EBB 181 – Restoring Black-led Nurse-Midwifery Care in Alabama with Dr. Stephanie Mitchell

Learn more about Stephanie Mitchell and The Birth Sanctuary here (https://thebirthsanctuary.com/). Follow Stephanie on Instagram (https://www.instagram.com/doctor_midwife/). 

Rebecca Dekker: Hi, everyone. On today’s podcast we’re going to talk with Dr. Stephanie Mitchell about starting a nurse-midwifery-led birth center. 

Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the Founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. Now, I would like to introduce our honored guest, Dr. Stephanie Mitchell, also known as the Doctor Midwife on Instagram. Dr. Mitchell is a certified nurse-midwife who earned her BSN from Curry College, her MSN from Frontier Nursing University, and her doctorate of Nursing Practice from Frontier with a capstone project about intermittent auscultation as the standard of care for low-risk people in labor. Dr. Mitchell is founder of The Birth Sanctuary of Gainesville, Alabama, a freestanding birth center under development and it would be the first Black-owned birth center in the state. 

Prior to the development of the Birth Sanctuary in Gainesville, Stephanie worked in Boston, Massachusetts, and Providence, Rhode Island in a full scope collaborative OB-GYN, midwifery, and academic practices. Stephanie is the author of the newly published book, The First-Time Parent’s Childbirth Handbook: A Step-By-Step Guide for Building Your Birth Plan. In her spare time, you can find Stephanie vlogging, blogging, and outside of the pandemic traveling near and far to expand her zest for unique food experiences.

Stephanie says you can also find her concocting ways to keep her bathroom clean as she’s an avid collector of cleaning supplies to which she manages to keep her four children and husband from living in squalor. Stephanie believes that humor can make it easier to talk about difficult subjects. And many people believe that Stephanie is funny, including myself. So we are thrilled to welcome Stephanie to the Evidence Based Birth® podcast. Welcome. 

Stephanie Mitchell: Thank you so much. I’m like, who wrote that? That’s just great.

Rebecca Dekker: Who wrote that? I don’t know who sent that to me.

Stephanie Mitchell: That was really nice. Thanks. Thank you so much for having me. I appreciate it. And just hearing all of the things, I’m like, yeah, definitely, that is me. So thank you so much for letting me talk to your audience. 

Rebecca Dekker: Yeah. We are so excited that you’re here to tell us about everything you’ve been up to. I want to go back to the beginning. I want to hear what it was that made you decide to become a nurse-midwife. With all your different skills and talents, what drew you to midwifery? 

Stephanie Mitchell: So I get this question a whole lot. And so apologies if anyone’s ever heard this before, but it’s an interesting question. And a lot of people are like, well, how do you get to that point? And for me, it was the time and place that I grew up is being a child of the 80s. And I grew up in somewhat of a dysfunctional home and I didn’t have a lot of positive influences to look upon, especially for another African-American family. Like, it was just my baseline. It just was what I knew. And so during that time in the 80s, there was a particular African-American family that was on TV. And they had a lot of children. The mother was a lawyer, the father was an obstetrician, and they were doing great by most American standards. 

And for myself, I was like, what in the world? Like, there’s a whole other life that could be outside of the life that I was living. And it always was surprising to me on some of these program shows and seasons that the father would come in and be so exhausted from working at the hospital and delivering babies. And that was another like, oh shit, moment for me. I was like, what is this? This is a job? Someone can do this for work? And so that was kind of my first kind of eye-opening experience in obstetrics really is what it was. And then it wasn’t much time later, I experienced my first pregnancy.

I was 16 at the time, so it wasn’t a far jump from when I had developed the idea of what it meant for someone taking care of someone who was pregnant and then actually becoming that person who was pregnant. And that was my first kind of real-life exposure into what it meant and what it means to be someone experiencing pregnancy in this country. And at that time, I was young. I’m Black. I was poor. A lot of adversarial kind of circumstances. And that was just my experience on what it meant to be a pregnant person at the time. And so I never lost my love for pregnant people even when I was pregnant and around pregnant folks, I never lost my love for that, and introduced me actually to midwifery because I was cared for by midwife during that time.

And the way that they were able to honor my body and show respect and inculcate me into the process of being pregnant, the more it sort of solidified for me like, for sure. It’s not obstetrics. That’s not the word I’m looking for. It’s midwife. That’s the word. And so from that point on, I knew that’s what I was going to do. And that’s what I was going to be. It only became later on that I realized that there were different types of midwives and different places midwives can practice care, and be with people in labor. But that was my first sort of aha moment that what I wanted to be had a name.

Rebecca Dekker: So even with all of the different stigmas that people might have attached to you at the time, you felt like you had a good experience, and you were treated well with your midwife?

Stephanie Mitchell: Yes. I felt like I was. I mean, there was some very particular moments that stood out for me during the care of my pregnancy, because during one part of my pregnancy in the beginning, I was cared for by obstetrician. And then my care got switched over to a midwife. And then again, in the hospital, I had a little bit of interference with the physician who I didn’t know, but kind of introduced themselves into the room and kind of announced that I was now on a time clock, and then I would be having surgery, because I wasn’t dilating as fast as I needed to. So I was like, what is this? This is my first kind of introduction. And I’m like, who are you first of all? And why is it that you’re coming in here and telling me these things? And I’m 16 at the time, so of course, I don’t say all of this.

Rebecca Dekker: You’re thinking it.

Stephanie Mitchell: I’m thinking it and I’m like, okay, so this is the person who’s in charge. Anyway-

Rebecca Dekker: So what ended up happening? 

Stephanie Mitchell: So of course, I ended up having a spontaneous vaginal delivery with my midwife. And then later on in life at subsequent pregnancies, I realized something interesting about myself, and that is that my body doesn’t do the normal multiparous thing that we would generally like to happen once babies. People have had babies twice and subsequently. It’s just slow. I’m slow laborer. They always try to threaten me with the knife-like, hurry up, hurry up and dilate. And I’m like, wait a minute, wait a minute, give me a second, my body doesn’t do that. Leave me alone. Leave me alone.  So that was kind of my very first kind of introduction to like, this is what this world is.

Rebecca Dekker: This is American obstetrics.

Stephanie Mitchell: Yeah, this is the dynamics. And I never lost sight of the fact that, okay, I definitely can function in a hospital space as a midwife like, that was never I didn’t lose sight of that based on my experiences or my subsequent three pregnancies labors and births.

Rebecca Dekker: Did that ever frustrate you as you went on to have more babies that it didn’t speed up with each child that you just had a slow birth each time?

Stephanie Mitchell: I didn’t know how off the curve I was, as I wasn’t a midwife when I had any of my children. So I didn’t know how off the curve I was. I didn’t have the information that I needed to even understand the normal processes of labor and birth. But I do know that every time a discussion of a surgical birth was brought up, and I found that to be kind of interesting.

Rebecca Dekker: I’m assuming you spoke up for yourself at some point, or did they just leave you alone and you just happen to have your baby and they stopped bothering you?

Stephanie Mitchell: Retrospectively, it was a lot of benign neglect. I know what happens behind the scene now with someone who, in the hospital at anyway, with someone who’s not necessarily laboring on the curve, and you’ve got someone at the time watch, like, okay, this has been long enough. And usually that person is like the person who has oversight of a midwife and in the hospital capacity. And a really good midwife will do all the things to get someone to just ignore this person. Leave them alone-

Rebecca Dekker: They try to create a barrier between you and that supervisor. 

Stephanie Mitchell: Yes. And I only know this after the fact because I ended up working in the same institution with the same midwives and same obstetricians. And I would say, they saved my ass on multiple occasions. But what they’re really doing is benign neglect, meaning, mom was well, baby as well. We don’t have any emergencies here. Let’s take a look at the whole picture and give this person a little bit of time. Leave them alone. Go find something else to do. Get involved in a surgery. Go meddle in some shit. Leave this person alone. 

And so behind the scenes, those sorts of things were happening and I was left to labor after the discussion of this is not what we’re expecting of you. And so I didn’t have to do with too much of my own fighting at the time. And it’s scary because I wasn’t in labor in delivery even though I had a love and a passion for these types of things, it wasn’t my base of knowledge on everything. If the doctor would have come in and said, this is too long, and this is not what we’re expecting, I just think this is really strong possibility I would have had a surgical birth. Like, I just didn’t have the wherewithal or words to describe the fact that I didn’t have the information I needed to make a good decision. Like I just didn’t have the information.

Rebecca Dekker: But thankfully, you had providers, midwives who are looking out for you and …

Stephanie Mitchell: No, that’s what happened. Yes.

Rebecca Dekker: So did you then go to become a labor and delivery nurse first? 

Stephanie Mitchell: Yes. So I actually was in pediatrics for some time. And I worked on a pediatric unit in one of Boston’s children’s hospitals. Well, the only one. I worked with the pediatrics and endocrine and gastroenterology and complex care for quite some time. And that is strictly because as diligent as I was with applying and applying and harassing and calling people and writing letters and knocking on doors, I could not secure an interview at the hospital, any of the hospitals for labor and delivery. And so it actually took years and years. And it just happened to be happenstance that there was an interim nurse manager who I don’t know how, I don’t even understand how it kind of came together, ended up with my resume and called me in for an interview. The interview I’d been waiting on for years and years and years and years. 

I went and I was shocked and surprised, this Black woman invited me in. And that’s because she was not reflective of what the unit had been on at the time. And in this very short, interim position she came, was there for a very short period of time and then left. And then the floor was the same sort of homogenous group that it had been in the past. And I didn’t realize that at the time. But after I was hired, I took a good look around in that unit was certainly not reflective of, A, the rest of the hospital, and B, certainly not reflective of the community where the hospital is in the backdrop of, which was my community, my neighborhood. All of the health centers were places I grew up. 

Rebecca Dekker: And that’s my understanding of the Boston area, too, is that the labor and delivery units are primarily made up of white staff, white labor and delivery nurses and physicians and midwives. But they serve primarily Black, another ethnicities communities. And they don’t necessarily live in the communities where they’re working. 

Stephanie Mitchell: That’s true. Where I could see the hospital from my front door, essentially, you had people who are traveling in from the north shore, from the south shore, from out of state to come to this job. And it was very, very high tenure. We’ve got people who are there for 30 years, 20 years. Like, it’s a wonderful union nurse job if you’ve ever wanted to have one. And so it just was very surprising to me that of the staff of 120 nurses that I was the third African-American nurse. And I sat there on the night shift did minding my business. But I did look around and notice a lot of things. And even in terms of like the providers and the practices that delivered there, there were differences in the private practices, there were differences in the academic practices. And it just laid out for me a lot of stark differences. Yeah.

Rebecca Dekker: So you were a labor and delivery nurse for a while, and then you decided to go on to graduate school to fulfill your dream of catching babies?

Stephanie Mitchell: Well, I would say the first five to seven years on labor and delivery, I just spent my time learning and being traumatized. I was like, this is not midwifery. What is this? What is this mess? What is this garbage? What is happening? And eventually, it was almost the internalized rage of like having to be in this capacity of not being able to truly advocate for your patients and actually taking part in some of the deleterious effects that were happening due to some of the interventions. You just kind of watch all of these things happen. I thought for sure. I said, “Well, I’m going to go and be a midwife.” So I’m not doing none of this [bleep]. I’m not doing … Can I say, as your people-

Rebecca Dekker: Yeah. We’ll let them know up front that .. Yeah.

Stephanie Mitchell: I said, “I’m not doing any … You can’t. I’m going to be a midwife.” And then I will show the people this is not the way. So I went back to school, went to grad school to become a midwife. And let me tell you, the problems just about multiplied.

Rebecca Dekker: Before we talk about grad school, let’s go back to the hospital because one thing that you teach about a lot on your Instagram page, doctor_midwife, is the MIC or MIC. Can you explain for our audience what that means and what it looks like?

Stephanie Mitchell: Yes. So I did not create this phrase, but I certainly probably resurrected it. The medical-industrial complex is just a way of kind of viewing the way that obstetrics is viewed in this country, which is a medicalized, industrialized method of providing care. It’s medical, it is industrial, and it is a complex. And so that just the state of how medicine is so deeply ingrained into a normal physiologic process, that’s kind of how I take the view of looking at kind of the hospital space. I always want to be clear like, don’t ever get me wrong, there is a time and a place where people just need to be at the hospital, they need to be cared for in high acuity centers, they’re high risk, they have actual complications. 

But I think we’re taking a huge misstep in funneling everyone into a place of higher intervention as at baseline, as opposed to considering individual needs of the lowest labor in person. And so that’s kind of why we’re in sort of this crisis, so to speak, in this country for our outcomes for folks who have babies, and of course, it disproportionately affects women of color, Black women specifically. And I think it is because of the institutionalization and the medicalization of this normal physiological process. You can’t do it, you can’t do it. It’s not made to work that way. And we’re still trying to after years and years and years, trying to force it and make it fit.

Rebecca Dekker: One of the analogies that you’ve said that really struck me is when you talk about like stadium A and stadium B, and it really like, I get this like image of people like filing into like a sporting stadium and being told you go here, you go here. Can you explain that? Like, what do you mean by stadium A and stadium B? 

Stephanie Mitchell: Well, it’s sort of just a way to look at obstetrical outcomes in this country. There’s not anything biologically different within our chromosomes and DNA that makes suddenly passing into the threshold of a hospital a high risk event for a Black woman specifically. But when we look at like the data and outcomes, unfortunately, we’ve got two sets of data. You’ve got people who are African-American, women specifically, and then you have our Anglo counterparts. And you get filed into the hospital system, and your outcomes are specifically based on color of your skin. It’s a really tough thing for people to kind of like conceptualize and visualize and even wrap their brain around. Like, are you telling me that just because you walk in and you’re Black, these bad things will happen to you? Yes, I hate to say it, yes. 

When you’re reading data and literature, sometimes especially when it comes to like outcomes, you’ll have a tendency not even to see African-American women and their outcomes have to be reported differently. Sometimes they’re reported differently under a caveat of an Asterix like, well, this didn’t include the segment of the population. Yeah. That’s because we know if we’re funneling them all into the system of obstetric care you land at the door. And if you are Anglo, counterparts who are African-American counterparts, you’re going into one direction, your stats are going to be one way. And your stats for Black women are going to be another way. They’re two different numbers and it’s based on anything else. And it’s strictly just based on a lot of the implicit biases that are embedded into the obstetric system.

I don’t want to say it’s like not necessarily a single individuals fault. It’s not anything that we’re being purposely mean or evil about or racist about, this is implicit. These are things that are embedded into the way that care is provided, probably because of its origin in medicine, and the relationship with Black women that probably could have something to do with it. But these are the things that we see stadium A, stadium B and two different outcomes, essentially, for the same individual. 

Rebecca Dekker: And outcomes, to be clear, aren’t that great in both stadiums, but they’re disproportionately worse in one of them? 

Stephanie Mitchell: Yes, that’s what it is. Yeah. It’s like not doing so hot. Like I always like to say, look, we’re all of industrialized nations, we spend the most on health care per person. And so you would think like, surely our outcomes would show that this means we’re receiving superior care. But it’s in fact, the opposite, especially when it comes to maternal mortality. And so that is always surprising to folks that it costs so much, but you’re getting nothing, you’re getting nothing. Our outcomes are on par with what they like to say are third world countries or less industrialized countries, and for many different reasons and for many different facets of outcomes. But It doesn’t make any sense. It doesn’t add up. 

Rebecca Dekker: And you probably witnessed this firsthand on the labor and delivery unit, sitting at the nurse’s station, overhearing conversations, seeing how people were treated.

Stephanie Mitchell: I would say it’s the implicit bias.

Rebecca Dekker: That you witnessed the most?

Stephanie Mitchell: Yes. It’s implicit, but I can put my finger on it. I can say exactly what it is. But people will do things and have conversations and treat people a certain way-

Rebecca Dekker: Not even realizing what they’re doing.

Stephanie Mitchell: I’m telling you, not trying to have like an evil intent, it’s not mal intent. It’s because they haven’t been taught, don’t know. I say like all the time, or have these assumptions that are rooted in misinformation, just many times and it’s dangerous. It’s dangerous when you’re caring for people and you carry those sorts of things with you because you-

Rebecca Dekker: And you don’t know your own underlying assumptions and biases you’re dangerous to Black families.

Stephanie Mitchell: It is. You are…and that people understand that and take it in and really do some work. And try and figure out, well, I got to this place through no fault of my own. But now I’m charged with caring for folks and making sure people are safe in my care. Now, what do I have to do? There’s only one answer, you have to commit yourself to anti-racism, you have to commit yourself to doing that. That’s the only way. 

Rebecca Dekker: And it’s not something you can undo in like a one-hour continuing ed class. It has to be a lifelong commitment, essentially.

Stephanie Mitchell: It is. And I think a really great way to start doing that, if you’re just new to even the concept of this being something that exists is exposure therapy. That’s what I like to say. Like, start listening to Black folks, people that you normally wouldn’t listen to. Someone you could find tolerable. Start listening to these conversations. Because there’s a couple of things are going to happen. One, you’re going to learn a perspective you haven’t previously thought about or considered. You haven’t even thought about it.

And then the other thing is as you are having conversations with Black folks, or in the room with Black folks, or whoever else that is not in your circle of comfortability, you are going to be able to learn how to just interact without making generalizations. You’re going to talk to me, for example, and I’m going to be expressive, and I’m going to be moving my hands, and I sometimes might get loud. And this is just how it is. And it doesn’t mean anyone’s angry, and it doesn’t mean anyone’s upset. And you have never exposed yourself to that. And that’s okay, but you’re going to learn today.

Rebecca Dekker: I think some of my favorite things that you post sometimes are just literally like videos and TikTok and other things that people can watch, that white people can expose themselves to like Black culture and just get used to it, because a lot of it is we don’t see for variety of reasons. Like you said, it affects how you treat people if you’re biased against them and their culture. 

Stephanie Mitchell: It’s absolutely true. It just is like a little snippet into my history on how I am able to see that picture so clearly, is that as I mentioned, I lived a very traumatic kind of upbringing. I was in the hood, we were kind of poor with substance abuse issues, abuse, and all types of crazy things. And we’re a Black family in the hood, there’s six of us, six siblings. And we were part of a busing program. And so busing program picked up students that were from my neighborhood in Boston, Massachusetts, and bus them out to the suburbs. And Western Massachusetts, if anyone’s aware, like Wellesley, and Weston, and Newton, and Acton, very affluent white neighborhoods.

And they plopped us in this environment and I really, really learned at a young age that we would live in two completely different worlds. And most of the time, my classmates, the parents, the teachers were completely oblivious to the fact that we had two completely different cultures. So while you sit at home, having your after school snacks, and mom’s helping you with your homework stuff, you’ve got real life, other situations happening in your home, you try to survive through the night so you could make it back to school the next morning and get some breakfast. These are two completely different lived worlds. 

You do that for 10 years or 12 years, what happens is you’ve got two different cultures that you’re balancing. And you learn a lot of things about the dominant culture, and you learn a lot of things about the way that they interact or the way that you are perceived. It’s a learning environment. It’s a learning environment. And a lot of folks just aren’t privy to having real interactions or real folks that are outside of their walked existence. And that was just carried through as I learned to navigate academic spaces and learned to navigate medical spaces as well. There were just different kinds of conversations, but still those kind of awarenesses and conversations now like, girl, you all don’t know. You all don’t know.

Rebecca Dekker: Most people don’t know their own culture. Like, in a lot of white people I talked to you if I say, well, what’s your culture? They like can’t describe aspects of it. And it’s like the dominant culture is so dominant that you don’t recognize it. It’s like not being able to see the air that you breathe. One thing that I found really helpful in my anti-racism journey is I actually have a Word document saved on my desktop, where I just have a bullet point list of every time I realize that something’s part of my culture, I add it to the list. 

Stephanie Mitchell: Yes. 

Rebecca Dekker: And it’s been like really eye-opening to see all the things that I never thought of as being culture or my culture. 

Stephanie Mitchell: Yes, exactly. I’m loving the fact that you are naming it. And there is culture. There’s American culture, there’s regional culture, but there’s culture embedded in each one of us. And there’s like, literally, nothing wrong with admitting that you’re from two different worlds, two different cultures, you don’t understand-

Rebecca Dekker: And there’s class culture as well. 

Stephanie Mitchell: It’s all in there, dude.

Rebecca Dekker: Yeah. It’s fascinating when you start really thinking about what was the culture I grew up with and then writing it down. So that was a big learning experience for me. So I’m still imagining you as this labor and delivery nurse now with the internalized rage of like watching all of this play out on a daily basis, and then you decide to go into nurse-midwifery, which is also a white-dominated field. But you survived because you’re here today to tell your tale.

Stephanie Mitchell: Yes, yes. That was definitely a whole other journey. And the surprising piece about it is like I’m still fighting for that ownership, so to speak, of being able to claim midwifery as mine and as my journey as a midwife. And that is because a lot of it has to do with having moved across the country to a different area that has a lot of embedded historical terribleness when it comes to midwifery. So I find it like through .. Though I’ve kind of like fought and clawed and kind of, whatever, got through all of that I yeah, I’m a midwife. 

But it just illuminates to me further like all of the extra work that it will continue to take until I’m able to truly claim midwifery, because it’s being purposely barred and obstructed as of now. It’s like one of those things I think about like, damn, I had to work so hard. Now, it’s just like, I’m not done, I still have to fight and claw. It’s just a sad situation. 

Rebecca Dekker: When you finished midwifery news started being able to be the one catching the babies and making more of those like decisions with your clients in the room. What did you love about it? Like, what were the things that kept you going? 

Stephanie Mitchell: Oh, my goodness. People were like, don’t you love the babies? I’m like, yeah, babies are fine. Babies are great. It’s not so much the babies, it’s everything up until that time. It is caring for this pregnant individual, this family, it is watching this growth.

I mean, you go from just living your regular, normal life. And now you are growing a whole entire human. You are personally responsible for a little puzzle piece of the next generation of humanity. And how we care for these people really shows up in how they are able to perform their normal physiologic function. So most people do best when they feel safe, when they are informed, when they’re able to act on autonomy and not fear, people thrive. And I like watching that. That is a great process. 

And as it unfolds, and as was done for me and being able to show dignity to others bodies in their journey, as was done for me, and to be able to continue to do that, there’s no greater joy, there’s no greater privilege. Like, what else do people do to find joy? I don’t know what else I could do. Like, is there other things? I don’t know. This is all I could be. And it’s that process again, and again, and again. I always kind of must imagine that people don’t even get involved with labor, birth, pregnancy until they’re actually expecting a baby.

And in that moment of time, they may get a little information or sprinkler or might get involved in the process. But then that time goes and they’re on to their next journey. I have been embedded, embedded in my toes, in my brain, head to toe on everything that is labor and birth and the human state, the human capability for a decade and a half. And it’s just not anything I could ever see not doing. It just doesn’t make sense to me. I don’t understand that world.

Rebecca Dekker: Yeah. So it’s your joy and it’s part of your tradition that you’re carrying on.

Stephanie Mitchell: I would say. 

Rebecca Dekker: It is part of a larger tradition, too. 

Stephanie Mitchell: Yeah, I would say, I definitely would say. It’s just such a unique journey for every person, whether they are performing perfunctory making a human or if it’s something they’ve always thought about doing, it’s a big deal. It’s a huge thing. And it goes really well most of the time. It’s my joy. It’s our human right to be able to experience this journey in the most healthy way possible. It’s our human right. We should not be deprived of that. And that’s kind of what I fight for. That’s what’s important to me, is that people take onus of that right and that responsibility to get that right. Because…within the birthing person, a lot of responsibility lies within them. So yeah, I guess all of those things.

Rebecca Dekker: Now you’re fighting in Alabama. But before that you were working in Boston as a nurse-midwife. Can you tell us why you decided to make that change and that big move to Alabama? What you said reset is even more oppressive to midwives than Massachusetts?

Stephanie Mitchell: I certainly, and I have never heard of anyone who spins the globe and is like, Alabama, let’s go there, never heard of it. Never heard of it. My husband is originally from Alabama, and the town that we’ve relocated to, which is in Gainesville, Alabama, it’s West Alabama, just shy of Mississippi is where he was born and raised. But we met in Boston, had all our children in Boston. And as he’s moved on to his second career, which is now in the barbecue restaurant business, he relocated for business. And this was a great opportunity, because of mostly you’d have to be part of a large restaurant group to even get a little sliver of real estate in Boston. And all of the kind of stars were in alignment and pointing to the direction that the city life and the cold life was not for us. And it worked out that this town actually is a beautiful, beautiful area, town and community. So it was like a no-brainer when the opportunity presented itself. 

But for myself, I had to decide like you move anywhere. You go check out the schools, you go see what’s in the area, what’s around. And being a midwife, an experienced midwife at this point, I was like, well, let me go see what they have for birth centers. Let me go see what … Nothing. They don’t have any. There are none. So it just led me on a deeper journey … And I didn’t flip on the light and come here, it was a two-year decision-making process and getting things in alignment. But just in my discovery, I just found out that there were not any options. If you were going to have a baby in Alabama, you could go to the hospital. Prior to 2019, out-of-hospital midwifery was illegal in Alabama. They were jailing midwives as recent as 2018. Okay.

So I got here and I’m like, you have got to be kidding me. I done took a dive back in time. Like, what is this? Especially Alabama, when you think about the historical context too and midwives, and we think about like the grand-midwives who were basically midwives caring for normal, healthy pregnant people in their homes and attending their births and providing them with traditional services and those types of things. That type of midwifery was outlawed, eradicated, made illegal, and criminalized in Alabama, and we had a lot of grand-midwives who are unceremoniously stripped of their duties as midwives, and told that they could no longer practice midwifery. So when I get down here, I’m like, but you all have this whole history and literally that happened and nothing changed up until 2019? You’re wild. You’re wild for that. You’re crazy for that. 

Rebecca Dekker: And that was a huge … Like, I remember when that law was passed in 2019, that was a huge achievement at the time to decriminalize midwives because it was hard. It was hard work. And it was not an easy, yeah, let’s decriminalize the midwives. No, it was with so much opposition, so much opposition.

Stephanie Mitchell: Imagine. And I’ve spoken to a lot of midwives who are like doing that work before I arrived here, and just about their painstaking fight, and some have completely burned out from that fight. 

Rebecca Dekker: It’s so traumatic to try and fight the system like that.

Stephanie Mitchell: Oh, my goodness. And when you think about … It’s well documented. Some people were penalized and persecuted for their stance on trying to preserve midwifery. And so it’s like a super toxic environment that I didn’t really know. I’m like, look, I’m a midwife. I’m coming from here, let me practice in my community based on my skills of caring for people. I’ve attended thousands and thousands of births and kind of like, I’m a midwife, I don’t know what else to say. And not be able to practice midwifery in the state of Alabama, literally floored me. I’m enraged, I still am enraged. But it just is really pointed to how much work has been done, but how much more needs to happen, especially in a state that is doing number three of the worst states in terms of maternal mortality and infant mortality outcomes. It’s a lot to take in. But, anyway. 

The fact that they didn’t have any freestanding birth centers, the type of person I am, I’m like, well, it looks like I’m going to get on tasked with building one. Because I’m going to tell you where I’m not going to be working, I will not be taking my talents and resources to a hospital to continue providing care that I wasn’t comfortable with and the streamline that I wasn’t comfortable with. And I think there’s a place in hospitals for midwives, and we all have our talents in our strengths. And we need midwives in hospitals. 

Rebecca Dekker: But Alabama’s particularly difficult state to practice in hospitals as well, correct?

Stephanie Mitchell: Well, there’s not-

Rebecca Dekker: There’s not that many midwives. I think there’s some laws that make it more difficult for them to practice in hospitals even because they need supervision. Correct? 

Stephanie Mitchell: Yes. And so that can look a variety of ways. I understand what that means is supervision. In some places, that could mean that a physician’s got to be in the same room with you, for some.

Rebecca Dekker: Yeah. You have to have the doctor looking over your shoulder. 

Stephanie Mitchell: Yeah. And I remember that, like, if I was Boston, Massachusetts, having my first second, third or fourth child, and it was a supervision of that nature, and I wasn’t able to be deflected or benignly forgotten, I would have potentially had the outcomes of the institution, which one in three people walk in and have a surgical birth. So it’s important when we talk about supervision what this really means. Does that mean that now we’re just like doing what obstetricians have been doing all along? Because if so, that’s not midwifery. It’s two different things. So there’s that discussion to be had. Basically, you come in Alabama, generally speaking, you’re having a hospital birth. And generally speaking, you’re having an obstetrician or team of obstetricians take care of you. That’s just what it is.

Rebecca Dekker: So you’re helping create an alternative to that system, the MIC. So tell us about the Birth Sanctuary and where you are in that journey.

Stephanie Mitchell: So any out-of-hospital birth space, the goal of it really is to mimic your home-like environment, okay? And it doesn’t have to like necessarily look like your home, but it needs to feel like your home. It needs to be non-medical, it needs to feel comfortable. Your body performs in its peak performance when it is comfortable. When it is an environment where it feels safe, your physiologic needs are taken care of, you generally operate in peak performance. I always say this, because this is a silly like analogy, but it really makes sense to some people. I have shut bowels. I could go for vacation for a week and a half, nothing, nothing’s happening. There’s no movement, nothing.

Rebecca Dekker: I’m sure a lot of people could identify with that.

Stephanie Mitchell: And when on the ride back home, or the airplane starts to land, it’s like, okay, something going on here. Wait a minute, my body’s starting to feel comfortable. And by the time you make it back into your home, your body’s like, this is my home. And there’s not a lot of physiologic processes that our body does have in terms of like this type of function or output, when we’re avoiding, when we have bowel movements, when we vomit, when we have a baby. These are the things that you can’t really take a lot of control over them, your body does what it does. But in pregnancy, sometimes in labor, certainly, we’re intent on like, no, must do it this way. 

Anyway, the moral of this whole story is that a birth center mimics your home-like environment to allow your body to feel comfortable, and sort of cater to the idea of having a safe space to have a baby that is not a hospital but is still fully equipped to handle most basic obstetrical emergencies. It’s an option for people who don’t want intervention as the standard of care. It’s a good option for those who don’t want to be funneled into just the streamline of what 98, 99% of folks receive for industrialize, medicalized labor and birth. That’s not what this is. So that’s kind of philosophically what it’s based on. It’s based on the tenets of midwifery. That you don’t need a whole lot of shit for people to have a baby and you probably need to leave most folks alone. That’s the tenants that that midwifery is kind of built on. 

Rebecca Dekker: And it’s where midwives can really truly practice to their full scope without fear of the medical and destroys complex kind of breathing over their neck.

Stephanie Mitchell: That is one hope. And because there are no freestanding birth centers in Alabama, as we’re creating this environment, we’re really going to have to be hyper-aware of how other organizations, facilities, providers are receptive of the validity of this type of care. There are like necessarily stringent laws and rules in place. Yeah, because nobody, nobody … We don’t know, we haven’t done it yet. But if we start seeing things in place like, an obstetrician must be on the board, you must have this such and such. When we start doing that, we-

Rebecca Dekker: Or we won’t accept transfers from your birth center.

Stephanie Mitchell: Oh, my goodness, that would just be non-human. I can’t even imagine. I don’t even want to even imagine. But that would be a true obstruction. That would be a true obstruction.

Rebecca Dekker: Even if they accept patients, how they treat them when they come in, that sort of thing. And then I’ve been following you, you also have an Instagram page for the Birth Sanctuary. And you’ve been showing a lot of videos of your progress. So can you tell people about how you found this building, and what is all involved with getting it ready.

Stephanie Mitchell: So the building is original two-story structures erected in 1835. Because my husband from this area, we’ve drove around, we’ve been around for two years and the house has stayed vacant. And I’ve driven past it so many times. And I’m like, that would make such a beautiful birth center. Never knowing like, five, seven years later, I’d be moving to Alabama, and I’m like, hey, is that place still available? Sure enough, it was. And so the structure was built in 1835, it really hasn’t had anyone living in their long term for quite some time. And it has a lot of the original structures of the building. So the first task was kind of like structural, and securing the roof and making sure there wasn’t water damage and those types of things. 

Now the process has moved on to kind of an internal structural work. And that is basically involved the full demolition, for the most part, while we tried to reimagine the space with two birth suites, office space, a library, education, space, room for families, if they want to be there and accompany folks while they’re in labor but they’re not right on top of them. A kitchen and dining area, things that make it feel like home. So that’s where we are now. We’re still constructing and building and growing. And then on the internal piece of it, in terms of building a birth center, I have to tell you, it’s a whole lot of practice guidelines. If you’ve ever thought about even building any kind of structure that was going to help individuals or provide care to individuals, healthcare to individuals, you’ve got to have a lot of rules and regulations in place. That’s a lot of typing and a lot of paperwork-

Rebecca Dekker: A lot of paperwork.

Stephanie Mitchell: Yeah. So that non-boring stuff, and then the physical structure stuff, I think that’s more fun. I’m enjoying that piece.

Rebecca Dekker: Yeah. And you’ve been able to raise funds to help support that physical structure work.

Stephanie Mitchell: Yes. This project has been completely 100% grassroots funded just in my journey into midwifery and into practice and wanting to provide out-of-hospital options for folks for midwifery. There’s always like this financial piece of it like, go to school, get more letters, get more letters, and then you can do it. Get this degree and you can do it then. And even now after obtaining like my nurse-midwifery certification and DNPs and all of these things, it’s still no, no, get more certifications, get more letters. So I was absolutely adamant that I would not be paying for this out of my pocket. Do I think the government should be funding birth centers on every corner? Absolutely. Absolutely.

They should not have to be privately funded when they are a valid safe option for low-risk people in labor. This should not happen. You shouldn’t have to be part of a huge conglomerate in order to get this work done. And I tax that to the people. I let the people decide, hey, do what breast center? Because we can do this. We collectively can do this. We don’t have to wait on the outside entities to be able to make this happen because it needs to, especially in a state like Alabama. And do so the project has been 100% completely from the grounds up, from the roots up people, individually donors. 

Folks volunteering their time, providing information even on like landscape and different type of shrubbery. And the human capital that’s going into Birth Sanctuary, Gainesville, it goes beyond windows and floors and painting. It is the knowledge capital, it is the people pitching in and saying it’s unbelievable. Like, I can’t even tell you like, yeah, I do work with interior design, I can help with this. Great, perfect. That’s the human capital that is-

Rebecca Dekker: So people are volunteering their actual time to help build and design and fill it. So you’re raising funds, some people can donate that way. But people are also donating their time, I did not realize that.

Stephanie Mitchell: And whatever it is. Like I always say, I don’t know what other skills that folks have. There are birth centers that are like, someone had called and was like, yeah, I’m moving my birth center, I’ve got five IV polls. Are you interested in them? We’re interested in them. We’re interested in them. We don’t have a large funder to go and say, yeah, we need such and such amount. We’ve got people who are like, you know what, my human capital is that I write grants. Is there some use for me? Could I offer my resources? And so to that I say, whatever it is that your specific privileges that could help with this mission of offering labor and birth space as an outside hospital setting, please do, please let us know. I don’t know what your gift is, I’m not sure. And for some people who are unsure of their gift, fiscal gifts, that works fine. $12, $36, whatever it is, it’ll get done.

Rebecca Dekker: And where can people go to donate to the Birth Sanctuary?

Stephanie Mitchell: Right now, we are using GoFundMe as our primary fundraising platform. So as our team grows, and we’re able to devote an individual person or team that can kind of do more fundraising, maybe we’ll switch to something else. But right now, that is the main driver and that’s where we’ve been. But if there are other avenues where people are like, yeah, I can’t do money, but I’m a great embroiderer and I can embroider sheets, I don’t know. Like, I ask folks to send me an email, info@thebirthsanctuary, because I don’t know everyone’s talents. And it’s not necessarily my job to kind of figure out what your talents are

Rebecca Dekker: Yeah.

Stephanie Mitchell: Your walked existence, you know you best. And that’s just kind of what I rely on for people to know what they could do best. That’s kind of what it is.

Rebecca Dekker: So you talked about the huge work it is to create this actual physical location with all the guidelines and policies. But I know, there’s also been another big barrier to your being able to practice at a birth center. Can you talk about the midwifery legislation in Alabama, and how it prevents nurse-midwives from working in birth centers?

Stephanie Mitchell: Sure. So we talked a little bit before about how some states require supervision, and what that supervision means is different from state to state. In Alabama, a certified nurse-midwife can practice with a physician in a hospital, or they can have a collaborative agreement, or they have a supervisory agreement to practice out-of-hospital. So in order to be a certified nurse-midwife and practice at a hospital, you got to have a physician who can cosign on you and say, yes, you’re under my supervision, you’re under my watch, whatever the case-

Rebecca Dekker: I’ve got my eye on this midwife all the time.

Stephanie Mitchell: But it’s crazy because you can be a certified professional midwife in Alabama, and you can practice out-of-hospital without that sort of supervisory clause. Now, they’ve put some other things in the legislation, which is a little screwy, which is an exorbitantly high insurance deductible. So that kind of eliminates some midwives from being able to practice. So they’ve really done a job it really eliminating-

Rebecca Dekker: Making it as hard as possible, basically.

Stephanie Mitchell: Making it as hard as possible. So as a midwife coming down here, if I would like to practice in an out-of-hospital birth setting, that means being available for your home birth or your birth center birth, which I’m open to build a birth center. I’m building it so it would be nice to practice in it. That I need to get yet another designation called a CPM or Certified Professional Midwifery Certification. And it’s an opposite in pretty much most other states, where you would be required to be a certified nurse-midwife in order to practice out of a hospital. And there’s states that are barring CPMs from providing care at birth centers and out of hospitals. So it’s a little wacky because whoever-

Rebecca Dekker: Every state’s got its own …

Stephanie Mitchell: It doesn’t make any sense because like nothing changes when you cross your state line. So let’s get it together in terms of who is a midwife? What does this mean? Who can we take care of? That’s the bottom line. Instead of all these weird designations and subgroups and organizations.

Rebecca Dekker: So now you’re having to go do all this labor of being eligible for this new designation?

Stephanie Mitchell: Right. Well, what would that require? Like, what’s the big deal? Like, write a check? No, I don’t write a check. I have to work underneath a CPM, a Certified Professional Midwife, for 10 births, and they have to sign off on my ability and for these 10 births. Mind you, the fact that the 500 other babies that I have delivered, well, I know babies aren’t delivered, everybody knows that.

Rebecca Dekker: Yes.

Stephanie Mitchell: So all of the other babies that I’ve caught, the 500+ just suddenly doesn’t matter. Now, I need to have someone else sign off on these 10 births, and say that you can do that. And there’s some very specific clauses in those 10 births, which make it even more extremely difficult and add a layer of difficulty. And that is that five of those births must be continuity clients. And that means I have to see them for five visits over the course of two different trimesters and catch their baby and have their postpartum visit. Now, why this is a problem is that there aren’t any midwives in the state available to be able to sign off on my paperwork. So here I am, a CNM midwife sitting in the state of Alabama, I can’t practice unless I get this paper. And the paper is like, well, how do I get the paper? Well, basically, I’ve got to have an entire client load for-

Rebecca Dekker: In another state for like six to nine months.

Stephanie Mitchell: Basically, that’s what it’s saying. Fortunately, I’ve had midwives in other states, West Virginia and Arizona, specifically, who were like, this is really, really dumb. Why don’t you come to our birth center and hang with our clients and meet these requirements at our birth center. By the way, our birth center is staffed by CNMs and CPMs, so we know full well how ridiculous this is. And so that’s what I’m in the process of doing. I hope to be complete with that process at the end of July, which will be great timing, because we’re slated for construction to be probably coming to a conclusion in the fall of this year. So timing is everything, but it’s really annoying. It’s really annoying that this has to happen and this level of obstruction. I’d love to just be focusing on taking care of clients now in their homes and being able to provide them that care. But alas, legislative foolishness.

Rebecca Dekker: And I don’t think people understand. They say, well, it can’t be that hard to get a physician to sign that paperwork. But I bet there is you probably count on one or two hands, a number of physicians in the country that would be willing to do that, because often their malpractice insurance won’t allow them to do that. Or their employer won’t allow them to do it. So if they work for a hospital or larger clinic, they’d have to get permission from their boss. And they would say, no, that’s too big of a liability. 

And then their insurance would say, no, we can’t cover that. That’s too big of a liability. And so even if you have physicians who want to sign that paperwork and support you, often, their hands are tied as well. So when they write state laws that make it a requirement for you to have a signed agreement with a physician, it’s almost always like predicting what will come true, which is no physicians will sign it. 

Stephanie Mitchell: Right. And that’s exactly the position I found myself in, which is wild. It is what it is. One thing I’ve learned is I don’t love no. No is terrible when it comes to, especially for the autonomy of a birthing person, it’s difficult for anyone to kind of utter those words. Like no, you can’t, or you shouldn’t, or we won’t. I don’t like that. It doesn’t feel good. It doesn’t feel normal. And so I never did like that in regards to this. So I love to find ways to go above and around and through these types of obstacles in the name of the preservation and liberation and birth and people. 

Rebecca Dekker: Yeah. One more thing before we go. I wanted to ask you about you do a lot of what you call free Black education on Instagram. And when people follow your page, you ask them to follow some basic guidelines. For listeners who want to start following doctor_midwife on Instagram, what do they need to know before they click the little follow button? Because they might get kicked out real quick?

Stephanie Mitchell: It’s just like people are like, what is that? I can’t do free Black work. I’m not Black. Well, sure you can. Because anytime you do kind of like … People are always like work, do the work, do the work, do the work. What the heck is that? Can we get like a template of what the work is? The work is when you get into a place where maybe of being able to learn something, specifically from a Black woman and you might not be used to it. Interact, participate, answer questions. She’s talking to you, which I am, if I’m talking to you, I’m talking to you like, this is a fun, leisurely space. But shit, I want you to learn. I want you to learn things. 

So one of the biggest things is I want to know who I’m talking to. If you go to the Instagram page, I just ask that people check in, or else I’m just some weirdo talking into their phone. I want to know like, are you a childbirth educator? Are you a mom? Are you a obstetrician? Are you a doula? Like, what are you here? What can we learn from each other? Why will this space be mutually beneficial? And then there’s some sort of like requirement to kind of like do something. We’re beyond the point of yelling and screaming into the air for people to bring awareness to subjects like awareness, awareness. Awareness is done. We’re done with awareness. Awareness is over.

Rebecca Dekker: Stephanie, I actually written it down on my list of white culture is that my culture believes that awareness solves problems. All we need to do is raise awareness and that will solve everything. That fixes it. But that’s not true.

Stephanie Mitchell: Okay, we did aware. Now that we’re aware, I’m all like, okay, well, what’s the action plan? What do we do with this awareness? And so that is what I am hoping to dig out of people every day. What is your specific action? What’s your free Black work? Sometimes it’s free, sometimes it’s not free. Sometimes it’s $12 donation. But sometimes it’s signing the petition. Sometimes it’s participating in polls. Sometimes it’s amplifying a page so that you can bring other people into the conversation. That is things that are real physical things that people can do that make a difference. And we’re sitting at home and we’ve been on this mandatory kind of retreat, some of us, indoors for several months. And it’s like, well, what can you do? 

I just want to emphasize that you can do so much from just scrolling through your social feed, like this is important. These are words that need to be heard about like the maternal mortality crisis, about birthing people autonomy, about a plethora of things. And so I just wish people would take a look at themselves and kind of figure out what it is they can do. But when they’re on my Instagram page, they can least answer the polls. They can answer the polls, and they can respond and they can build community, they could show up, they can comment, they can share, they can like. These are all in all really powerful internet tools.

Rebecca Dekker: Thank you so much, Dr. Stephanie, for all the work you’re doing to educate people. I’d love to encourage people to follow you. It’s doctor_midwife and also you can follow the Birth Sanctuary on Instagram, it’s the.birth.sanctuary. So thank you so much. Is there anything else you want to share with us before you go?

Stephanie Mitchell: No. I mean, this was great. I look forward to seeing you guys on the internet streets.

Rebecca Dekker: Yes, you too. Today’s podcast was brought to you by the Evidence Based Birth® Professional Membership. The free articles and podcasts we provide to the public are supported by our professional membership program at Evidence Based Birth®. Our members are professionals in the childbirth field who are committed to being change agents in their community. Professional members that EBB get access to continuing education courses with up to 23 contact hours, live monthly training sessions, an exclusive library of printer-friendly PDFs to share with your clients, and a supportive community for asking questions and sharing challenges, struggles, and success stories. We offer monthly and annual plans, as well as scholarships for students and for people of color. To learn more, visit ebbirth.com/membership.