I recently stopped by the cozy home office of Samm Magpi of Magpi Midwifery to chat about all things home birth. We were joined by her associate, fellow Philadelphia-area midwife, Krystina Derrickson and student midwife Jamie Davison-Ortiz. In our conversation, we discuss the level of care that can be expected from a midwifery collective, the extensive training and continued education for Midwives, home birth vs. free birth, they share their birth stories and their individuals journeys into midwifery.
I hope you enjoy!
Thank you so much for taking the time to talk with me today!
Would you like to start by Introducing yourself and introduce your practice?
Samm: I am Samm Magpi, I am the owner of Magpi Midwifery. I have been in practice for five years and I serve Philadelphia and the surrounding area.
Krystina: My name is Krystina Derrickson. I am a midwife based in New Jersey. I attend births through my own practice, Baraka Birth, in the greater Philadelphia area as well as South and Central Jersey, and by the shore. I also have worked with Samm for years now and we help each other out in our practices.
Jamie: My name is Jamie Davison-Ortiz, I am currently a CPM student attending Midwives College of Utah. I am in my final year of midwifery school and am planning to be a liscenced midwife by the end of 2024. I will be serving the South Jersey area as well as the Jersey shore. I am currently working with Samm Magpi and Krystina on my journey to becoming a midwife.
What are the benefits of a group model of care, having associate midwives, and working as a collective?
Samm: I always imagined myself as a solo practice and I really liked the idea of that, but now, being in practice for the last five years, I am like, "No! That is not what I want at all". I realize that need help. I need consistent time off in order to continue doing this work. I think that Post-Covid has really complicated a lot of things, midwifery included. Midwifery has been different and more intense than I ever remember birth work being. The past year or two has just been wild. I came to the realization that if I really want to do this long time then I need to have consistent help in my practice.
Before, the way that Krystina and I were working, was that she would back me up if I needed it. But I am finding more and more that I am wanting to integrate other midwives into my practice. I have grown tremendously over the years, I am getting so many inquiries and there are so many people that want to be apart of this community that I built, but I can't realistically serve ten people a month. Although now I am trying to bring other midwives in so we can all work together, we can all take time off, and we can all build community together.
Do you find that the midwives you bring on are coming from different perspectives and does that play into the way that you collaborate? Or do you all have the same values and that is why you work well together?
Samm: I am very selective about who I work with in my practice as midwives and am selective in my clientele as well. And I think that is why we work well together and why I want them to be apart of my practice, because I could really call on any midwife in the area, and we all have good relationships together, but there is a select few midwives that I really trust and I know that they deliver the same type of care to my clients that I would if I wasn't there.
Like yesterday for instance, I was sick so Krystina and Jackie, my other assistant, attended a birth for me and I knew that she was in great hands with them. And as sad as I was to miss her birth, I knew that she got the care that she needed and deserved. That felt good, it doesn't feel stressful-- I didn't have to worry whether or not back-up midwife was doing this, this, and this. I know that those things are being done and are taken care of and that is a huge relief for me.
Krystina, do you have anything to add to what it is like working as a team as opposed to working by yourself in a solo practice?
Krystina: I have worked in a couple different states and the Philadelphia area is unique in the kind of community we have. I have never seen such a cohesive midwifery community where we communicate well, we lean on each other, we show up for each other, and we can process things together. It is a really warm and supportive community and even so, there are definitely the people who I feel most aligned with. Samm and I have such a similar practice style and our values are so consistent. I trust my clients in her care.
It is a very beautiful thing for you all to be serving woman in this very womanly way-- as a community and as a team in a group model of care.
Krystina: As someone who has my own practice, and I have been on my own for a while-- I have been practicing for five years as well. It can be very lonely. Doing the work in isolation is challenging. The more relationships that I can build with other midwives, the more that I can consult with other people, and the better it is. Community means everything to me. Otherwise, when I first started, it was very lonely. It is not fun trouble shooting somebodies labor by yourself, it is really nice to lean on Samm, or I have a couple other people that I can consult with.
Samm: Yes, I can call you if I have a question, like: "would you transfer for this?"
Krystina: Exactly.
Jamie, from your perspective as a student coming into this practice, how do you feel about this way of working?
Jamie: I think this is a sustainable way of working. I currently have a main preceptor in New Jersey that does have a solo practice, she does not work with other midwives, obviously she has back ups. I can see the strain that it puts on her day-to-day life of wondering, "am I going to be able to do this thing today? I have three people in labor!" The group model of care, where midwives are collaborating and working together, allows you to have a life. Many of us have families, many of us have quite a few children. It allows us to have time with our families and to take time off to actually enjoy our lives because this work is all-consuming. It is a 24/7 job. We are never not thinking about it.
So having people that we can lean on is important. I know personally, as a student, as you are learning and as your going through these experiences for the first time-- if you don't have people to talk to you are going to absolutely loose it. I have called Samm after a very long, intense experience and just cried. She was there to talk me through it and be like "Hey, this isn't going to be the last time-- this work is hard-- but we are here for you." And the other midwives in the community have been so kind to me and are helping me get through this to become a licensed midwife. I think that means something.
Krystina, you had spoken earlier about having a midwifery style or personal flair-- what would you say that is for you?
Krystina: I would say that for me-- and not to speak for Sam, but I see this a lot in her work too-- I think we are both very good at putting people at ease. We are both very calm people. Having a sense of humor in this work is really important too . I like for people to feel very comfortable in my care. I like for people to feel that they can relax back into to it, and also that they don't have to hold anything back. It is important for me to cultivate a safe space beginning at the prenatal appointments, all the way through birth and the postpartum. People can express whatever they need without fear of being judged. At birth, I would say I am very quiet, supportive person. I see my role as holding space for a safe experience. and then whatever way a family chooses to move through that space is sort of intuitively up to them. I am there as a companion. I would say that my style of midwifery is to facilitate an anxiety free environment-- a calm environment-- and I do that by being relaxed, having a sense of humor, and at the same time being very attentive, but not in an anxiety-based way.
I like to tell pole that when their baby is born, I want thier hands to be on thier baby. I have worked with providers before where they are very hands-on people and who would be stimulating the baby and drying the baby off and doing all these things. If I see that a baby is transitioning like a normal little mammal, then I would much rather that a parent's hands be on that baby and not mine. If I had to step in, I would not hesitate to do so, but my default is to really hold a space for people to have an autonomous experience.
I love that. I had always envisioned myself catching my own babies and being super aware, you know like pulling them out of me-- and it never happened, I was always so out-of-it in the moment. But I do understand, as a mother, wanting to be the only one holding my baby and rubbing my baby's back to get him to cry. When my oldest son was born, I was like "no, this is my baby, don't you touch him, I am going to be the one to stimulate him."
Samm: We will quickly help somebody in those first moments after birth, but then it is like "oh, you've got this" and we'll step back.
Krystina: That is what my midwife gave me.
Samm: And that is what Karen Webster, my midwife, gave me. I think Krystina and I were trained in a very similar way which is why we work well together. There are other midwives who have trained in home birth midwife practices, but that are not trained in the same way that we were.
It seem like your own births were a part of that training. So cool.
Samm: To echo off what Krystina said, I think a lot of our clients want as close to an unassisted birth experience as possible, but with the safety-net of having a midwife present and trust in our judgment as professionals. There is this big culture of free birthers now and some don't necessarily want a free birth, but they want as much of a hands-off experience as possible. Which is essentially what I wanted for my births and that is what I want to be able to provide people with.
Can you clarify what free birth is for people who may not be familiar. And also, do you want to offer an opinion?
Samm: I've got lots of opinions!
Whatever you feel comfortable with! I found that I really sought out providers that had a hands-free birth approach too and that my multip birth experiences were such, with timing and everything, that a couple of them were very nearly unassisted. I have always been curious about it and thought that unassisted birth should be something that I at least should prepare myself for. I don't think I'd intentionally try for free birth, but I would want to be ready-- and I would want my partner to be ready-- in case my baby came before the midwife showed up!
Samm: So free birth means a lot of different things to a lot of different people. I have a lot of clients that have described being in my care feeling like a free birth. They will say "I did everything on my own, I didn't even realize that you were there" And that is the utmost complement to me and that's how I want people to feel-- in a good way! Not like I left them to thier own devices and that they didn't have any support! It's more like: "you gave me everything I needed and the reassurance that everything was ok"
Free birth culture has become such a thing. You know "do it on your own with no one there" and "women have been doing this thing forever" As birth providers, we are seeing such an uptick in-- what I would say is-- avoidable injury and death and that is scary. Ultimately when they transfer to the hospital with these catastrophic things, Midwives are getting lumped together with the free birthers. But we are not the same thing. We are practicing safely. We are following guidelines and upholding a standard of care whereas there can be free birth "attendants" or doulas who are not trained and it ends up being a train wreck.
Would you like to speak to the level of training you have to go through to become a licensed CPM and that safety-net of skill and experience that you bring to a birth?
Sam: We go through years, and years of training. And even still I think that a lot of midwives come out of midwifery school and still do not have the hands-on expierience that I did.
I am sure there was a big hands-on component to your training. It seems like you would have to experience a situation first-hand to learn how you are going to handle it.
Samm: luckily for me, I had attended hundreds of births as a doula prior to becoming a midwifery student, but it also depends a lot on your preceptor and how you are trained. Karen, as soon as I started working with her threw me right in. A lot of preceptors will have you just sit on the side lines and then they will have you jump in to catch the baby, but they are not actually letting you manage care. Whereas Karen would ask me "What would you do?". And I was like "I don't know!" But that is how I learned, she was just like "This is you-- you are doing it-- all of it" I think that is what made me a good midwife and gave me the confidence right off the bat, whereas. a lot of other newer midwives, even with the same midwifery school training, don't necessarily feel that confident. They have never managed a hemorrhage or any of these things before because their preceptors were just letting them catch the baby, but that was really it- not managing the rest of what goes on. Where you are trained and how you are trained-- all of that matters a lot.
Krystina: Coming up this weekend, we are spending all of Sunday drilling skills. We have to do a certain number of continuing education ICU's every year. We are doing birth emergency skills training in April, we have to re-certify every other year in neonatal resuscitation. Using the equipment and understanding the normal process by which babies transition to breathing room air and then what happens when that process is disrupted and how do we know when to step in. The appropriate steps to take. Rarely do we have to do these things, but I have had to it twice this year. There is enormous value in drilling.
And we also gather and we do peer review. We process births. We get feedback from one another about what could we have done differently or recieve suggestions from people. I am attending a big midwifery conference later this year where I am also going to be doing skills drills. The things about home birth is that true emergencies are so rare that we do have to keep up those skills and we are very attentive to that. Otherwise, there are situations that we could go our entire careers never-ever seeing, but we have to be prepared for them.
Jamie, since you are going through your schooling right now, would you like to talk about how the hands-on experience of attending a birth is helping to prepare you to become a confident, capable midwife?
Jamie: As Samm said, it really depends on the preceptor and every student's expierience is very different. We go through three phases where we have to attend X amount of births as an observer, and then we go through another phase called the "assist" phase where we are helping the primary midwife by drawing up meds or bringing them things that they need, and then your final phase is what is called "primary" where you are acting as the midwife under supervision and another midwife is there to attend with you. This is the portion of program that I am in currently. I am learning to be a midwife by doing the things. I am managing births and being apart of the client's care and being the one responsible for making those decision calls which is going to help me be a confident midwife when I am on my own and there is not someone over my shoulder that I can ask "Hey, should I be doing this?" There is a safety net of having that apprenticeship model and always having someone to bounce your questions off. But even as a newer midwife, it is really nice to have other more expierienced midwives call and ask questions. Because I will need the support. So having a community to bounce those questions off of in those early days will be invaluable.
Why is it so important to be supported by a trained professional when you are giving birth. Do you want to talk about difficult situations you have come across in births and how you have managed them?
Samm: Loss is one of the hardest things that I have gone through as a midwife and then complicated birth situations like hemorrhage, shoulder dystocia, and the need for resuscitation. Like Krystina said, we don't often see emergencies and most of the time we can sit on our hands. And then there are other times when everything about the birth is flawless until the babies head comes out and you are like "oh crap this is an emergency" and have to act, or a flawless birth happens and then the mom is faucet hemorrhaging-- it is times like those that I am grateful that we carry things like Pitocin and are trained to know how to manage those births. But even if we are carrying oxygen and pitocen and are skilled, we can never gartuntee anything. Yes, we are a safety-net to a degree: we know when to sit on our hands, we know when to use our hands, when to transfer appropriately-- but we also can't control the outcome.
Krystina: Which is the same as in the hospital. They also can't control the outcome either. But those are all very rare scenarios. The most common reason for a transfer to the hospital is not an emergency, it is a long labor. Where somebody is really tired, it is typically a first baby, and that person's labor is normal but it is slow and maybe they have been awake for 24 hours, or maybe they have been awake for 48 hour or longer than that and they are so tired that in that case an epidural is actually appropriate and getting that rest is appropriate. So we do see that. My personal transfer rate is 1 in 10 and in most of those transfers it is this exact scenario. And in most cases, I am having a conversation with the client about what they are feeling, and what we are seeing. It is not an emergency like "we have to go right now" it is usually something that develops over time. It is a multi-point check-in over the course of their labor until we are at the point where we all feel like we have tried everything and we have exhausted all the tools that we have available. Going to the hospital-- they have a different tool kit-- which we can utilize. And that is also where having a midwife is really valuable because we can reflect back and evaluate whether something is normal, or not so normal for labor. I have talked to people who have had free births where they don't know what is normal and that can be a really difficult spot to be in.
Yes, I think it would be hard to have the presence of mind and to take on the responsibility of making those assessments of yourself and your progress. Or having your partner be the one to be like "Is this normal?" and feel the weight of that responsibility if something where to happen.
Samm: Especially the first time. There are certain people that I feel like could have a free birth. In these cases--a midwife is not going to make it in time. They live like a hour away, there are no midwives nearby, and they give birth in 30 minutes.
Krystina: Or at the very least, that person should be prepared for it.
Samm: Exactly. There are some people who I think are really great free birth candidates, but that is not something I would advise for first time moms. Often times they transfer because they don't know birth. They get really stuck in their head and they don't have the external reassurance.
You had mentioned earlier that you are very selective with the clients you take on. Could you maybe elaborate on who would be a good candidate for home birth, specifically for your practice?
Samm: I think that there is the general candidate which is people who are low risk, who don't have diabetes or other pre-esisting conditions, no hypertension, or blood clotting disorders. And then there are those who are good candidate for home birth in terms of their emotional wellbeing. It is important for me to gage where people are at and why they want to have a home birth. I am pretty selective for who I take on as clients and for me it is not necessarily just about taking a low risk client, it is about really understanding why someone wants a home birth. We have to discuss the fact that yes, we are a safety net to a degree, but clients have to understand that they are taking responsibility in this process as well. So somebody who is a really good candidate for home birth is somebody who understands that they are going to be taking care of themselves, being aware of thier nutrition and exercise and being aware of their emotional needs and their relationships. There is a lot more that comes into play with regards to who is a good candidate than just that surface level medical low-risk status.
Krystina, Do you find that you have a similar selection process and standard in your own practice?
Krystina: I think that Samm is the best at it.
I am sure that it is hard to say no to a potential client and turn them away.
Krystina: The longer I practice, the better I am at saying "NO". The times I have regretting taking someone on, I knew at the very first prenatal appointment that something didn't feel right about the situation. It is really rare that that happens, but when it does, I feel it in my gut starting at the beginning, And I am learning to be better about listening to that intuitive voice.
So who is a really good fit for you?
Krystina: A really good fit for me is someone who feels safe at home and is not avoiding a hospital birth. One red-flag for me is if I ask somebody why they want a home birth and they say, "I am so afraid of hospitals". That to me means: "oh, then we are probably going to end up in a hospital".
I feel like that is me, but also not me.
Krystina: It can be a part of it. Like me, I don't want to go to a hospital for anything!
Samm: If it is somebody's number one driving factor and they are seeking a home birth out of fear that's a bad sign.
Krystina: I take on people who genuinely want to be at home, who genuinely feel safe at home-- because that is going to manifest in their whole nervous system. If they don't-- on a fundamental level-- feel safe at home then they are not going to stay there. Their body is just going to manifest going to some place else. So that is one thing.
I also take on people who take real responsibility and don't expect that we are there to tell them what to do. That is big thing. People who are taking responsibilty for moving thier bodies, for thier diet, for managing thier stress. It's not a situation like you go to the doctor and they hand you a pill that is going to take care of your problem. Our clients have done a lot of research, they understand why they are coming to us, they are choosing us deliberately and with intention.
People can come from all different kinds of backgrounds, from all different kinds of living situations, all kinds of different family constellations. There is tons of diversity in our clientele, But it's really that they want to be at home and all the other things-- they are healthy, thier baby is healthy-- green flags the whole way.
I love that -- thank you for clarifying!
I was very curious-- you are all mother's correct?-- How have your personal birth experiences influenced your decision to become midwives-- or did you decide to become a midwives prior to having children? I would just like to leave that open for discussion.
Krystina: So for me, I started my midwifery training in 2011 and then I was pregnant in 2013. And the midwife who I had first started attending births with ended up being my midwife. And it was really cool getting to expierience being her student and providing services to people and then to be a recipient and recieving the care and having her come to my house. I do a lot of in-home care in my own practice-- almost exclusively-- and part of the reason for that is that I really loved how that felt. I had a really wonderful birth expierience with her, I trusted her completely. My doula was another firend of mine who is also a midwife. I felt so safe and secure, and held and supported in thier care. Even as thier were really tumultous things going on in my life otherwise, they were so grounding. I will never forget what that expierience was like. And also they gave me the kind of hands-off that I love to provide for people.
I gave birth in my bathtub in my bathroom in Boston-- in a big claw foot tub, and my midwife was just standing at the door to the bathroom watching, and my friend who was the doula was there with her hands on me, but I caught my daughter myself, I brought her up right away. and that was such an empowering experience and then on the flip side of everything, I had real challenges with breastfeeding and having my midwife there when I was a hot mess and miserable nursing her. Having her show up and make a plan for me-- because I really needed someone to be like "this is what we are going to do. I called the dentist, this is when your appointment is". Having someone there holding my hand those first couple of weeks was priceless. So amazing. I can 100% understand why some people stop breastfeeding within the first couple days when they are alone in that process. Because breastfeeding was so much harder than the birth. I was a student midwife at that point but beyond all the training I did and attending births, being able to experience that myself had a huge impact on the kind of care that I knew I wanted to give people. I loved my birth, it was great.
That is awesome! I am so glad you had such a beautiful experience and you are able to pass that onto others with your midwifery practice.
Would anybody else like to share?
Samm: Yes. I trained as a doula in 2012 and I attended my first birth in 2013. Last year was my 10th anniversary of doing birth work. When I saw my first home birth, I was like "Wow, this is what I was put on this planet to do". It was the most amazing thing I had ever witnessed. So then I was looking at what kind of midwife I wanted to be. Did I want to go to school to be a CNM or did I want to go to school to be a CPM-- "what is all of this? What does it mean?" and it was so not straight forward. So ultimately, I was like "I definieatly have no interest in ever practicing in a hosptial" and I wanted to be able to offer homebirth midwifery, but I couldn't find any preceptor anywhere close to me. I reached out to every midwife I the area and they either did not answer or were like:" no we are not accepting any new students at this time" and I was like "How am I going to do this?" And so I found a preceptorship available in Oregon and they seemed great. It was at a community birth center. And I was like "Great, guess we are moving out to Oregon". It was a time in my realtionshipo wiht my partner that I was like "Are you moving out to Oregon with me so I can become a midwife?" and he was like "I guess". I had signed up for Midwives College of Utah and as soon as I started my first semester there, I found out I was pregnant. Which was not the plan at all, I was only 22. So I had to put becoming a midwife on hold.
And then I started in care with Karen Webster. I had reached out to all these midwives to be their student and they didn't answer me. So I was like "I'm not going to reach out for them to be my midwife if they didn't give me the time of day". It just felt Bleh to me. So I found Karen and she was just everything I wanted and more in a midwife. And although I drove over and hour for prenatal appointments, I just loved being in her care. She would joke around with my husband and it was a fun drive down to see her every time.
Karen was my midwife with my last baby too. At the time, she offered appointments at Synergy Chiropractic in Elsmere, and they were just 5 minutes down the road from my house, but I always opted to drive down to see her at her home office in Chesapeake City instead. It was always a fun time and so good to see her.
So I was having a great experience throughout my pregnancy. I had a smooth labor too and until we got to the actual birth-- it was a shoulder dystocia. Everybody in the room was quiet and I was just like "that was great!"--It was this great experience to me. Karen was just so calm and told me to "Just talk to your baby. Tell you baby to breathe" and I did. Afterwards, everybody was like "Dude, that was wild" but I felt great about it.
You are the second person I have talked to who gave birth to a baby with a shoulder dystocia with Karen as the attending midwife. Karen managed it with so much grace that this other mom had no idea it was happening until afterwards, she too was like "that was such and empowering, positive experience." Her baby was an 11 pounder-- should dystocia, no tears.
I just figured, It was my first birth, and that "Shit gets hard at your first birth!" And that birth was a little hard. Karen was like "Ma'am, that was a large baby! And a pretty severe shoulder dystocia. and I was like "Meh, it felt fine to me!" After that, I wrote my birth story and I started to get back into doula work. My birth made me want to be a midwife even more. I wanted to provide the quality of care I received to my clients.
One of the first births I attended after my own birth as a doula was a shoulder dystocia and the way it was handled mad eye want to vomit. Had I experienced that, I would have felt traumatized by my birth, but I felt that my birth was great. Karen read my birth story after I had shared it online and she reached out to me after reading it. She was like "I love that that was your perspective, let's talk about you becoming a student". And I was just like "Oh My Gosh!". Karen is this rock-star midwife of the area. So many people wanted to be her student. And I was like "Wow, she is picking me to be her student." And so we started working together and it was great!
That is so special! I love that you forged such a deep connection with her and that she the midwife in you! Thank you so much for sharing your birth stories with me!
If you are interested in reading Samm's oxytocin fueled home birth story, you can do so HERE.
If you are pregnant and considering home birth in the Philly area, check out thier contact info below!
Krystina Derrickson CPM & LC, home birth midwife and owner of Baraka Birth
Instagram: @barakabirth
Website: www.barakabirth.com
Samm Magpi, home birth midwife and owner of Magpi Midwifery
instagram: @magpimidwifery
Website: www.magpimidwifery.com
Jamie Davison-Ortiz, student midwife, birth doula and placenta encapsulation specialist serving South Jersey
Instagram: @jamiedavisondoula
Eebsite: www.jamiedavisondoula.com
Do you enjoy reading about home birth midwifes?
If so, check out this interview with Monika Karaosman of Althea Midwifery HERE.