My interview With Aleks Evanguelidi. LA’s Badass Midwife
Ok ladies I am soooooo excited to introduce you to one of my favorite BADASS ladies and the most joyful to support births with of all time! Aleks Evanguelidi https://www.aleksevanguelidi.com is a Los Angeles based midwife, nutritionist, herbalist and is pure magic! There are many models of care When having a baby or for women's health in general. I wanted to share with you a midwife's point of you by doing a Q&A with Aleks.
Aleks Evanguelidi LM, CPM has been working in birth for 20 years. She began her work in birth while maintaining her presence as a nutritionist and as an herbalist and educator for Gaia Herbs. A firm believer and proponent of living a sustainable lifestyle, she utilizes her years of experience in nutrition to support her clients in having an extraordinary sense of wellness while preparing for conception or to experience the healthiest pregnancy possible. Having studied pre and perinatal psychology and birth, Aleks brings to her clients a profound sense of trust in their own bodies while supporting them in this tremendous period of transformation. Over the years Aleks has worked with over 3000 clients, opened and operated as Clinical Director at The Sanctuary Birth & Family Wellness Center, trained 25 student midwives, and has contributed to several documentaries and publications on birth related topics. She is also co-host of the popular women's health podcast Under the Hood https://www.underthehoodpodcast.com .
"Those of us who are surrendered to the bizarre hours, sleepless nights, and time away from our families do so because we are compulsively drawn into the realm where miracles exist and transformation occurs. We do so because we are virtual junkies for the essence of what’s possible in an empowered birth." - Aleks Evanguelidi
How do you work with clients? Model of care:
I use the holistic midwifery model of care when working with clients. What that really translates to is that I use a combination of functional nutrition and herbology when managing their health. Then, we address the whole person, the whole relationship and family structure when looking at the care experience my clients are looking for. Partners are not considered an accessory to the prenatal experience, they are integrated as much as they can be or are willing to be. Parents are given full informed consent so that they can make the choices along their journey that will aid them in feeling empowered and at the center of the decision making. Ultimately, it is my intention that they come through their care feeling like they have been heard, seen and empowered to make parenting choices by utilizing the agency that has been practiced during their prenatal care.
Do you need a doctor if you are working with a midwife?
Doctors can be wonderful for many things during prenatal care, especially for high risk patients. However, for most women who are low risk (btw, age is not considered a risk factor in midwifery care!) having an obstetrician manage the prenatal care is unnecessary. Midwives can do all the necessary cultures and labs required during care and tend to be much more thorough when it comes to labs. Midwives also spend between 60-90 minutes with each prenatal appointment which gives us a window to get far more in depth information that allows us to see risk conditions long before they present giving us an opportunity to change the course of a high risk condition. Most midwives refer out for ultrasounds, including the 20 week scan which is best done by a perinatologist. That being said, midwives can manage the bulk of prenatal care, referring out only when necessary or for backup and transport options.
Midwives imbed in the time spent with their clients opportunities to delve into birth preferences, childbirth education, and looking at previous health issues. We often create plans of care for clients with a history of depression so that the new parents can be well supported postpartum. Clients working with a midwife have full access to our cell phones and can text or call when the need arises. Since we take relatively few clients due each month, we have the luxury of time to spend with each client such that they feel supported throughout their care, the birth and the postpartum period. Most OBs after discharging the new parents won't see them again until 6 weeks postpartum, with very little communication in between. Midwives do home visits in the first week and spend time checking in so that we can identify what isn't working and create solutions for successful breastfeeding, optimal healing and a speedy recovery.
How safe are home births:
There is quite a lot of debate as to whether home birth is safe, or as safe as hospital birth. According to the largest studies and meta analyses done to date, perinatal and fetal outcomes of done births run similar to that as hospital births among the same population of birthing individuals. Midwives do not lose more babies or mothers. Because midwives work with a hand selected population and are excellent at assisting their clients to maintain their health, they are able to support their vitality in such a way that they have consistently good outcomes. Also, midwives who work in conjunction with hospitals or a back up situation in the event that birthers or babies need more care, tend to have the best outcomes. Rural midwifery settings or unlicensed providers tend to have more complications due to proximity of emergency back up care. The short answer: home birth is as safe as the provider is and should be measured not as a whole but from provider to provider and client to client. And while complications do arise in home birth settings, they occur far more frequently in hospital settings due to the high levels of interventions. Both midwives and doctors are able to manage complications when and if they arise. How they are managed is quite different depending on the training.
Why is there so much fear about home birthing in the US?
Birth is the great mystery in life. You can prepare like MOFO and still end up with complications, and you can do nothing to prepare, eat fast food and Ding Dongs every day and give birth in the 7-11 bathroom while taking a crap. Because birth is mostly hidden from our day to day reality and most people aren't looking at their own birth trauma, it is entirely possible to not even consider what kind of experience one would like until already pretty far down the perinatal rabbit hole. Also, most people aren't really embracing the experience of discomfort in their daily lives- consider that according to CBS News more than 1 in 3 adults were prescribed opioids in 2015 and the US consumes 80% of the worlds opioids and 99% of the world's hydrocodone. Our population fears pain and very little of the births we DO happen to see in the media aren't depicted as rays of sunshine. Add this to the horror stories of mismanaged birth experiences from our parents and there really isn't much positive information to draw from to help guide us on our journey. Where are the role models of strength and victory around natural and sacred birth? Who is talking about their beautiful and empowering experience? And those individuals that are sharing their experience feel anxious that those who have been traumatized by their experience might feel like they are being shamed. In the US, pregnancy is perceived and portrayed as a bomb waiting to go off at any moment and the Obstetricians that care for and manage most of the pregnancies in our culture are trained surgeons. Modern medicine has been painted as the "Save All" answer to the pain and physical suffering of humans, however, that in itself is a campaign based on nothing more than good marketing. Doctors appear as the authority of our health and well-being and a large audience of the population is more than willing to hand over our consent and our power for someone with "expertise" to manage a situation that is otherwise too overwhelming for us to embrace. It is more often than not that diagnoses and procedures miss the mark and complications result. There is a cognitive dissonance between claiming our health into our own hands and the residue of fear that permeates modern birthing.
What happens if there is a complication?
Licensed Midwives are trained medical personnel. We are not necessary for a birth where there are no complications. Midwives carry several certifications for the resuscitation of the newborn and are more highly trained than emergency medical responders in the complications of birth. Also, we are excellent at keeping our clients low risk because we have time to refine the diet and supplements that our clients take. Medical doctors receive zero education on nutrition in medical school, where midwives spend lots of time learning about nutrition. Myself, I was an herbalist and a nutritionist prior to becoming a midwife and I have
gone on to study functional nutrition and am in the midst of studying to be a GAPS practitioner which is all about gut healing.
What is a favorite birth story of yours?
Its difficult to pick one favorite birth. There are many moments that stand out as purely magical in the last 20 years of midwifery practice. Moments where the partner's jaw drops in awe as their child's head emerges from the yoni, the victorious point in labor in which the laboring mama gets her mind into focus and the strike of determination moves through her and she announces "let’s do this!" Another birth where the mother experiences waves of ecstasy...all of the moments where the phone rings at 2am in the still of the night and I know that even though my bed is cozy there is still something worth getting up for.
Do midwives work with doulas?
I freaking love doulas. Seriously. My doula saved my ASS in my own labor. Who else but a living angel would willingly put themselves into a potentially hostile environment to support empowerment and integrity of birth? Doulas are life savers, they are pure gifts. Everyone should have one if giving birth in the hospital. At home, they are delightful and make the whole process of birthing that much smoother for the whole team.
If someone wanted to do a Vbac could try do it at home? What are the risks and what are the pros?
VBAC births or TOLAC (trial of labor after cesarean) births are my favorite. And yes, they are safe at home, assuming that the placenta isn't implanted into the uterine scar and that 18 months have gone by since the surgical delivery. And of course, these births deserve extra care and awareness. For instance, we would never augment a VBAC uterus with castor oil or herbs to get things going so as to not add extra stress on the uterus. Extra monitoring in labor and earlier monitoring than usual would be prudent measures to take. The risk of uterine rupture for a VBAC mom is on par with a uterus rupturing even if there was no previous cesarean.
What are the pros of delivering in water?
Using water for delivery is a delightful way to reduce the sensations of contractions. There is a part of the brain called the homunculus; this part of the brain is responsible for translating the sensations through the neurons in the body. When a laboring person is suspended in warm water, the sheer amount of neurons firing all at once confuses this brain center, thus minimizing the magnitude of what might others be considered pain. Also, water is extremely helpful for aiding the tissues stretching at the time of pushing. we definitely see far less tearing of the perineum when we have a water birth.
What if baby poops and has meconium ? How do you handle that?
When there is meconium in the amniotic fluids, the first thing we do is observe how the baby is handling labor through doppler monitoring. Through my experience over the last 2 decades (about 1,000 births) is that full term (40 + weeks) babies tend to have meconium in their waters because their gut is more mature and any major stress (such as cord pinching, the sensations of labor) might make them release their bowels. This doesn't mean that they can't handle labor or that they are in trouble, it just means that they are more mature and ready for life outside the womb. It is important to assess whether laboring at home is still a prudent plan. If babe is not having issues with the contractions and is handling labor well, parents can choose through informed consent if they feel comfortable staying at home with the understanding of how the levels of meconium in the waters might affect the baby should they aspirate the fluids before delivery. Over the last 1000 births I have attended out of the hospital, I have only transported one babe for meconium aspiration once, and there was no obvious meconium in that particular bag of waters. However, I have probably attended 50 births at home WITH meconium stained waters with no complications. This dissent mean there aren't sometimes risks associated with meconium in the amniotic fluids. It should be treated on a case by case basis with each client being given counseling on the risk levels before assuming there will be an issue.
What are your top hacks for having the dream birth?
Absolutely find the midwife of your dreams. In a town like Los Angeles, there are many options to choose from. Meet some of them! Even if birthing in the hospital is the best option for you, you can compliment your care with a midwife by seeing them a few times during your pregnancy to create a well rounded experience and supplement the standard 7 minute appointment with your OB. Midwives take the time to unpack the concerns of your prenatal experience. They can focus on nutrition and help you get to the birth experience you want. Also, midwives will go deeper into your bloodwork, reducing your risks of blood loss and supporting an easier transition to postpartum. The next best thing you can do is to take a childbirth class such as Bradley or Birthing from Within. And lastly, but not least- Hire a doula. Even though I am a midwife, I had a doula and she made my birth experience. With her expertise and experience, I was able to delivery vaginally, which for me, having fibroids blocking my babe's ability to descend, was a legit miracle. I was so grateful to have someone who understood the nuances of the pelvis. Doulas are the best, assuming you find someone who is the right fit and has solid experience to draw from.
To lear more about Aleks follow her on instagram @thevitalwoman or check out her website https://www.aleksevanguelidi.com