Ariel Bernstein is a doula, CLEC, placenta encapsulation specialist and, most recently, has completed her training to become a CPM. This included studying at Birthwise Midwifery School in Bridgton, ME as well as a preceptorship at the Birth Cottage in New Hampshire. She has been on a rich and diverse path to becoming a midwife, spanning continents in her birth work. She gave me a chance to share in her unique perspective and her journey to midwifery care.
Maine Doulas: What is your philosophy of birth?
Ariel: I think that its hard to pinpoint one philosophy, but I would sum it up by saying that I believe that bodies work, that birth works, that babies work. I think that we need more faith in ourselves in pregnancy and birth, and that our culture needs a more positive birth outlook. Birth shouldn't be grounded in fear and mistrust, it should be grounded in love.
MD: When did you know you wanted to be a midwife?
A: I knew after the first birth I ever attended. I was a doula for a close friend. She had a long and difficult labor, but I remember crying on the way home (mostly from exhaustion) but also thinking 'there has to be a better way'. I was frustrated at what I saw, and what she experienced, and I knew that I was called to be a midwife to improve birth in this world.
MD: What drew you to Maine and Birthwise?
A: I started off my midwifery training in a non- MEAC accredited distance program and apprenticing a traditional midwife in the Pacific North West. After a few months it became clear that I was getting the experience, but not the foundation that I needed to be a great midwife. I started looking at my options for a campus based program, because I felt thats what I needed to be able to succeed in my education while raising a family. I'm originally from New England, and I was drawn to Maine and the structure of the program.
MD: How has your view of midwifery changed since you began your training?
A: In so many ways! When I was a doula, I couldn't always understand why a provider would make certain choices that didn't seem right to me. Sometimes I still feel that way, but I also now see the other side. For better or worse, I understand needing to make sure you are always following community standards for care, and also the virtue of letting your clients make informed decisions about testing, ultrasounds, screenings and treatments. I used to think that to offer all of that, or to even discuss certain tests and treatments meant that I wasn't trusting nature or that I was being a "medwife". I don't feel that way anymore. I think we need to get away from that divide - that discussing all the options out there for care means that you are too medical, or you are only a "real" midwife if you reject a certain amount of technology and medicine. Now I feel that the true hallmark of midwifery care is personalization: we allow families to make the decisions that are right for them based on sound information not fear or denial. If a family wants every test available, that doesn't mean they shouldn't be in midwifery care. Likewise, I feel that every midwife has the right to have her own comfort zones. For example some midwives will not feel comfortable with a client declining certain screenings or tests to make sure that they are candidates for out of hospital birth. I think thats ok. There is tremendous amount of responsibility and liability resting on the shoulders of midwives, and we should be supporting each other and lifting each other up, not trying to divide up who is a "real" midwife based on practice and comfort levels.
MD: What is your claim to fame as a midwife?
A: I hope the babies whom I have tried to make their first moments ones of love and welcoming to this earth.
MD: If you had a super power, what would it be?
A: To remember everything I read.
MD: That is a really good one. Now that your training is coming to an end; what is next for you?
A: I am hoping to start a practice in Portland, serving greater Portland and southern Maine down to the NH seacoast. I want to some day open a birth center as well.
MD: That will be a very exciting new option for families. When that new practice starts, who would you not take on as a client?
A: I think that in order for out of hospital birth to be safe, there has to be tremendous communication and trust between providers and clients. I don't think I could safely serve a client who wasn't able to communicate openly and honestly with me during their pregnancy. I can't manage care when I don't know what factors I am caring for.
MD: One of the reasons we hear of transfer of care with home birth midwives is with twins or a breech presentation. Would you do a breech birth or twins?
A: I truly want to be able to do breech and twin birth some day. But only if I am able to get support from midwives or doctors who are experienced at such births. Unfortunately I never experienced a beech or twin birth as a student, and aside from an emergent situation (if its coming its coming!) I wouldn't want to provide that care unless I felt I had the experience to do so safely and competently.
MD: Will you work with doulas when your midwifery practice is established?
A: Absolutely, those are my roots!
MD: Since you came to midwifery through your work as a doula, how do you now balance the two? One of the most common questions we are asked as doulas is "How is a doula different than a midwife?". How do you answer this question?
A: I think it's very important for doulas to have clear boundaries with their clients. They are hired to be support specialists, not medical specialists. I think a lot of doulas tend to blur those boundaries in a way that doesn't really support our profession or the families we serve. It's appropriate for doulas to help their clients get information, resources and to give them abundant emotional and physical support. I think it's inappropriate when doulas start making recommendations for or against tests, screenings, interventions, etc. I have heard too many stories of clients being telling me "well my doula said I shouldn't do that test" or "my doula said it was safe for me to use x". It brings our professionalism down when we (doulas) are perceived to be "meddling" in our clients care instead of supporting their care. I think doulas best serve families when they help them navigate information, not dictate it. Since training as a midwife I have made it clear to my clients that when they hire me as a doula, they are hiring me to be their doula, not their midwife and as such I won't be giving them medical information or medical advice, but I will definitely be there to help them navigate the information they get from their care provider. A midwife is a medical professional, a doula is a support professional. We are both birth professionals and I think that we only serve our families better when we make our role clear.
MD: That is well said. I think the line is often crossed when a doula has grown in experience and knowledge in a medical situation and feels that, incorrectly, it's her job to "save" a mother from a certain outcome. Hopefully through our time in prenatal contact, the mother has been encouraged to grow a dialogue and connection with her doctor and trust that the relationship is being honoured. As you said, our role is to help navigate the information that is passed between them. Being a midwife and being a doula are similar in that they are both an "on call" lifestyle. What is one of the differences between your “on call life” and “off call life”?
A: How I dress! I definitely dress up and make sure I look put together for clients, but at home I have my hair in a bun and yoga pants on!
MD: Now for a slightly silly question; if you were a car, what would you be?
A: I think my Volvo station wagon is my spirit car.
MD: What’s the funniest thing that’s ever happened to you at a birth?
A: There are so many memories! Recently I had a baby who just kept pooping after he was born, I mean like 9 or 10 times before we could even get a diaper on him! We were scrambling to weigh him because he was loosing credit! We usually wait and hour or two to weigh a baby, but we were like "wait he's loosing weight every time he poops!". Everyone was laughing and it was pretty funny. That mom had worked so hard to birth him, and he was a big baby, we wanted her to get the full credit for his birth weight!
MD: What are three words to describe you?
A: Determined, Driven, Committed
MD: What’s your guilty pleasure?
MD: What are some of the elements of the birth world in Southern Maine that you find exceptional or positive?
A: We really have a beautiful community here of people working hard to improve the climate for birthing families. I have lived and worked in a lot of communities where birth workers (midwives, doulas, placenta encapsulation, etc) are really cut throat and its more about making a profit than effecting change for our community. Not so here, I feel that people here really show that they are committed to working together to improve birth and raising families.
MD: What do you hope to see change in the birthing community in Maine?
A: I would love to see better relationships between the hospitals and OB practices and the home birth community. I think there is a lot of room for improvement and a lot of that starts with coming to the table and licensing the midwives. I wish that certain OBs would stop seeing midwifery as a threat that needs to be stopped.
I also hope more families consider home birth as a viable option for them, and see it as a mainstream possibility, not a hippy fad.
Maine Doulas: If you had to use just one word to describe birth, what would it be?
You can find Ariel at www.birthwithariel.org.