[00:00:00] Dr Renee White: Knowledge is power, and we are all about empowering the mamas of the world. In each episode, we will unravel and interpret the latest research and evidence based practices for pregnancy, postpartum, and motherhood. As mums and researchers ourselves, we have experienced firsthand the overwhelming complexity of information, myths, and those classic old wives tales.

[00:00:27] Dr Renee White: I'm Dr. Renee White, and this is The Science of Motherhood. Hello and welcome to episode 151 of The Science of Motherhood. I am your host, Dr Renee White. Thank you so much for joining me today. For all those keen observant listeners, you're probably wondering, hold on a minute, don't we normally do check in Tuesday episodes this week?

[00:00:48] Dr Renee White: Uh, you would absolutely be right. Uh, however, we are interrupting the normal programming for something a little important. It is pretty breaking news. It is the changes in legislation to private midwives and we thought. That we would have none other than the wonderful Kelly Langford, who is the founder and midwifery leader at Mama, to come on the podcast and talk us through exactly what that all means, because this has essentially been 13, 14 years in the making.

[00:01:26] Dr Renee White: And so this is some really important changes to our laws here in Australia. Um, and so it can have major, major impacts to you if you are pregnant, um, or thinking about, um, becoming pregnant. So we thought we would fast track this episode cut into the normal check in Tuesday programming to bring that straight to you. Because that is what we love to do here at the Science of Motherhood, that is the whole purpose, which is to take all the fast breaking news, cutting edge resources and research, and bring it straight to you, the listener. So in today's episode, you are gonna hear from the lovely Kelly. Kelly, she completed a Masters of Midwifery in 2013 while she was running, um, the Mama practice.

[00:02:21] Dr Renee White: While she was maintaining a full time caseload, like holy moly, this woman is an absolute machine. She continues to run the largest private midwifery practice in Victoria that spans across three locations, employs 10 midwives alongside some wonderful allied health and admin support service team.

[00:02:43] Dr Renee White: You will be familiar with Sarah, who is one of our lactation experts in the Full Cup Village that we have. She practices at Mama and you'll hear in the interview that Mama was the very first organisation that took Fill Your Cup on as a bit of a partnership. I was living in Kensington at the time and Mama's, I guess, hub, it's primary hub is in Kensington and I reached out to them and said, Hey, do you want to work together?

[00:03:19] Dr Renee White: And, um, yeah, they said yes. And, um, we've been working alongside each other for the past four years and it has been absolutely amazing to work with these women. You will also hear in this podcast chat with Kelly about how I guess the roles of midwives have evolved, um, her personal experience, professional experience, and I guess what has led her to develop this amazing team at Mama and shift into private midwifery practice.

[00:03:56] Dr Renee White: And then how as a leader, she has I guess seeing the pain points of, of being a midwife, the, you know, as I think we talk about it as mother lovers a lot here in this sphere, and it can be quite exhausting. And so Kelly has started a sustainable midwifery model at Mama, which really enables the private midwives to be kind of, you know, employed and also obtain that work life balance, which is so, so important.

[00:04:31] Dr Renee White: Kelly and I kind of chatted a little bit more offline about that and, um, and how we manage Fill Your Cup as well, which is another one of the major reasons why I started the village. Um, the Doula village which was because I could see a lot of burnout. I could see a lot of people who weren't used to like working in silos where they were sole practitioners and didn't really have anyone to talk to and, and, um, you know, bounce ideas or just debrief with right.

[00:05:03] Dr Renee White: And so Kelly runs a beautiful, um sustainable model there at Mama and you'll hear all about that chat. It is the start of December. I have to say it, and I've been saying it for a couple of months now. We are already well and truly taking bookings for our doula practice, um, across Tasmania, Victoria, and New South Wales. If you are pregnant, um, and you want Um, and you're thinking, Hey, I want someone in my corner at my birth who does not leave my side and is essentially my, um, birth BFF and cheerleader, then you might want to consider having a birth doula.

[00:05:44] Dr Renee White: If you're someone who is a little bit anxious. and uncertain and you might be a first time mama and you're like, uh, I don't even know how to hold a baby. Like, how do I feed a baby? How am I going to get sleep? How am I going to change, you know, the baby while struggling like life and chores and relationships and all of that fun and exciting stuff. How am I going to do this? If you're feeling that you're a little bit lacking of confidence. You're a bit anxious about it, but you want to actually feel more confident and step into motherhood with, I got this, then maybe a postpartum doula is for you. I think some of the typical conversations I have with people, when we first have a chat is, you know, I've got a really supportive partner and I love my family and my parents are great, but I just want them to be grandparents.

[00:06:46] Dr Renee White: You know, I, I, I don't feel comfortable asking them to throw a load of laundry on and I'm not 100 percent sure that, you know, the advice that my mum's going to give me is the right advice because she had kids 30 years ago, like, oh my God, I just need someone to help guide me. I need someone to support me. I need someone to listen to me. I want to be heard and I just want that real kind of impartial, you know, advice. From another mum who's been there, done that, got the t shirt. So if, if that's something that you're feeling right now, then maybe you might want to consider having a postpartum doula. We essentially come in, um, three hours.

[00:07:33] Dr Renee White: Typically it's every week, but it can be more than that. We cook beautiful meals for you, stock your fridge, stock your freezer, give you opportunity to nap, go have a shower, hold your baby, do all those things. So, if that sounds like something that's up your alley, head over to our website, ifillyourcup.com and you can have a look at some of our offerings there under our pregnancy, birth and postpartum doula packages.

[00:08:05] Dr Renee White: If you've got any questions, you're not sure, let us know. So just hit me up, DM, contact me through the website. So on our homepage, if you just scroll down, there's a message box there that you can send me a message and just go, Hey, can you give us a call or explain this a little bit more to you? Happy to do that. Alright. Let's dive in to today's episode with Kelly Langford. Hello and welcome to the podcast, Kelly Langford from Mama. How are you?

[00:08:38] Kelly Langford: I'm, well, thank you, Renee. How are you?

[00:08:40] Dr Renee White: I am excellent because I am speaking to you this morning, um, which we've already said offline, it has been way too long between drinks, um, for us to catch up, um, for all those playing at home. Mama is an amazing, uh, midwifery practice. And I was saying to Kelly offline that Mama was the first organisation that really went out on a limb for fill your cup in our very, very early days. I reached out and said, Hey, Can we be doulas for you guys? And Jan, who was also there at the time and people would, they can go back to her podcast, Jan Ireland's podcast.

[00:09:25] Dr Renee White: She brought me in and interviewed me and grilled me and it was fascinating and exciting and terrifying all at the same time. But you were the first organisation that we partnered with, so I have a very soft spot for you and, um, everyone at Mama. So with that said please, Kelly, introduce yourself, tell us who you are, and a little bit more about Mama and the practice that you're running.

[00:09:52] Kelly Langford: Oh, thank you, Renee. I, um, I am Kelly Langford. I am one of the original founders, um, and directors of Mama, and we were the first private midwifery practice to open in Victoria, um, the second in Australia at the time, and since the opening of Mama, I have also become a mother, so I have added that to my, um, My agenda.

[00:10:15] Dr Renee White: Yeah. I have grown a human being.

[00:10:19] Kelly Langford: I have in fact, a business baby and then 2 human babies. Um, so part of, you know, part of my, a huge part of my life now is, is my work, but also, of course, my, my, uh, relationship with my children and my partner as well, which I feel like over time. The business has grown to allow capacity for that, but not only myself, but the other midwives.

[00:10:48] Dr Renee White: That, I think on that point, I would love to know. First of all, like, why did you become a midwife? Was there something in your life that was kind of that pivotal moment or was it something that you kind of slowly progressed into? And then why also private midwifery practice? How did you transition to that?

[00:11:14] Kelly Langford: Right, so when I was in high school, I always knew that I wanted to do something with something sort of human body biology related. That was always my favorite subject at school, but I didn't really know what direction I thought marine biology might actually be where I wanted to go

[00:11:29] Dr Renee White: Or want to be marine biologists and swim with dolphins.

[00:11:32] Kelly Langford: I think so. But then I realised I was actually quite scared of sea creatures. So at some point I realised that that wasn't actually the career I wanted to do. And when I was in year 10, I did a placement and flooded a lab, um, that I was in. So I thought, no, this probably isn't the right career path for me.

[00:11:51] Kelly Langford: But around the same time, my cousin had twins. And she had them at the women's hospital. I remember going in not long after she had birthed the twins and twins run in my family. There's multiple sets of twins. And so she birthed them and she was in the postnatal ward with a midwife lactation consultant.

[00:12:11] Kelly Langford: And, um, I sat and listened to this midwife, help her breastfeed the twins. And I just thought, wow, that's, that's what I want to do. That's really cool.

[00:12:21] Dr Renee White: Wow. So that was quite young. Like, you were just like, yeah, this is a pivotal moment, like core memory for you. Yeah.

[00:12:29] Kelly Langford: Yeah. That was really that I had no idea it was a career at that point. And then, yeah, that's when I realised that's what I wanted to do. So I did the double degree at La Trobe, went through the degree quite happy with what I was doing, knowing nursing was okay. Midwifery was my, my passion, what I wanted to do. Did a grad year at a major maternity hospital. And by the end of the grad year I found myself in the, um, handover room, midwife in charge would read out who was coming in and who was in there in labor. And I found myself hoping to get the woman who already had the epidural.

[00:13:07] Dr Renee White: Okay.

[00:13:08] Kelly Langford: And at the start of my midwifery career, that was definitely not what I had hoped to be doing and who I'd hoped to be looking after. I was, you know, very excited about having women in labor, but by the end of my grad year, I was feeling so unable to practice in the way that I wanted to that. I felt like if I have someone with an epidural, it's already done. I can just sit with her and work with her for the day, but there was something about not feeling like I was able to achieve what I could in the interactions. I did and feeling quite powerless as a midwife in that setting So I actually did a transition program to the children's hospital worked in E.D. at the children's for six months as a nurse Just trying to see if that's what I wanted to do because I felt burnt out in the midwifery space.

[00:13:55] Kelly Langford: Yeah, but quickly realised nursing is okay but midwifery was what I really wanted to do. So thankfully I was still doing shifts at the at the hospital at that point at the women's and a midwife that was working there and also in private practice, um, Fiona Hallinan saw that I wasn't happy and said, hey, do you want to just come along to a home birth and see what that's like?

[00:14:18] Dr Renee White: Yeah.

[00:14:19] Kelly Langford: And in my midwifery degree, I hadn't had any exposure to home birth. I actually didn't know that people were doing them. Yeah.

[00:14:27] Dr Renee White: Did you think it was like a bit, not like woo woo, but like a bit out there? Like, You know, were many, I don't know what the stats are around.

[00:14:34] Kelly Langford: Yeah, no, it was, it was not common. There were no home birth, hospital based home birth programs. It was, you know, only a few, really a handful of midwives, Jan included doing home births in, in Victoria at that time. So it was really sort of more underground, I suppose you would say. You didn't get exposure to it in the system, in the main system.

[00:14:52] Dr Renee White: Yeah.

[00:14:53] Kelly Langford: So, and I really loved and trusted Fiona. So I was like, yeah. Um, I'd love to come along. So it was her and GP obstetrician Peter Lucas that was working at that time that were at the birth and that was another pivotal moment in my life. I just essentially gave up my jobs and Jan and Fiona were working together and so they both mentored me into private practice.

[00:15:15] Dr Renee White: Yeah. Wow. Just off that one, like I can't even imagine what that would feel like. Like it was, it's, it would almost be like everything coalescing together and you're like, this is the missing piece. Yeah. This is, and, and also I think, you know, I don't want to put words in your mouth, but I can only imagine it'd be like, Oh, this is what happens when we pull all the red tape off and we just let people's bodies do what they need to do. Right.

[00:15:46] Kelly Langford: Yeah, absolutely and it was, it wasn't only that it wasn't only the beauty of the physiological birth, but it was feeling like I had a place in the space as a midwife to be able to support this person, and she was in charge, whereas it did not feel like that when I was working in the hospital system. It felt like I was having to read scripts to people and follow policies and that they were never really in charge.

[00:16:12] Dr Renee White: Yeah.

[00:16:13] Kelly Langford: And so, yeah, it was really another pivotal moment and from then on, I was working with Jan and she would pick me up in the morning, take me around Victoria. This is before we had endorsement or Medicare, before we had a clinic or anything, had a little clinic at the back of her house. And we'd just spend hours in the car and going to home visits and that's where I think my real midwifery learning began. Hmm.

[00:16:40] Dr Renee White: Wowsers that, yeah. And I think, as you say, learning alongside, I'm gonna call them the OG yeah, Jan and Fiona. Like that. Holy moly. That would've been amazing to see. Yeah. Okay. So you are cruising around Victoria with Jan.

[00:16:59] Kelly Langford: Yeah. 2009.

[00:17:01] Dr Renee White: Yeah. Is, is this the evolution? Like how does this evolve into Mama.

[00:17:07] Kelly Langford: Well, I think, I think for every midwife, it's their dream to start their own practice. I feel like I've come across many midwives that wouldn't love to do some sort of, you know, practice, whether it's home birth or just, you know, community clinics. I feel like it's a fairly common passion. Something that I've talked to my, my friends about at uni, it was, you know, something that, oh, wouldn't that be amazing if we could do that together. But for Jan, it, you know, she was already in her own private practice. And it was when the maternity reforms came in 2010 and allowed us to access Medicare rebates, prescribing rights, ultrasounds, blood tests that we could all order ourselves. That was the, the point where Jan said, actually, I think we can do this. We can, we can start a clinic and, you know, make this a bigger thing than just a couple of ladies show.

[00:18:03] Dr Renee White: Couple of ladies driving around VIC, just helping other mamas out. Yeah. Okay. That's interesting. So, yeah, it is this thing where. They start because we're going to get to some other recent changes in legislation to do with midwifery practices, but it does appear to be this like loosening of the reins from government that's kind of, you know, you get this cascade domino effect of, okay, now here's all the things that we can do. So there's those reforms. You guys start thinking about starting Mama.

[00:18:40] Kelly Langford: Yeah, we sort of started thinking about it and yeah, we started thinking about it and also started it all sort of at the same time, I think it was sort of went from an idea to, um, to opening within the year. Um, so, 2010 was, was the year that it was announced and the year that 2011, we started, um, we opened Mama our first Mama in Kensington.

[00:19:07] Kelly Langford: So we'd gone up to see, um, Liz Wilkes at My Midwife, she had the 1st, um, clinic open in Australia. Um, so we went up and saw what she was doing there and we felt like we wanted, she offered if we would like to become a My Midwife's clinic, but we felt like the other part of the practice that we really wanted to, um, to have as, as, Um, holistic practice was all of the allied health practitioners so that people could come in and see a midwife, but also see a number of other allied health practitioners that were specialised and really committed to this area of practice, including doulas and a whole lot of other allied health clinicians. So it was sort of more than just the midwifery part of the practice that we wanted to focus on, and that sort of holistic collaborative model

[00:19:59] Dr Renee White: And I think that, like, we, we, we've seen this, um, I think in, like, at least the last couple of years really ramping up, um, where you've seen these models, that are like hubs now. You know, you've got the whole village there. You've got lactation consultants, you've got massage, osteo, um, you know, pelvic floor they're all in the same hub. I think people are really, I think, understanding that one, we've lost the village. Um, that we would typically have, but also it benefits from having everyone in the one place because who the hell wants to cart their kid around to multiple sites when really, and I see this time and time again, the benefits of having people working in the same practice who can, like, nick out of one session and be like, hey, can you just come in here?

[00:20:56] Dr Renee White: I think there's something else going on. Yeah. You know, you get what I mean? Like when we're complex species. Yeah. Um, sleep revolves into feeding, which evolves into, you know, maybe we've got pelvic floor issues, which evolves into maybe we need some, like acupuncture or something like that. And you guys were you, you were ahead of the pack,

[00:21:21] Kelly Langford: Well, yeah. I mean, in, in the early days it was actually quite difficult to, to have all those practitioners around and to feel like as midwives, we I really hate charging money for our services. It's actually the hardest.

[00:21:34] Dr Renee White: I think it's a woman thing as well. Right?

[00:21:36] Kelly Langford: Yeah, it's a woman thing perhaps it is, but actually then also saying, oh, we've got this, you know, other person that you should see and this other person. So, it took a while to get over that and it didn't take long, actually, because as soon as we said, oh, you've got that pelvic pain, go and see the chiro or the osteo and they would, and then they would see how beneficial it was and keep seeing them. It wasn't like, you know, it didn't take long for people to realise and for us to have that feeling sort of put down to rest because it is, it's the value of having all those, those practitioners that know what they're doing and that love working in this space.

[00:22:11] Dr Renee White: Yeah, exactly.

[00:22:12] Kelly Langford: So valuable.

[00:22:14] Dr Renee White: I want to talk about the evolution of, I guess, midwifery practices. We hear about terms like, um, endorsed midwife or eligible midwife. We hear, you know, as we've kind of already touched on, home births. For some people, and I'm going to only talk about it from personal and kind of anecdotal experience, is that I noticed that when COVID hit, particularly in Victoria, I'm going to say Melbourne, because we were, we are worse than the world.

[00:22:49] Dr Renee White: There seemed to be this real shift, um, and also, uh, taking back of power for mothers in the sense that we had the hospitals changing policies like week on week or day by day, really. And then, like, a lot of pregnant mamas going, you know what, you can jam it. I'm not doing it. It's not happening. I'm having a home birth. And so I saw this real kind of pendulum swing from not doing the hospital, which is typically the standard practice, right? To, no, I'm going to, I'm going to do this in my own home and this is what I'm going to do. Have you, I guess my first, first part of my question is, have you seen that transition as well, like this uptick. And secondly, Can you explain, like, what's involved in terms of finding a midwife? You can't just like have anyone or can you have any midwife? Do they need to have a special qualification for a home birth? How does that work?

[00:23:55] Kelly Langford: Yep. Okay. All right. I'll go into the first.

[00:23:57] Dr Renee White: That's a big question.

[00:23:59] Kelly Langford: It is. And you might have to remind me to get back on track. So I think, yeah, women have always been fighting for, for what they want, but I feel like there's been a perfect storm of things coming together, things happening over the past couple of years that has meant that change has happened. Seemingly quite quickly in the last couple of months, there's always been rallies.

[00:24:24] Kelly Langford: There's always been, you know, women fighting for better care or for, you know, less intervention or whatever. The thing is more, more birth centers, there's more home birth, more publicly funded models. Um, but I think COVID definitely, um, made that more apparent for people that the, it's so, obvious when you're getting not when you're not getting good care with people that you know, are not allowed to enter the room Yeah, really taken away that care altogether versus people that were then choosing to birth at home in that time that were able to you know access practitioners and have people in their space and felt quite safe in that space.

[00:25:03] Kelly Langford: So there was a bit of a shift in the tide in that sense. Also the parliamentary inquiries into birth trauma, I think have come at, you know, just the right time for that to be more in the public eye. People saying actually that happened to me too. Um,

[00:25:19] Dr Renee White: And also people not realising that they have choice as well. Like they can say no to things. I was one of those people. I was like, Oh, I didn't realise I could, I could actually say no.

[00:25:31] Kelly Langford: Yes, yeah, isn't that incredible when you, when you know now, but that is the majority of the population that they're handing over the, the everything to their care providers to midwives included a lot of people will come to us and just, you know, they, you're looking after me, I'll listen to what you say. Less so because usually we get very informed people that are that are already empowered and ready to make the decision making. Yeah. So the, the parliamentary inquiries, I feel like have helped. I spoke at the Tasmanian one recently.

[00:26:05] Dr Renee White: You did, I saw that.

[00:26:07] Kelly Langford: And it was, yeah, it was hard to talk. About all of the trauma that I've witnessed or heard about, but I think this is what's so important. And this is what's going to keep pushing things forward at that that level that, um, political level, because that's where the change needs to happen. So, the things that have changed in in this month, actually, that have come into legislation this month, the first one is that they've taken away the collaborative requirements for midwives. So what that means in simple terms, midwives that are working in private practice have access to Medicare and writing prescriptions and doing writing ultrasounds and blood tests. But for the last 10 years or 14 years, since we've had access to Medicare, we've also had an arrangement in place where we've had to have a referral from a GP obstetrician or a collaborative arrangement with a hospital to be able to use those things to be able to use Medicare and to be able to write a prescription and ultrasound with.

[00:27:07] Kelly Langford: So there was almost a barrier in place and that's what it became. It wasn't intended to be that. It was intended to make this arrangement between midwives and other obstetricians and doctors easier. A pathway for referral easier that actually became a barrier for people to access midwifery care, because they might have trouble getting a referral from a GP or an obstetrician, or sometimes they would see that person and then it wouldn't be weeks before they would be able to see a midwife, because they'd already had their initial care with the GP. So that's been taken away, which is massive um, for women and midwives we've had so much fun since the 1st of November, just saying, walk in the doors, see a midwife. You know, we've had so many clients just walk in, just peed on a pregnancy stick, got two lines and they're coming to see a midwife. And it's just something that, we always dreamed of when we first started, Mama was people could just come in and see us anytime.

[00:28:07] Kelly Langford: No barrier of referral and that's just a massive step forward for midwifery in Australia. So that's excellent. And the other thing that was confirmed that day was that we will have an insurance product for home birth that will be fit for purpose. So, since I've been working in private practice, so the last 16 years, but it was a decade before that as well, that private midwives haven't had access to insurance for birth at home. We've had an exemption in place, which means that the government has allowed us to practice without having insurance because there's no insurance product available. But at the start of this year, the government committed that they would, um, be backing an insurance product for private midwives for home birth, but with the announcement came a criteria list that would have meant that about 70 percent of our current clients and Mama would have been risked out of our care.

[00:29:05] Kelly Langford: So, we, and many, many other practices in the Australian College of Midwives and the ANMF have done lots of advocacy work in the past months, and on the 1st of November, it was confirmed that they're taking away the criteria. Which means that we're just going to be able to continue practicing in the way that we are. And theoretically, we will have access to an insurance product for birth at home that will cover our practice.

[00:29:30] Dr Renee White: That's amazing. Now, just to clarify, is that Victoria or is that Australia wide?

[00:29:35] Kelly Langford: Australia wide. Yep. Yeah, that's across Australia. So it's, it's a, it's a massive win and I think that, you know, there'll, there'll still be bumps along the way and there'll still be things that we'll need to sort out and iron out. But in what I can see it looking like at the moment, it's a really big win. But there is still the barrier for midwives getting into private practice because currently you do need to have 5, 000 hours to be able to become endorsed and you're not able to have the exemption for insurance, unless you're an endorsed midwife.

[00:30:13] Dr Renee White: Can you explain what an endorsed midwife actually is?

[00:30:16] Kelly Langford: Sure. So, originally we were called eligible midwives, but the language changed. So, eligible is the old word for endorsed. And endorsed essentially means a midwife who has done ticked, the boxes that has made them eligible to have access to Medicare and prescribing. So boxes we need to ticker that we've worked across the scope of practice for a minimum of 5, 000 hours post graduation. So I know that the APHRA have a bit of a buffer of the 5, 000 hours. So I've heard midwives can do about four and a half thousand hours and get considered for endorsement. You have to have insurance in place and insurance is the exemption is in place for the home birth part of insurance. So midwives that want to go into private practice, unless they come into a practice like Mama, where we have insurance for the company and we can employ the midwives into the private practice. And there's currently eight practices across Australia that I know of that have this company insurance.

[00:31:19] Kelly Langford: Unless you go into a practice like ours, you have to wait until you've done the 5, 000 hours and the only way you can get those hours is in hospital.

[00:31:27] Dr Renee White: Yeah, yeah, that was going to be my question. I would, yeah, imagine that that would all be coming from hospital. And I can't imagine, like, very similar to your personal story, Doing 5, 000 hours in an organisation that just really doesn't sit well with your values can be quite frustrating.

[00:31:46] Kelly Langford: Yes, exactly. Yeah. So there's only, I mean, we've just started employing midwives in the last two years because we've moved across to a different model of care. For the first 12 years that I worked in private practice, I worked in what I'll call the traditional model of private practice. Um, we're on call seven days a week. You own your own business. You're a subcontractor to, if you work for a company like Mama, you would subcontract to the company. Um, you look after your own tax and BAS and, you know, everything. Um, and you get your own insurance. So that was, that's the traditional private practice model and it's still most midwives in Australia.

[00:32:26] Kelly Langford: That work in private practice work in that way, and you can do mentorships through a number of midwives online to work in private practice in that way. But again, that's a barrier for a lot of people, because to be able to set yourself up in private practice and have enough income to begin with to pay for the insurance and while you build up a client base and do you work in hospital at the same time and then do you have someone else in, in the community that can be your second midwife or backup or can back you up if you're sick.

[00:32:57] Kelly Langford: So part of the reason that we started this sustainable midwifery model was because I myself went through having children and really wanting to, well, needing to work in this model. I'm not going back to working the hospital model as much as it may have changed in certain pockets. This is where, where I'm going to be forever. So I felt like there had to be a way that midwives could not just devote everything to midwifery if they wanted to work in private practice in this, in this continuity model, that there had to be a way that you could have young children and still support women and have this beautiful connected continuity relationship, but have backup and support.

[00:33:42] Kelly Langford: So Jan's always given me backup and support when I had my children and I came back if I wasn't available, she would, she would be there for me or sometimes should come to birth and look after my kids while I would be with the client. I felt like there had to be a way that we could make that possible for other midwives. So that's part of the reason for the sustainable midwifery practice, but also so that we can employ midwives and they could get the benefit of what you get in the public sector and the private hospital sector of having sick leave and holiday leave and not having to think about running your own business that you've got a stable income.

[00:34:18] Kelly Langford: And so. The midwives that work in our practice now, um, all of them are employed apart from one of our OG midwives, um, Marita, who's still very happily working in the subcontractor model and having her own caseload, but we still back her up and support her if she's unwell or has holidays, of course, but all the other midwives are employed and they work whatever EFT suits them and their family life. Majority of them have young children, and if they don't, we still very much encourage them to have their days off and to have other activities that keeps them happy and, and balanced humans. Um, so a lot of the, the work that we do when we're having midwife team meetings is talking about, you know, what are we doing to fill our cups and making us feel like we can continue to do the work that we do, that we love and give so much of our body and soul to, because you don't go into it for any other reason.

[00:35:15] Kelly Langford: So it's, yeah, it's been two and a half years now and we've tweaked it. And I feel like the model is working really beautifully for those midwives. And it also allows us to get on board early career midwives that we can mentor. So we've got two grads starting next year that I'm really excited about having more of a structured program for them that we've always had midwives come on board as mentees and, um, working towards endorsement, but this feels like it's a commitment because we advertised it as a grad mentorship program and it feels like it's, we're really going to be starting a new, a new exciting model next year.

[00:35:56] Dr Renee White: That is absolutely amazing, because, I mean, like we touched on earlier, it's, I feel like whenever it's women looking after women, it's very hard for us to get over that bump, typically, of having to charge an amount, you know, a financial kind of dollar, and it's something that we spoke about, um, in our training as doulas quite extensively. And I see it time and time again, you know, with new doulas coming on board, you know, they're quite green and they're like, oh, I don't feel like I can charge anything because you know I don't know a lot or like I just I feel like we should just be I think the mentality is we should be doing this anyway, I can't negotiate in my head why I'm charging for this and it's this conundrum I think we come up against because we have lost that village.

[00:36:54] Dr Renee White: And typically, you know, we would be seeing with our mums and aunties and cousins and all the rest of it, and we would be looking after one another. But I think, you know, times have changed. And so we get this on one side. this beautiful energy of like, I need to help, I want to help mothers. But if you don't charge for it, then how are you looking after yourself and your own family? And then you get burnout. Like, and you would have, like, Burnout in like the mother, I call it the mother lover sphere, you know, is so right, you know, like I, that's one thing I'm very cautious of with our doula practice, because I'm just like, you know, we've got to be so careful how we structure, um, clients and, and things like that.

[00:37:46] Dr Renee White: And I can, I can see, like, I'm not even in the same state as some people and I'm like, you need to slow down a bit because I can see that, you know, things are spiraling.

[00:37:57] Kelly Langford: Yes. And then if you burn out, you're no good to anyone.

[00:38:01] Dr Renee White: Exactly. And most importantly, you're no good to yourself and I'm all about prevention is better than treatment. So, I'm just like, just don't. Just don't go there. Don't jump off that cliff and like think that you can help everyone because you can't. And I'm not sure, like, I would, I would imagine that it would be very similar. And I can already hear from like the things that you've said, but we have a mantra here at Fill Your Cup, which is family is family comes first.

[00:38:28] Dr Renee White: Yeah, we love our clients to death, but at the end of the day, if you have an emergency and like, it's beautiful how you structured Mama in the sense that like, you know, if you at the end of the day, we can have these jobs and they're great and they're fulfilling and they're amazing. But if we don't have our beautiful connection and bond with our own family, then what the hell are we doing?

[00:38:55] Kelly Langford: Yes.

[00:38:55] Dr Renee White: No, it doesn't make sense anymore.

[00:38:58] Kelly Langford: No, it doesn't. Yeah. We really need to have that happy, balanced, you know, people coming to their, to their jobs with full hearts from where they've come from to be able to give what, what we do give without burning out. And and that's what I'm so excited about being over time with this model that I'm hoping that we can get that balance and then be able to replicate it in other with other people because we've got so many midwives daily calling, emailing saying, you know, I want to set up a Mama and I just, I'm not ready yet.

[00:39:37] Kelly Langford: Yeah, I need to make sure that we've got the, all of the parts right to make sure that we can say, yes, this is a model that's going to work. That's going to be sustainable that, you know, if you've got these pieces and you, you put them all together, you should have a practice that thrives for decades. Um, and that you can keep working in because we have over, over the past 14 years set up clinics in Queensland and in multiple places in Victoria, and without having that sustainability built into the practice, they just, yeah, they shut down and that's happened with a lot of practices over Australia since we've opened. So, that's what um yeah, the new passion.

[00:40:15] Dr Renee White: I have a question. Yeah. Because this is the business brain in me. Um, what are the thoughts around a birthing centre? Is that something that Mama has ever explored or is that something where you're just like, no, that's not really our jam.

[00:40:31] Kelly Langford: Yeah. So we would like to, we've thought about it over the years and there are a few spaces in Victoria that you can birth at, but to actually call it a birthing centre, there's a whole lot of legislative hoops that you have to jump through and criteria that you have to meet. Including, you know, medical oxygen on site. Um, a whole lot of criteria of who is there on site at all times and things that I think the cost benefit of it.

[00:41:01] Dr Renee White: Yeah, right.

[00:41:02] Kelly Langford: For a small private practice, if there was, you know, philanthropic funding and people to be able to set it up, perhaps that would work.

[00:41:09] Dr Renee White: Shout out to anyone who's listening.

[00:41:11] Kelly Langford: It would be a dream. I mean, it would be incredible to have birth centres set up again across Australia. And that's, you know, hopefully part of what these parliamentary inquiries do start to realise that there are spaces for practices that are in between the medical model and the private model that that birth centre model might be reinvented again. Hopefully, but yeah, we just don't have the the money or the capacity to set up a birth center. People have birthed at our clinic. Oh, okay. But they're officially considered home birth and we have the same equipment that we have. at home. So yeah, with the understanding that they were birthing at home at the clinic.

[00:42:08] Dr Renee White: Wow. Okay. All right. Um, one last question before we jump into our rapid fire and it's around, I guess, uh, again, it's this understanding of, um, choice and, and what people are getting into with a private midwife. Because I had, um, Tess from Nurtured Bayside on a few episodes ago, and we were talking about this concept of, if you have a home birth and your private midwife is there, if you have to be transported to hospital, the notion of her still being able to maintain that role as a midwife and I forgot what it's called is it

[00:42:53] Kelly Langford: credentialed when your credentialed in the hospital

[00:42:56] Dr Renee White: Yeah yeah I feel like there was another word for it but let's go with that is that what is that what like is that what if someone signs up with you guys are you guys still able to then continue being their midwife in the hospital

[00:43:12] Kelly Langford: I'd like to say yes and no.

[00:43:14] Dr Renee White: Okay.

[00:43:17] Kelly Langford: Officially, in terms of insurance, no, the hospital midwife is the person who's responsible for the client when we get into hospital, we did, I actually got credentialed at one of the hospitals many years ago now, and there's, we've decided for a number of reasons not to do the credentialed model. Yeah, So, one of them, well, I'll list them. Many reasons that we decided not to continue with credentialing is that it costs the client a lot more money to, for us to be the primary carers, because then they become private clients. So the hospital also bills the client. It also means that we have to, well, with the hospital that we're working with anyway, we were bound by their criteria and their policies and protocols.

[00:44:08] Kelly Langford: We also were asked to do a shift a month at the hospital as part of the staff, which majority of my team cannot, don't have the time capacity to fit into their full time workload. And what we also thought, although we didn't, we, we never actually got to see this in practice, but once we become the practitioner in the hospital, we have to do all of the computer logging, all of the blood pressures, fetal hearts and everything that the hospital midwives currently are doing for us.

[00:44:43] Kelly Langford: So it takes away from us being able to be there with the client. Right. In our current model. They don't get billed by the hospital. We're able to be there with them, but not having to park away at the computer and fill in all of the tick boxes that the hospital requires, because there's a lot of additional paperwork that the hospital requires.

[00:45:02] Dr Renee White: Oh, I can imagine.

[00:45:04] Kelly Langford: And, um, it means that we don't have to do those extra shifts in the hospital and that we actually don't have the time or capacity to do anyway. So when we step into the hospital, we're still recognised by the client as their primary carer but officially, the hospital is responsible for the client's care, and I think it actually works quite beautifully for the most part, because we've been doing this work for over a decade in Victoria. So, the hospital's known them and advised really well, they know that when we transfer, we're not transferring with someone that's, critically ill, um, you know, we're usually transferring well in time and we can be that sort of negotiating middle person between the client. Who's got, you know, their, their values and their ideas of exactly what they want the hospital.

[00:45:53] Kelly Langford: Who's got their values and exactly what they want and we can use our midwifery knowledge and our intimate knowledge of that client to talk to them about, you know, in this situation, this is actually, you know. Something that we think is valuable for you to consider or, you know, this is a hospital policy and you can, you know, do whatever you would like to decide to do.

[00:46:19] Dr Renee White: It sounds like you almost default to like a doula position. Yeah. Is that right? Like, yeah, because that sounds very similar to like birth doula. Obviously, you know, you've got a degree in midwifery, but okay. You know, like that advocacy and education piece, right?

[00:46:37] Kelly Langford: That's right, yeah. So it's like a doula but with the medical background, I suppose, to be able to interpret CTGs and all those sorts of things.

[00:46:48] Dr Renee White: Yeah, okay, cool. All right, I'm so glad we clarified that because I don't know like when it comes back to choice and it comes back to education for me because and I've been very vocal about this I had a very positive birth experience I chose to go with a private OB because I thought at the time that you get what you pay for and so I was like well if I pay a lot of money then apparently I get really amazing care and I did It did to the extent that I got to make my own choices. But the thing that like really spiraled for me is that I didn't feel like I had the education and I didn't feel like I had someone in my corner the whole time. And I was so naive. Like I honestly thought that my OB would be the person who would be there as soon as I walked into the hospital in labor and would be with me the entire time because I chose, like I specifically chose this person.

[00:47:52] Dr Renee White: I didn't just like go random and then to come to the realisation that I was like, I'm sorry, what? Uh, you're not going to be that person necessarily. Cause it could be someone else on call and hold on a minute, that person might not be there. Like I'm some midwife who I've never met before is what, like, I was just like, how did no one tell me this? And I'm sure they did in like a little, Oh, well, of course, like, that's kind of, you know, in the 30 page document that we gave you at the start. Um, but you know, what ended up happening was my brain spiraled. I like completely lost control and then I was like, okay, you're going to have to like cut this baby out of me because I'm not doing this.

[00:48:40] Dr Renee White: I'm absolutely not doing this. And so as soon as I got control back, I was like, well, of course, the OB that I chose is going to cut the baby out of me. So yes, I'm getting the OB that I paid for that I want, but it would have been so much nicer to, I think, to have developed a relationship that I thought I would have had with someone like yourself, a private midwife, who's like, yes, we're going to come to your home in a safe environment that you've lived in for like, you know, four years and not cart you off to hospital and like actually trust that your body can do what it needs to do.

[00:49:16] Dr Renee White: And I think the other important piece of this is because my husband, he said something to me, which is like a ding, cool memory, was that when I was spiraling, he said to me, you're not even in labour and I'm not sure I'm going to be able to pull you back from the edge of this cliff when you are in labour because you are already like on the edge. And he's a very strong person. He's very observant, um, very in tune with me. I'm a bit of a space cadet sometimes with my emotions. And so I, like, that was the moment for me where I was like, holy moly, like, the rock in this relationship is like, I'm crumbling. So that was when we were like, that's it. Elective cesarean. We're doing it.

[00:50:09] Kelly Langford: And, and for you at that time, that was absolutely the right decision. Yeah. And that's why, you know, you, you were in the right model for you at that time.

[00:50:16] Dr Renee White: Yeah, absolutely. Absolutely. And it's, it's interesting cause I, we actually do get a lot of mamas who come to fill your cup now who like I'm choosing to have an elective cesarean because I know you won't judge me because I've heard that you.

[00:50:32] Dr Renee White: You did the same thing and I was like, okay, whatever works, whatever floats your boat, because at the end of the day, like, if it's what you need to do to get that control back, then, then that's what you do. Absolutely.

[00:50:45] Kelly Langford: Yep. Absolutely. Yeah. And I think that's one of the, the beautiful things about the work that we're able to do in the private model is that around 70 percent of our clients plan to birth at home and over 90 percent of them have a physiological birth at home. And the rest of them choose to birth in hospital, but it's not that everybody that comes to us wants to have a physiological birth, wants to know epidural, you know, people are coming to us wanting to be empowered by their experience, wanting to know that they're the ones that are in control, or sometimes people don't come to us for that reason, but by the end of pregnancy, know that that's what they want, and that's what we're able to facilitate and, you know, um, It's still probably 85 to 90 percent of our clients that plan to birth in hospital would have a vaginal birth or a physiological birth just through decision making throughout pregnancy.

[00:51:42] Kelly Langford: But that's not our agenda. Our agenda is making sure that people are empowered and feeling safe and a feeling like they're making the decision that's right for them. And if that is an elective Caesarean section, we are 100 percent supportive of that. And, you know, celebrating with them and supporting them in the postnatal period, exactly in the same way as we would someone who'd made a different decision.

[00:52:05] Dr Renee White: Yep, love that Kelly. We are going to jump into our rapid fire. Are you ready?

[00:52:10] Kelly Langford: I'm ready. I think.

[00:52:12] Dr Renee White: Okay, here we go. First question. What is your top tip for mamas?

[00:52:18] Kelly Langford: Support. Getting support in whatever way that looks best. Like for you, whether it's family, friends, doulas, midwives, person down the street.

[00:52:28] Dr Renee White: Neighbour Bob, whatever it takes.

[00:52:31] Kelly Langford: Yep, yep, yep. So getting that community set up for when you transition into motherhood. Love it.

[00:52:39] Dr Renee White: Um, do you have a favourite, like, go to resource for pregnant mamas or postpartum mamas, whether it be a workshop, um, some people have even, um, spoken about, like, a poem or, you know, anything, any go to resource that you absolutely love?

[00:53:01] Kelly Langford: I have my own personal favourite, but I don't think it's one that a little saying that I love that I don't think speaks to everybody. And in terms of resources, that's, I would give people a list and talk about what can be valuable for different people. It's not one particular book, but my favourite saying is that, um, in transition to motherhood or in labor, mothers go to the stars to collect the souls of their babies and come back down to earth when they're born.

[00:53:33] Dr Renee White: Okay, well, we spoke about the fact that Jan is the only person who's ever made me cry on this podcast and that was very close, Kelly. Okay, that needs to be in a book of something. Have you, like, put that in writing? Like, you need to sell that or something, like, on, like,

[00:53:52] Kelly Langford: I'm certain I didn't come up with it, so I don't know where, where I saw it written, but it just, it is something that I truly believe to my core that is how, where mothers go when their baby's born.

[00:54:08] Dr Renee White: That doesn't make the reel for the podcast. I'll be very disappointed.

[00:54:16] Kelly Langford: I'm glad you like it.

[00:54:17] Dr Renee White: Um, that was very beautiful. I love that. Okay, I'm not sure people are going to be able to top that, Kelly.

[00:54:23] Kelly Langford: Well, someone will be able to tell you where it was originally from. I can't, I can't claim that I made it up, but I don't know where it was from.

[00:54:30] Dr Renee White: Because this is the time that Jan made me cry too, because I asked her, I asked her what her top tip for mamas were, and she said to me that she always tells mum, tells mums to stand in the mirror naked, and just like, be absorbed, notice, appreciate, love your body for what it is and what it's about to do and what it's been doing, like, and that you're so powerful. And I was just like, far out Jan, like seriously. You guys are drinking something at Mama in the water, like, I should have known I had to bring the Kleenex this time.

[00:55:17] Dr Renee White: Okay, last question before I get teary again, um, what do you keep on your bedside table? We borrowed this one from Brene Brown, who I absolutely love.

[00:55:27] Kelly Langford: Oh yes. Amazing. Um, on my bedside table. Oh, well, it's just behind me. What's on my bedside table? Pictures from my daughter. Yeah, probably a new picture every day and I usually keep some, um, we've got a beautiful aromatherapist massage therapist at Mama who makes up oils and so I keep some of her, um, I've got three of her oils at the moment on my bedside table that are, um, for different things. So one of them's for nurturing, one of them's for sleep and one of them's for um, waking up, I think it's getting energy.

[00:56:01] Dr Renee White: What's it like? I'm a very, um, sensitive smell person. Like, I feel like that's my superpower. Um, and even more so since I've become a mother, because you know how we just get really heightened. Um, I'm a citrus girl. I love citrus. Like, that's really my jam. What's your jam when it comes to oils? And obviously it's different moods, but like, if you need to kind of, you know, get ramped up and every day. Okay.

[00:56:27] Kelly Langford: Yeah, citrus is good, but I think actually, um, something like a, a really earthy bergamoty smell.

[00:56:37] Dr Renee White: Yeah.

[00:56:37] Kelly Langford: Um, one of my favorite people in the world, my granny, my abuela, um, was always, always had this smell that I can't actually makeup in an oil or I don't know what she wore, but it was this really sort of earthy smell. And I think whenever I smell someone like that, I just want to hug them.

[00:57:00] Dr Renee White: Isn't it amazing? I was talking to my daughter these past couple of weeks, uh, cause we were traveling. Traveling always brings up like memories for me. And we were talking about the fact that, you know, smells are something that can invigorates specific memories for you and I think it was just fascinating talking to her about that because I was like, I'm always she's 7 and I wonder, you know, in 10, 20, 30 years time, is she gonna remember this conversation that we had about like certain smells and where we've traveled and like different things. And like, as you said, you're nanny, like, you're just like, Oh my God, I just want to hug those people.

[00:57:42] Kelly Langford: Yeah. It takes you to a place. So, so instantly like Clary Sage will take me to a labor. I smell Clary Sage. I'm like, Oh, I'm at a birth. Here comes the oxytocin.

[00:57:54] Dr Renee White: I love it. That's so good. Kelly, thank you so much for coming on the podcast. wonderful to chat with you again and to connect. Before we go, can you please just let all the listeners know about where Mama is, how they can contact you, and also it's not just midwifery, we've touched on that, there's a lot of allied health, um, associated as well.

[00:58:20] Kelly Langford: Yep, sure. Well, people can jump on our website mamabirth.au or call one of our clinics. We've got three clinics across Victoria at the moment. One's in Kensington, one's in Hampton and one's in Warragul in Gippsland. So we essentially service all of Victoria. And we have, um, different services across the clinic. So it's probably best to talk to admin 93767474 or jump on our website to have a look at what clinics have different services. Um, but as of, um, 1st of November, you can just walk in and see a midwife. Probably call ahead to make sure that there's a midwife there to be seen. So we're not all at birth, but it's, um, we're just so excited to see anyone that, um, is pregnant, planning a pregnancy or after their baby. And, um, can't wait to see

[00:59:13] Dr Renee White: you.

[00:59:14] Dr Renee White: Thank you so much. Happy days. Walking in. Imagine that. Yeah.

[00:59:18] Kelly Langford: It's, it's really, it's a game changer. It's so exciting for the midwives and the clients to have this, this primary maternity care back in our hands as midwives where it belongs. Yeah.

[00:59:31] Dr Renee White: Yeah.

[00:59:34] Kelly Langford: Thanks Renee.

[00:59:35] Dr Renee White: All right, then everyone, we will see you next week. Everything will be in the show notes, um, for you to contact Kelly and the team, um, across Victoria. All right, then. See you. If you loved this episode, please hit the subscribe button and leave a review. If you know someone out there who would also love to listen to this episode, please hit the share button so they can benefit from it as well.

[01:00:03] Dr Renee White: You've just listened to another episode of The Science of Motherhood, proudly presented by Fill Your Cup, Australia's first doula village. Head to our website ifillyourcup.com to learn more about our birth and postpartum doula offerings, where every mother we pledge to be the steady hand that guides you back to yourself.

[01:00:24] Dr Renee White: Ensuring you feel nurtured, informed, and empowered so you can fully embrace the joy of motherhood with confidence. Until next time, bye!