LISA YOUNG: Can you tell me a little bit about how you got involved with Delta Health, and then how you learned about the closure of the labor and delivery unit.
MORIAH MELIN: When I first arrived here years and years ago, I participated in a it's called neonatal resuscitation course at the Delta Hospital. It's part of our licensures. Every two years, we need to renew our CPR and our neonatal resuscitation. At that class, I met Doctor Amber Angles and had this really wonderful connection with her. And she was just so generous and gracious and and over time, I've been developing this relationship with her. She's fantastic. She's my family's doctor. I highly recommend her. She she invited me some years ago to come and participate in what's called the OB committee meeting at the Delta Hospital. So every three months, for about the last year and a half, I've been going to these meetings, and everybody involved in obstetrics at Delta Hospital is a part of these meetings. And it's been incredible the way that I was welcomed into those meetings.
You know, sometimes I felt like it just was a very unique experience. I haven't had that previously in my midwifery career to be so welcomed and received as a colleague and an integral part of the maternity care system within our county. Doctor Amber Angles recently had another baby, and I got to go and visit her in her home and bring her food and just do that community building, you know, that ecology that I'm talking about anyway. And so I had this beautiful meeting with doctor Amber Engels. As I left her home. She sent me the DCI (Delta County Independent) article and she said, 'you know, I wanted to talk to you about it. I wasn't able to do that. But now, you know, here's this article and this is what's happening.' And so I found out from from her and I forwarded the article to the other midwives in the county. And it was quite shocking, to say the least.
YOUNG:
Can you tell us a little bit more about what it's like to practice midwifery and the relationship that you like to have with a local hospital?
MELIN: You know, like I said, midwifery is a it's a very huge responsibility to hold, you know, essentially life and death and, and those pieces for families. And before living here in Colorado, I was in California and I practiced. I've been practicing home birth midwifery for a very long time, but never as rurally as I am now. And that was part of my hesitation when I first moved here, was like, oh, we're a little bit farther from the hospital and there's more inherent risk that comes from being the farther. So that was part of my hesitation to just dive into practice here. But then over time really saw that there was a need. There hasn't been a licensed midwife practicing in the North Fork for a very long time. And so, you know, it was like, okay, I have these skills. There's a need here. I'm going to step into that. And that's why I first and foremost was like, the most important thing is to develop these relationships over at the Delta Hospital, because that is the higher level of care that I and my clients need in order to be able to practice as a midwife.
I am licensed to support low risk birth, and thankfully, birth is not a disease. It's not an illness. And most families, most women are low risk. And that's the clientele that I serve. But on occasion there are needs for higher levels of care. And in that case there would be either a prenatal transfer depending on what's coming up prenatally or a transfer in birth to that higher level of care.
YOUNG: It sounds like knowing that there's always that possibility that you might have to make a transfer for a birth, that may be more difficult, that it really is important for you, and has been important to build a quality relationship with your local hospital. Tell me more about that.
MELIN: Again, I had worked really hard to develop those relationships because the more that those health care providers know me and understand the services that I offer and what the protocols and the regulations that I follow in those kinds of things. The more comfort they have with me, the more the better of an experience it is for my clients, right? If the practitioners feel safe and comfortable for me, then as I transfer people in, then there's an understanding there and the experiences that I've had. I've only had two transfers into the Delta Hospital in these years, and both of them were just fantastic, like the way that my clients were received and respected in the way that I was received and respected, was just a beautiful thing.
YOUNG: So Moriah, hearing about the closure of Delta Health's labor and delivery unit must have been difficult news for you. Tell me about how you were feeling.
MELIN: There's like tears in my eyes. Just thinking about it now. Not only is there grief that these relationships and this opportunity is not there, after spending so much time developing these relationships. But even more importantly, the transfer time has now doubled. Well, depending on where my clients are, right? So if someone's out in the North Fork, clearly the transfer time to the Delta Hospital is say, thirty minutes. And if we're going to Montrose, it's an hour. And if we're going to Grand Junction, it's an hour and a half.
YOUNG: How does the closure of the OB unit affect your decisions that you make when you've got to make a transfer?
MELIN: I'm already like a a sensitive, not necessarily a conservative.... I don't know exactly what the best word is, but very thoughtful about when to transfer into the hospital. Right. I'm not like a die hard stay at home at all costs. That's not my job. My job is to be the guardian of safety. That's what I'm there for. That's what people hire me for is to know when we're. You know. What are the yellow flags, right? Not the red flags. What are the yellow flags? And when is the appropriate time to make that call to transfer into the hospital? And so certainly that is with me now. Right. Like now it's just another factor in my equation of making that decision. Since the labor and delivery unit is closing at Delta Health.
YOUNG: Sounds like this is going to force you to make some different plans and different arrangements. Tell me about some of those future plans.
MELIN: One of the things that I've been working really hard on is to figure out every single piece along the step of a hospital transfer. So I just recently connected with the head of education at the North Fork EMS, and connecting with the EMS providers and making sure that they not only know who I am, but what it is that I offer and what kind of equipment I carry and what are the meds that I carry. And I also connected with Doctor Avery McKenzie. She coordinates Delta EMS. So on September 16th, I'm going to be participating with myself and Jamie Doty, who's another midwife down who is in Ridgeway, but comes up here often and we're going to be training EMS providers.
So first responders do not get a lot of training, if any, training in in birth, in out-of-hospital birth. And what I've been saying is that they need this training, not just for the clients that I might call in their help for. Right? Like a hospital transfer for an intended out-of-hospital birth. But for those who are intending to birth in the hospital but don't arrive in time because sometimes birth happens really fast, right? And there was a gal who shared that at the meeting at the hospital, that her first baby was really fast. She lives out in Crawford near the near the, um, the Black Canyon.
YOUNG: So, Moriah, it sounds like you're already making plans and doing some training. Tell me just a little bit more about what's happening.
MELIN: So these first responders need this training. And so I'm going to be meeting with the North Fork EMS and the Delta EMS and doing some training with them. They need training in neonatal resuscitation. They need training in just normal physiologic birth. Like to understand like if there's cord that's really you know how to manage that. It's not a big concern most of the time. How to help support their nervous systems because without having any training it's really scary for them if there's a birth or they're called to a birth and even more now than before, they need training and out of hospital birth. And then the potential complications, of course, that can arise as well, which are less frequent but important. And so myself and other midwives who do out-of-hospital birth, we are the experts in out-of-hospital birth. It's what we do. It's what we've been trained on. It's all of our equipment. So we're going to be doing some training with them.
I'm also working with the head of dispatch. What does it look like? Careflight. Understanding the helicopter systems and understanding all these different pieces. And if there's a baby in need, then how do we go to Grand Junction instead of Montrose? Because there is no NICU in Montrose. Our closest NICU - neonatal intensive care unit is in Grand Junction, so I have just been working really hard.
YOUNG: Just listening to you describe the training and your plans and what's happening. I just can hear a lot of emotion in your voice.
MELIN: Yeah, I definitely there's been a lot of emotions. I've been feeling deep compassion for the providers who like Doctor Lebsack and Doctor Angles and Doctor Jimenez, who also spoke, who didn't get any warning that this closure was coming. Like, as a practitioner who develops these deep relationships with my clients, to me, their clients in the medical model, their patients. But these relationships that we develop and this trust that is grown between practitioner and and client is really profound. And I you know, I'm having a deep compassion for the Delta health providers who were given I don't know what was it, two weeks notice or something that all of their patients were being transferred out of their care. Like I, as a practitioner, it just it hurts my heart. So I have compassion for them. And then, you know, mostly it just sent me into action to what the new reality is. We all hope that it will only be temporary, that's unknown. And in the meantime, I just need to put the pieces in place so that myself and my clients can be as safe and prepared as possible. Yeah.
YOUNG: I would like to talk a little bit about your clients. Not specifically, not specific cases or individuals or that type of thing, but just as an overall relationship with your clients. And perhaps you have some families that are getting ready to deliver within the next couple of weeks or the next couple of months. And what the conversations you're having around the closure of Delta Hills OB unit. What are those like? And it sounds like you're already got a lot of contingency plans in place. But tell me a little bit about how clients are feeling and the process that you're putting them through, or working with them to get them prepared for the what if.
MELIN: Most folks who are choosing out of hospital birth understand that the inherent responsibility that they are choosing to take over their own care. It's a very different model and so the conversations that I've had so far with clients definitely like there's some shock like, 'wow, okay, wow, that changes in everything'. I haven't had anyone express doubt around their decision to deliver out of hospital. I think that comes mostly from the way in which I have been working to create those contingency plans. Right. And in terms of that's an interesting question. Like you're saying that loaded question around like yellow flags. And does that make me potentially transfer sooner. I would say it's just another piece of the puzzle, but I'm already a cautious midwife and I'm already going to transfer if I have any concern. And yes, that's just another piece of the puzzle, right? It's like how many pieces of the puzzle are going to stack before I make a decision to go or whatnot? You know, looking ahead, I'm curious how this is going to affect our practice or affect those who are choosing at a hospital birth.
YOUNG: Tell me a little bit about why you got involved with midwifery.
MELIN: Oh, I got into midwifery at a very, very young age. I was eleven when I heard my calling and originally I wanted to be a nurse midwife. So there's three tiers of midwifery here in the U.S. There's nurse midwives which have hospital privileges, It's a master's in midwifery. You get an RN degree and then a master's in midwifery, and you can work in the hospitals. And then there are licensed midwives like myself, which depending on the state, depends on the legal status and how that works. And then there are lay midwives and lay midwives are those who have learned through apprenticeship. It's more of like a traditional midwifery model, but that don't have legal practicing rights in most states, including Colorado. So there's different tiers of midwifery.
I got into midwifery because I love babies and I love birth, and I love the idea of informed decision making and the way that we come into this world is it leaves a lasting impact. So I'm also a practitioner in the field of pre and perinatal psychology, which looks at our earliest experiences from conception through pregnancy and birth and those first three years of life. And there are many experiences that we have in that time that create before we actually have conscious memory, but those experiences lay down in our bodies, somatically. It's a very important developmental time in all of our lives.
YOUNG: I think as I get older, I've come to appreciate what you've just said, and it's so important.... the kind of care that you give to women and families before the baby arrives. And of course, that little baby can feel what's going on on the outside as well. I'm really curious. Tell me a little bit more.
MELING: It's such an essential part. Having a baby is not just getting a baby from the inside of one's body to the outside of one's body. It's about growing a family and growing a mother. And the way that the baby participates is just such a beautiful and very, very important part of life. And so I do my best as a midwife to offer physiologic birth understanding. That you know, the implications of the hormonal process that influences birth and how that influences bonding and attachment and how that affects breastfeeding and how the way of including other siblings and the way that affects the bond between parents and so many elements of birth that are very, very important. And sometimes in the medical model, interventions can interfere with those natural processes. And so I do my best to offer that physiologic birth... which is just basically uninterrupted birth.
YOUNG: Moriah, my understanding is that you work primarily in the North Fork Valley. Do I have that correct? And can you tell me a little bit about why that's important? The location itself?
MELIN: I've been here in the North Fork for eight years now, and what interests me most in my life is ecology, healthy ecology. And how healthy ecology presents itself in the natural world, and how healthy ecology presents itself in the human world, the animal world, all the all the all the kingdoms and how they interact with each other. And so for me, that's one of the things I love about living in the North Fork Valley is that it feels like many of us here are interested in that ecology. We participate in our local ecology and so for me, it's like my way of contributing to our local ecology is by offering this service of midwifery and supporting families in this way. And sustainability is really important when we're talking about ecology.
YOUNG: Besides primarily being in the North Fork Valley, have you been to other areas of the region and worked as a midwife there?
MELIN: I've worked with other midwives in the Roaring Fork Valley and I've been out to Grand Junction and silt and all those areas, and it's just not sustainable for me, because, we travel to their home and we do postpartum visits in their home and it's just too much travel. I want for myself and my family that which I want for the families I serve, which is sustainability and time to be with my children. And time to rest and do self-care and so in order to be able to have those, it's really important to me to just serve locally.
YOUNG: I know that we've talked about you being specifically located in the North Fork Valley. But I also understand that you are also serving all of Delta County. Is that correct?
MELIN: I serve the whole of Delta County and I have a new midwifery partner, which I'm really excited about. Her name is Rachel Snow and she just moved here and she and I are working together. We've got this new practice, North Fork Midwifery. I finally feel like I can come out into this community. I haven't really I've done some births here and there, and I've supported some other midwives, but I haven't wanted to practice on my own. It's such a huge responsibility to be a midwife. And midwifery is only one facet of many, many things that I do professionally in my life. And so now that Rachel has arrived, I feel like we can finally really come out. And it's just fascinating timing that this is happening with the Delta hospital. I feel like I have the support now with Rachel to be able to step forward into whatever it is that's coming for us with that.
YOUNG: Moriah, I would like to give you an opportunity to share how people, folks, families in our community could connect with you who are concerned or really want to know more about your practice and what you're doing. How can they reach you?
MELING: My partner and I, Rachel Snow, we have a website, and it's North Fork Midwifery com. You can find out a little bit more about us and the services that we offer. And our phone number is 970-239- 1266 that's the best way to reach us. And then our email is North Fork Midwifery.
We are very much available to sit down with families and do a free consultation or just answer questions about our practice and and offer support. I also do counseling services. My partner does Mayan abdominal massage. She's also does lactation support and there's a lot of services that we offer here.
I don't know if this is appropriate to put in there, but you had asked around, like, how this changes our care and specifically with clients. One of those things is around vaginal birth after cesarean. Can I share just a moment about that?
YOUNG: Yes. Go ahead. Thank you.
MELIN: VBAC. It's called vaginal birth after cesarean is something that we midwives offer. It's a part of our licensure to offer vbacs at home. And one of the criteria to be able to birth at home after having had a cesarean, is that you need to be within thirty miles of a hospital. And so that is something that is really changing for us with the closure of the Delta hospital. And so just just so that folks know we do offer VBAC, which is rare. They did not offer that at the Delta Hospital. We were actually the only providers in Delta County who offered that. Folks who do want those services now have to travel to Delta or travel to Grand Junction and find somewhere else to birth. And that definitely is changing with our practice. But those are still services that we offer. So there's, there's a lot that we offer and we're we're available to have conversations and just to help kind of navigate others through, um, the these changes.
YOUNG: Moriah, as we wrap up our conversation today, we've talked about a lot of different things. We've talked about the closure of the Delta Health, Labor and Delivery Unit and about your journey through midwifery. As our conversation comes to a close today, I'm just wondering if there's maybe some kind of a silver lining in all of this.
MELIN: One of the beautiful things for me of, I mean, it's not a beautiful thing, the closure, but what what has resulted is just a deepening in my relationship with Doctor Matt Lebsack and Doctor Jimenez. So it's just been really sweet to be united in something together. I already have these relationships with Doctor Angles, but there's just something....something is growing in terms of that local ecology. Something is growing within us as practitioners, even within the different models of what we offer and that's a beautiful thing, like the relationships with the EMS providers and all of those things is a it's a beautiful thing. Even in the face of this challenge, there are beautiful relationships that are growing.
YOUNG: You're talking about transformation of systems and relationships that hopefully will come out even better. So I really like that. I think that's what something we all need to keep in mind that, actually universally, we're going through a huge transition time in the planet and everything that is happening is pressing down on us. But we need folks like you and others who are sensitive to that and are willing to guide others through the process because you've been there, right? You know the principles and how to guide and help folks so that that in itself is beautiful.
MELIN: And that's really happening. And it's really, really beautiful. And I think that previously in my midwifery career, I've experienced a lot of prejudice or negativity and hostility for sure, from different types of providers. And so what's happening with the North Fork EMS and with the Delta EMS and with the providers here and with myself, and these conversations are just really healing.
