Welcome back to the Resource Doula podcast. Today's episode is a little different than normal. You guys all know I created this podcast to provide you with more information so you can make your best informed healthcare decisions for yourself and your family. So I'm. Obviously passionate about encouraging you to take an active role in your health. Today's episode about the state of midwifery care in Alaska is going to equip you with information that you need to help make lasting change, not only for Alaskan families, but potentially make midwifery care more accessible nationwide. So even if you're not a local Alaskan, please keep listening and send this episode to a few friends. Together we can make a big difference in the birth options that are available in our country today I have Rachel and Mary, two local Alaska midwives and birth advocates on the show to talk about the status of licensed midwifery in the state of Alaska. Statute changes in how midwifery care as we. Is on the line and up for a vote in a matter of days. We talk about how you can make a direct impact and help protect birth options for families even if you don't live here. I'm your host Natalie, and I'm thrilled to introduce our guests. First up, Rachel. Rachel is a wife, mother, grandmother, and midwife. She was a childbirth educator, ache league leader, and a certified I C E A birth doula and doula trainer for years before becoming a midwife. She is a home birth practice in Eagle River that supports women in Anchorage, Eagle River, Palmer, Sutton, Wasilla, and Willow, and she travels all over the state supporting women having Homebirth. In communities where there are currently no midwives. She is also the vice-chair on the state board of midwifery. You can find Rachel on social media with the handle traditional roots midwifery. Next up is Mary. Mary is a homeschooling and homesteading mama in Wasilla at the base of Mount Baldi. In a budding the little sue. She had five boys before she got a little girl. But the three-year-old girl rules the roost around their homestead. Mary began her journey in caring for women and babies a decade ago after her own experiences in the mainstream medicalized system, she sought out more education, more empowerment, and more wholesome holistic care. She's passionate about education and informed consent. She's even more passionate about autonomy and fighting the coercion of some philosophies. She owns her own midwifery practice, valor Midwifery Services, and cares for women desiring home birth and birth center birth. While she doesn't own her own birth center and is adamant that she never will, she is very thankful to have the ability to bring her families to three local birth centers if that is what they desire. Mary loves home birth. The ability for a mama to be in her own space, have her comforts of her own home surrounding. feel the safety and security of the walls of her home with the support of her midwife who comes to her.. That is what Mary feels works best physiologically and emotionally. Mary also often talks about traditional concepts of midwifery care, where each community had a midwife and there was a midwife in each community. Her work in helping with the update of Alaskan midwifery statues speaks to her desire to see more midwives in the communities and more personalized midwifery care for each family. You can find Mary on social media with the hashtag Mary Mary a k midwife. That's M E R R y M A R Y A K midwife, or her business page, valor Midwifery Services on Facebook. Mary and Rachel, welcome to the show. Thanks so much for being Of course. Thank you for having us. Absolutely. Okay. I brought you on because the state of Alaska has some big changes coming up for midwifery and care. Postpartum care, preconception care. Um, So can you guys just, um, whoever wants to go first, talk about how you're involved and kind of what the current state is and where we're headed. Okay. Do you wanna go first, Rachel, or you want me to? I'll let you go All right. All right. So I am a midwife here in Alaska, so that's why I am involved. On the cusp of it, but I'm really involved, um, in helping move things through because I, uh, a couple years ago was elected as our, um, president of the Midwives Association of Alaska. So it's our professional organization. And, um, as president, one of my all, pretty much my whole platform was to educate and educate the. About midwives and make sure that, um, midwifery is continuing to move forward and evolve with changes. Um, and also to advocate for all of us midwives and our families that we care for. So when the board, um, was making these changes and proposing everything to, uh, go through the statutes and all those statutes updates, um, I got really involved., here I am. Famous. Last words seem like an easy gig in the beginning. Cause you know, you're just hosting a professional meeting once a month and, and now it's like practically a full-time job to, uh, stay involved. But it's good. Uh, it's been great. Um, uh, I, I'm a local midwife here in Alaska also, but I do sit, sit on the state board of midwifery. Um, and we were tasked, um, with a legislative audit to change our statutes and regulations to bring them up to national standards. Cuz this is a huge movement with the maternity care crisis that's going on in our country, including in Alaska. Everybody thinks, oh well that's just down the lower 48. It's not down the lower 48. We have huge maternity care deserts in Alaska ourselves. Um, there are lots of communities where there are not only not, they're no mid wi., which there should be a midwife in every community. That's my goal, right, is to get a midwife in every single community back in Alaska the way it used to be. Um, but there's a lot of communities that don't have obese. There's a lot of communities that don't have hospitals, um, and women are having to travel, um, in their pregnancies to come to the larger areas to have their babies. When, if there were midwives in their area, granted if they were high risk yep. They would pro, probably still have to come to Anchorage. Juno or fly down to Seattle, wherever their closest hub is. Um, but, uh, the majority of these women are having to travel from communities to come into larger communities due to lack of care in their current community. So, um, we undertook the big project of statutes and regulation changes. which has not been done for close to 30 years in the state of Alaska. There's been little projects here and there. Add this, take that out. But this is kind of like a big overhaul, which was seriously, seriously needed to be done, for sure. so not all of the listeners of this podcast are all over the world, not just in Alaska. Um, so if somebody is outside, like a more populated area or a., like if they're receiving any prenatal care, where does that come from? If there's no midwives, ORs in that community. So it's my understanding that a lot of the communities might have a local small health clinic, and so they might receive care, um, through the traveling nurse or the traveling, um, doctor that comes. Once a month or however often they're coming. Uh, but a lot of them are just going without care. Um, tra Rachel does a lot of travel midwifery and she goes into communities and, you know, there is no hospital at all there. Or there is, you know, one nurse practitioner that is coming once a month. And um, yeah, there is nobody really there to provide care. So somebody. Not going to free birth. They're not just birthing on their own, they're traveling. Then what does that look like? Like when do they, when do they decide to travel to Anchorage or Juno or a larger So typically it's up to the, it's up to their provider or whoever they're coordinating with. But what, like right now I have a mom under my care that lives in Wrangle and she loves her little town of Wrangle and, um, they sent her off the island. at 35 and a half weeks cuz she was having some contractions and sh they thought she might be in labor. So they met, have backed her out and she rodee a helicopter and she got a first class ticket to Providence. Um, she wants a birth center, her birth ultimately. And so, you know, for a minute we were like, you know, you can't have a birth and birth if you're preterm. But anyways, she, her labor stopped and she's now just waiting. Her husband is still home in Ringle cuz he has to work and that's where they live. Um, and she's waiting to go into labor, but kind of, it's not easy on them and thankfully they are. It's their first baby, so they don't have a bunch of kids in the house that, you know., they're trying to logistically coordinate. Uh, mom is gone for a month or more because she has to go to town to have a baby. Um, ideally, and, and Wrangle is a big enough community, like this person in particular, wrangle is a big enough community that they have a clinic there. And she was under the care of nurse practitioners and then coordinating with me because that's where she wants to deliver, but, Ringle still, they don't do hospital birth, they don't do any births on the island at all. Like if you have a baby on Wrangle, it was totally by accident and it happened really fast cuz they couldn't fly you out in time. So usually, long story short, it's about 36 weeks cuz they don't want you to deliver on accident. And then how long makes sense if they're not prepared for it. So they'll leave their communities at 36 weeks, stay in town until they deliver, but then they stay for six weeks postpartum. Wow. Because they received that six week up until that six And if you think about these family, That's a long time is so it's a logistical nightmare for just the family themselves. But then if you think about the cost, their insurance is covering. all that. Not just the flight and the medical care, but their hotel, their housing, their meals, um, travel vouchers, if they need to get a taxi cab to go to their appointments, like it's a huge cost. Versus train up more midwives and get a midwife in each community or at least close to their community. Right. How long has it been that way? Like how, how long ago was it that there were midwives Mm-hmm. Well, unfortunately that happened. That was when. licensure actually happened when licensure in Alaska happened. There were a lot of traditional midwives, Okay. that were in the remote villages and such, but they didn't want a license. And what that did is that made them now illegal to practice, so they stopped. Wow. Wow. Okay. Can you talk a bit, a little bit more about that? Why, what licensure means, and I guess why it's important and why you guys are fighting for it or, or talking about it more with the board? I. when it first started, um, was a good mo movement forward because before we were basically like what's called an illegal state where midwives weren't illegal., but they also weren't considered in the healthcare profession. Right. Um, so entry midwives he had traditional midwives then, and weren't able to build insurance. costs, right? All cost was out of pocket. Uh, when you're illegal cuz you can't bill for insurance, um, there's certain medications you can't carry, um, because you're not licensed right? Then you're dealing with a totally different. uh, handling emergencies differently than what we can now. So being licensed has huge advantages for midwives because then there are meds that we can carry. There are procedures that we can do, um, we can bill your insurance. So it's a lot less out of pocket cost for families. Um, so it does have its advantages? Yes. Right. Um, it does kind of make sure that everyone has equal. That doesn't mean traditional midwives did not know what they were doing. I am not saying that at all. Um, but it just kind of changed things in some of the traditional midwives. They just didn't want to, um, change what they were doing. So, um, Hmm. Yeah, that makes sense. Um, okay, so all of the cost of people traveling into town, potentially like a spouse coming in with them and taxis and places to stay, does the state of Alaska foot, any of that bill., or is it all insurance they have Medicaid or, uh, state of Alaska, Medicaid is Denali Kid Care. If they have that, then yes, they have to do some paperwork with their provider to make sure that Medicaid will cover it. But yes, it is part of their healthcare because. there is no access to care on at their home. Right. So that would be why it would be beneficial to have midwives in for not only, not only clientele and patients, but for taxpayers. Right. That's less money the state is pain. out algo Yeah. The state of Alaska is putting the bill for anyone that is covered, that is coming from out of town. Yeah. in addition to all of their medical Do you guys have any stats. Right, right. Do you have any stats on that? Like how much I Alaska is somebody, somebody pulled some numbers, and on the top of my head, I think it's 40% of babies born, their mother had Medicare or Medicaid. Yeah. So 40% of the babies born in the cost are covered under Medicaid. and that would encompass every, all the babies born in Alaska, whether they lived in Anchorage or they lived in, you know, the, the outlying areas and had to be flown in. but I don't think anybody's ever run the number on cost of how much that would cost. You know, like the, how much it costs the state to fly moms in and having a place to stay and., it covers, I wanna say two meals per day. Taxis if they need to, you know, get to appointments or to the hospital or what have you. Um, and then flights and, you know, there's a Mm-hmm. There's is a lot. there is a yeah. Logistics. Holy cow.. I'm just thinking through all of that and yeah, like you were saying, if, if a family already has kids at home and they're young, especially, they need family or friends to watch them, um, does a spouse or partner always come with the, Not always. It, it doesn't make sense for everybody to bring their partner because they, um, might have to watch the kids or they might have to work, continue working. Um, yeah, so that's another facet of it is mom doesn't have her support person. Right, right. Oh man. There's a lot of layers to this that I haven't fully thought through. Hmm. So what is being done as far as the statute changes to midwifery care in general? Um, what's, what's coming down the the statutes changes, I'll just touch on it a little bit because I know Rachel is the one that's the expert, but I wanna make sure that I get my 2 cents in. Um, so we are. We're we're, one of our talking points is that we, we are going to grow up more midwives here in Alaska, which is going to increase access to care for our community families. Um, and how are we doing that? Because we are streamlining the licensure process, we're streamlining the ability for midwives from other states that are already licensed. To come into Alaska, get their Alaska license and start practicing. We're streamlining the process for apprentices. We're streamlining the process for the, the preceptors that are here, training new midwives. So we are hopefully, I mean, it's not gonna happen overnight. We have to get people to come and then retain the midwives that are here. One of the big deals in Alaska that we've seen over the past decade is retention. The midwives that we're already here in practicing can't afford to. Some of them can't afford to maintain their license because of the cost of the license. It has been so expensive to be a practicing midwife in Alaska because our licensing fees have been so high that a lot of them have retired or they've moved, or you know, they're choosing not to re license. So we're losing our AB ability to care for people. because there's not enough midwives in Alaska and we are losing the ability to train up more midwives because it's too much of a process for apprentices to go through their apprenticeship programs. All right, Rachel, take it Those are important points. No, that part's, it's really important though because that is a huge port, uh, part of what's happening right now. We used to it, I think our maximum was close to 75 midwives in our state. And when we kind of did this,, it's not an official consensus. A kind of general consensus. We're gonna be down to like the last time we checked Less than 30. Yeah. Whoa. That is significant. Wow. Yeah. And it's, it has a lot to For the entire state. entire state, not just one area. they're all, we're all concentrated into the areas of Anchorage, the Matt Valley in Juneau, so most of us practice in those areas. And then outlying areas have nobody between Meadow Lakes and Fairbanks, there's no midwives, none like Willow, Tona, Healy, Kawell, all the families that are in those area. Have to go to either Fairbanks or the Valley or have a crazy midwife that is willing to drive two hours to care for them. Oh, I'd be that crazy midwife. I was just gonna say, Rachel is laughing right now. Yeah. I can see that. So you guys are extremely, uh, taking on a lot of the load because, I mean, Alaska leads the nation in out of hospital birth. So these 30 some midwives are taking on all of that, which is Wow. Okay. That puts it into a lot of Yeah. So we want more midwives. more, No When when I was a student, I feel like I'm taking over the conversation, sorry. But when I was a student and Rachel was a student as well, we had felt like an apprentice on every corner there were apprentices, as much as you could find like a coffee., tons of apprentices, but because of some changes in state regulations and the dynamics of the, um, cost of licensing, not just for the midwives, but for the students, the cost of being a student. Um, we have hardly any students right now, and for the past few years there have been hardly any students. So there's not very many new midwives. There's the older midwives that came through. Um, and, and they're still sticking around, but there's hardly any new midwives like for the past few years. Wow. Can you quickly walk us through the process of what it, what it looks like to become a midwife in the state of Alaska? Yes. Um, so If it can be you have to, you're fine. You have to choose a program. So there's, most of the time people will choose an online program. Um, and do your di whole, your didactic, uh, education through that online program. Finish the coursework, and usually you're doing that in conjunction with your in-person clinical training. And the in-person clinical training is done with a preceptor who is a licensed midwife here in Alaska and also has done her preceptor. Certification to, to show that she is able to teach. She's not, she's not a brand new midwife herself. She has experience and she has a practice and you know, she's not just bringing on somebody and then is going to take advantage of them for five years. She is going to train them up, help them get their license, and typically it's the two to three year how, okay, that's what I was gonna ask. Yeah. And I can see how all of those different moving parts can play into how like the barriers to the student has to get apprenticeship rights or licensure permitting or whatever. And then the preceptor has to go through a training. Like Yeah, there's a lot, a lot in place that needs to happen. and the work that Rachel and the board has done, they've successfully been able to, um, make it so that it's more of a streamlined process and it's a more affordable process, not just for us midwives, but for the students as well. The opportunity to get a student permit in Alaska used to be like $1,800, and you would have to do that every two. Just to say I'm a preceptor, I mean I'm a student and am able to have an app apprenticeship. And then in um, this past month, the board, um, finalized their regulation project and it's now $300. So they've essentially taken the huge burden off of the student and, um, financially made it a lot more access. That's exciting. That's great. and we removed the ME accredited schooling require. um, because that was a huge financial burden for a lot of the new midwives. It's um, it's a college level course without transferability . So you get a, a non-transferable bachelor's degree in midwifery through a accredited school, but it could also cost you $40,000. So when you're looking at having to pay $40,000 for a. then spend two years of your life unpaid cuz apprentices are not paid for all of their work that they're doing to get all of their skills and, um, and their clinical experience done. That's a, that's a lot of money and a lot of time with a, without income to be able to, to become a midwife. So we tried. make it more affordable, um, because it has been proven that there is no difference between the skills that a midwife who does the online, um, training instead of the ME accredited schools has, um, between Amek and a and a non ME student. So a lot of their training comes from their hands-on experience with that midwife. Their preceptor. That makes sense, . That makes a lot of sense. Yeah. We wanted to make it more affordable and easier for people to do because once that meek requirement hit our regulations, that's honestly when all of the apprenticeships stopped Yeah. Hm. just couldn't afford it. Yeah. And are those the meek accredited schools? More so in person No, there's none in the state of Alaska. okay. Okay. Yeah. So someone would have to travel if they wanted to there is plenty of opportunity for them to do those, fulfill those courses online, but it is much more of a university led, um, style of an education, the burden of credits, the, the type of classes that you're required to attend., all of that. So the non make accredited coursework is a lot more Yes. And it's hones into midwifery training. Only it hones into your midwifery training and not so much all the other like college type of requirements. Nice. Hey, you guys are like taking down the walls one at a time. I like it. I like it. Um, okay, so what are some of the other statute changes? The biggest one is we will be changing our name from Certified Direct Entry Midwife, which is a non recognizable title by insurance companies to licensed midwife because they understand what that is, and that's in their verbiage. What that does in the long scope of things is it makes midwifery more affordable for Alaskan. Um, the two biggest insurance companies right now in our state, Aetna and Cigna, um, will not pay for home birth. They will pay for your prenatal care with a licensed midwife. They will pay for your postpartum care with a licensed midwife, but then they won't cover the actual home birth fee itself. Um, professional fee. And then so then therefore that financial burden with, you know, their monthly. Payments to their insurance so that they can have insurance and their normal deductibles and then their normal copays all still apply. But then they would have that out-of-pocket cost of the home birth fee. Um, and a lot of people, it's a financial reality. They just don't have that kind of cash laying around. Not to mention why aren't they paying it all the other insurance companies pay it. Um, but it is in their, it is in their, um, policy handbook. That is the reason they're not paying it is because it's not state mandated in our state statutes. So we put verbiage in there so that they are required then to pay for home birth so that that is no longer a burden for Alaskan families if that is their choice. Again, women should have that choice to birth where and with whom and how they would want to. Yeah, agreed. This makes me very excited, . I always feel like it's like a stab in the heart, you know, when somebody says, oh, I would have a home birth, and I'm all set for that. But yeah, my insurance won't cover it, so I'm going to the hospital and like obviously their choice and everything and, and. but if they wanted that home birth experience and the only thing holding them back is the financial piece then. Yes. That should not be there for them. Yeah. Exactly. Or even, I mean, I've recently talked to a mom who has an Aetna policy that she pays out the nose for every month. Who said, I just realized that you are not in network and they won't cover my homework. and I said, yeah, I know I've tried to get a network with Aetna. They're hoops to jump through are not feasible for my practice. Um, but I can work with you on, you know, all of those fees and stuff. I don't want you to have to feel that burden. And she said, good, because I'm my, uh, what I would do if I can't have you come to my birth if I can't afford it, is I would just have a free birth. And, you know, I. will not, um, downplay the option for people to choose free birth. But if someone wants a midwife and they have a amazing insurance plan that they're paying $800 a month for that insurance plan should cover the medical care that they choose, that they want to have, are. Yeah. Oh man. Oh, that's, I can't , can't imagine. I mean, do you think that it is insurance company's agenda to like push out home birth, or is it just how it, like how the I think, I think at the, I think at the end of the day, insurance companies just try really hard not to pay anybody. So we have to be able to organize and stand up to 'em and say, no, your, your clients, your customers that are paying all of their premiums are requesting this service and it's very reasonable that you should cover it. So I think at the end of the day, they're not necessarily trying to isolate and you. Push us away. I hope not. Maybe I'm naive in saying that. I think they're just, you know, they're really good at accepting money from their policy holders and they do their best to negotiate down what they're paying out. And midwives and doctors alike are always negotiating with insurance companies. You know, I probably have., 50 faxes a day from policy, uh, companies or Yeah, insurance companies that are trying to offer me a lower price. And at, um, Rachel's nodding her head as well. I get, because they'll send it two or three or four times to see if you'll take a, a lower fee. And at first, before I had anybody, Before I knew any better, I was like, okay, I'll accept it. I'll accept the, your, your, uh, negotiated down price. And then a biller told me, oh, don't do that. Just wait a out, you know, wait another week or two and they'll come through with their actual price that you're asking for. So Wow. name of their game? I hate that. It's such a game that you have to play. Yeah. But I don't know if that's exclusive to midwifery. I think it's healthcare in general. insurance companies just do that with all providers. I think. Hmm. I don't know. I don't think they're calling up hospitals asking me if they'd take. Maybe not. Hmm. You should ask around and see. Just saying. we should talk to a hospital biller and ask them. are. you should, I think I would be very curious to know that. Um, uh, I was gonna say the, if you are faith-based, if you're, you have a client who's faith-based, the, the cost sharing programs will often cover the entirety of home birth, but they see pregnancy as a preexisting condition, so you have to sign up prior to actually getting yes. So just other, another hoop to if you're going that route, make sure you have your policy in place before you get pregnant. like a month before at least. Yep. Man, what women have to go through to get the care that they deserve. Mm-hmm. agreed. yeah. agreed. Um, speaking of , the care that women deserve, um, you're extending. or insurance is extending, I guess I should say, um, your postpartum care abilities for 12 months. Is that correct? And part of the ch One of the changes in the statute bill and it's not just that insurance will pay right now, state of Alaska restricts us. We can't see someone, uh, after six weeks. So it's, it's considered outside of our scope of practice, whereas nationally, we have the 12 month scope of practice for postpartum. But yes. Um, Rachel was able to add that to the statutes update, and if that's gonna be a game changer, it'll be a game changer for moms and families. No kidding. I mean, it's, it takes a year to recover from childbirth, if not more. So , it just makes sense. Like it's, it just, yeah. Oh, you're a rock star, Rachel. I'm impressed with you. I don't know about that, but, and we also included preconception care, which we, which we do right now. when women call us up and say, Hey, what can I do? I'm thinking about getting pregnant in the next six months. Tell me what I can do. Then we meet for coffee and we chat with them. Um, but, But you're not getting paid for that. Right? And it can't be part of their medical record and, you know, we shouldn't, we're not ordering labs and, you know, doing all those things. right. We're. now you Yeah. If that statute change passes, we can, we'd be able to help women ahead of time, get some labs done, see if there are some deficiencies we can work on, um, and then move forward from there. Then do their pregnancy, birth and postpartum. But yes, then the postpartum would extend that whole next year, which is Oh man. That's incredible. Yeah, I mean, it just, it makes so much sense, like to be able to walk alongside somebody from preconception all the way to a year postpartum, like if. Somebody had that support, like just think of how much better mental health is gonna be. Think how much better like community is gonna be. I, I don't know. I'm very, very excited about all of this. Um, and.. Yeah. Like people's pelvic floors, they're gonna be okay , because they're talking to someone about them regularly and not having just that six week checkup and like, okay, see ya. Like, can't do anything more after this point. Um, so a lot of people get like birth control right at that six week mark. Is that because they can't come back after that point? Yeah. So, um, that's kind of, so just, just to, um, make sure that your listeners understand birth control is not in scope of practice of. licensed midwives, but a prescribed birth control can be achieved through a nurse midwife or, um, a prn or a doctor or family practice. Doctor can do it as well. But yes, that is the policy. That's where the six week checkup really came from is six weeks. You are considered fully postpartum and that's when you should be started on your birth control plan. Hmm hmm. Interesting. So I wonder too, like if people are choosing to go in hormonal birth control and they're seeing potential issues or imbalances from that in their postpartum season, then maybe if they have extended care, they would wait longer and things might be more balanced if they choose to Yeah, yeah, for sure. Yeah. I don't know. That's where my brain is going. Yeah. I'm all about the balance. if you could check in and talk with your midwife once a month. Yeah. There would be a lot of things we could be Mm-hmm. that. You know, like, am I, am I actually fertile right now? You know, what does that look like? Different for everybody, but we could be talking about all of those things. Yeah. Yeah. And I'm sure you screenings. That's a big one that we'd be able to do for moms, um, and help them get the care that they need. because you guys can do referrals at that point, right? If you're doing a, a postpartum depression screen and get Mm-hmm. a positive screen if that's, yeah. Um, yeah, and you probably already talked to people up till 12 months or longer, I'm sure. We do They all the, even people that ha, you know, we had a baby five years ago, they'll still text or call and say, Hey, um, this has nothing to do with my pregnancy and postpartum, but, I addressed you in your opinion, like, who can I go and see? And so we can, we can help facilitate, um, those referrals or just, you know, recommendations. Yeah. Amazing. I'm, yeah, . I'm just impressed by you guys and I'm really excited that you get to be paid more for what you already are offering the community. Um, okay, so how do we get the statute bill to pass? What does that look like? That's a Rachel looks like lots of letters. That's what that looks like. Right? We have an online petition, unchange.org that people can go on there and sign. If you don't have the direct link, which I can give to Natalie so she can post it, um, you just look up, um, Alaska midwives unchanged.org and it'll pop right up. so they can go on there and sign. Um, and then we are going to be having the bill coming out hopefully this week. Fingers crossed. I Okay. texting the representative earlier today. Um, and as soon as that bill comes out, then we'll have a bill number. Um, so if people want to like pre-write a letter, and Natalie had even said she's willing to kind of help by giving kinda like a. um, on Yep. For people to use. You can use that template and tweak it however you'd like to tweak it with the bill number and email it in, and it would be, um, you'd want to email it to your representatives, your, your state representative in your, um, senator in your area, um, so that they are getting, you're getting their attention. But then we'll have specific people and Natalie can have those email addresses. with that template letter as to who it goes directly to. So the people who are sponsoring it through the Senate and through the house. Um, and then therefore, the more letters we get, I've heard the magic number is 500. And what they do with them when your letter goes, gets sent in is they literally print them off and it goes into a folder with the bill. So when it goes from committee to committee to c, and this nice big old thick folder shows up and they're like, oh, that could be a lot of angry constituents if we don't pass this Okay. Okay. literally how that works, right? So the more people we can get into writing letters of support, the better and the more recognition that Bill takes. Okay. Yeah. And I will, I'm going to write like a prefab letter that people can take and personalize. Um, and I'll put that in a Google doc and I'll link it in the show notes along with the petition so people can easily find that. Yeah. Um, can people outside of Alaska signed the petition on change dot. They sure can. In case you know, they may be the grandma of somebody who lives here or sister or best friend or whatever, that it's anyone who believes. And I, and I encourage dads to sign them and grandpas and grandmas to sign them, um, because we need midwifery to stay alive in the state of Alaska. And this does nothing but benefit the women here. And nationally, I mean, it kind of sounds like yes, oh, go ahead. go. it kind of sounds like it. There's benefits to the midwives and it's really just opening our scope of practice to help more demographics of women in our state and just more women in our state period. If they knew about midwifery and what we offer and if they didn't have the financial burden of having to pay for things they shouldn't be paying for since they have insurance out of pocket. Um, then, you know, the grandmothers and the sisters and the aunts and the uncles and the. Uh, should be writing in those letters also saying, you know, my wife had a fabulous experience with midwife Mary. Great. Write that in. They want to, they need to hear that They really do. So the, the more personalized the letters, the Absolutely. Okay. And I was gonna say, this is not just an Alaska issue, this is a national issue. So even somebody that's listening to your podcast in another state, um, maybe you're in a state where you don't have li legal, uh, licensure, or you don't have access to midwives in your community., if you support us here in Alaska, we can ripple down and help change other states. Like we have to be able to support midwifery nationwide, um, in order to really make a big difference in those national numbers. If you look at the national statistics, Alaska has the highest amount of babies being born outside of the hospital. With midwives. That's a given, and it's been that way for many decades. Um, but nationally we're only. Getting about 2% of the babies that are being born total in America, being born with midwives outside of the hospital, only about 2%. Wow. I didn't realize it was that low. And so we need to have a national conversation and if they can look to Alaska and see that Alaskan midwives have great statistics, we have excellent. We have, uh, an excellent integrated model of care where our midwives are well respected. We can show up at the hospital with our families, and we can transition to the hospital if we need to. We can be a great example of how you can get good insurance coverage and licensure processes. Like all of that thing can be a national stand, national conversation, but first we have to do it here in. Yeah, Well, cuz a lot of people don't realize there are quite a few states in our free United States that midwifery is actually Mm-hmm. because of their state statutes. So like when I was writing the statutes, the place that I went to as I called up our national certifying organization, I said, is there somebody here that can help me write basically a midwifery constitution? Right. Um, I would like it to be a living document. And so they, they did, they, they did help me and um, they said, right. They were like, Hey, you know, if you get this passed, this looks fantastic and great. This could be a temp. So like what Mary said, states that are illegal, illegal, great. Use us. Yeah, Yeah, absolutely. That's why we're trying to get this pushed through is it's not, it does help our Alaskan families, but it could potentially help other states. So the bill is up for vote very soon. Yes. Today is the 20th. We're recording on the 20th I know, right? Today's the 20th Spring Equinox, First, um, the whole legislative process is totally cumbersome, but it's whatever it is, um, it has to get brought out of legal and presented to the house floor and the senate floor. And there it gets assigned a bill number, um, on the house side and the Senate side. So you'll have HB bill number, whatever, and senate bill number, whatever. And then, um, once we have those bill numbers, then it's alive and it's no longer. in theory, this is an actual legislation, a bill that the legislators can talk about and discuss in their committees, and then ultimately vote on it has to go through the committee processes. And last year when we were attempting to move it through, um, it got stuck in a committee and it didn't progress from there. So this year we need it to progress, which is why we've been so active. out there and doing podcasts like this and bringing as much awareness as we can. Um, but once it gets active, then it's going to be called up into each of the committees and talked about in each of the committees, probably three committees in the house and two or three committees in the Senate. And then once it makes its way through the committees, it will go to the house floor where every legislator gets to vote. So not just the families that are from Alaska and the Valley, or not Alaska, Anchorage and the Valley and Fairbanks, where there's a lot of midwives, but we need families from Galvan and Delta Junction and Bethel and Kotze View and Bristol Bay. Like we need families from everywhere, not just because each of those representatives, they might not have any constituents that are using out of hospital midwifery. because there are no babies being born in their communities. They're all being shipped to Anchorage. Yeah. So the legislators, when we were able to go to Juno, we were able to talk to some legislators that served people in those communities, and they were very interested in carrying this bill through because of the huge impact it can make in community healthcare in their. Oh, I just wanna say that was a beautiful summary of how a bell becomes a law I feel like I was going to have to put the schoolhouse rock link in the show notes so people could watch that. Song but you did an awesome job of summarizing it. Makes a lot of had to explain it to lots of lots of people, and I guess maybe it's my homeschool mom coming out of me that I'm like, look, let's break it down as simple as possible, and I don't have all day to do it. So we're doing it in like two sentences. Well own it. That's amazing. Um, I was gonna ask too, if somebody is already receiving midwifery care, I think I heard you guys say there's petitions printed, like in offices around town. Um, how is the best thing for them to do is to write a letter, sign the petition? Is there, are there any other ways that people can show support? Call, they can call their state representatives and and senators, lots of phone calls. Call 'em every day. Call 'em every day. Tell 'em, Hey, that midwifery bill is coming or it's there and here's the number, and we want you to support Yep. and have grandma call and have your sister call and have your uncle call Mm-hmm. every day. every day. Mm-hmm. Pester him. Yep. Yep. The more phone calls they get, the more they realize that they need to start paying attention to because it, it would be a big deal if they had 10 phone calls a day in each office, but wouldn't it be even bigger deal if they had a hundred phone calls a day in every office and each phone caller said, I want you to support this midwifery bill. This is really important for me. That way they know that they have the numbers, but they also have very interested constituents, like we're not just bystanders. they're paying attention. Right, right. Active participants. Mm-hmm. kind of a little bit like midwifery care, right? Yes. Yeah. You want your clients to be active participants in their care. Hmm. Um, it's funny how life works a lot like birth. I feel like. Um, So what happens not to be a negative, negative Natalie , but, um, what happens if it doesn't pass? What happens if it doesn't pass? Well, unfortunately our board is also in, um, uh, could be sun setting this, um, June. If we do not get statute, uh, the statute changes. Because this is a combined bill of statute change and board extension. what does that mean? Meaning if our board, if our board, cuz our board, they call it a sunset. Basically it's in the process of going away. So if we don't get this bill to pass, um, in June, our sunset bill, I mean our sunsetting begins, meaning they kind of wind down the clock and we have one year, um, to get things taken care., which would be statute change Yeah. right. So then does LI licensing go away if the board doesn't exist? it nobody really knows. well we've given, yeah, we've been given three options because it's, it's an, it's an unknown of which direction it could go. Um, it could stay exactly as it is, except there wouldn't be a board. Right. So we would still could be legal., but yet there's no one to ever update statutes or regulations. Um, it just is problematic. Um, then, or we could be taken over by another board, like the medical board or the board of nursing, which that could be, um, an interesting ride. Um, uh, or we could, the board could cease to exist and they just cancel it all together, which would then., they have the option of making us illegal, which is kind of what we were talking about earlier, where we're not illegal but we're not, not licensed. Um, or they could make us illegal, meaning we couldn't practice legally in this state, um, which would mean midwifery would go away. Hm. And on that note, I will, um, I'll interject too. We don't know what will happen because the administrative state, the, the adminis, the big administration of the state of Alaska, it would at them at that point just be making decisions. So the state of Alaska division of Boards and professional licensing would be making those decisions for us. The benefit of having a board, and you're a physical therapist, so you fall under the, exercise uh, do you fall under the physical therapist board? Mm-hmm., I'm not, I'm not professionally licensed. so you're not professionally licensed, so you don't have a board. So the benefit of having a board for your professional license is that the board is a board of your peers. They understand what you do, they understand your scope of practice, what you can do, what you can't do, what you shouldn't do, who you should be referring to if you need to when you don't have a board. Who is making any of those decisions? And do we wanna just. Doing whatever. So boards are important. We have seen in other states that their midwifery board dissolved and it has not worked out well for the families and midwives of those states. Yeah, it seems, I mean, largely beneficial to have people who are affected by the statutes, be part of the decision making process and the constituents as well being very active. So everybody listening, this is imperative. This is like, this is life changing for a lot of people actually. I mean, to put that significance on it, I feel like is necessary because it changes how people come into this world and the care options that are. offered to women and families. Like it's, yeah, it's important. It's very, very important that we get this passed. Yep. why like when you notice, when you go to the the change.org petition, it literally says Protecting childbirth options for Alaskan women. That's what we're doing. Yeah. And even if someone is choosing to birth at the hospital, um, Still sign it, like still sign it, , because it still gives more options for other people. Like even if it's not your choice, that's okay, but you have a Mm-hmm. correct. Yes, that's, yeah. That's what it's protecting, right? Is future babies, you know, all of the female babies being born are gonna need options when they, when they are our age and having Right. age. your age, your age, and having if we are only updating these statutes once every 30 years, then this is what my daughter will deliver her babies under. Or if she chooses to go with a midwife. Mm-hmm. Mm-hmm. have she will have the option. She better. Mm-hmm.. That's right. That's right. Wow. Well, thank you both for being so, so involved and. Working hard and literally coming to this interview on very little sleep after having a couple of midnight , middle of the night babies in the last few days. Um, I, I am honored that you guys would come here and I am really excited to push this out and see the change that happens cuz I, we're just gonna get this passed. That's what I, I'm hanging on to. Yep. crossed Yep. It'll happen. Thank you, Natalie. it will. Awesome. Yeah. Thanks Natalie. This was great. Thank you, Thank you so much for listening and for choosing to take action to actually make a difference in the birth options for women in this country. I hope this was informative and inspiring to you to help make a difference and get this bill passed. I'll put a link to both Rachel and Mary's sites and social pages, as well as the template letter and change.org petition in the show notes for this episode. Please remember that what you hear on this podcast is not medical advice, but remember to always do your own research and talk to your healthcare team. Hopefully some midwives in there before making some important decisions about your wellness. If you found this podcast helpful, please consider writing a five star review in your favorite podcast app, subscribing on YouTube or sharing with a friend. Thank you so much for listening. I'll catch you next time.