We here at Birth by Design celebrate and support birthing women, no matter what their birth looks like. From home births to planned c-sections, we are here for you!
However, since May is for Midwives, what is it like to be a midwife or to use a midwife in Arkansas? (look for more concerning what it looks like to have a doula at a c-section, VBAC, and all sorts of other births in the coming months!)
So let’s explore what it means to hire and use a midwife in our state!
Every state has different laws about where, when, and how midwives can operate. In some states, midwifery is illegal. In the rest, laws range from unregulated to fully able to practice and even bill medicare. Midwives Alliance of North America has a comprehensive list.
In Arkansas, midwives are able to practice and be licensed as lay midwives or certified nurse midwives, and are overseen by the Arkansas Department of Health and the Arkansas State Board of Nursing.
The guidelines for Arkansas midwives can be found on the Department of Health website, but what does it take to become a midwife? The regulations say that a midwife must have basic education (high school graduate or equivalent), be up to date on TB tests and immunizations, and CPR certified for adults and infants. Then there’s the practical experience. Midwives “must demonstrate competency in performing clinical skills during the antepartum, intrapartum, postpartum, and the immediate newborn period.” What does that look like? Well…
“a. The applicant must attend a minimum of 20 births as an active participant.
b. Functioning in the role of primary Lay Midwife under direct on site supervision, the applicant must attend a minimum of an additional 20 births, of these:
a. A minimum of 10 must occur in an out-of-hospital setting and
b. A minimum of 3 must include at least 4 prenatal exams, birth attendance, the newborn exam, and 1 postpartum exam, each conducted personally by the applicant with direct supervision.
c. 75 prenatal exams, including 20 initial exams
d. 20 newborn exams
e. 40 postpartum exams”
Y'all. That’s a lot of work. But there’s more!
After all that apprenticing, midwives still have to pass several exams.
“1. Pass the North American Registry of Midwives (NARM) written examination. The exam may be administered by the Arkansas Department of Health and Human Services, Division of Health, or at a regularly scheduled test site arranged through NARM.
2. Pass the Arkansas Midwife Regulations exam with a score of 75% or higher. This exam is administered by the Division.
3. If necessary to obtain a passing score, the examinations may be taken up to three times. If the Midwife fails either the NARM exam or the Arkansas Midwife Regulations exam three times, she must repeat an apprenticeship before being allowed to re-test. “
After this, there’s licensing renewal (including continuing education requirements) that occurs every two years.
So, what does it look like to actually use a midwife?
First, you have to qualify to use a midwife and homebirth. “The Licensed Lay Midwife may provide complete obstetrical care to women who are determined to be at low risk for the development of medical or obstetrical complications of pregnancy or childbirth.”
Second, you have to satisfy these requirements…
Now you’re ready to give birth! There are more requirements! (yay?)
The midwives have all sorts of responsibilities during labor, not the least of which is supporting the laboring mother. They check fetal heart rates, mother’s blood pressure, etc… My favorite line of the rules and regs… “All services should be provided in a supportive manner and in accordance with these regulations.” A supportive manner is in the laws!
After labor, midwives assess the placenta, repair tears (if needed), check all sorts of vital signs and physical symptoms of both mother and newborn. She’ll stay until everything is within normal, and then come back for a follow up visit within 24 hours. Midwives are also responsible for the newborn heel prick (required by law), fills out the birth certificate and social security paperwork. Then, just like with an OB, there is a follow up check at 6 weeks.
What else do midwives do?
Record keeping. So much record keeping. They turn in a monthly log of their midwifery activities. Document, document, document. Keep records for 24 years. Submit to audits.
What about midwives in hospitals? Currently, in central Arkansas, certified nurse midwives are only available at UAMS. According to the UAMS website, “The UAMS nurse-midwives in the OBGYN department are primary health care providers to women and are able to perform physician exams, order laboratory tests and ultrasounds, diagnose and treat common problems, provided prenatal care, women’s health care, labor and birth care, as well as health education and counseling. Our nurse-midwives attend labor and birth for the patients in the hospital setting, working in collaboration with physicians trained in Obstetrics.” Practically, this means that women birthing at UAMS can request a midwife attend their birth, but it’s not guaranteed.
I hope this gives some understanding to the hard work that goes into midwifery in Arkansas. The women who choose to become midwives are caring, motivated, organized, responsible, capable and so hard working!
(There’s lots of things happening concerning the status of midwifery in Arkansas, Check out some of it here.)
As part of a celebration of midwives, and as an ongoing series, we'd like to introduce Arkansas Midwife Kim Jacob! She is a certified midwife working in the central Arkansas area. She has been licensed by the state of Arkansas and certified as a Certified Professional Midwife since 2005.
All midwives go through an apprenticeship, and according to Kim, she had the privilege of working with several different midwives. "Every midwife has something unique and special to teach and I’m so lucky to have learned from some of the best." It took her about 4 years to get all the experience required to apply for the NARM (North American Registry of Midwives) exam. But she feels like her real training happened after she passed the exam. "My mentors continued teaching me, attending births with me and keeping me rooted in the wisdom and respect of birth. They still do! And this is also what I do for anyone who I train to become a midwife. The preceptor apprentice relationship is vitally important in creating a solid midwife. I believe this with all my heart."
Kim's love for the women and families she works with is so evident- especially in her reasons for becoming a midwife, "My births changed me. My midwife inspired me. It’s a human rights issue. I love Moms and babies so deeply and want to provide the care they deserve by using evidence but mostly love." Not only that, but her favorite part of being a midwife? "The people!!! I love meeting new people and helping them attain the births they desire. I love how we become friends through the process. I get to see women at their most raw, vulnerable, strongest and most beautiful times of their lives. There’s no hiding who you really are when you’re in labor. Gosh, I love that!!"
She also has loveley words to say about how being a midwife has affected her, personally. "Sleep deprivation? JK! Haha!! I think the mutual love that I have for and from all of my clients throughout the years is like a blessing or charm of some sort. All the love and continual good vibes I get must make me a lucky person in my day to day life. Just like we can curse someone by speaking ill of them we can bless people by speaking and feeling love. I definitely feel the love I receive makes me a millionaire in that way."
The role of midwives is so unique, with a midwife spending lots of time with a family before and after birth. Kim's favorite advice for the mom's she works with is genuine and open. "With a positive, can-do attitude you can have an ecstatic birth. But mostly, just set your space up as positively as possible with the support of people who love and respect you and then open yourself to all the possibilities. You can do it!! Also, always keep a good sense of humor about pregnancy, birth and especially parenting! Try not to take anything too personally."
More about Kim...
What are your other jobs/hobbies/interests, etc...?
I love to cook (but mostly eat), read and hang out with my main squeeze.
Tell us about your family. Husband? How many kids do you have? What are their ages?
My husband’s name is Nathan and he is the raddest of all the people I know. I don’t know anyone who is loved the way he loves me. He’s my biggest fan! My daughter, Tig is 18 and just graduated high-school. She’s working for family now and will be having a baby in October. It’s not what she had planned for but we’re all very excited to meet this new baby and spoil the heck out of him! I’ll be mostly taking care of her but my dear friend Shea Childs will probably be doing most of the “thinking” during the actual birth. ;) My son is 16 and even though he seems like a reclusive gamer dude, was voted class favorite at school last year! He’s super-cute and funny.
What is the last book you read?
I’m reading book five of the Outlander series! So good!!
I always have a hard time picking colors because I like ALL the colors! But I seem to have a lot of purple in my closet. ;)
Oh man. Didn’t I tell you eating is my hobby? Nathan and I are total foodies. We love to read cookbooks and other books about food, watch shows about food and discover awesome interesting food wherever we travel. Picking a favorite food is like picking a favorite color. Can’t do it.
I love Thanksgiving! No gifts, hanging out with family and ALL the best food! We usually host the family gatherings at my house so it’s especially fun to host a party with all the people I love the best.
I’m all about the earthy smells. My friend, Sabrina told me once that I started smelling like patchouli the day I became a midwife. Haha!! Nathan just bought me a fragrance that actually has the word “turned earth” in the description. I feel like I should buy up a few cases of this stuff because I’ll be a sad girl if I run out and can’t find it again.
It’s a tie between Spring and Fall. I like the weather mild y’all!
Favorite way to de-stress:
Netflix and a margarita is my fave. But if I can’t have a margarita, I’ll take netflix or a good book any day.
If you want to get in contact with Kim...
Kimjacobconwaymidwife.com. (This is being revamped at the moment and I’m super-excited!!) My number is 501-514-1277.
Our heart here at Birth by Design is for women. This month, we honor the women in our lives: the mothers, mother figures, aunties, sisters, cousins, grandmothers. The tribe of like-minded sister-friends. The women at work, the other mothers or mother figures at school pickup, dance class, summer pool. The solid group of women doulas, lactation consultants, nutritionists, chiropractors, massage therapists, nurses, doctors, and physical therapists we have the pleasure to work with.
We are a unique sisterhood of women supporting and serving women, and our support for each other overflows into our service for our clients.
We are honored to witness mothers being birthed. We are in a distinct position to laugh, cry, grieve, celebrate, comfort, endure with, sit in silence with, and empathize with the women we support. Our time with clients is short, but full! We love you and we see you.
We also know that Mother's Day isn't always easy, To those who experience loss, guilt or irritation, we hope that you find the support you need. We love you and we see you.
Happy Mother's Day from the doulas at Birth by Design!
As the month of April comes to a close, so does Cesarean Awareness Month #CAM2017. People usually become passionate about certain causes when they or their loved ones are directly affected by said cause. For me, I had a great deal of ignorance about cesarean births before I had one myself.
Before getting pregnant, I viewed cesarean births as a cop-out, the easy way out of labor pains--cheating. I subconsciously viewed mothers who've had cesarean births as having not tried enough, or not strong enough to endure real birth. I qualified my mother’s own cesarean experience to say hers was necessary because she had twins, one of them breech. Which one was breech? Me. I caused my mother to have a cesarean birth.
Twenty-four years after I came out of my own mother’s abdomen feet first, I found myself laying on an operating table awaiting the birth of my own child. She was head-down, engaged, and had managed to help me dilate 8cm. However, 20 hours of position changes, nipple stimulation, pitocin, or prayer would not help me to progress any further. My water had been broken for over 30 hours, I had not eaten or drank anything, had not slept, and was ready to meet my baby. (See how I’m trying to justify my decision for a cesarean. It’s what we do when we feel we could have done better). When my doctor mentioned a cesarean, it sounded right. We had tried everything and I was exhausted. What else could I do? At the time, I felt 100% ok with this decision.
Needless to say, I changed my tune about how I felt about cesarean births and moms who have had them. My cesarean was not a cop-out, I experienced hours upon hours of labor pains, and I most certainly did not cheat. There a million different rhymes and reasons for Cesarean births, I know my story is not everybody’s. But I know we all want what's best for us and for our babies. I am now passionate about a cause that I before had very little experience or sympathy for.
This post is to legitimize every mother who feels like her body failed her, that her birth team wasn’t enough, that her birth wasn’t real, and that the scar on her abdomen means she’s broken. You are strong, and beautiful, and your worth as a mother is not defined by which part of your body your baby came out.
I know that not everybody feels ill-will about their cesarean and does not want to be categorized accordingly by their experience. I see you too. I want to celebrate all mothers who’ve had a cesarean birth be it elected or not, necessary or not, emergent or not, gentle or not. Our scars tell a story and yours is important to me.
I will end with a Maya Angelou quote that I learned from a friend at our local ICAN (International Cesarean Awareness Network) chapter meeting: “Do the best you can until you know better. Then when you know better, do better.”
--Jenny Knight, BbD birth doula.
Jenny sees every woman as a being of deep power, capable of birthing new life into the world. She is honored to serve and guide women and families as they embark on this journey. No matter the circumstances, pregnancy and childbirth are extraordinary experiences. Every woman and family deserves love and support through this miraculous time.
This month, we’re featuring the lovely Jenny Knight. She serves women in Morrilton, Conway and Little Rock. Not only is she a certified birth doula, she graduated from Mills High School and earned a BS in Environmental Science at University of Central Arkansas. She lives and works full time as the Program Director at Camp Mitchell, the Episcopal Camp and Retreat Center on Petit Jean Mountain. Their biggest program is their 8-week summer camp program when she needs to take a hiatus from doula work. When she’s not busy planning for or recovering from summer camp, she enjoys camping with her family, farming, making kombucha, and amateur quilting. She is kind, patient, steady, and articulate. Her sister doulas love her for her honesty, no-nonsense approach, and the fresh ideas she brings.
This is how she explains what she does as a doula, “ A doula is literally a woman serving a woman. She supports a woman and her family during pregnancy, birth, and beyond. Doulas are not medical professionals but are extensively experienced with birth. Thus they often bridge the gap between mothers and their medical care providers, answering questions and providing additional resources that doctors don't always have time to do. Doulas are a constant and present support during labor providing physical, mental, emotional, even spiritual support. Doulas help ensure that the journey--pregnancy and birth--are just as valued as the destination--a baby.”
Her favorite part about being a doula, besides getting to know so many wonderful clients, is witnessing the empowerment of a woman during her birth. “No matter the drugs, potions, or prayers used during labor, the moment a mother and baby are united earth-side is breathtaking. There is so much triumph and joy and toil that it is overwhelming. A mother becomes the strongest, bravest, and most epic human being on the planet in that moment. And to witness such a feat is truly an honor and a blessing.”
Her story of becoming a doula is fascinating. She says, “When we were pregnant with Odessa we took childbirth classes with Birth by Design. My understanding of a doula was very naive and judgmental. I considered them birth cheerleaders and didn't feel like we needed or could afford one. After 30 hours of natural labor, I birthed Odessa via cesarean section. At the time I was ok with that outcome as we were just so ready to meet our baby. But after months passed I became more and more discontented with my birth story. All the “what if?” questions got me to thinking that if I had a doula there, she would have been asking those questions when it mattered. If I had a doula at my birth and it still ended in a cesarean, I would have the peace of mind knowing that we tried everything. The nagging feeling about my own birth story grew into a passion to help other mamas avoid this discontent. I found myself at Birth by Design training to be a birth doula :)”
More of Jenny in her own words...
Tell us about your family: My husband, Doug, and I met at UCA. We married our senior year and shipped off to Japan as soon as we graduated. We lived and worked at the Asian Rural Institute for a year as missionaries with the Episcopal Church. That year turned our hobby of farming and sustainable living into a passion and solidified our call to serve others. When we returned to the states we began our work at Camp Mitchell. Doug as the farm director and me as the program director. We got pregnant our first year home and Odessa is now 2 and a half. We also have a beagle terrier mutt named Nellie.
What is the last book you read? Phantom of the Opera in preparations for seeing the live performance at Robinson
Favorite color: burnt sienna
Favorite food: fried okra, tiramisu
Favorite holiday: thanksgiving
Favorite smell: Odessa’s morning breath
Favorite season: autumn
Favorite way to de-stress: I want to say something healthy like go running but really Doug and I veg out watching something shameful like Desperate Housewives and eating chocolate :D
It is officially World Doula Week! All month we've been posting video testimonials from our beloved clients, but this week, check out your doula friend's profiles. We'll be publishing our favorite things about being a doula, and how our sister doulas and clients have influenced us.
I know it's still March, but we do have a very exciting event coming up on April 1. We're hosting an event to kick off Cesarean Awareness Month! Sign up is available exclusively on our website. Click here!
World doula week is March 22-28! The date is chosen because it coincides with the spring equinox, which represents the return of fertility in countless cultures. It also happens to coincide with Spring Break Week, so we here at BbD have chosen to celebrate all month instead of just one week!
We're celebrating by celebrating our accomplishments and our clients. We love to see you achieve your birth and postpartum goals, and we are honored to be a part of your motherhood journey! Keep an eye on our Facebook pages all month. (Conway) (Little Rock) Every day we'll be featuring one of our clients, their success stories, and the role that a Birth by Design Doula was able to play in that success. .
We've got other events coming up this month, too! Events where you can see us in person!
We'll be at Rhea Lana Conway all week. The doulas will be rotating in and out, manning (womanning?) our booth. Come and say hi!
We've also got another fun Freezer Meal Group happening March 25. I've been to the last two, and they are so much fun! You'll have other mamas to talk with, and several doulas in attendance, too. After last month's group, one of our clients went into labor and delivered her beautiful baby girl that night. So.... just do with that information what you will..
Registration deadline is March 11, so grab your spot!
Welcome to our next installment of Meet the Doulas, Daspri Swymn edition!
Daspri is a birth AND postpartum doula serving in Conway and Little Rock for birth support, and Conway and surrounding areas for postpartum support. She is not only an amazing and overachieving doula, she also holds a BA in Writing and Rhetoric with a minor in Management Information Systems. We here at BbD love her reliable, steady, and entirely energetic presence; not to mention her sense of style!
When asked how she personally explains who a doula is and what a doula does, she answered, “ A doula is a support person for a women during pregnancy, labor, and postpartum. A doula is the perfect combination of girlfriend and coach all wrapped into one.” Her favorite part of being a doula- helping women have the experiences they desire in birth and the care they need during postpartum. She decided to become a doula because she’s always loved helping her friends during their pregnancies and labor. At one point she was asked by a sweet lactation consultant if she was a labor and delivery nurse years ago because of the way she handled mommas and babies when visiting family in the hospital. She loved the thought of being an L&D nurse, but not exactly… then she found out what a doula was by having Nicolle at her first daughter’s birth, and he new that being a doula was IT, exactly!
Daspri in her own words...
Tell us about what you do when you aren’t doula-ing: All the things. I love physical activity and outdoor sports, home reno and design, sewing, making jewelry, and the list goes on.
Tell us about your family: I have an awesome husband that is in love with the Lord and gets me and helps me get to do the things I love. I have a 6 year old daughter that is smart and silly and so fun to be with. I also have a 19 month old that is the most loving little thing and the most honery little thing all wrapped into one.
The last book you read: Children’s books...all the children’s books.
Favorite color: Teals, blues, royal purple, and greens...I can’t see in a single color there are too many out there to pick just one.
Favorite food: Most all things Mexican.
Favorite holiday: Most all the holidays are fun but I love summer break when we get to visit the beach, that’s my holiday.
Favorite smell: Clean
Favorite season: Spring
Favorite way to de-stress: Exercise, a nice hike, or a good long bath.
Welcome to February!
We've got some fun things going on this month to brighten your life...
Doula Little Dance! Make a little Love! If you have loved our February shirts, you can now purchase your own. Click here!
Keep an eye out for photos and video of your
And what better place to wear your dancing shirts than at our Dancing for Birth classes. New series starting soon, click here to sign up!
As the doulas have welcomed in the new year (with a few babies, as well!), a look back at the year 2016 was necessary in order to create new goals for this year! We are beyond honored to serve so many women in pregnancy, labor, postpartum, lactation, education through classes, and placenta encapsulation. Each year, we like to look back and see what we have accomplished, and hope to improve and create better ways to serve the women of our communities. So here’s a look back to Birth by Design’s 2016!
Overall, we served many women in 2016 and welcomed 112 babies with the help of our birth doulas! (Birth by Design hopes this number will grow in 2017, as we have several more students who have completed their certification and have already started filling their calendars!) Of those 112 births, 90 of them were vaginal. (That translates to 80% of our clients!) Some were home births, some were drug-free, some were with pain meds, some were inductions, and some were VBACs! (Did you know that of our clients that decided to labor for a VBAC, almost all were successful!! That is huge!) We also served at 22 cesarian births. Some of these c-section births were elective, some were because of medical issues, some were twins, and some were just silly babies who decided to not come into this world head first. There is a great joy seeing a woman achieve her goals both as a birthing mama and as a birth worker! We were honored to serve all kinds of women with all kinds of birth plans!
Did you know that we now offer postpartum doula care with certified postpartum doulas? Those doulas finished their training in 2016 and began their work in serving mamas! Overall, albeit new, they were able to serve 16 mamas, 17 babies, all for a total of 230 hours of postpartum care! We are positive this number will grow even more in 2017!
Our goals for 2017 are being set even as this is written! Already our calendars are filling up with more babies! Already, our office space in Conway has grown by moving locations to a bigger space! Already, we are looking for ways to better serve the community! Our hope is to serve even more women from all sorts of backgrounds and with all sorts of birth plans- there is no right or wrong plan… just what works best for you and your family!
Thank you for making 2016 a great year for us and here's to making 2017 even better!!
-Mekelle and the rest of the BbD team
813 Parkway Street
Conway, AR 72034
Little Rock Office
13401 Chenal Parkway
Little Rock, AR 72055
-inside Wellness Revolution