The Indiana Partera: Delivering Diversity in Midwifery

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By: Hilary Powell

December 31, 2014 — Marisol Holman thinks her job is more important than yours.

“The realization of what it means to likely be the very first person to touch another human being coming into the planet. I mean, seriously, there is no other greater honor that I can come up with,” she says.

Her calling card is her name.

“Just because of my name, people have come,” she says.

Her work is not only life-changing, it’s life-preserving.

By many accounts in the maternal health community in Indiana, she is the only one providing her type of service.

She is known as the only Spanish-speaking home birth-certified professional midwife of Latin American heritage, regularly working out of Hoosier homes.

“She speaks Spanish, so I was like, ‘I want her. I wanted something very intimate,” says Johanna Perez Ray, a mother originally from South America. “Because she knew Spanish and because she was from a South American country, there was a special kind of bonding. I kind of trusted her automatically.”

Columbian-born Holman is based in Anderson, Ind., but travels hours around the state to “catch babies” as she calls it.

To use the Spanish term, a modern-day partera, or midwife, in Indiana.

With the state as diverse as ever it may be important to embrace cultural traits and traditions now more than ever.

The latest U.S. Census Bureau data estimates show that from 2010 to 2013 the Hispanic population grew more than any race or ethnic group in the state, with Lake County leading most others in growth.

Holman says she wants women of all ethnicities, especially Latinas, to be empowered to know maternal care is not one size fits all.

“My families of color who come, usually at the consultation when they come and sit down [say] ‘you have people that look like me,'” she says. ” There’s pictures, there’s dolls, and have said that’s just so comforting. I need the affirmation that people like us do this.”

Holman says her fellow midwives in hospitals have just as high a calling.

But for many in the field of maternal health, there is a schism between two schools of thought: the midwifery model of care and the doctor model of care.

Some caregivers think birthing options should include home birth awareness, while others think the best care is always provided in hospitals.

“Thing right down the hall, within steps is really important,” says Mary Ellis, a hospital-based midwife — often called a certified nurse midwife. Her training includes a nursing masters and 12 years as a labor and delivery nurse. “If there is a problem, a slight problem with test results, we have access to highly-skilled physicians.”

Holman says the subject is so sensitive in the state, she’s worried about backlash, but her concern for diversity is greater. She says 15 percent of her clients are black and Latina. Although in her experience, Latina women aren’t as open to the idea of a homebirth, she thinks even understanding cultural differences is key to starting dialogue.

“They carry along with them some of the very old traditional customs of the things they want done,” she says.

15-month-old Elizabeth Ray is special to her parents but also statistically rare. Figures from the Indiana State Department of Health show only 27 Hispanic babies — classified as an ethnicity, not race — were born by home birth in 2012.

Elizabeth’s mother, 35-year-old Johanna Perez Ray, says when she moved to Carmel, Ind. a few years ago from Chile, she wanted to embrace a form of birth culturally frowned upon.

“I don’t know if there are many Hispanic women who want to have their children at home,” Perez Ray says. “It’s seen as something you just want to avoid. You just don’t do that. It’s not safe, it’s not anything that you would expect in a birth. So, when I told my friends and family, they were all shocked.”

We reached out to the state health department about how the rising Hispanic population rate is affecting birthing choices and they did not immediately reply.

What we do know is in the numbers: A growing body of health policy experts say midwifery care — which often includes comprehensive prenatal care in addition to delivery — can be lifesaving. A June 2014 report from the World Health Organization and its health partners calls midwives “essential” and reports their services could cut maternal and newborn deaths by two thirds worldwide if properly trained.

Per the American College of Nurse Midwives, nearly half of counties in the United States have no maternity care professional.

A 2013 Indiana law, House Bill 1135, recognized midwife-assisted home births as legal.

Anna Vallow is a doula who provides non-medical care to pregnant women. As the legislation committee chair for the Indiana Midwives Association, she says culturally competent and thorough training is the loudest call from the midwife community.

“Definitely within a safe model of care,” she says. “Definitely following guidelines if those guidelines are put in place. We do need a level of accountability, and we need skilled attendants who are great at the craft that they serve our populations with.”

Ellis calls home birth midwifery a niche community.

“Home births are a niche. They are highly-educated women who’ve done their research on home birth and find someone to attend their home birth. And, I’m not familiar with that too much,” Ellis says.

The latest 2012 Indiana Natality Report shows fewer than 6,000 Indiana births were attended by some type of midwife.

Ellis says some of her clients come to her North Shore Health Center in Lake Station, Ind. because they can’t afford the costs associated with home births.

“We are called to work with the poorer women,” Ellis says of the sliding scale fee services offered by her health center. “Where can we do that most good? They go and speak to our counselors about presumptive Medicaid. Basic service, but still service.”

Lake County has a higher below poverty rate than the state, with nearly one in five people living in poverty.

Holman says she charges no more than 3 thousand dollars, and is willing to barter and that her insured patients find her services less costly than a hospital visit.

Elizabeth’s mom says having a birthing expert who looked like her was so invaluable she’s doing it again. She is four months pregnant.

“It was a mix of English and Spanish, actually,” she says. “I don’t know, it was so amazing. I’m so grateful I was home.”

“Birth is cool, it’s the cruix,” Holman says.”We need more midwives of color here. Everywhere.”

These four women, though not speaking for all Latinas, say varying opinions are appropriate for a subject that’s always been about choice. And they say, the only demand should be one for diversity.

This project was reported with assistance from an Institute for Justice & Journalism fellowship.


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