(with Pat Burkhardt, CM, Ph.D., Mom of 2 ) “I didn’t know it could be this way. My maternity care during pregnancy & birth was amazing! I never thought I’d feel so confident during pregnancy, in labor, during birth & just having a baby overall. Especially after my first birth. I’m so glad I looked into my other options, I can’t imagine not knowing what I know now.” …this is what a lot of women say who learn their options, ask questions & then find care that feels right to them.
This could easily be you!
But during pregnancy, how do you know what the best model of maternity care will be for you during birth?
Do you know the two main maternity care models? The medical approach (allopathic as Pat Burkhardt explains) -OR- the holistic (as in whole) integrated approach. What exactly would each model of maternity care look like & feel like for you? How would each model differ in helping you have a healthy birth & healthy baby?
We’ve found the perfect expert (an unbiased 40+ year veteran) to compare the medical model of maternity care to the holistic model of maternity care for you … so you’ll know which is the best maternity care for you. Having a baby with each of these different styles of maternity care is not the same. Not even close.
One is right for you. But you have know what both are to make the best decision for you & your baby!
Pat’s 40 plus years as a midwife, plus her background training midwives at New York University has given her first-hand knowledge & invaluable experience as to WHY it’s important to consider the big differences between these two models of care, WHAT those differences are & HOW they’ll impact you during pregnancy, in labor & during birth.
Pat uses the analogy of a sailboat and a powerboat- watch this to see what that was about, it makes all the sense in the world! Pat also tackles the misconceptions of holistic or integrated healthcare as only being practiced by hippies who don’t have proper training. There’s no one ‘right way’ to have a baby. But there’s a ‘right way’ for you.
You’ll Also Learn:
- How “mind over matter” relates to a whole approach in care & why that makes a difference for YOU.
- Tips on how to find the right healthcare provider who’ll fit you, your goals, and your desires.
- Why asking open ended questions to your prospective healthcare provider is ESSENTIAL. Pat gives examples of what those could be.
Who is Pat Burkhardt?
As the letters following her name imply, Pat Burkhardt is a Certified Midwife. She’s been a midwife for over 40 years and recently retired as the Director of the Midwifery Program at New York University (NYU). In addition to being a mama of two kids, Pat also has her Ph.D. in Public Health and is the President of the New York Association of Licensed Midwives (NYSALM).
Watch the Class (download the MP3)
What do you think? Share below…
Sarah Blight: Hi. This is Sarah Blight with Your Baby Booty Interviews where we cut through the fluff and give you the information that you want to know and need to know about becoming a mom. Well, today we’re talking with Pat Burkhardt. She’s a Certified Midwife and she has her PhD also in Public Health. She’s been a midwife for 40 years and she just recently retired as a director at the Midwifery Program at NYU and she’s also the mama of two kids. So thanks so much, Pat for being with us today. I wanted to talk about the idea of being treated and cared for by your health care provider as a whole person not just a uterus today. So I’m excited to delve in to this topic with you. But before we get in to that, can you tell us as a mom and with all your experience as a midwife what is the one thing you want new moms to know?
Pat Burkhardt: New moms as in baby in arms already?
Sarah Blight: Expected, I should say expected moms.
Pat Burkhardt: Okay, expected moms. I think the most critical value that women in our culture today in 21st Century have to acquire because it has been taken away from them is the trust in their bodies and their ability to reproduce the species which sounds terribly scientific but the bottom line is women were made to birth babies and in the main they can do it and they have had their confidence in their ability to do that. So badly undermined not in a — not for malicious purposes but because of the way Allopathic medicine functions and –
Sarah Blight: And what is Allopathic medicine mean?
Pat Burkhardt: Allopathic medicine is the method or is the medicine in which our physicians in the US are educated and in which they practice. And by definition, Allopathic medicine focuses on organ systems and we’ll get back to your uterus question, because it focuses on organ systems, physicians look at individuals no matter what individual as a system as oppose to as a human being and then the more they specialize, the more focus their system approach becomes. So by the time they get to be obstetricians and gynecologists, they’re in the pelvis. That’s all that really — I mean that’s their focus and that’s their skill and they’re great on diagnostics and treatment if there is in fact pathology present. But over 85% of women are normal healthy women having babies. That’s not pathology, that’s normal. And how do we help women understand that they can do that and it’s good for them and their baby that they do it as naturally if you will as physiologically as they can.
Sarah Blight: So why is it important for women to be treated as emotional, spiritual and physical beings especially while they’re pregnant?
Pat Burkhardt: Well, we’re integrated creatures and so what is done to one level of us impacts all the levels of us. And Norman Vincent Peale years ago was the man who came up with that fine statement about “Mind over matter” and the mind is a critically important and extremely strong element in each of our beings that can impact and influence how the rest of us goes and within our minds, we just don’t think we can do it or we are led to believe we can’t do it. Then in the end many times we can’t do it unless something turns that around for us. And so whether it’s heart, mind, soul, spirit, all of those elements are critically important for women, well for any human being but in this context for women when they’re having — when they’re going to a pregnancy and when they’re looking toward labour and birth and then taking care of this baby post partly as a mom.
Sarah Blight: Can you give us a specific example of a situation where you saw a mama, you know, her mind was over her matter or maybe it wasn’t and how that kind of — how that affect to her?
Pat Burkhardt: Simple story I have one that is just a very good colleague friend of mine who I work with at Presbyterian Hospital New York. She only worked weekends and she worked 24-hour weekend. And one time a woman came in in labour and got to meet Deb and Deb went through the labour with her and she learned a lot about Deb. Deb learned about her and she knew that Deb was only on weekends and she didn’t do any clinic here. She didn’t do antepartum care in the office. Well two years later, this woman arrives on the doorstep of the hospital ready — in labour again for her next baby looking for Deb and she knew Deb was on and she came in. And Deb then birth her next three babies. And so, you know, and we’ve all seen women who kind of don’t go in to labour in their midwife is on vacation or if their physician is on vacation or if there is a big wedding coming up and they want — they don’t want to — they want to be at the wedding but they’re still going to have — so they’re — we’ve people look at — look back at their own life experience, they can see that many times our heads overrule our bodies in many ways.
Sarah Blight: That’s very interesting. That sounds like not to be — not to be morbid but it sounds like when someone’s, you know, ending their, you know, nearing the end of their life and they’re waiting to say goodbye to somebody, it sounds very similar and it makes a lot of sense that we do hold on in order to let something happen that we want to happen. So that’s interesting. What does kind of the traditional or as you called it the Allopathic style of medicine, what is that offer to women and how does that sort of compare to the more whole or integrated approach as, you know, the difference between those two?
Pat Burkhardt: Well, I think you can look at it in a couple of ways. Certainly, if in fact you have a problematic pregnancy then clearly the best person, the most expert person to take care of you is an obstetrician or even better maternal fetal medicine physician who is not only an obstetrician/gynecologist but now has sub-specialized in to the relationship between the mother and the fetus during the whole pregnancy process. Because that needs expertise and those individuals with that education and training have that expertise. The other side is for those women who don’t have any complications or any pathology going on in their bodies and during their pregnancies, many times the best person is someone who just looks at pregnancy as an integral and integrated process where in fact we know that this is a human being, a woman with a heart, mind, soul, body, spirit the whole she bang and that she’s cared for in that integral and if as we use the word these days, holistic way.
But the other element that enters in to all of the decision making for women in today’s world is that in our society, the physician is the gold standard and many — and if you just watch TV every given night, how frequently do you hear the phrase “Ask your doctor, ask your doctor” and it’s the pharmaceutical companies telling you to ask your doctor about prescriptions and drugs but the bottom line, it’s a refrain that just gets built in the minds and hearts of people and they think that’s the best way to go. And again, if you have serious pathology, it is clearly the best way to go. But if you don’t, it’s a question whether it’s the best way to go in my view.
Sarah Blight: So what would be the alternative for a mom who wants to be kind of cared for and attended by somebody who sees her as a whole being? What are her options?
Pat Burkhardt: In general at this point in time in our culture, in our society, midwives are the best or the next option if you will. Nurse practitioners tend to do pregnancy care but they don’t do birthing care. So if you really want the same person with you for the entire journey, then you get the person who can do the pregnancy care, the labour birth care, the postpartum care and then also taking one for your next yearly appointment for your checkup and for your contraceptive if that’s what you’re in to, just all of the woman’s care that you need for the rest of your life if you will. Midwives basically care for women through their lives.
Sarah Blight: Oh so midwives aren’t just for giving birth, they also can do pap smears and all the womanly duties that we need for them to do from time to time?
Pat Burkhardt: Absolutely and they also take women and health women through menopause. So again, it is — and it’s for women who don’t want babies. You know what I mean? Many women choose not to have children in today’s world and so the midwife is the one who can basically lead you down that road or guide you down that road to avoid pregnancy if there’s a possibility you could get pregnant or to just help you live well as a woman choosing not to have children.
Sarah Blight: So what is it about midwives that lend themselves so readily to this whole integrated or holistic or whole approach to care? Why is there such a difference between the doctors and the midwives?
Pat Burkhardt: Well, I think one of the essential elements for the midwives perspective is we really — we’re all about the women and if you ever talk to any midwives particularly if you hear them in the group, its the focus is always on the women and we treasure, really treasure our historical antecedents. You know, we had at NYU when I was running their program there we always had a “Blessing of the hands ceremonial” on graduation each year and the “Blessing of hands” was to emphasize to the newly graduating students that their hands were their best tools. Certainly their head is an equally important tool in order assess well and to make good clinical decisions but their hands and what you can do with hands in terms of touch and contact are most critical to midwives and in that ceremony we always go back to our grandmothers and our foremothers and all the women through time who have been — and any women who’s had a baby is part of our group back there and not just the women who helped them birth but all the women who have come before us who have done this amazing work of giving birth to babies.
And so that mindset, that’s a very different mindset than from physicians. Now, does that mean every midwife is of that yolk [0:10:32] [Phonetic]? No. Does that mean that every physician is pathology-focused? No. But they tend to breakout in that direction. Vast majority of physicians or one way of vast majority of midwives or another and in each group there are exceptions to that rule.
Sarah Blight: Of course and I think that’s a really good point that you’re making. What about the idea that or maybe the perception that a midwife isn’t as skilled and isn’t really trained that’s kind of a tree-hugger granola hippie thing? What do you say to people who kind of have that idea about midwives in their head? You obviously trained midwives at NYU so you know about what they actually go through as far as their training. Can you fill us in about that?
Pat Burkhardt: Well I think I want to address the first question first and that is certainly there is a historical perspective because it’s certainly was in the 60′s that midwifery was reborn in this section of our society in the communes. And again, it was a natural evolution in a community that was close knit that took care of its own and so when women got pregnant and were getting ready to birth and women of that commune got together to help them and as that — as they sought more and more of that they realized they needed education to do this well. And so we cannot negate what we had learned over time in terms of women’s well-being around this process and that’s basically the bottom critical line for educating midwife is number one, we are the experts in encouraging and supporting and enhancing physiologic processes for women having babies who have no complications. That’s our skill. That’s our strength.
For those women — and we are equally as astute and educated to discern developing pathology. So when a woman, should a woman starts developing some hypertension or that she starts to develop or we test her for and find out she’s in fact got pregnancy and dues — sorry, she’s got gestational diabetes, then in fact we will minimally consult or depending on how we have our practice set up and what are state laws are, we will certainly take proper care of that and if it’s beyond our scope of practice, we will certainly consult and refer to someone who has the more pathology focus skills and knowledge than we have. But again, about 85% of women aren’t that in pregnancy and in birth.
Sarah Blight: Okay, good to know. What would a good analogy be that would kind of describe the whole approach, the holistic, the integrated approach to something else that we might understand? What would be a good analogy?
Pat Burkhardt: What I use and it’s kind of like that but it really is about trusting nature and nature has, you know, mother nature has her own strengths and she does overall a really good job with the creation that is out here and the analogy I use particularly when I’m dealing with both midwives and medical students is the difference between sailing and motor boating. And if you’re a sailor and you tend to sail a sailboat, you’ve very cognizant of the wind and the water and the occurrence and wherever it is you’re heading for, you know you’re going to get there, you know you’re going to get there in an adequate length of time and you usually set that and you just let the wind, wind and wane and you go with it and you tack and you — you kind of just let it all. You play with it and it plays with you and you get to where you’re going. Might take you longer than the motorboat that pulls off from the dock, the skipper at the wheel, hits the throttle, pushes it forward and zooms off across wherever they’re going to zoom in to.
And if they’re at the same destination point and left from the same leaving point, they’ll be there way ahead of you but they will not have enjoyed the trip so much and most importantly, the trip was not important. It was going from point A getting to point B. For sailors, the sailing is important. And most critically, birth matters. It matters to society. It certainly matters to most women and men, couples. And so if it matters, then it has to be treasured and experience, not just gotten through and that becomes I think of — now, for some women, they really just want to get through it and that’s their choice without question. But when you think about what that’s going to mean or how that will influence your relationship with child, that you know, people need to think about that because if you’ve done your best, then you’ve done your best.
No matter how it all comes out, if you’ve done your best, that’s fine. Because sometimes we do our best and it doesn’t work the way we wanted to but in fact, you know, it does matter and it’s important and so we have to make it work as best as it can.
Sarah Blight: So is the whole — is this integrated approach, is this kind of midwife or I don’t want to just say midwife because there are OB’s who really care about that as well but is this integrated whole approach to care, is it based on scientific research? Is there actually a research that shows that this is more effective that women do better in labour? What is kind of the research behind this?
Pat Burkhardt: Evidence?
Sarah Blight: Yeah, the evidence, yeah.
Pat Burkhardt: Yeah, yeah. Well it’s interesting, Sarah because part of the problem — there is evidence without question, all right? The issue is most of the evidence is not in the medical journals because the questions that the physicians ask are not the questions that people who believe in the integral-ness and the holistic-ness of birth being asked. So for example, a physician will do a study to see if moving around in labour shortens the process. Well, I don’t know if that’s the proper question to ask but because the physicians are very interested in time and you know, just those are the things that matter to them so that’s how they focus their questions.
We would ask the question was it — did it facilitate the woman’s ability to get through the labour walking around, staying vertical, doing the kinds of things that facilitate her uterus doing its contractions, her pelvis is kind of moving around to help that baby descend. We would ask questions like that. Those studies would wind up in midwifery journals. They would wind up in sociological journals. They would wind up sometimes in anthropological journals and the physicians don’t read those and many women don’t. I would recommend to women that they look beyond the medical journals to see what other questions are being asked by other professionals who are equally involved or interested in the process.
Sarah Blight: That’s a great point. What someone experiences this whole approach to care? How many of them often go back to the Allopathic or the more pathological type of care if they don’t — if they’re just, you know, they don’t have any special extenuating circumstances?
Pat Burkhardt: Usually the reverse is what happens. What we see certainly in many of the midwifery practice is a woman in usual fashion goes to a physician because that’s the gold standard has an experience that isn’t what she really wanted or expected. And then on her — if she has a second pregnancy will look — will choose a provider against what she doesn’t want which is not necessarily the best way but sometimes you need that contrast to know what it is you want compare to what you had.
Sarah Blight: That’s true.
Pat Burkhardt: So I’ve seen much more women going to midwives on a second pregnancy many times than going on a first because they still can’t quite trust that that non-physician would be the best person to provide care.
Sarah Blight: And again going back –
Pat Burkhardt: And it’s a qualitative judgment.
Sarah Blight: Well and I was going to say kind of going back to the training aspect that we talked briefly about that midwives really are skilled in their craft.
Pat Burkhardt: Yeah, they are definitely skilled in their craft. But again, when you hold up in today’s scientific and economically pushed world, the concept of craft against science, then all of a sudden that sounds — doesn’t sound quite so good. And part of it is just again, the pejorative nature of some of these words but yes, it is a craft but based on science. That’s based on hard fact science and so but the output is craft and it’s craft because womanly crafted that point but with the scientific eyed when you’re observing.
Sarah Blight: And can you give us an example of something that midwives do routinely or trained to do that maybe doctors don’t necessarily know how to do or maybe have lost that skill?
Pat Burkhardt: Or don’t — or just don’t want to be bothered? Well, I think that the biggest piece that I would talk about it and it’s a real problem for us is supporting labour. Most midwives will be with their clients throughout labour. And so if you’re in a hospital, if a woman comes in to a hospital and the — I’ll talk about hospitals in New York because that’s what I know most in factual reality. They’ll get offered an epidural and if the woman says, “No, I really don’t want an epidural at least not right now. I want to see if I can do it,” too often they’ll get pushed by, you know, some comment about, “Well if you don’t take it now, I might not be available later because we’re busy,” all right?
So it’s kind of now or never. And so woman who strongly say, “No, no I’m still going to, you know — and then the problem is then unless she isn’t midwifery patient, if she’s a physician patient, the physician is not even in the hospital. He’s, you know, either in surgery or he’s in the office scene or the clients and the resident staff is checking his patients or maybe comes in to check her but then he leaves because he knows it’s going to be a long labour and he doesn’t need to hang around. And so he’s gone. And if she chooses not to have an epidural at that time it’s offered, she does no other choices. Nobody comes in and says, “Okay, I’m going to be with you for this labour,” except maybe occasionally in some hospitals but most critically when a woman is verifying what her choices are going to be in a given place and within a give provider, she needs to find out, “Okay, I don’t want an epidural. What’s going to happen? What other choices are going to be offered to me?”
A midwife will stay with her client. She’ll take her to the shower. She’ll take her in to a tub if there is a tub. She’ll keep her and most critically one of the things you want to do during labour is stay mobile and stay vertical as long as you can do that because that just helps move everything down the right direction and so — and there’s some hospitals they’re starting some good things in terms of encouraging that those particular components and assisting people. When Ina May Gaskin who is a lot of people know Ina May. She’s a midwife from the farm and she’s a national leader for midwifery in many ways. And she had developed and used for her daughter’s birth a pole, a big long stick not a pole cemented in to the ceiling, right. But just a big long stick for her daughter to hang on to because there is a factor of when you’re hanging on to something and relaxing to hang on to it, you’re also relaxing the rest of your body and that’s part of again, the tricks of the trade if you will to help women just — and then the most critical part all of that is constantly saying, “You can do this,” because every women hits a wall during labour.
Every — “I can’t do this anymore,” then you get ways again, “Okay, take a deep breath. Relax. Okay now, one contraction at a time. You can do one contraction at a time, right? You’ve done it. Okay, let’s do the next contraction. It’s all you need to think about.” So it’s equally as much human presence and language that supports and enhances and encourages and then some good, you know, stroking. You know, touch is very important for most people in labour and so you know, whether you’re doing [0:22:23] [Inaudible] with the belly or you’re doing some back rubbing to just kind of counteract some bad thing. Bottom line is if somebody who’s there to aid in her best and keep you going because you can do it.
Sarah Blight: That’s really — I love that. What about women who are saying “Yes, sign me up. That sounds great. I’m a whole person. I want to be cared for as such,” what tips do you have to help them find the right care provider for them? What questions do they need to be asking I guess or what things they need to look for?
Pat Burkhardt: Well, they certainly need to know what it is they’re going to want but they need to sit down and do their own homework for themselves and then they need to interview a couple of providers and again, not every midwife would suit every woman. There’s no question about that. So sometimes it’s just personality click, that’s a big thing. You certainly want to be sure that the provider you’re talking to is licensed and properly educated so that you have to look at credentials. And then you come with a list of very open ended questions and that’s for physicians or midwives, it doesn’t matter. When you’re looking for a provider of any yolk [0:23:26] [Phonetic], you come with open ended questions because you basically don’t want to leave them to the answer.
So if you say, “Well do you do epidural — do you do epidurals?” “Yeah.” “Well, okay.” I mean that doesn’t gets you anything, you know. “Do you do episiotomies?” “No, I don’t do episiotomies,” because they know that’s what you want to hear. So the real question is “How do you help a woman cope with the pain of labour?” You know the wide open ended question that puts the provider whoever the provider is on the — on the raft just talk about what their range of choices that they use with their clientele is. And that’s so you can focus on pain relief, you can focus on some of the activity during labour. You can focus on food and beverages, you know. Obstetrics in this country has long denied women calories and hydration orally because anesthesia doesn’t want all of that in people’s stomach as if — it’s not a real issue anymore but it’s still what they do. And so when you ask somebody, you know, no person would ever run a marathon without carbo –
Sarah Blight: Carbohydrates. [Laughter]
Pat Burkhardt: Carbohydrates — the night before and hydrating throughout and yet, we do IV’s and we certainly have literature that states that women get over hydrated through IV’s and they tend to get waterlogged because they don’t necessarily put out what they’re — what’s given to them and the better way to do all this is thru the GI trend, drink and eat if you’re inclined. If you’re not inclined, if your body is not working in a way that says you want to eat, then you don’t eat. But you have the choice to which in most places you don’t.
Sarah Blight: Wow, really good tips, Pat.
Pat Burkhardt: And then the other critical piece is — yeah, the other critical piece is for birthing is baby access. One of the things that is still being worked on hard and strong across the nation is mothers and babies, newborn babies belong together. Babies don’t belong over in warmers. They don’t belong in the nursery down the hall, they belong with the mother and they belong — you know, they have — there’s a lot of scientific articles these days about Kangaroo Care and it was originally focused on premature babies. And Kangaroo Care is — I mean just think of the kangaroo, that little kangaroo baby is right in her pouch against her belly and just kind of crawls up her chest to get some nourishment and goes back down to their little pouch in the belly. Bottom line is Kangaroo Care is skin to skin mom to baby and you know, babies do much better when they are nestled next to their mother with their head on the chest hearing that same heart beat that they have heard for nine months in utero.
Sarah Blight: Yes. It seems like –
Pat Burkhardt: And term babies needed as much as premature — preterm babies without question.
Sarah Blight: So it helps facilitate that bonding between mom and baby which I would imagine would help breast –
Pat Burkhardt: I’m sorry I can’t hear you.
Sarah Blight: Oops, can you hear me now? Oh, that’s weird.
Pat Burkhardt: Yeah, well keep try again. I can’t go up any higher in line.
Sarah Blight: Okay, can you hear me now? Can you hear me now?
Pat Burkhardt: That’s better.
Sarah Blight: Okay. So yeah, it seems like the Kangaroo Care would facilitate, you know, breastfeeding and the bonding that is really important at, you know, those first especially the first few hours of birth, first couple of days. Cool. Well thank you so much. Thank you so much, Pat for sharing with us today why it’s so important to have holistic integrated care as a woman especially as a pregnant woman. To all the mamas who are watching, if you have any questions or comments, please leave them below. We’d love to hear from you. Thanks for watching everybody. We will see you next time.
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