to keep trying mid wifeing the system and that we. I don't drop out because that gets

Hadja: 6:42

Mm-hmm.

Katie: 6:43

And pivoting, I think can be a big piece of that, of knowing where you're at at that moment and what you need from midwifery and what you can give as a midwife. And, honing in on that. And you have certainly had some career pivots, how do you know you need one? Where, how do you feel like you realize you need to pivot out of something and into something different?

Hadja: 7:06

Yeah, I think that's such a good question and I almost, I always feel like it's a question of faith and maybe not faith in the sense of like religion or like dogma, but like in the sense that, I feel like I'm always taking a chance. I'm, anytime I make a decision am always like, oh my God, am I gonna regret this? Am I gonna come back to what I was doing? And I've never regretted a decision. But in that moment of pivoting, it really is like a question of faith you want to do something else, yet you're so comfortable in what you're doing right now, or you're afraid of the unknown, and yet you're gonna take that leap and it may not work out, or you think it's not gonna work out, or you're gonna regret it and maybe it doesn't work out. But I rarely have I ever regretted, I've always felt like I've learned and gained something from this new experience and like, move forward.

Katie: 7:57

That's well said. I believe that you learn just as much from something being a not ideal situation or not a great experience as you do from it being a great experience, I think you can say, okay, that didn't go well because of X, Y, Z, but now I know that that's not something I wanna push into now. It's easy to think very narrowly of midwife jobs, but there's actually not a shortage of jobs I don't feel right now in the midwifery field. If you're willing to get a little creative about what you're able to do, I think there's, there's a lot we can do. Yeah.

Hadja: 8:33

Yeah.

Katie: 8:34

And I think a lot of different personalities fit a lot of different, parts or maybe just in that moment your personality fits this job and then, later you're like, I don't need that now. Things have changed. Just being aware of that. Yeah. I, I think there's also this thought by people that look at others that take risks and think that there's no fear involved or that maybe we're just okay with risk taking. I think to some extent, you and I are similar in the amount of risk we're willing to take, but. But it is hard. It's hard and it comes with, with sacrifices and, and a lot of potentially tears and questioning yourself. Yeah. But I too have never regretted

Hadja: 9:21

Yeah.

Katie: 9:22

Transitioning.

Hadja: 9:23

No, absolutely. And I think that risk feels like it gets larger or bigger, The older you get, because undoubtedly you like have kids and you have family, right? You have a mortgage, you have things that really, really do depend on your sta stable outcome. And midwifery can provide you with a stable career and and income. And so sometimes it can feel like you're tied down to what you're doing that you initially went into with lots of passion, and you're thinking about pivoting, but feel fearful of pivoting because of those things. Those are real concerns and real risks. But I always say unless you're willing to take that next step, you may never know what, how great like of, a chance you could have or how great you could be at something else, right? If you just stay with what you're doing. You would never know that something greater is out there for you. Or that you could have a bigger in impact in a different way. Mm-hmm. And you just stay in where, where you are, where you're comfortable.

Katie: 10:24

Yeah. And if you're okay with that, you're okay with it. But I think it's this, what makes me sad is when people. Ignore that tug that they start

Hadja: 10:35

mm-hmm. about

Katie: 10:35

like, this isn't right. I need to do something else. For whatever reason, they ignore it and ignore, ignore it. And now we're burned out and now you don't have the reserves to go through what's gonna potentially be a very big transition because it is.

Hadja: 10:47

Yeah. Yeah. And I, and I also think like the makeup of a midwife is in a way that. You truly are Never com comfortable with the status quo. You know what I mean? Yes. I like people that go into midwifery.

Katie: 11:00

have a little re like rebellion

Hadja: 11:01

yeah. They've always like, wanted to change the system to be better for women. Like they, they, like they have that in themselves. Right. Or otherwise they would be, I don't know, like something else, but not midwives.

Katie: 11:16

Yeah. And I think we all realize that about ourselves probably at different

Hadja: 11:18

times. Mm-hmm.

Katie: 11:19

I, said in another episode that I remember the moment when I was like. Oh my God. This is a field of advocacy and it, yes, every aspect of this is advocacy. And I don't know if I'm strong enough to do this. Why, why did I make this decision? But I was already so far involved in it, in school at that time that it, I was just gonna continue with the path. But there has to be something inside of you, I think. Yeah. Inside of each of us that has at least a tiny bit of rebellion that we can pull out.

Hadja: 11:51

Yeah. And also like rebellion and being able to like, speak up and speak your truth about something,'cause some people they feel uncomfortable in certain situations, but they remain quiet because, they, that's what is comfortable to them versus I feel like midwives are always like, okay, you'd be comfortable to stay quiet, but I, I just can't do that and I need to speak up for, for the people that I'm taking care of for my community. And that takes a lot of bravery.

Katie: 12:19

It does, but I think it can look different for different people. I know, for example, I am not a protestor, there is not enough money you could pay in the me in the world or enough that, like, I, I guess maybe there are some very extreme circumstances where you'd catch me at a protest, but like, that's really not my shtick.

Hadja: 12:36

Yeah.

Katie: 12:37

but you know, there are other aspects that I'm really willing to put myself out there for, especially like in written word or, through people like advocating for, midwives in a, like one-on-one kind of way. Where I feel like I have, where it's not such a, an unknown to me. I, I guess is the best way

Hadja: 12:58

to say it. Well, I, I mean, I, I sometimes feel like it's easy to be a protester and a mass then like being, I know, I know you for, for a fact, Katie, like you, you've been in like situations where you've had to advocate to like someone higher up than you for someone else who, who was who you were in leadership for, right. And I think that's sometimes harder when you're like face to face with someone who has a higher role or, um, space. Yeah. And, and whatever organization you're in, but, and then speaking up for someone who's below that person, and I know, and so to me that is that, like protesting that, like advocacy. Right. And that's, that's harder to

Katie: 13:39

Well, I think it's harder in your mind,

Hadja: 13:41

Right. Right, right, right, right.

Katie: 13:43

but that's the beauty. And I think we all need to look within and, and realize that we're not gonna be every facet of

Hadja: 13:51

what Yeah.

Katie: 13:52

is needed. There's so many different ways. Sometimes it's a touch, uncomfortable, no matter how you do it, but you should focus on the, the parts that aren't so horribly hard for you personally, and channel that way, because I think you can accomplish more when you have a degree of it feeling

Hadja: 14:10

Yes. And it feels authentic. Really. Yes. Yeah. Yes. When you do something like, yeah,

Katie: 14:14

So call out to everyone to

Hadja: 14:18

Yeah.

Katie: 14:19

out what that is about yourself and, don't feel like it's less than Yeah. No

Hadja: 14:23

They're different ways of advocating.

Katie: 14:26

Let's talk about how things have changed for you and what type of job has been appealing to you based on where you are in life at that time.

Hadja: 14:35

it's always felt like internal for me and almost again, based on like faith and like risk taking. When I graduated, I joined, in Dover, Delaware. I'd gone to school, in Philadelphia and so it felt like a change in environment and community and people that I would be taking care of. But it also felt really right because when I went and met, the group, really felt like a place, where I wanted to learn and grow as a midwife. There it was a large group of midwives and, it felt supportive. Was there for about four to five years and then, really felt like I wanted to. Focus on teaching. I've always loved teaching and since I was in undergrad, I've taught, I was a TA for a little bit, in my a MP class, anatomy and Physiology. And then, did some, tutoring for students, in one of our, departments in my undergrad. And so always loved teaching. And so really felt like I wanted to focus on that. And applied for a faculty position at, Penn, and then started teaching there. And it just felt, it felt right. Again, it was scary though. It felt like I was taking a chance that there was so many risks. What if I failed? What if it wasn't, what I, was thinking that it would be, But was excited about doing it and so it just took a chance and was teaching for, a couple of years there. And then, it got to a point where it didn't feel right, it didn't feel like, I was accomplishing what I thought I would, would be. There was like a mismatch in values between myself and the department. And so decided to, leave and just do clinical practice. And during that time I remember thinking like, what if I regret leaving? What if I can't come back to teaching? How does this look? I've only been here for, two to three years and, I was really excited about this, but then it's like,, take a chance. And I went back to clinical practice, and. It felt great. Like it, it, it was great leaving clinical practice for a bit and then doing something else and going back. It almost felt like a sabbatical. And I think we should do those more often in midwifery. Yeah.

Katie: 16:43

Yeah. Most of the midwives I know. I, I was gonna say every, but not quite every, but almost all of the midwives I know have, if they get to this like 15 plus year mark, have taken timeframe. Where they weren't doing full scope. Yeah. Maybe they were just in the office. Maybe they were just hospitalists for me, I rounded for two

Hadja: 17:06

Yeah.

Katie: 17:06

Yeah. Or they taught, but I think that's a very healthy way to step away from the problems you've been dealing with for a long time. Yeah. You're gonna find problems there too. I don't, I mean, I

Hadja: 17:17

yeah. Yeah. It's just different. Say

Katie: 17:20

that there's a jaw without problems, but sometimes you just get sick of handling the same problems Yeah.

Hadja: 17:26

Over and over again. Yeah. And

Katie: 17:26

Yeah. And you just need to take yourself outta that Yeah. For a little while.

Hadja: 17:30

No, absolutely. And also like using a different part of your

Katie: 17:33

Mm. Mm-hmm.

Hadja: 17:34

like teaching in clinical practice. They're similar, but they're a bit different also. And that felt good. And it also, it really felt good going back into clinical practice that like, I remember like what I would be teaching and, how I would talk to students about the importance of the care that we provide and being able to do that, it, it almost felt like I had a refresher on, on how to be a midwife and that was good. Yeah.

Katie: 18:00

So right now, tell us about what you're exactly doing right in this moment.

Hadja: 18:05

Yeah. And right now I'm also in a crossroads of trying to, take a leap of faith, to do something, a little bit different from clinical practice. I have always wanted to do or be involved in global health and global development. i went into nursing really because of feeling like, nursing is a career that, can, that can help people all over the world and wanted to go back, to West Africa to work. I am trying to find a way of, going back to that, I feel like that is, that is my life's purpose. To do that work. I always wanted, to do it. It's felt harder. As I've, I have a family, I've established a family of kids, to do that from the us. And things are, it's just hard right now to see, to see how to do that with so many things changing in the last couple of months. So, trying to figure out if, that looks like teaching or, that looks like trying to find something abroad and moving, to, to a place to do that and yeah. A lot of uncertainty right now.

Katie: 19:18

How do you go about, or is this part of the struggle for you finding positions in that work? Is this happening through networking? Is it happening through job searches? How are you

Hadja: 19:28

is, it's incredibly diff difficult. I, I have found that, finding a position in, in, global health, unless you have, a public health degree or, you have some sort of connections that it, it's very hard, which, I think that really prevents, midwives from being able to, spread their skills and teach and help train, a larger, cohort of midwives for the future. So, I've been applying, I've also been talking to folks to see, what the best pathway is. It's also harder if you're not in academia. I feel like when you are in academia, often there's connections between institutions and so it's a bit easier. But, I'm contemplating going back to school. To help me and being able to do this work, whether it's through public health or through a terminal degree. And so I'm trying to figure out like what is the best pathway in, of doing that?

Katie: 20:26

Yeah, this is something we've definitely talked about off air a lot is, the DMP role and where midwives stand and the jobs we're able to get based on our degrees. And certainly when I went through school, the DMP midwives are still really pushing hard to not have a DMP be part of midwifery education at all. And that has changed. I am personally not a huge fan of the pressure for that. And it is unfortunate to see when you are meeting barriers, even though you've been in the field for a long time, because you don't have, a doctorate.

Hadja: 21:06

Yeah, I, I agree with you. Katie, I think the most midwives do not support, or do not want midwifery practice or the ability to train, future midwives to be dependent on, the ability to have a doctorate. There's so many types of midwives out there with so many, different types of training. And I think certainly there's like space for, everyone to be able to provide care. And also just thinking about what we're facing and like what we need to do globally to improve maternal outcomes. And what we have to ask ourselves is, will, will forcing midwives to have doctorate training in order to practice to the full capacity of, midwifery will. Mean that we have more midwives to face the problems that we're facing, or is that restricting the amount of midwives that we have? And so then, these problems that we, we need to address are not being addressed, in a timely fashion. I think a lot of people will say no, like forcing midwives to, or creating this, pathway that requires midwives to have doctorate degrees is not going to be helpful in improving outcomes. I think there's definitely, value in training in like terminal degrees doctorates, whether that's a doctorate or, in nursing or midwifery or, a PhD. But, making that sort of the base line of having, midwives is, I, I don't think it's a good policy or a good idea.

Katie: 22:33

Yeah, I worry about barrier access too. I just can't imagine that that's not gonna be a barrier

Hadja: 22:40

Oh, absolutely. Individual

Katie: 22:41

we don't want

Hadja: 22:42

Yeah. Not be

Katie: 22:43

into the field. And so that saddens my heart and it saddens my heart to feel like we're in this weird spot with midwifery right now where a lot of our institutions are requiring doctorates even to be involved in teaching. And when I look at who's not able to

Hadja: 23:01

teach mm-hmm.

Katie: 23:02

we're losing these soft skills that midwifery has, to stand behind degrees. And I really struggle with that. I, I had a mentor that, practiced clinically for 40 years, 50 years, I don't even know so long. And to not have her be recognized to the extent that she should be for that contribution that she gave to so many midwives, she mentored so many of us.

Hadja: 23:31

Yeah.

Katie: 23:31

like I am who I am as a midwife because of her. Yeah. And she did not have a doctorate. Yeah. And she wouldn't have gotten a doctorate. Yeah. And that. That saddens my heart.

Hadja: 23:41

I feel the same way. If I think about the midwives that have had the most impact on me, it's been midwives without doctorate degrees. Yeah. You, for example, my current lead midwife, my faculty, in midwifery school, none of you all had PhDs and I think, or doctorates in general. And I think there's something to be said about people who ha, who have knowledge but don't have, letters behind their name and the experience, and what they can pass on. You don't need a, you don't need a doctorate to provide Great. Free care.

Katie: 24:12

Yeah. I do think that it does help you in certain areas, but it might be a PhD even in something

Hadja: 24:19

Mm-hmm. You know,

Katie: 24:19

sometimes it's just that further, level. So if you're like thinking about going into school and you're stressing over a program and what that program looks like, to me, I would still value the experience that you get at that program versus what the program outcome is. And how they're training you.

Hadja: 24:40

and the mentorship

Katie: 24:42

Oh, massive. Right? I mean,

Hadja: 24:45

yeah.

Katie: 24:45

I don't, I don't even know if you can be on my show if you don't believe in mentorship. That is a test, right? To me it is. Absolutely. Without question. The foundation of midwifery. Even if you are not super excited to mentor, it is part of who you are. And it looks d. With different people. I had my like primary mentor, right. But I also had this, I don't even know that she would think she was a mentor to me, but she just worked triage. Okay. She was a midwife, had been a midwife for like 45 years, just worked in triage, loved triage. But there was a piece of her that I learned so much from, and it wasn't even like she would've thought she had that label.

Hadja: 25:25

Yeah. Yeah. And a lot of it happens informally like that. I, I mean, and also life is about mentorship. Like, I mean, there's so many ways that we learn on how to be a human, how to be a good citizen, how to participate in society. And it's almost always through mentorship. Yeah. There's formal education, but it's also someone showing you like, how, how do you behave this way? How do you do what you do? And I, in any field, I think in order to be successful, you need good mentors. And certainly midwifery. Yeah. Yeah.

Katie: 25:59

So as, as you move forward in your, career, what's giving you hope currently? This is a tough time for midwifery and for healthcare and women in this country, and I think, I just can't imagine that no matter where you lie on the

Hadja: 26:18

mm-hmm. of politics,

Katie: 26:19

that you aren't holding your breath a

Hadja: 26:20

Mm-hmm. I, yeah. imagine Yeah. that

Katie: 26:24

not all holding our breath a

Hadja: 26:25

Right I almost feel like we're at like the precipice of something, like something something is gonna come out of this and I, I don't know, I believe in humanity and that we're so, intelligent and have so many innovations that good people will work on creating like a new system that's not so dependent, on folks that one decision and one person can. Change, everything for everyone. So, I'm hopeful. I'm really hopeful in that sense. And it took me a while to get to this point, but just seeing like how so many things have changed in the last 50 years that there's gonna be something comes

Katie: 27:05

that especially where women's health in this country is concerned, it had to get worse before it gets better, actually. To me, that was always part

Hadja: 27:13

the story.

Katie: 27:13

We haven't been in a place where we've had good outcomes like we should for the resources we have. And in order to change those problems, I think to some extent it has to, it it has to get a whole lot messier and you have to get to this place of like being able to innovate.

Hadja: 27:33

mm-hmm. one of the

Katie: 27:34

things that was really interesting to me when I was deep diving

Hadja: 27:38

mm-hmm.

Katie: 27:38

was that, one of the books I read, which I, I'm forgetting the author off the top of my head, so I'll have to cite that later. Was saying that, everybody looks at constraints as a disadvantage. Okay. But he's like, but that's actually not totally true because when you have constraints, you actually have to get more creative to be able to, figure things out. And so when it's limitless, when everything's limitless, you actually stop having to be creative. Yeah. You know? And so I'm hoping that that's where we're at right now is like, we have a lot of constraints. We have a lot of craziness happening, and maybe through that we can get creative and emerge, in a better place than we started. Yeah,

Hadja: 28:23

A good, an example that I have of this is during the pandemic,, my colleague and I who are teaching. This midwifery class. and one of the objectives in the class was learning how to do a second degree perennial repair, something that we do often as midwives. And when we had been in person, we would meet in the lab, do it with the students and they would continue to practice. And we couldn't do that. In 2020, during the pandemic. So we did this virtually live, and then I recorded a video and uploaded it, and the students, were to practice. And, and then one of the assignments that we came up with was having the students record a video of themselves doing a repair and talking. Through all the steps of what they were doing, including like the instruments, the suture that they were using and submitting it. What, what came out of that was something that we actually kept even post pandemic that we wanted.'cause it was such a great learning assignment that we wanted the students to just do this all the time. And again, like in that moment we were like so desperate. We're figuring out how to teach them how to do repairs. And so like that scarcity mindset. And then, this great thing came out that we used even when we did have all the resources back again.

Katie: 29:31

Well, one of my favorite things that came out of the pandemic was outdoor seating. I mean, we always had the option of outdoor seating, right. But it took the pandemic to be like, oh, okay, I'm gonna create the outdoor seating. So let's, let's, let's pray, hope, whatever it is you do that, that is, that's how,, we, we move forward.

Hadja: 29:50

So we're gonna talk about, caring for, for patients, for families, for people, who are discordant from us, whether it's religiously, racially, ethnically, culturally, because I do think that this is something that happens often, in midwifery. And I, I think this can be like within the US or even internationally, obviously. But thinking about my experience, I. Went to school in Philadelphia prior for midwifery school. And prior to that I was living in Virginia. I was born in West Africa in Guinea. And so I've feel like I've always occupied this space of caring for people or working in communities where there's always been more differences than similarities in some way. it really has forced me to learn to be adaptable and pivot while staying true to my core and to myself, right? There's some things that I believe in, values that I have that are not negotiables. Like I will always hold onto those. But thinking about how do I move into a community where I. I'm seen as different, and I almost always have this, I went to West Virginia once and I remember the community that I interacted with there, I remember them asking me like, was I from the Caribbean or something like that. Like, almost like

Katie: 31:12

yeah,

Hadja: 31:12

I,, I don't think they meant they were attempting to be offensive, but almost like I was this exotic person that they'd never seen. And Dover, Delaware, certainly I feel like that I came across a lot of people that I had very, a very different background from different upbringing, different exposures. I, I came, I came across people that had lived their entire lives, generations and generations in Dover, Delaware. Um, and I, I, I'm not like that, but I like also living in Philly and growing up in Virginia, I lived in such like diverse groups that almost. All of my friends were people who had lived somewhere else and moved to a different place. And so just a lot of diversity. But also realizing that the people in Dover that I was caring for, that had deep, deep roots in Dover, really had a lot of similar values to the ethnic community that I'm part of in, Guinea. Mm-hmm. Like that sense of like family Yeah. Community. Yes, yes. Yeah. Um, and being able to see and connect with that, was, was really, really important for me. And so I think it's important, like a, a lot of us will, just because of the way the world is, everyone moves, we'll move and, go work in places, that, we're not accustomed to. And the importance of trying to see similarity rather than difference while holding on to, your true values in, in core, right? Like, you don't wanna be someone who just like changes with the wind, but you also wanna be able to, see people and understand who they are, based on something you can pull from yourself.

Katie: 32:55

So I had this. Day, the other day that I actually almost called you about,

Hadja: 33:00

but I, or texted

Katie: 33:01

you, but I just didn't know how to put it in a succinct way. But I had a

Hadja: 33:06

Mm-hmm.

Katie: 33:06

and after, right after the birth, they said the Islamic

Hadja: 33:11

Mm.

Katie: 33:12

Um, I hope I'm saying that

Hadja: 33:13

right.

Katie: 33:14

but like, and it was, and I knew it was coming, so I was prepared for it. and I, I, it's very beautiful to me and, I loved holding space for that. But then right after that, like the next delivery I had, the baby was gonna be going to the

Hadja: 33:30

Mm.

Katie: 33:30

and the NICU or the neonatologist came over and was like, do you wanna say a prayer for your baby, together before I take it to the

Hadja: 33:38

Mm.

Katie: 33:39

And I've never had that. Happen in any of these deliveries. And it was right. The next delivery. And they were like, yes, please say a prayer with us. And so it was like one delivery, that's one religion right into another delivery. Completely different religion. And it was just so beautiful to be a part of this, something that these parents needed in

Hadja: 34:00

that moment. Mm-hmm. Mm-hmm. And not

Katie: 34:02

my own opinions about what anybody needs, just letting that, that flow. Yeah. Like so naturally, I was happy to be a part of

Hadja: 34:09

Yeah. You know?

Katie: 34:10

you know? Yeah. And I think that is the beauty of coming to the

Hadja: 34:16

mm-hmm. as

Katie: 34:16

midwife and having your own, I mean, I certainly have my own viewpoints

Hadja: 34:20

mm-hmm.

Katie: 34:21

Background and whatever, but being able to like. Just let that unfold for people Yeah. And kind of be on this journey for them, whatever that

Hadja: 34:29

looks like. And hold space, like you said. So for that to safely And openly happen.

Katie: 34:33

But I think it can be difficult sometimes. So I practiced in Baltimore, Baltimore, Maryland, very diverse.

Hadja: 34:39

Mm-hmm.

Katie: 34:40

Mm-hmm. And my particular practice we catered to. A more natural side of things.'cause we were an all midwife practice and, but we'd got really diverse groups within that and it was very interesting to see. And so two of the groups that we ended up having a lot of patients coming from were Orthodox Jewish or Muslim. And one of our midwives was Orthodox Jewish. And one of our patients felt very, very, very strongly that she did not want an Orthodox Jew delivering her baby. And we had to sit in a meeting as mid as a midwife group. And

Hadja: 35:16

we were like,

Katie: 35:18

are you comfortable with that? Because we wanna make sure that we're supporting

Hadja: 35:21

Mm-hmm.

Katie: 35:22

um, with your background and your belief system, but also supporting the patient. Like what do we do about that? And, those are not easy conversations to have and it's not easy to even check your own belief

Hadja: 35:37

mm-hmm. and be

Katie: 35:38

to be receptive to how, how that could exchange. And in the end. She was like, no, I'm good with this. We're I, we're gonna proceed for it as we normally do. And of course, she was the one on call for the delivery. Yeah. But it went really well. Yeah. You know, and, and I think she felt good about that, that it went well

Hadja: 35:57

yeah.

Katie: 35:58

know, so we're in that situation all the time as midwives

Hadja: 36:02

actually. Yeah. Whether like it's open or explicitly Exactly. Stated that way And I guess this, going back to, what we were trying to get with this question is patients often self-select into who they want to care for them. Either because they've heard from their friends community or they like Googled or, looked up the providers. And I get this experience often where I walk into a room and, the curtain's drawn up and I pull up the curtain back and it's like it's a black patient and. I've, couple times I've had this happen where they're like startled and they're like, oh my God, I've never had like a black midwife, a black provider before, and like startled in like a positive way. And very often they like will explicitly say, it's like, I'm so glad that you're, like here, that like you, I'm saying these things to you because I know that you can understand in some way., Sometimes people self-select or choose their providers based on what they appear to be, not because they wanna exclude other providers, but really it's like finding someone who knows you, that you don't have to say the things and in between, to help them help the provider understand. There's so many things that, patients say, I, I always joke with my black patients, this, like black women nesting is getting our hair braided. If I see a patient at the end of her pregnancy and her hair is all braided and neat, I'm like, you've been nesting, you are repairing, right? Um, and so like, sort of those cultural nuances, but also, patients know that that's not a privilege that they will always have, that all their providers will be, will look like them. And so how do we, create like safe spaces and discordant, scenarios, right? And I, I think just always coming from a place of respect and curiosity of people's cultures, right? Like I am, I don't understand what is happening here, but I'm going to be respectful the best way that I know how to, for that example, for that patient who's praying, like there could have been someone in there who had no idea what was happening, but knowing that this is like.

Katie: 38:02

Sacred

Hadja: 38:03

to that sacred thing that's happening after birth. So, you know, that, you know, this happens in many cultures. Like I've, I just, the other day I had a patient who was from Benin who just started praying in French after the baby was born and was just saying like, joie, joie. So I knew like he was saying Jesus, like, he was just like praying out and and like it was in French, and I'm sure the other nurses picked up on the Jesus. But, but if you didn't, you would know that, okay, this is like a sacred ritual happening after birth. How can I hold space and allow for this to safely happen? We will never be able to mirror the patients that we care for, but, how do we just be respectful in any, in all sense of the word, you know?

Katie: 38:42

And I think that you also have people that just assume something about you mm-hmm. Based on how you look anyway. And so. Even if you're racially concordant, you actually might not relate to

Hadja: 38:56

patient. Oh, absolutely. At all. Absolutely. Or

Katie: 38:59

same thing if you're religiously or what, whatever,

Hadja: 39:01

or class. Right. I feel like we've talked about this a lot. There's such, there can be such a class divide between like some of the patients that we care for and us. Um, and that can be very hard.

Katie: 39:13

Yeah, absolutely. That's the beauty of midwifery though, that we frankly care about that. Yeah. That we have those conversations. Um, and I do think it's important that as midwives we are really trying to, if we can at least to some extent, visually mirror what our patient population looks

Hadja: 39:33

like. Mm-hmm.

Katie: 39:33

Maybe not entirely, but it's nice when somebody feels like they're at least represented in even a small capacity at the place that they are And then just continuing to have awkward conversations.

Hadja: 39:46

Yeah. Yeah.

Katie: 39:47

And then as midwives being able to talk to somebody else about said awkward conversation that we just had. You

Hadja: 39:54

know,

Katie: 39:54

I think that you and I have been a good sounding board for each other with some of the, the stuff that I hear I am very curious religiously,

Hadja: 40:04

Mm-hmm. Like,

Katie: 40:05

I love world religions. I can't tell you how many people I've had in my life that get really involved in trying to convert me to their particular religion because I'm so receptive and open. Because I love hearing about it. I really genuinely

Hadja: 40:21

wanna

Katie: 40:21

know, like, your experience and, and that it can get awkward at times, but I think we each can bring that to the table where we have this, this curiosity and. And that serves you really well? Most of, most

Hadja: 40:34

oh, it almost always does. No, I feel like I've never been in a scenario where I'm like, tell me more, or, give me more information that patients feel like offended or hurt by. I, I, I think it's quite the opposite, like when we don't ask questions, right? They're like, patients report, like they didn't talk to me. They didn't ask me about, what I was worrying about, what I cared about. I think that's the beauty of midwifery is that we, midwifery comes in with like questions and trying to get information. And then medicine I feel often is about telling you what to do. So I really think that as midwives we should like, hold onto that I talk to new students, like new grads about this and students about this. It's really important to ask people like more questions. Right. Like, tell me more. Tell me your story. I've seen myself develop as a midwife over time. And truly this is one of the things that I'm most proud about is ability to communicate with patients. I'm not proud of my hand skills. I'm not proud of, my spinning babies, like all the things that I can do to, Help get a baby out, but like truly sitting. And this is why I, like, we were talking about this like where we are, like, I really like office. I like sitting and talking to patients, like learning about them, like asking more questions about what brings them in. Like why haven't you been in care for five years? You know, people will tell you all sorts of things. Like, my wife was bad in cancer or I, I was traveling. I, I just decided not to come in and, it's so beau. I dunno, like maybe we like talking and asking people. I think it's beautiful hearing. I

Katie: 42:06

we both do skew a little, uh, far on that side, but yeah, it, but I do think

Hadja: 42:10

And she's appreciated though. Such a though. Yeah, I really, I really believe that. Yeah.

Katie: 42:14

I think that's part of what we get mentored in, actually,

Hadja: 42:17

how to talk.'cause

Katie: 42:19

it's not, you don't necessarily come out knowing how to conversate. And I would say that that's one of the things that when you first have a student, you know, you send them into the room, they're like, uh, what do I talk about? Right? And, um, and that's, and that's part of that mentorship and that training of like, how do you, you know, figure that out Because you can train people to be jaded right from the gate.

Hadja: 42:41

Mm.

Katie: 42:42

You know, you can train them to have chips on their shoulder to look at somebody and be like, well, why can't you do whatever? Why can't, why are your sugars so

Hadja: 42:52

bad? Yeah.

Katie: 42:53

this is, we've been telling you, you know, you can, you can train someone into that. Yeah. Or you can train them into like, okay, so this person's sugars have been really bad. Why? Okay, well let's find out more about them. And then you find out that they, their whole family's full of diabetics and they've been taking care of their diabetic, you know, grandmother, aunt blah, blah, blah. And to them, they don't need a sugar. That's one 40. Yeah.

Hadja: 43:18

You know? Yeah.

Katie: 43:18

because their family members don't need a sugar that's one 40. So why do they need a sugar that's one 40 or less? You know? But then you see okay, well now we know that's. That's the situation. So let's go back and talk to them about why that's different. You know, why is that different for you versus this whole experience you've lived in?

Hadja: 43:39

You know? Yeah.

Katie: 43:40

Yeah. And without figuring out what they're living in, you can't even get to the place of helping them.

Hadja: 43:45

yeah. Absolutely.

Katie: 43:47

And if you just assume a hundred percent of the time that you have to be like from their space to understand their space, you'll still miss it.

Hadja: 43:53

Yeah.

Katie: 43:54

we all have little nuances,

Hadja: 43:56

So many, so many. Yeah. And really, truly, unless you talk to people you don't know and people wanna talk, that's the other thing. Right. You like, you just start asking and then they start asking you and it's like a conversation. It's not like you have a motive, you're just trying to learn about them.

Katie: 44:14

For me, as a midwife, this is a both a blessing and a curse

Hadja: 44:17

sometimes. Mm-hmm.'cause

Katie: 44:18

it's part of what has made me become very burned out in the office setting,

Hadja: 44:22

Yeah.'cause

Katie: 44:23

that. You end up with these patients that come to you. I always had a very diverse group of patients actually. Because I listened. It's really not that hard.

Hadja: 44:33

I listened. Yeah.

Katie: 44:34

then you suddenly become the provider that listens. So then you suddenly become the provider. People are going to you, but there are also people that are gonna, you know, have needs that aren't gonna fit into that 15 minute window. Yeah. And, um, and then you can carry this huge weight of like, how, how do I keep serving you? Right. When the system is

Hadja: 44:56

Yeah. That process makes,

Katie: 44:58

And I think for a lot of us midwives, that is one of the chronic issues that we're always dealing with.

Hadja: 45:04

Yeah. And no, it is, it's very hard. It's very

Katie: 45:09

And I know for me, I have had to step away from it at

Hadja: 45:13

times. Mm-hmm.

Katie: 45:14

Um, I know that group care for me has worked well

Hadja: 45:18

Mm-hmm. Because of that. Yeah.

Katie: 45:19

What, what do you feel has helped you with, with that, especially as a black midwife, you also have this like, added level. And I always feel for my, peers that are representing whole segments. We had this physician she was Hispanic, the only one that spoke Spanish in the, in, our practice. She was the only one that did abortive services. So she had all of these things and it like, you could visually see how much of, of, of that burden was on her. Yeah. And not appreciated by the other people that were there.

Hadja: 45:53

Oh, absolutely. And it's almost always like you're carrying an identity that's marginalized, so then you're. You're getting folks who are, have had these experiences in life because they're marginalized. So it's not like you're carrying like, I don't know, like I am known for my perfume and my chocolate let, right. It's like, yeah, you have, you're part of a community of people who have expressed oppression and so people are coming to you. Um, and it's a lot, it's a lot of trauma to carry. I'm really thankful that currently in our, in the group that I'm working in, we have, three black midwives that practice in the office. And then we have, a couple more that practice in the hospital. So we're sort of able to like disperse, the weight round. But it is definitely a lot when you're a single person. And I think thinking about, like practice that you wanna join, that's really something that I look at. I, I will google the employees to see what sort of diversity's present, for many reasons, but. One of them being that, that I don't wanna carry the weight of, of everyone. That's from my community and it's a lot. But I al I also feel that, when I work with a group of, of women and I can say to my, to the clients like, Hey, go see my colleague. She's, she's white, but she's great, or she's white and she's great.

Katie: 47:14

not

Hadja: 47:14

Not, but, um, right. Like I would go to her. I think having, someone say that is really, really important. And like she's, she's an ally. She's done this work like that, that's very important.,

Katie: 47:27

I had a resident recently that I was working with that was looking at a, I forget if it was, like a, like one of his. Training sessions. That was a longer term training session, or it was his end career regardless. He pulled up the, the group that was already there and he's like, look at them. Do you see? Do you see my problem? And he, he's Hispanic and he's like, there's no diversity here. Like, and so it's definitely

Hadja: 47:56

mm-hmm.

Katie: 47:56

where people are searching for that, you know, very actively.

Hadja: 48:01

Mm-hmm.

Katie: 48:02

Um, and I think, as business owners, one of my things with healthcare is it refuses to acknowledge it's

Hadja: 48:09

a business.

Katie: 48:10

Okay? It's a business. I don't care what anybody says. I come from a, I'm the only medical person in my whole family. Everybody is

Hadja: 48:18

business. Yeah. Okay. Yeah.

Katie: 48:20

the thing is, when you start admitting that things are business, you realize it's customer driven, right? And then you start planning

Hadja: 48:27

accordingly. Right? Right. right.

Katie: 48:28

healthcare likes to pretend otherwise. Right. And I think it gets us into a lot of trouble sometimes because if we just acknowledge that it is a business, yeah. Then you can start putting money towards things that are customer service

Hadja: 48:41

Yes. Yes, yes, yes. And

Katie: 48:43

that are even sometimes just like optics, right? Yeah.

Hadja: 48:47

Yeah. Like,

Katie: 48:48

you know, when I was lead midwife was really important to me that we try to get a diverse, midwife group diversity in every sense

Hadja: 48:57

of what diversity means. Mm-hmm. And

Katie: 48:59

but you have to actually actively do that, right? You can't just be like, today I have decided I'm gonna do this. You know, like you have to put steps in and then realize what it is that is holding you

Hadja: 49:11

that mm-hmm. To start with. Mm-hmm. Like, why aren't

Katie: 49:12

you already there? You know? And now we need to like address and then you have to put money towards that or time or both things but I think that that is starting to get acknowledged and as time goes on, especially with this young, these younger generations, I think that they will start molding that because they're, they're looking

Hadja: 49:29

it. Right. Right, right. I also recently started saying this, out loud in our practice that we should have a business orientation. And I think business, can, can be bad because sometimes business is greedy and it's all about, money and profit. But thinking about it, not in that sense, but that we are selling a product. Yeah. And the product is healthcare, right. Health services. Exactly. And so how do we make this, marketable to people? How do we treat patients, family members when they come in? Right. Sometimes it kills me when I see A patient spoken to in a certain way. I'm like, if this was a business, like I would be doing everything to ensure that this client comes back. Right? Like, why aren't we doing the same thing in healthcare? It's almost like we're doing, we're trying, we're behaving in, in a way that we're doing them a favor. Yes. But they're buying a product from us, and we're trying to sell that product to them. what is our Chick-fil-A brand? Because, you know, you know the difference between going to Burger King and going to Chick-fil-A Services that you are gonna get, right? And also it's like, you know that you're going to be respected, right? Like you're going to be talked to in a certain way. So I always say this to my colleagues, what is our brand as like a group? What is our thing that we're trying to sell to the, the community? This is a product that we are trying to offer. And business is hard, but this is what we're doing. Right?

Katie: 50:50

Yeah. The more business books I read, the more, or I should say kind of like business focused books, the more I realized there's so much crossover with problems in our healthcare. Yeah. Problems in our family life. Like, you name it,

Hadja: 51:05

in a

Katie: 51:05

all there. Like this book I read in podcasting was so relatable to so many other aspects of

Hadja: 51:11

life,

Katie: 51:12

And business and being a midwife even. And so I think that's important to know because I think we feel. Better if we serve well, even if that can sometimes need to be a little bit more of a narrow focus.

Hadja: 51:26

Right. And

Katie: 51:27

One of the things that happened in Dover is all of the practices closed. And so then we have this very large practice that had a very good reputation for a very long time. And kind of by circumstances to some degree, now you're serving everybody and the reputation is not

Hadja: 51:49

Yeah,

Katie: 51:49

well part of that is because you can't do that

Hadja: 51:51

Hmm.

Katie: 51:52

or if you're gonna do that, you have to own that and. Make some, decisions about, once again, what's your brand look like? How are we gonna handle it? You still have to have a brand. You can't just like be a no brand, you know?

Hadja: 52:06

know? Right.

Katie: 52:07

Um, and it's tough. It's a, it's a tough piece, but I also think this piece burns people out. It burns people out to feel like you're trying to take care of the world and not taking care of anyone well. I don't have all the answers for that, obviously, but something I think we need to being mindful of as we are, working in places that have scarcity

Hadja: 52:28

And it, it's hard because it's healthcare and outcomes in people's lives. And so we do wanna provide care or want everyone to have access to care. And that, that becomes hard where when you are the only person that can provide that care. Mm-hmm. Right? Like if you're in a community where you're the only OB provider.

Katie: 52:48

and I think that speaks to two, how easy it is for,, midwives of color. To get burned out. We need to be mindful of how we're burning those people out. But also it's okay to feel like it's too much.

Hadja: 53:04

Oh, yeah, yeah. You know? Yeah, yeah. And

Katie: 53:06

to step away from

Hadja: 53:08

Oh, absolutely. To pivot

Katie: 53:09

and to take care of yourself. Yeah. I think that's hard to watch even like on the outside, because that's not my lived life. But to like see people go through that and to have that pressure. But I just hope that as a field we can, give grace to those people and, help them, be okay with, taking care of themselves. And even if that means like you are leaving, you are going somewhere

Hadja: 53:32

Yeah. But no, like, sometimes you do need to leave the field. Right. Sometimes like that's self-care.

Katie: 53:37

But I think before you leave the field, try a different, try to pivot.

Hadja: 53:41

Try, try to pivot, try to take a break, but also increasing the amount of, black midwives, midwives that are representatives of, representative of the communities they're from. Right. Or even like within a community, like I feel like sometimes practices could do a better job of supporting other practices. Right. So that way you're not left being the only one supporting the entire community. Right.

Katie: 54:09

So I am in this interesting situation right now where, I've become pretty close to a CPM in the

Hadja: 54:15

area. Mm.

Katie: 54:16

And she takes care of the Amish community And there's a couple of other CPMs in the area, and none of them really, I, I think they're cordial to each other, but they're not

Hadja: 54:29

Mm.

Katie: 54:29

and they definitely aren't collaborative. And, and that's challenging because they have no one to kind of turn their patients over to if they just wanna like go somewhere. And they're, for the most part, are all aging. And so then what happens when, yeah, they retire right. But to me, that speaks to this like competitiveness. Sometimes that practices feel towards

Hadja: 54:56

each other. Yeah.

Katie: 54:57

When, right now, I don't care where you are. I cannot imagine that your community and all those providers are seamlessly taking care of every patient and having to actively worry that you're not getting another patient coming through the door. Like we, we don't have enough providers for that kind of worry. Yeah, yeah. You know, and so supporting, practices, other midwives, other, teams and being like, Hey, I'm so glad you exist. Yeah. Yeah. Because if we have more of that, then once again, you can have a better brand that you're catering to, a

Hadja: 55:33

group Exactly. That you are catering well to. Right.

Katie: 55:35

you actually do not want these other people to go outta

Hadja: 55:38

business. Right? Absolutely. Yeah. Yeah.

Katie: 55:40

That always blew my mind. So back when we had all these practices, they'd talk about, like the practice we were at, and it was big. They'd talk about how, oh, well, so and so's gonna retire. I'm like, you don't want them to retire. You want them to stay in business as long as possible. You do not want these patients, you already have enough patients. You know,

Hadja: 55:56

Yeah.

Katie: 55:57

you should be viewing it as this. Like, this is a, this is not a good

Hadja: 56:00

It's it's not. It's not. It's not for the patients. It's not good for the patients to not have choice. It's not good for the practices to absorb everyone. Right. Yeah. So then, yeah. How do we, how do you make it sustainable,

Katie: 56:16

I think as, as midwives, we need to demand that we have representation within the leadership positions. Yeah. And we need to keep demanding it Yeah. Over and over and over again. And it's exhausting to continue to demand that. It has taken me out of positions before. And caused me to pivot. And right now I am kind of in this personal space of. I'm doing deliveries, but I actually am trying to stay a little bit removed from the system because it's not a system I can change at the

Hadja: 56:48

moment. Right.

Katie: 56:49

And in order for me to survive in that, I have to stay kind of removed

Hadja: 56:55

from it. Right. Because

Katie: 56:56

I'm not somebody that can just like, chill with that

Hadja: 56:59

in a full-time

Katie: 57:00

way. But, we need to keep pushing

Hadja: 57:03

Yeah. In

Katie: 57:04

any way that we can. We

Hadja: 57:05

need to keep

Katie: 57:06

and, as a new grad, like coming out and being like, who's mentoring

Hadja: 57:10

Mm-hmm.

Katie: 57:11

How does that look? Mm-hmm. And, I think new grads actually have some power. I think that new grads can help shape the, the way that we work and the way that, The way that we mentor, if we have all of our new grads coming out, all of a sudden being like, Hey, I'm not taking this job unless I have, a three to six month mentorship that my, mentor is getting paid, that I have a lead midwife that I can report to. You know, if we have enough new grads coming out and saying those kind of things, it's going to help change

Hadja: 57:42

the system. Oh, absolutely. Yeah.

Katie: 57:45

there's no lost voice in this. And as midwives that are going to new practices, if you're experienced, midwife the same thing, who's my lead person? what kind of power do they have? What kind of autonomy do we have as a midwife group

Hadja: 57:59

Right. And I strongly believe this, and I, I believe that when I started, but especially now, that midwives need to be led by midwives. It is baffling that you have practices where. The mid, there are midwives that are under physician leadership. Right. Like that you don't have a lead midwife, that you just have a lead physician that creates a culture for everyone.

Katie: 58:24

Yeah. I mean, they're entirely different

Hadja: 58:26

cultures. Yeah. Yeah.

Katie: 58:27

And they don't, they coexist very well when there's acknowledgement of that. I believe that midwife groups and physician groups can work very well together, but there has to be acknowledgement that they are different

Hadja: 58:38

entity. Yeah.

Katie: 58:41

A lot of times when there's not, the midwives kind of just get held to whatever the worst standard is for us, actually. You know? Yeah. Like, we're kind of held towards being like a partner ish, but not in any way that has power, just in a way that has liability.

Hadja: 58:56

yeah. And yeah. Division of work. Yeah. It's almost like you're seen as like a physician, like an extension of the physicians and doing the work. Yeah. And the liability, but yeah, you're not given any power at the table.

Katie: 59:10

No. And the, the sad reality is, When people are in power, most of the time they don't realize what it feels like to not have it. Yeah. And so they don't understand how, what they're doing that is not giving power to someone else, like what the consequences of that are. Yeah. So we just all need to keep pushing for that. And even the most subtle ways, like sometimes it's just noise, like just continuing to be like, we need this, we need this. As an entity.

Hadja: 59:38

Yeah. And yeah. And I also think midwifery programs can, train future midwives to be very vocal about being part of leadership, taking on leadership roles that we don't just work in silos, you know? Home, birth, birth centers and hospitals that we need to be integrated and be part of the leadership.

Katie: 1:00:00

I think that's a little bit of the sadness I have for the online programs.

Hadja: 1:00:03

Mm-hmm.

Katie: 1:00:03

I do think that they serve groups that we. You know, that are really important. But when you go through school as a team and you start developing those connections as a team, I think you come out actually understanding the importance of that and understanding the importance of advocating for the pe, the midwives around you.

Hadja: 1:00:24

you. Mm-hmm.

Katie: 1:00:24

You know,

Hadja: 1:00:24

You know? Mm-hmm. Um, we're

Katie: 1:00:25

we're only as strong as we are together. Really. Yeah.

Hadja: 1:00:28

And red flag, if you interview at a job as a midwife and you only meet with the physicians and you meet no midwife, even though they're midwives that work there, I think is a new grad, that should be a red flag to how much they value their midwives. Massive. Right. Massive. I, I interviewed In an organization that I only interviewed with the physicians and I ended up declining that position because it's like you have midwives, why am I not interviewing with the midwives? Yeah. Do you not value them enough

Katie: 1:00:58

or, Is this a midwife that doesn't even wanna be involved? Right. And maybe you're okay with it. Maybe. I know I took a job at one point where I was literally just trying to move into the state, and I was leaving my dream practice. So it wasn't to go to another great practice, it was to be in a specific

Hadja: 1:01:15

location. Mm-hmm.

Katie: 1:01:16

And so, the midwife was not a part of that interview process. But to me, I was at the time just happy there was a midwife. I was not a new grad and I just needed to switch spots. But let me just tell you what a train wreck that was. And I knew it. I mean, I knew it was gonna be, it was no less of a train wreck than I expected. But it is a massive red flag. And so if you are continuing with that path, there better be a good reason you're continuing with that

Hadja: 1:01:43

path. Mm-hmm. I've never heard of a midwife that stayed at a practice long enough after just interviewing with the physicians. Yeah. It is a major red flag.

Katie: 1:01:54

Can you think of any other red flags?

Hadja: 1:01:57

I think mentorship orientation is a, or onboarding orientation is really important and advocating for that time. If you're given anything less than three to six months, that is a red flag. As a, especially as a new

Katie: 1:02:12

Yeah. Right. But to be honest, when I would have midwives that came in that were experienced, I still always was like, there, there has to be time, unless you're coming from a practice that is in that community already. Mm-hmm.

Hadja: 1:02:28

Mm-hmm.

Katie: 1:02:28

The same community you're working in, at the same hospital that you're gonna be practicing at with the same EMR and the same general flow, you are still gonna need some degree of. Leadership helping you with that transition. Right. And it's gonna be, about six months before you feel totally comfortable. I don't care if you've worked for 20 years. Yeah. You know? Yeah. There's, each practice works differently and the, the flow could be different. And if, if a practice is not willing to, understand that, then to me that's also a huge red flag.

Hadja: 1:03:03

Yeah. It really is. And I feel like this is a controversial red flag, but I don't think I would, I think joining a practice that does not have anyone who has some sort of. Family or kids that they're raising, not because that there's, there's anything wrong with not having kids because I don't know that if your goals in life are to have a family and raise kids that working in a group of, within a group where no one else has that experience of how hard it is to be a parent, a new parent, and then like having a family and that balance that's needed, I don't know that anyone else will understand. And that one of the top reasons why I left academia was because I did not feel that the department, chair at that point really understood or, supported the younger faculty, the junior faculty, the lecturing faculty, who were parents. There were times that I had to take my kid to. In the er, in the middle of the night, early morning, and then go in and teach the next day because there was no alternative. And that to me is, it's crazy.

Katie: 1:04:17

I think that if, you know you are raising a family that needs to be part of your interviewing for sure. I also think, the thing is that when you go to interview with someplace, they, there are questions they can't ask you, but there's nothing stopping you asking those same questions. Which honestly, I think should be asked if you're going to an area where you don't look like anyone there, I would probably ask, how do you think I'm gonna be treated? If your marriage or your partnership doesn't look like something that anyone else has going on, how are you gonna be accepted there? Yeah. Because these things they can't ask you, thank God, but, but you probably wanna know.

Hadja: 1:05:00

Right. Yeah.

Katie: 1:05:02

It's interesting. Because there's so many different ways to practice. Sometimes you don't know what you're getting into. It doesn't matter how many questions you ask until you've been at the job for a little bit. And I do encourage people to stay in that position for at least six months before they've made a, a, total decision about what they're doing. You might, from day two be like, Hmm, no, this isn't happening. That certainly happened at one of my jobs. I, on day one, I was like, oh, I'm not gonna last here long.

Hadja: 1:05:30

Yeah. But,

Katie: 1:05:32

I needed to give myself that, that time to, to confirm that I was accurate, that that was not someplace I would stay at for long.

Hadja: 1:05:39

Right.

Katie: 1:05:40

Also, you should always anticipate that it's gonna take about four to six months to start a new job anyway. It's taken me a. I think pretty solidly about four to six months, even as long as a year to find a, and get actually started in a new

Hadja: 1:05:54

position. Mm-hmm.

Katie: 1:05:55

Mm-hmm. And I think that's one of the things new grads are not prepared for a

Hadja: 1:05:58

lot of times. Yeah.

Katie: 1:05:59

Yeah. They think they're gonna get outta school and it's gonna go quickly. And it could be a solid year before, you have that job, you have started on that job and you've had your first paycheck.

Hadja: 1:06:09

That's so true. All the things that are important for you to know. And then yeah, mentorship, mentorship, mentorship is so important. Anytime I hear someone who's joining a practice that has any less than seven midwives, that to me sounds scary.

Katie: 1:06:27

Yeah. I think that's a good point

Hadja: 1:06:28

especially as a new

Katie: 1:06:30

If you feel like you need a lot of schedule flexibility. Let's say you have family members. It doesn't even have to be children. It could be parents.

Hadja: 1:06:38

Right. If you're in any caretaking role. Right. Any caretaking role. Right.

Katie: 1:06:42

If you and your significant other are both working, I know a lot of midwives whose, partners travel. Yeah. Okay. So if you need that kind of flexibility, you are not gonna find that probably with anything less than seven midwives. Yeah.

Hadja: 1:06:56

definitely something

Katie: 1:06:56

to think about.

Hadja: 1:06:57

Yeah. And there's no universal parental leave, system in the us So you really, I, I really like, again, one of the things that. Now I know, is that I would never join a practice that does not verbalize how they support their employees and caretaking parenting. Right.

Katie: 1:07:17

Yeah. Believe

Hadja: 1:07:18

that, that's so important.

Katie: 1:07:20

Injury. That was a interesting lesson for me too. And actually part of the whole process of me pivoting was a knee injury that really, it really made me rethink a lot of things. What does, what does all that look like? Because if you aren't pro family in the sense of, you have maternity leave policies, you are actually probably also the institution, not proin injury, not pro family care taking, right. Not pro any of it. Okay. It's universal. It's

Hadja: 1:07:54

part of your work culture. Yeah, yeah, yeah. If you haven't hired to have a buffer for Right. I think is like you have to think about beyond just like going to work, and then take having your vacation, you have to plan for the unexpected that you're gonna need.

Katie: 1:08:10

Yeah. Staffing always has to be higher than just covering if best case scenario.

Hadja: 1:08:16

Right. Right. And that, that was really evident during the pandemic. I, yeah. I remember that's when. Our, at least for me, clinical practice started to sort of shift a little is when certain people in the, in, in our clinical practice were doing telehealth and others were not allowed to do telehealth. And that was mostly the midwives that were not allowed to do

Katie: 1:08:37

And why was that? We were never given a good reason.

Hadja: 1:08:39

No, no. And I do telehealth in my current practice now. Yeah.

Katie: 1:08:44

Yeah. So definitely that's something, and we need to push for each other on that too. It is really hard to hold down a practice when somebody is on maternity leave or when you know somebody has an injury. But it's also unrealistic to look at it, even if you're not planning on having children with that

Hadja: 1:09:05

practice Mm-hmm.

Katie: 1:09:05

say, I will never need these services. You

Hadja: 1:09:08

don't know that. You don't know that. Yeah.

Katie: 1:09:10

I certainly didn't know that I was literally gonna step backwards and injure my knee to a place where I could not walk. Right. You know, just take a step back, you know? Yeah. Like, I didn't know that.

Hadja: 1:09:19

Yeah. Yeah.

Katie: 1:09:20

Luckily we had a culture at the time that had, the midwives had really, pushed for, our maternity leaves and, we had good staffing and all the things, and the physician group had given us the ability to be supportive of that. Right.

Hadja: 1:09:34

Right. Or having an unexpected outcome at work and needing to just be off. Right.

Katie: 1:09:40

That's a great example. Yeah. What do they do if you are going through a lawsuit?

Hadja: 1:09:45

Or Yeah. Or even, even if not litigation and if there's an unexpected outcome and you just need mental, like a mental health day. Yeah. Or two. Like what are they? Yeah.

Katie: 1:09:56

Everybody knows this, right? Like we deal with really heavy things and sometimes if you had just taken a few days after that had happened, like that event, maybe you would be able to keep practicing. Right. But maybe because you didn't, it just spiraled. Right. And now you

Hadja: 1:10:13

Now you just Yeah. You know? Yeah.

Katie: 1:10:16

It can't be oversold how important

Hadja: 1:10:18

is actually. And also just knowing how people are supported and adverse outcomes, right? Mm-hmm. Are they scrutinized? Are they supported? And

Katie: 1:10:28

So it was really interesting, this, I think this changed, but the hospital that we worked at together, I don't know if you've ever noticed, but finger sticks were put in the same variance category as if you, assaulted a

Hadja: 1:10:42

Mm.

Katie: 1:10:42

you know, and it's like, it's a finger stick. Like I just went through the trauma of being stuck and worried about the consequences of that. And it is in the same place as if I had like verbally assaulted a patient.

Hadja: 1:10:58

Yeah. That's

Katie: 1:10:59

wrong. That's

Hadja: 1:11:00

wrong. That's a red sign, red flag. Yeah.

Katie: 1:11:04

Some of these things, yeah. A little more subtle than you, you, would even think to ask.

Hadja: 1:11:09

Yeah.

Katie: 1:11:10

Well,. I think I could have you on a lot more shows, Haja. So maybe I will. We'll see how your life goes. I know that we had started talking about a podcast a long time ago, so, you kind of were part of my starting journey on

Hadja: 1:11:23

this, and thank you for

Katie: 1:11:24

that. And thank you for agreeing right away to be a

Hadja: 1:11:29

Thank you. Thank you, Katie. Thank you for all you've done for me for being such a great mentor. Katie has been my mentor unknowingly. That's

Katie: 1:11:40

my favorite thing to

Hadja: 1:11:41

be. All

Katie: 1:11:43

Alright, bye-bye.

1:11:44

I hope you have enjoyed this episode of Mindful Midwifery Presents, the Labor Behind Labor with my guest, Haja. Haja is currently working on a business plan that she hopes to launch soon. Also, the podcast book I was referring to in this episode was Make Noise, A Creator's Guide to Podcasting and Great Audio Storytelling by Eric Newsom. It's a great read if you have time, and applies both to personal and professional life. In two weeks, I will be sharing Jenna's episode with you. At the time of her recording, she was on maternity leave. This episode is unique because she is also a relatively new midwife, so she's navigating both being a new midwife and a new mom simultaneously. If you are enjoying listening to these episodes, please share them with one person. I pull a lot of life advice from these conversations regularly, and I hope that others are able to do the same. I look forward to sharing again in two weeks.