by Becca Shaw Glaser April 13, 2021, The Free Press

Hope Jackson grew up on Green’s Island, Vinalhaven’s little neighbor, and became a certified professional midwife (CPM) in 2012. She has taken part in over 200 births, mostly in Maine, and also in Costa Rica, El Salvador, Senegal, Vermont and Indonesia. She lives in Searsmont with her two young children and partner. A recent monumental change in Maine for birth choice, the state finally, in January 2020, formalized official licensure for CPMs, who primarily support people in out-of-hospital/home births. In our interview, Hope and I discussed midwifery, birth (how spectacular! how common! how we all got here!), and raising kids to be “positive citizens,” particularly during the pandemic. Among other challenges, for most of 2020, if something came up that warranted hospital care, CPMs were barred from accompanying their clients in many hospitals in Maine. “Happily,” Hope says, “most hospitals are again allowing doulas and midwives to attend their clients.” 

Becca: I first met you on Green’s Island, where you grew up, when we were basically kids. My memories of you from then are a vibrant blur of you and your brothers — red hair, spruce trees, bare feet, knowing every inch of an island as home. How did growing up on Green’s affect who you became, and perhaps how you approach caring for people through pregnancy and birth?

Hope: Growing up on Green’s has had an impact on every aspect of my life, and I would credit the independence and self-sufficiency we were raised with as being integral to taking on some of the challenges of being a home birth midwife, and for giving me the confidence to pursue a non-mainstream career path. My brothers and I were all born at home with midwives, so my roots in midwifery start with my own birth.

Becca: If you take a few deep breaths and close your eyes, and think about what it is like to be part of the birth process, what comes to mind?

Hope: When I’m present at a birth it feels a bit like being two people at once. Externally I move slowly, the space is warm and time slows down, all the focus is on the birthing person and their needs. Internally my mind is working quite hard, remembering everything that needs to be done to keep the birthing person and their baby safe, as well as constantly assessing progress, risk, considering the next step, the next need, thinking about this individual’s risk factors, keeping an eye on the weather and thinking about transport time to the hospital if needed, doing all the work of knowing and assessing for warning signs in birth while also holding the knowing that birth works the majority of the time. Midwives are very available and supportive physically, but really most of our work is cerebral.

Becca: You worked with midwives in various cultures and countries. What are some things you bring from that into your midwifery practice?

Hope: My time studying under a traditional midwife in rural El Salvador had a great impact on my faith in the birth process and joy in the magic of birth. I spent about a year living and working in El Salvador before I started midwifery school, and that time — although I witnessed many challenges and losses relating to poverty and lack of medical access — really laid the foundation of my calling to midwifery before I took on the academic rigour and responsibility relating to the profession. There are so many amazing things I learned during my time overseas, and I dream of returning to this work [in other countries] when my kids are older.

Becca: What made you decide to remain in midcoast Maine? Are there things you wish would change about Maine?

Hope: I love serving the community I was raised in (or near) and being part of the midwifery community here. There are so many wonderful things about raising kids in midcoast Maine, but I do think a lot about the lack of diversity in this area and how to best raise children as anti-racist and positive citizens. This is a constant work in progress in our family.

Becca: How do your kids feel about the work you do?

Hope: I think their impression of my work changes day to day. They don’t love anything that takes my attention from them, and they can’t quite conceptualize that even though my work can call on me at all hours I’m ultimately with them much more than if I worked 9-5. Being a home-birth midwife is very much a way of life, and it has been a part of their beings since the beginning. They certainly know more about birth and reproduction than most children, and they love to give advice to pregnant people. They keep tabs on how many births I’m on-call for, and how “close” someone is to giving birth, as well as asking “did the baby come out?!” each time I come home. In non-pandemic times they were often present at prenatals and liked to help listen with the fetoscope and say “happy baby!” the same way I do. The 3-year-old recently told me he’s going to travel to people’s homes to help babies out when he grows up, and the 7-year-old used to comment on how clients had gone “too late” and should have had their babies by now.

Becca: Since you’re trying to raise them to be “anti-racist and positive” citizens, have you been introducing them to concepts around racism, sexism, transphobia, etc.? Favorite kids’ books?

Hope: We strive to keep a diverse library of children’s books in our home, and having curious children means there are endless opportunities to talk about these concepts as we follow their lead and answer their questions. Parenting in a way that supports a consent-based culture is extremely important to us, and it can be hard work to undo what we are taught, but it is amazing to witness what they have been raised with put into practice as they grow. Recently our 3-year-old was pushed over at the playground and he got up looking upset and angry, but he turned to the other child and said “I didn’t like how you pushed me! I only want you to touch me like this…” and put out one finger to “tag” the child. Having two kids means I get about 1,000 opportunities a day to reinforce the message of consent and body autonomy as they play, fight, wrestle, etc. We’re loving “Antiracist Baby,” “Jabari Jumps,” “Julian is a Mermaid,” “It’s Not The Stork,” and “Mama Midwife,” to name a few.

Becca: Childbirth is among the most miraculous, phenomenal, and also rather common things that happen in our lives, yet it often seems almost nonexistent in mainstream media, or is seen as a niche “women’s issue.” Why do you think that is, and what can we do to bring it more into focus?

Hope: Gosh, I think we could write a whole novel on this topic. Honestly I think education and communication are very important in sharing the diversity of experiences around reproduction and birth. There are a lot of expectations people carry around reproduction, and people are hesitant to talk about their experience if it didn’t go the way they thought it would or should. There are a number of wonderful podcasts these days that share hugely diverse birth stories (such as “The Birth Hour,” “The Longest Shortest Time,” and “Birthful”); I think that storytelling is very healing for people and helps to highlight how extremely individual and varied birth is.

Becca: My understanding is that the pandemic has led more people than usual to choose home births rather than navigate the COVID restrictions put in place by many hospitals. Has there been a trend like that in Maine?

Hope: Absolutely. 2020 was an extremely busy year for midwives in Maine. We were receiving a lot of late transfers from hospital care in the early days of the pandemic; that has slowed down, but home birth continues to be in high demand.

Becca: What changed during the pandemic as far as labor, birth, and pregnancy care?

Hope: Providing midwifery care in a pandemic was certainly never on my radar when I started this profession, and just like all professions [midwifery] stumbled through a steep learning curve in the past year-plus. Midwives in Maine generally started masking and using strict cleaning protocols; I don’t believe any required birthing clients to wear masks, and it varied as to whether or not other people in the birth space did. Early on in the pandemic most of us moved to virtual zoom-based appointments when possible, just in the early lock-down days. We all jumped into many online trainings and seminars regarding the unique challenges of providing care in a pandemic. It was a lot of added stress figuring this out as recommendations changed and evolved. I do have fond memories of many back porch and yard prenatals in the warmer months, laying blankets on the grass and feeling bellies under the sunshine.  

Becca: Has postpartum depression/despair been worse during the pandemic?

Hope: Yes, I think the isolation has been extremely difficult for pregnant and new parents. We focus a lot on helping people find ways to feel connected; many of the local support groups have gone digital in the pandemic and in some ways are even more available to parents who, say, have multiple children at home and otherwise couldn’t make it to a class or group. I encourage new parents to connect with other new parents for a walk, or even talk on the phone with. Having a new baby at home can be very isolating even in non-pandemic times, so that issue is amplified now.

Becca: There are many young people, concerned about bringing children into this world of rapidly changing climate, who do not want to have children. Are you noticing this trend?

Hope: Well I have to be honest that I’m mostly seeing the people who have decided to have children :). I have certainly seen an increase in people waiting until later in life to begin having children, until they have completed education or career goals, or established security in whatever way feels important to them. And yes, I do hear from people choosing to have fewer children based either on climate and population concerns, or just on the uncertainties in the world.

Becca: I tend to think of home births in the U.S. as often being financially inaccessible to people with fewer resources. What is done to make midwifery and/or home births more financially accessible? Does MaineCare pay for midwifery or home births?

Hope: Home-birth midwives’ fees are significantly less than hospital-based care, but it is case-by-case on whether private insurance will reimburse families. With people carrying private insurance they often find the fee for complete care is less than their deductible would have been, and things like ultrasound and lab testing are covered by insurance. Most midwives offer extended payment plans for their clients to help make home birth affordable to them. MaineCare does not pay for home birth midwifery care yet; we have only been licensed in Maine since January 2020, so that might open up insurance coverage in the future. I think there can be a message that only a certain “type” of person chooses home birth; but truly we serve clients from all types of backgrounds and who are choosing home birth for all kinds of different reasons.

Becca: Do you and others in the Maine midwife community make attempts to be trans- and gender nonconforming-centric?

Hope: The beauty of home-birth midwifery is that the care is so individualized for each client. We are all educated in providing care for trans and gender non-confirming individuals. I had a client once tell me, “It’s just such a relief to know that I won’t be needing to inform everyone who walks through the door what pronoun I use when I’m in labor.” That one-on-one care is what makes midwifery care so unique, and so essential for people who want their gender identity respected. I would say that awareness of the needs for trans and gender nonconforming individuals in reproductive healthcare has grown notably in the past five years, and it’s an evolving and engaged topic in the midwifery community, so we can improve the inclusivity and care we provide. Of course some midwives have made this more of a focus of their practice than others, so it’s always encouraged to interview multiple midwives to find the right fit (this applies to anyone pursuing home birth).

For more information check out the Maine Association of Certified Professional Midwives, which lists many of the state’s CPMs, at macpm.org.