Sacopee Midwives has been serving families and their choice for safe, natural home births for over 20 years. As with many home birth options, this group has a strong devotion to the sanctity of labour and birth. I caught up with Robin Illian, CPM , who joined them in the summer of 2014 after leaving behind her own practice, Open Circle Midwifery. Robin has a remarkably calming presence, which is a tremendous asset in this line of work. She is deliberate in choosing her words, so you have to lean in sometimes to soak in the magic.
Maine Doulas: When did you know you wanted to be a midwife?
Robin: I was first inspired in college when I took an herbal training course from a home birth midwife. This was the first I heard of home birth and it immediately resonated! A couple of years later, I had a dream of catching my sister's baby that made me sure this was my path.
MD: Until a few years ago, you were found through Open Circle Midwifery, a Portland based home birth practice. What prompted your decision to end that practice and collaborate with Sacopee Midwives?
Robin: I had originally been part of Open Circle with Deirdre (Sulka-Meister) and I really liked the collaboration aspect of that. And as a midwife with kids it’s nice to have more than one midwife know your clients well, so if something comes up with your family I don’t feel like I’m having to choose and leaving someone stranded. So it was mostly about wanting that collaboration and not putting my clients in a situation where they only have made a connection with one midwife and risk something coming up with my family. It has never happened, that I’ve missed a birth when something came up with family, but I imagine that it could.
MD: So when Deirdre moved on to become an FNP at Royal River Family Care in Yarmouth, you felt that void and were looking for more support.
MD: What are three words to describe you?
Robin: Let’s see, calm is one of them. Patient. And curious.
MD: What is your claim to fame as a midwife; and what makes Sacopee Midwives unique to our community?
Robin: I have no claim to fame. But I do love feeling the love from families that I get to serve multiple times. I like when kids in large families see me in their homes and come snuggle up to me-- they've known me since birth and felt my presence at exciting times in their family's life. That's a good kind of "fame".
(At Sacopee Midwives,) we have a great group of experienced midwives. We complement each other, as we all have unique strengths to offer our clients. We can offer this and yet still create the strong bonds with our clients.
MD: What do you feel are some challenges that home birth midwives are currently facing in Maine?
Robin: That’s a hard one, because I think it varies across the state, but there definitely are home birth midwives having a hard time accessing labs right now. Which is not a problem that we’re having but…
MD: Is that just based on local facilities or providers not wanting to work with them?
Robin: It’s because we’re not licensed and so we have to have licensed providers who are willing to be a part of our lab account. It definitely is a barrier for some.
MD: So people who are perhaps in a more rural area have trouble?
Robin: Yes, but I will say I feel like things are better than they have been in the past in terms of access to collaborative care when it’s needed.
MD: Do you feel that extends to local facilities, like Maine Medical Center, and any time you need to transfer during labour it happens quite seamlessly?
Robin: Yes, definitely.
MD: Sacopee Midwives was quite busy this weekend, welcoming three babies in three days! So since you’re kind of off call right now, can you note any differences between your "on call" life and your "off call" life?
Robin: There are a few things, one of them is not having to take two cars to events with my family. Or just having to keep my phone on me, to know where it is at every single moment versus allowing myself to go out to the chicken coop without my phone. So that’s a huge one. And being able to be tired at night and thinking “Great I’ll be able to sleep through the night” which is something that midwives and women with new babies don’t have. I like that knowledge that I’ll wake up in my bed in the morning when I’m not on call.
MD: I definitely push it sometimes when I’m not on call and stay up a bit later than I should because I know I’ll wake up in my bed in the morning! What is your transfer rate; and what would be some of the reasons someone who transfer out of your care?
Robin: Our transfer rate is around 10%. Typically it's because of prolonged labor, usually due to a malpositioned baby, in combination with a sleep-deprived, exhausted mom. That's the most common reason. Other less common reasons could be meconium in the amniotic fluid or a placenta that is retained, and even more rare-- a baby that shows signs during labor that he/she is not perfectly happy. The overwhelming majority of our transfers are non-emergency transfers. It is very rare for a healthy pregnancy to suddenly turn into a not healthy pregnancy. Clients do not get "risked out" on being over-due alone, though being over-due with very low amniotic fluid could be a reason, and a baby coming before 37 weeks is a reason for a hospital birth. In general, the short list is: preeclampsia or other high blood pressure issues, gestational diabetes not controlled by diet, breech presentation that does not turn, and twins.
MD: Are you familiar with other ways of assessing dilation besides the good ol' vaginal exam?
Robin: Lots! Being with our clients, we can read the signs of labor and do very few vaginal dilation checks. Yes, vocalization, contraction pattern, and the more unconventional ways. These things, I find, are not to be solely relied upon, but they can be one piece of the puzzle-- the line in the gluteal cleft is a really interesting one that I've seen many times to be true. I also know of feeling the thickness of the fundus, but this is not one that I've used in practice.
MD: How many births do you take on a month? Who are your clients, typically?
Robin: Currently, we take up to 6 births per month. And our clients are anybody and everybody! I love the wide variety of people I get to know as a midwife. When I was training, the midwife I worked with and I wanted to make a bumper sticker, "Homebirth: It's not just for hippies anymore!" We care for a lot of medical providers, folks both religious and non-religious, city apartment dwellers and families homesteading off the grid. Blended families, single-parent families, straight and gay couples, women who have moved to Maine from other countries, women who come from a long line of home birthers, and women who choose home birth despite families who would prefer they birth in a tertiary care setting. It's so fun!
MD: Who would you not take on as a home birth client?
Robin: Someone who felt more comfortable birthing in a hospital setting. Birth works best when you are in a place you feel comfortable! And, folks with pre-existing medical conditions who would do best birthing in a hospital.
MD: Do you work with doulas?
Robin: We love doulas! We do not often work with doulas, as midwives get to spend more time in labor with their clients at home, than hospital-based providers do, but doulas are always a great addition to any birth.
MD: If you were a car, what would you be?
Robin: Ha! My son would do better with that question. I would say, not the car I had that caught fire on my way to a birth!
MD: Can you share a funny moment that you remember from a birth?
Robin: I feel like there’s got to be so many. Oh, then there was the time… well, maybe i shouldn’t tell it. Midwife humor, when you’ve been working in the birth world for a while your humor gets a little bit different. The car on fire was definitely an adventure.
MD: What’s your guilty pleasure?
MD: If you had a super power, what would it be?
Robin: Also sleep!!
MD: If you had to use just one word to describe birth, what would it be?
Robin: Just one word? I have so many. Okay: b e a u t i f u l
To reach Sacopee Midwives visit sacopeemidwives.org, call 207~329~2111 or email firstname.lastname@example.org.