Kathy

It's the mentor episode! Katie is excited to introduce, Kathy, her mentor! Baltimore, Maryland gained so much from Kathy's trailblazing efforts in the field of midwifery. Learn how a city's birthing population can be shaped by one midwife's perseverance over decades. This episode pairs best with a cup of english breakfast, prepared traditionally, of course!

Transcript

Katie 0:01

Hello, and welcome to my podcast, mindful Midwifery Presents, the Labor Behind Labor. My name is Katie O'Brien, and I've been a nurse midwife since 2007. Midwives have tremendous pressure to show up to their work every day as their best selves. We must show up despite bad weather, bad days, or bad situations. Additionally, being a midwife is a role that often you don't have just at work. Midwives are regularly tasked with showing up for their communities and in their personal lives, day in and day out. The goal of my podcast is to highlight this challenging world and give listeners an insider's view on what it feels like to be a midwife tasked with being your best self, both professionally and personally. For this episode, I'm super excited to introduce you to Kathy, my mentor. As I have mentioned in other episodes, I am the midwife. I am because I was mentored by Kathy. Kathy has been a trailblazer for her whole life. I don't think she knows how to be anything else along for this ride. In this episode is Kim the office manager at Kathy's practice. Kim was a huge participant in my growth as a midwife and as a mother. The practice would not have been the same without her. Kim graciously accepted my request to record this podcast episode at her house in Baltimore. Her house has become a meeting place for the five of us that were in my first practice to reconnect. Kim has been a lifelong cat lover and seamstress, and her house has a cozy vibe that I miss when I'm gone from my people in Baltimore for too long. The three of us recorded this episode, drinking tea from a teapot complete with a cozy to keep it warm. Little known fact about me. A tea kettle hissing is one of my favorite sounds so make yourself a cup of English breakfast tea, and enjoy learning about how Baltimore Maryland became a better place to have a baby because of Kathy and Kim. I have been super excited about this podcast episode because I will probably cry a lot and actually I should have brought tissues, but, I have referenced my mentor so many times to so many people and you're my mentor. And Kim, you have been such a part of my, well growing up as a midwife and also as a mother and that journey, and it's so wonderful to be able to talk about that and cry and tell other people about this. But you've also. Both actually in your own ways, mentored a lot of midwives over the years. And, hopefully some of them will listen to this and have very fond memories. And then hopefully other people will, listen to this, especially if they're going into school or coming out of school and recognize how important it is to have a mentor and, and to be a mentor in the future. And I really wanna start with talking about your career timeline, Kathy, because most midwives around, now have, have not been practicing in the timeframe that you were. And it was an interesting time, I think, to practice as a midwife and to have gone through decades of practicing as a midwife and what that's looked like across decades because. I do not believe that midwifery is necessarily a stable career, as far as what you can be doing one decade versus the next, or how you're being handled, how you're being treated. So let's jump in. I believe that you were a, an RN first practicing for a little bit. Is, is that correct, before you became a midwife?

Kathy 3:24

That, that's true. I became an RN in 68, and worked in labor and delivery at,, in Indiana, at the university where I'd gotten my degree. And in senior year of my nursing school in the trends course, we were presented with three ways that you advance in nursing. One is to move up in, administration, and it didn't take me too long. And if I offend any administrators, I

Katie 3:56

apologize.

Kathy 3:57

I got into nursing because I wanted to be at the bedside. I wanted to be with the people I was helping. That was my whole reason to be a nurse, to be an administrator was taking me away from that, and I wasn't going to do that. Second is to go into education and on a one-to-one situation or in a small group, I'm fine. The more people, the more my shyness kicks in and I'm horrible. I get physically ill, and for, for, for several, for a good decade, I would accept teaching. Assignments or whatever you want to call it. Because I was going to teach myself out of that. It never happened. I was always physically ill, didn't show it, but I was always physically ill until we got finished with being a presenter at whatever conference I was at. So teaching was out of the question. I can do one, one-on-one in the, in the clinical setting, but not in front of classroom. That wasn't going to happen. And the third route was to go into advanced practice nursing. When I did my OB rotation right from the get go, I had a love connection with obstetrics and. So in spite of cautioning by some of my other, classmates saying, Kathy, you're way too smart to just stay in obstetrics, only dummies do obstetrics. It took about five minutes of reflection to realize that in obstetrics, not only was I doing obstetrics, but I had to be a skilled surgical nurse. I had to be a skilled medical nurse because if you're female, it doesn't matter what medical illnesses you have, you can be pregnant and we have to deal with both issues. You had to be a psychiatric nurse as well as the OB nurse because I've had a person brought over from the psychiatric hospital. And I was sent in to special her. Been there, done that. So I had to be very good in all areas of nursing in order to, work in obstetrics. It was more challenging than being specialized in one of the other areas. There was two paragraphs, maybe only one in the trends course that spoke to midwifery. And I knew then if I ever went back to school, which of course by that time I was never going back to school. It would have to be as a midwife. I I was starting my third year working in labor and delivery and was one of the three of us that joined the department at the same time outta my class that were up for assistant head nurse. And the bells of doom rang and I said, get my name off that list. I'm going back to school. And by the fall I was in school. That

Katie 7:18

works. And so then where did you train?

Kathy 7:22

I only applied to, Columbia and to Yale. Okay.

Katie 7:28

Okay.

Kathy 7:29

To live in New York City was, not something that I would relish. Yale New Haven, worked for me, and I just, with utter faith, put in the application. Did the interview and Surprise, surprise was accepted.

Katie 7:49

How long was the program back then? And was it full time? Were you working or, it was, it was totally immersed.

Kathy 7:56

They advised that you did not work and being virtually penniless, I told them upfront that. I had applied for, grants but did not get one at the time and said, I'm gonna be honest with you. I have to work in order to exist. But it's not going to interfere with my schoolwork. But it, it was two years full time and, well two academic years in the summer. So, I got on the registry for, being a special nurse. I forget the term now. Where you more or less bedside someone who's too anxious to be alone at night at the hospital. So I could sit there and study. Oh, yes. And got paid much higher than the floor nurse got paid.

Katie 8:48

Wow.

Kathy 8:48

Uh, summertime, I, I worked at a nursing home that was at the end of my block where, my apartment was, and they couldn't believe that they had a real registered nurse who wanted to work. And I worked nights. And, the most useful skill I learned in, in that job was how to pick locks because the, the facility never supplied adequate, supplies to do the changes for the patients that they should have, by standards. So if I couldn't even change the, the adult diaper once on all of our incontinent patients, that was not good. So my aides would always say, well, we don't have enough Ms. Sloan. I said, okay. And I would go pick the lock on day shift and we'd take what we needed for a single change for all of our, we didn't go for the two changes per shift. We went only for a single change. For the shift and useful skill.

Katie 9:52

Yeah. I have so many thoughts on that. Both of these, things you were doing strangely. Fit into what you'd be doing as a midwife? We, labor, sit in silence sometimes, just being present with a woman, much like your patient watching. And then there is a, there is a lot of changing of, of garments and labor, so you can't be squeamish about that. So you then ended school and did you stay in Connecticut?

Kathy 10:24

I looked for jobs that were in Connecticut.'cause at that point I, now, I'm a panelist, graduate, graduate student. And it would've been easier just to have a job there and not leave. But at the time I wanted to, to secure and tie down a job. There wasn't anything available.

Katie 10:44

How many midwives graduated with you? What was your class size?

Kathy 10:48

I think we were, less than 20.

Katie 10:50

Okay. And when you all were looking for jobs, what were the jobs that were out there at the time? This was, so this was 70,

Kathy 10:58

I graduated in 73.

Katie 11:00

So, yeah. What was it, what were the job prospects looking like? What were people going to

Kathy 11:05

Uh, well, one of my, fellow students, lived in the area, was married, had a family, husband, had a job, really needed to stay. So she had gone to, a local O-B-G-Y-N practice and talked them into hiring her on the grounds that if, if I don't work out, you can fire me. And of course, she never did get fired. There weren't many midwifery programs within the hospitals. So it was trying to find a job working in a clinic situation or, working in a, in an existing practice as an assistant, to the physicians in the practice.

Katie 11:45

How many of you were looking at home birth options at the time? Was that popular for nurse midwives? Or was that mostly CPMs that were doing that at the time?

Kathy 11:57

It wasn't presented as, we knew about it, but it wasn't one of those things that you, you would have to be going out to find that on your own. But then we had to go out and find our own jobs anyway. So, in that second year, I'd gone as a, student representative to an educational, a midwifery educational conference, along with one of, one of our, instructors. And while there I was, approached by midwives that were working at Johns Hopkins here in Baltimore. And, basically they were, trying to find someone who would be interested in joining the department of ob, GYN at Johns Hopkins. They were sent to by the chairman to find an American certified midwife to work in the group. And so, I, again, I'd not found or nailed down a job yet, and so I agreed to go down and interview, with, Dr. King. Um, it was an interesting, process because, I didn't know, the area most of the midwives in Baltimore were working for the city health department running their clinics. There were others that were working in practices or again, in, physician run practices. So when I interviewed at, at Johns Hopkins Hospital. At the department of ob, GYN. I was surprised at the laid back approach. It's almost like I defined the role ultimately. So, Dr. King's first question is, well, what do you think you should be paid?

Katie 13:43

That is a tough question for midwives now. Yeah. And we, know that we get paid less and it's a, kind of sexy topic about how women get paid less. And so, we think about this,, when I go in to talk about pay and like, put your big girl feminist panties on and get in there, Katie, and,'cause it's not natural for me. But it must have been so much harder for you even then. I can't imagine that was easier, that conversation then.

Kathy 14:10

It wasn't, but luckily I'd prepared the right way, because I had already looked up pay scales, both as a nurse and as a midwife in Connecticut. I didn't know the area down here in Maryland. So, I threw out a number, to Dr. King as a midwife if I was getting a job in Connecticut. Then I got, ooh, the, well that seems a little high, came back at me. And I just stared him straight in the face. I have blue eyes. I have a stare that really works well, and I just gave him a straight unflinching stare and said I can walk down the hall to the nursing office and get a job working eight hours a day for X number of dollars with my years of experience, and I'll work my eight hour shift and walk and go home with no concerns. I'm going to work here as a midwife with a job to be done, and I don't drop the job when I walk away and go home. I got my money.

Katie 15:24

In general, we're nurses and midwives being paid pretty similarly at the time? Were nurses being paid more?

Kathy 15:32

they were paid more.

Katie 15:33

I don't think that's gone away easily. But you got

Kathy 15:37

what, what I got asked was more, and they had an English midwife who was kind of working undercover but not actually doing delivery. She wasn't working as a midwife. She was married to one of the doctors at the department, And I think that's why they wanted a American certified midwife in the department. And she had told me that, they will never give a raise more than cost of living ever. It, the Hopkins was just very tight. The next year in advance of being told, what, My salary was going to be in the coming year, Dr. King said, oh, Ms. Sloan, how are things going? Yeah. Do you, are you enjoying it with us? Your time with us? And, this started a, an 11 year song and dance every spring.. Well, you know, it's, it's okay, could be a little bit, but, but yeah, I got a very large pay raise that first year. Every year after that. So I was in a position of never being able to say to anybody other than driving down to see my family and say, guess what I'm making now? Because I didn't dare open my mouth there at work Because I was beyond their norm of what their expectations were. But when I did numbers, I'm very good with numbers. During my years at Hopkins for what they did pay me, they made easily more than three ti, three or four times what they were paying me in the business that I did for them.

Katie 17:20

This makes a lot of sense to me because, one of the indirect ways you mentored me, and Kim mentored me and to some extent even Mercy at the time, was you were pretty involved and aware with the finances, even when the hospital took over, your practice, which I would there for that, after the, the hospital had taken over your practice. But the midwives, the, the group of us were much more aware actually of what we were bringing in, as a practice than I think is normal for midwives. Which is to the detriment of midwifery. We are often very unaware of what we're bringing in for the practice. And so it's harder for us to negotiate our pay because we're unaware of those numbers. Um, and now that you've explained it, it makes sense. You've been very aware of those numbers your whole career.

Kathy 18:14

I. I went into midwifery, and this was part of my interview at Yale with a long-term expectation to be in private practice. Crazy me. And I think that's part of what got me into Yale because I wasn't going to just come and do a job and, and I am sometimes distressed when people come in and it's just a job and like, like they do on the nursing floor, that they can do their job and walk away at night and not worry about it. So I came in to be totally invested in what I was doing. So that makes me a strange bird. And I haven't found too many like while I with was with Hopkins. A small group of us decided to work and move the people we were seeing outside of the hospital to an office building across the street. And it was kind of a demonstration project the office was paid for by the department, but it was a private setting, not a clinic setting. And we had a, a secretary who said, you guys are gonna learn what it costs for what you guys are doing. And if we were, getting into ordering maybe too many tests, she said, do you know what this is gonna cost the patient? She gave us financial education. And so a lot of what I had to pass on to you later. It came from when we had our office meetings. The secretary, our, our office manager, secretary was a part of, the physicians and myself, the only midwife and the secretary. We all had the meeting together and the secretary didn't hold back when it was like, you got, you gotta learn you, you gotta stop wasting stuff and you gotta do this and you gotta do that, and so on and so forth. So, setting up that demonstration private practice with all of us being within a hospital group was a big awakening for all of us.

Katie 20:25

And so then how did you move from Hopkins? Although I'm not sure you totally left Hopkins.'cause you did students at Hopkins too,

Kathy 20:34

that was different. In school, my class set up the first ever teenage contraceptive clinic for, Yale New Haven, planned Parenthood, So we set it up, we staffed it, we did all of the care. And, so I've jokingly always said that adolescents were a subin of my midwifery. And I'd said that to Dr. King in the interview. So. 50% of my job was to be the OB GYN care provider for this pediatric HMO run by the hospital from that catchment area. So the day I arrived, I wasn't even told what time of day to show up, just come on July one, and I went to Dr. King's office. Oh, oh yes, Ms. So well, Dr. King's off doing a me let me take you. Let's go get your badge and we'll do this and do that, and then I'll take you around to introduce you to, comprehensive Childcare and let you get to know who's over there. So after I had my badge and I got taken over to Comprehensive Childcare and got dropped off with their nurse. I introduced myself and I said, I'm here to find out, what you need me to do. How do things run? Well, we're too busy. I, Dr. Lord had been gone a month. Dr. Lord was leaving to do full-time private practice in Western Maryland, and she wasn't waiting around for anything. The nurse was doing the care. Nobody came over to help them. So I said, well, give me a room. Give me a chart. So I started at that moment to see patients, and when we got to the end of the patients that were checked in for the day, I got together with the nurse and the LPN and said, okay, now I'm Kathy Sloan, and I'm here to take Dr. Lord's place down. Why don't you tell me what I'm supposed to be doing here?

Katie 22:43

Hmm. And then you stage doing that for the rest of your career? much Pretty

Kathy 22:47

un until comprehensive childcare closed. But yes, ultimately they did integrate it back into regular OB population. But,

Katie 22:56

and then you were taking care of students, I

Kathy 22:59

Well, that was another side thing that Ted King decided. Johns Hopkins, had been an all male facility, over on the Homewood campus. And then they integrated, and became, both genders. And after several years of having women on campus, the women kind of rebelled and said that the student health center was not meeting their needs because they had, no access to GYN Care the year before I came. Three doctors from the department were sent over one day a week to provide all the OB GYN care and the, wife of one of the doctors who was a British midwife but was not at that time, American certified, went over. So she served as, Assisting nurse to the three physicians who are doing the care. When I arrived, that summer, then Pat told me, Kathy, you are doing Homewood with the doctors.'cause you have to go in a half hour early, set all the rooms up, chaperone all the visits, blah, blah, blah, blah. blah. Okay, I can do that. And then so the doctors whooshed in, saw the patients whooshed out, and then I cleaned up, collected everything and went back, took stuff back the next morning to the hospital. Pat never told me about Hopkins doing these, these teaching sabbaticals, under the, auspices of Pago, where they would go for a month over to Southeast Asia for teaching. She just shut the clinic, but no one told me that. So they're taken off, but the clinic is still open because it was never shut down. And so I was running this impossible schedule because they were scheduling for three physicians whooshing through. And I do remember one night, well let it say I was there till midnight

Katie 25:05

Seeing patients, somebody wanted to be a patient at midnight. I

Kathy 25:09

I kept saying, why are they staying? Don't they See there were 20 patients

Katie 25:15

guess they were young though, right? They were like students. So

Kathy 25:18

I mean, you know, it was supposed to be from six to eight,

Katie 25:21

was president of cocktails in the waiting room.

Kathy 25:23

It's supposed to be from six to eight. They had like 20 patients scheduled and I told'em they can't. And I kept telling'em, you can't do this, you can't do this. So I left an uh, a abrupt note for the manager saying next week two things. I did not have someone working the front desk,

Katie 25:43

Oh my

Kathy 25:43

so I had to be my own secretary, my own chaperone, and my own provider for 20 people. I said Next week if I walk in here and there's not a secretary at that front desk, I'm turning around, I'm locking the door and leaving and you won't see me ever again. I was told I was being unprofessional, but One of the secretaries offered to be, the evening secretaries'cause she could come in late and work only afternoon in the evening. And Carolyn was so wonderful'cause when people were scheduling she would sit there flipping pages and say, Nope, we don't have anything that way. Nope, we don't have anything that way. Nope. She would go, go in and she would just take a pen, cross out, reschedule all of those. cause there's too many for the evening schedule. And it, it all settled out, after that first year when I was there alone. The next year. Well, Ted King and his group came back from Southeast Asia and it's you ran the clinic and we weren't there.

Katie 26:48

Look at that. the woman did it.

Kathy 26:51

Well, no one told me I was supposed to shut it down.

Katie 26:54

hilarious.

Kathy 26:55

And um,

Katie 26:56

please tell me your bonus was quite large that year.

Kathy 26:59

No. Oh, I'll tell you what the bonus did turn out to be. The bonus was come, come the second year I was there. Guys didn't come back. It was just me.

Katie 27:11

Wow. That's a twist. So you bought yourself, solo employment at the organization that used to have. Three physicians

Kathy 27:19

well. uh, I got rather favorable ratings because I talked to people, I asked questions, I let them ask questions, and I answered them. And the students liked that. So the second bonus came later on in the year that I, I started September by myself and by the spring there was a meeting where, Dr. Tory Brown, who was the medical administrator for the health services, told Dr. King, they actually wanted more midwives. They wanted more time. They wanted one of the midwives there during the day, at the clinic to see people. And, Dr. King kinda looked at me and said, well, well Ms. Sloan, um, what do you have to say? And I gave Dr. King my look and said, well,

Katie 28:14

I

Kathy 28:14

met doing all of comprehensive childcare by myself. If you want me to also do daytime

Katie 28:22

at

Kathy 28:22

Homewood, then I won't be able to work in the private clinic on your days. Well, that wasn't gonna fly cause he could do other things. And I saw his patients. So I was rewarded with another midwife.

Katie 28:41

Were you doing deliveries at this time, or it was just office? Totally. I

Kathy 28:45

not taking call. We were seeing patients to feed into the residents training, but private patients. A little bit later when as a small group, we had our private patients, then we were rotating on call and I was taking call for our private patients when we were in the office across the way.

Katie 29:06

So how long were you there when that started? By, when you started doing deliveries through the, the private,

Kathy 29:13

Probably the, about the, third, second or third year that I was there.

Katie 29:18

That's a lot of progression in a short period of time actually.

Kathy 29:21

Well, yeah.

Katie 29:22

Especially considering they were so new to the idea of midwives. You really trailblazed in that sense.

Kathy 29:28

This kind of standing thought among the residents is Dr. King's just giving her enough rope to hanger shelf. I never hung myself,

Katie 29:37

thank God.

Kathy 29:38

I was the first one to not go into a delivery room to do a delivery and just do the delivery. The labor room. Ah,

Katie 29:47

Ah, yeah. At first I wasn't sure what you meant, but Yeah, you're right.'cause they used to, get to the point where they were about to literally have the baby and wheel them off into another room. Right. Which I'm sure was just so fun for women.

Kathy 29:59

Right.

Katie 29:59

right. Being wheeled in that vulnerable second.

Kathy 30:03

Well, because they allowed us to have the fathers in the labor room. They were very progressive, they felt, but not in delivery room. So, we're just gonna stay put and it's like, what?

Katie 30:16

Okay. So you were the first one to stay in the labor room, which, ultimately now in this country is also the delivery room, but didn't start out that way. What year was that, when that happened, do you think?

Kathy 30:26

Well, it had to be about, it was fairly soon after I started actually doing deliveries of our private clients, because our client doesn't want to go to the delivery room, so we're gonna not do that.

Katie 30:41

So like 75,

Kathy 30:43

76, something like that. Uh father stayed, once they weren't passing out in the births in the labor room, then if we did need to use the delivery room. It wasn't too much arm twisting to say, if we have to go into the delivery room, say for a forceps, delivery, et cetera, then the husband could come. and so then everyone else started letting their husbands come into the delivery room as well. And I had a couple that was very close and she ultimately w wound up needing a cesarean. But of course, even though they could go into the delivery room, they weren't gonna let'em into the surgical suite. So I waited till they're all in the surgical suite and I grabbed the husband and we went up to the student observation, platform and had him up there where he, yes, he's a little distanced, but he could observe the birth of his child. And at one point someone looked up and said, oh, who's up there? And then we were back around on the floor when they brought her out so he could join her and go into recovery with her. And having done that, then it was like, well, these were our private patients. So, uh, we got that changed where, I could take care of the husband and he could come in, of course, if, if King and his group were doing it, everybody else decided they were gonna do it. And so we started having fathers come into surgical suites and, be with their wife during cesarean sections.

Katie 32:25

Yeah, so, my youngest, cousin, so the youngest in my generation was actually the first birthday I saw. And she just had a birthday, recently,. And I had this moment of clarity that my entire family, my entire mom's family was outside of the delivery room, waiting for the birth of Kayla. And my grandfather was

Kathy 32:49

outside

Katie 32:50

and He had never seen a birth, so he was just pacing up and down. My whole family's out there and he's just pacing up and down because, he was not involved for his daughter's births, in the delivery room. They were born in the sixties. And so I was, I was in the room, with my aunt and my uncle and those, and, those were the only people in the room. Just everybody else was literally right out the door. Probably 15, 20 people waiting for Kayla to be born. And I had just decided I wanted to be a midwife. And so it was very interesting timing, that, because there's a, a fairly. A good size gap between, Kayla and the, the cousin right above her. So it's this like beautiful memory to me, but part of that memory is thinking about my grandfather and how he just thought it was just wild that anybody could handle, being in a delivery room with their loved one because that just wasn't, the normal, it was, that was not what they were doing. So

Kathy 33:48

oh, one, one of my fun births was, the husband was this big strapping marine, and, we had talked about, birthing in the room, and he, he could, he could be present if he wished and. my, my patient, my, my client had said, she was really worried because, he, he's a marine, but if anyone in the family even got a cut finger, the side of blood, he'd faint.

Katie 34:19

Mm-hmm. I have met some marines like that.

Kathy 34:22

And, and so she was very worried about that. I said, well, I tell you what, we'll leave it up to him. He could leave it, he can walk outta the room anytime he wants, but I'm gonna tell you, there's like this energy that forms and anyone in the room, as we're approaching the birth, it's tied into it through this energy bond and you just can't leave. It's mesmerizing. You cannot leave. And so we got, we got through the birth and he actually cut the cord and. Afterwards, I said, did the blood bother you at at all? And he looked at me and said, what blood?

Katie 35:04

clai he missed that whole thing.

Kathy 35:05

He saw nothing but his child

Katie 35:08

Mm. Aw.

Kathy 35:09

and that's all he saw his child and his wife. And it was beautiful.

Katie 35:15

Mm. I have this very distinct memory of one of our patients saying, because you got so little sleep all the time when, when I was in practice, your practice, chronically sleep deprived, and, sometimes you would look worse after you had had a couple of days off, where you. Weren't doing things. In fact, actually I took over the schedule when I got there and I would like schedule these days off for you because you were so bad at requesting them yourself. And yeah, sometimes you'd come back looking worse. And I'm like, what have you been doing? But one of our patients one time said to me, she's like, Kathy is a white witch. She gets all of her energy from births Katie. So it's just so funny you just said right then that yes, there is an energy there.

Kathy 36:00

definitely. Maybe

Katie 36:01

you are. Okay, so we sidetracked a little bit, but how did you get to having a practice, a private practice, ultimately where you were delivering these patients and not directly attached to a hospital system?

Kathy 36:16

Well essentially, things kind of had to evolve because to start with, For the birth that I was doing, I was, not being allowed to sign the birth certificate. And I made comment about this to, to Dr. King because that's ridiculous. I, I did the birth. The attending didn't have to attend my births. It wasn't gonna help anybody if, if they did, and it, it took a while to finally settle it out. But, while in my early years there, we changed that practice around where the midwives now did sign their own birth certificates. And the, and because it's a teaching hospital, there are almost always plenty of people around. But there have been times when things were shorthanded and, I think of one time in labor and delivery. My lady was in labor but didn't need me. But, the two residents and a, a student physician. That were out on the floor for all of the clinical patients, And suddenly everybody else is off doing a delivery. And then the next clinical patient was to go to delivery. And who was left? The, the medical student was going to be sent in to do this birth, and they had no one to supervise him. I says, I will supervise him. And it's like, you supervising me. I think I can do a normal birth.

Katie 37:47

I, I, think you can do a normal birth, uh, better than a medical student, student unattended. I,

Kathy 37:52

I, I,

Katie 37:52

let's hope.

Kathy 37:54

so I went in and I was instructing the student and said, uh, he knew I was not a doctor, I was a midwife. And, so I said, you need to support the peroneum and, a little more support. I, and finally he just snapped at me. He everyone says that, but I don't know what you mean. And I put my hands on his hands and we supported the peroneum and completed the delivery. Just, I said, that's how you support the peroneum. I think it, it was always an interesting thing that even with two midwives in the department, the first one I had, and the ones that followed, we always had offered saying, if you ever would like us to have a hand in. Any, of the medical school teaching, we'd be more than happy to lend a hand. We were always told, well, their first lecture in, when they start their rotation is on the normal birth. So that's all they need. It's

Katie 38:55

normal. Uhhuh their version.

Kathy 38:57

Yeah. So they get one lecture on normal birth and that's the end of it. And, the thing is, is I spent two years on normal birth to get where I am. So needless to say, I, I, uh, Dr. King would have me, supervise, students when they When they were, being taught how to do a pelvic exam on a live patient. And then afterwards, after the patient was finished and I'd stop and I'd be in the back hall with a student saying what questions I had. And I remember one instance when we had done a diaphragm fitting on one of the patients and the student had inquired, well, how did I, how did I make up, make a decision about what I was doing? And so I talked him through about what I was feeling for, which then decided what type of spring I was going to use. And of course, the size and diameter of, of the Pel interior pelvic bones, I went through the whole nine yards. Now. The student left with a better understanding of what we had just been doing. Dr. King was behind me the whole time after the student left. He said, when we're finished here today, Ms. Soan, would you come back and we will have the discussion about what you just said? And I taught him what we were doing to do a diaphragm fitting.

Katie 40:28

You're an excellent teacher and I think you've mentored more than just midwives, but part of that is you have very high standards for yourself. It's not good enough to just like do something. You better do it as, as well as it can possibly be done. A lot of people learn how to fit a diaphragm from a textbook or did, And it's like not very nuanced. And I remember, when I was learning about in school, it seemed like it's pretty, pretty easy. You just pick a size and it's, it's really gonna be fine. And then. interestingly, our patients actually still were wanting diaphragms when I went to the practice. And it was a whole thing fitting a diaphragm. And then when I left, to move back to Delaware, diaphragms were still, they're still around, but kind of phasing out. But it was amazing to me that, the practices I went to didn't even have like, like sizes that you could try. It was more guesstimated. So not at all surprising to me

Kathy 41:27

Yes. Training, you

Katie 41:29

just, midwives on that. So then you ended up in fully private practice. What year was, was that?

Kathy 41:39

so that would've been in 84. I was there 11 years. Dr. King had been, moved up to, a vice president of the, university. And one of the doctors that I'd been practicing with in the experimental small group practice was then named, chairman of the O-B-G-Y-N department. And, and needless to say, some attitudes, some other attitudes reared their head. And, So I, I felt, the handwriting was on the wall, because the atmosphere was changing. So. I made the decision, it was time to leave and do the private practice. I always wanted to, and I had the one midwife that was working with me and both of us decided to leave and, was able to, one of the, a physician who had been a resident at, at Hopkins, I was there the whole time he was doing his residency, and he was thrilled to death to have me come and seek privileges at his hospital, although that was a kind of a rough transition. But anyway, at the end of June, I finished with, Hopkins and opened up the practice, over at union Memorial.

Katie 43:06

Hmm. Now, did you still keep the Homewood students the whole time or did you come back to that later?

Kathy 43:11

Well, actually, uh, Homewood came to me and said, we don't want you to leave. So I then hired onto them as a private contractor.

Katie 43:22

Nice side hustle.

Kathy 43:24

Yeah. And, as the practice was getting started, we, we all did two days of outside work that we then pooled those monies originally there was just the two of us, and then there was another group of two midwives that were doing something similar also, getting back up at Union and then when. Individuals at Union, were trying to pit us against each other, but we were meeting every week as a group of four, and so that wasn't working. So finally we said, let's just put'em outta their misery and we'll join as a group of four, as a unified practice. And then there's no reason to try to pit us against each other ever again.

Katie 44:06

It is truly amazing how much leadership can make a difference. And sometimes that difference is really positive and sometimes it's really negative. And all it takes is a change in leadership to completely upend something which you have experienced multiple times in your career.

Kathy 44:24

Yes, I have.

Katie 44:25

Mm-hmm.

Kathy 44:26

Just almost every time.

Katie 44:27

Mm-hmm. But I think you've also done a really good job of predicting that it's coming and reading the room, which I. Also, find, that's something I do, you, you kind of feel the current and you try to get ahead of it.'cause you're like, Ooh, it's changing. I can feel it, I can sense it, and I gotta figure something else out. Which speaks to resilience because, you're, you're you, it's not okay, it's ending. I'm not gonna keep doing something. I'm gonna go find another career. It's okay. I need to shift and do it quickly and figure out where my next move is. And you've done a really great job of that. So you, anyway, you had four midwives then at that point. Mm-hmm. And you were delivering at Union

Kathy 45:12

Mm-hmm.

Katie 45:13

and what? So that was 80,

Kathy 45:17

uh, we would've started the suburb of 84.

Katie 45:20

Summer of 84. And then how long did that particular group last in that capacity?

Kathy 45:25

Oh, so, I can't quite remember how long because, one of, one of the group left the group. Debbie Arm Brewster had left the group to become an international liaison with a c and m and do overseas work, with the Barefoot, oh, I forget the name, the exact name of the title, of the program that, that she was involved in. And Debbie had been the last midwife working with me. At Hopkins. And then the other of the other two, one of their midwives, Her husband who was a family practice physician, was finding the malpractice environment was getting too difficult for him to continue to do deliveries. Again. Gradually, malpractice insurance was rising, expenses kept going up. And when I started out, I, I only had to carry nurses insurance. It was like$25 a year. Which covered us Yes. Um,

Katie 46:32

and how much, so I remember. And I've quoted this, so hopefully I'm kind of right about my quotes that I've been saying over the years. I remember you talking one time about reimbursement for deliveries. You got, mm-hmm. Back when you first started, like right away, reimbursement for vaginal delivery then, and then comparing it at the time when I was in practice with you, which was like, 2010 ish timeframe. Do you remember the, the amount you were getting? Because I think that's so interesting. So your malpractice was like nothing, but your reimbursement was pretty high compared to what it is now?

Kathy 47:08

I think in the beginning, it was like, the whole charging system had altered, so the, the 3,500 was what was being billed for prenatal care and birth. And, our reimbursement was like 1600. And because, there's this funny rule that, each practice would set its own profile, but it took four years to establish a profile. So if you increased, it didn't necessarily mean you were gonna get an increase in your reimbursement until you'd had the increase for four years, and then they would start increasing. But somewhere in, through there, the insurance companies decided that they had the right to set, usual and customary by what they decided was right. And because, what we, what we were charging, was technically lower than what physicians were charging. We got reimbursed at a higher percentage. So that we, we would get like 1600. We would get reimbursed about 1600 later when the insurance companies had decided, what was, reasonable and customary. They dropped it to 1200.

Katie 48:22

Wow.

Kathy 48:22

And, and our rise raising the rates wouldn't help. And, oh, the insurance companies are a whole different issue. Because there would be times when I would be doing something I had already done for 10, 15 years and the insurance company would come back and, we went through this I had learned how to do, humors, post-coital exams to help ladies that were attempting pregnancy, because, that's a so simply done on a regular pelvic exam if you know what you're looking for. And in fact, I had, instructed Hillis Weby, who later, became, an employee of, Dr. BEUs at Union Memorial. It had gotten to the point where I trained her how to do a humorous post coil and done right. I could actually have an indirect look at sperm quality in the male partner without offending sensitive male sensitivities.

Katie 49:26

Mm-hmm.

Kathy 49:27

And, When Hillis started with Dr. Baus, Dr. Baus very quickly decided she didn't need to do humors anymore because Hillis did it better. And Hillis said, well, I'm just doing what Kathy taught me how to do anyway, so I had been doing those since I was at Hopkins. And so here I am, some 20 years into having done funeral and being reimbursed for it. And suddenly, the insurance company came up and said, oh, well you're a midwife. You can't be doing, you're not trained. I said, what do you mean? You've paid me for doing it for 20 years. You're gonna come back and tell me I gotta pay you back for the 20 years that you've paid me to do these. And every time the insurance company would come and say, oh, well we can't reimburse you for that because you're only a midwife. No, you can reimburse me for doing that because you've already been doing it for decades.

Katie 50:23

Did they respond to that? Did

Kathy 50:24

they They paid me.

Katie 50:25

Oh good.

Kathy 50:26

Oh, I, I had, first I had Trish, and then I had, Kim. Kim, I just turned them loose on'em.

Katie 50:33

Well, that's gonna bring me into roping Kim, into this segment here. Kim, when I came to the practice was, running the show, as office manager and was a huge mentor to me and, and how important teamwork is in the office setting. And it's interesting, I've said this on another podcast, but I, I was always chasing our practice. Ever since I left our practice, I was always chasing it, trying to find it, in Delaware. And I opened for prenatal care. Last summer, and spent a year doing prenatal care, and I, by myself, and I was controlling the environment and I figured, oh, if I'm controlling the environment, I can make it like our practice was because I'm controlling it. And it was just, the problem was that I, I, had other people controlling the environment since I've moved to Delaware. But then I realized that even with me controlling it, it's never gonna be the practice that I was at and that I left. And so much of that is the dynamics of the whole team. We had a small team, but it was an amazing team. And,, and, that is just gonna be a special time in my life and I have come to realize that and I'm not gonna try to recreate it anymore. But you have worked, Kathy, you worked with Kim for how many years? It had to have been decades by the time you guys, 92 when I started.

Kathy 51:56

I started in 92 with Kathy.

Katie 51:59

And then you retired, what year was that?

Kathy 52:03

2019.

Katie 52:04

2019,

Kathy 52:05

yeah.

Katie 52:06

So that's a long time. And, in a lot of ways I felt that you do had a kind of like sisterly relationship, or even kind of a, a work marriage. And it was really special. It was also very honest, How did Kim, how did you end up with Kathy? How did that happen?

Kathy 52:27

Kathy's original, office manager wanted to go away on vacation for a week, and she asked if I would sit in and. Take over for that week, and I, I just never left.

Katie 52:39

So did you have two for a while or Eventually She

Kathy 52:41

no, Trish was the office manager but Trish was also leaving to go to Hopkins to go to school and become a midwife herself. So, I got left on my own more and more. I can't tell you how many phone calls I made to Trish help. But eventually she left the practice for her, for her personal career and, and so I was just taking over.

Katie 53:03

Yeah. And that must have been, a huge tears success really as a practice, Kathy, because, Kim did, did do a lot of

Kathy 53:10

things Well, Trish set it up and Trish was an excellent, excellent organizer and manager. She really set it up. Now, when we first started the private practice, it had fallen down to just, Hillis, WEBY, myself, and a third midwife who we were butting heads with. And it was just before Thanksgiving and I got a phone call. I was working over at Hopkins, and I got a phone call from the third midwife saying, there's no reason for you to come to the office today. You're fired. And

Katie 53:48

were you partners? Yes. That's, that's nice.

Kathy 53:52

Equal partners. Yeah.

Katie 53:54

It's hard to fire an equal partner,

Kathy 53:55

and basically she had taken over the practice, it's only after she'd gotten a locksmith in to change the locks that she's, she called me to tell me I was fired. Okay. So basically, I knew this was, was the boiling point and four months prior to that we we'd had some issues and so we set up to buy out, and this was actually the second time we'd set up to do a buyout where I'd buy her out. And she reneged on the buyout both times, but seeing how she was behaving, Trish was one of our clients so when, when I was informed I was now fired, I, I basically got together with Trish and we printed off a letter saying we, we are separating ways and we will be opening, and in one month we will be open. And we opened, we rented the office across the way from the old office.

Katie 55:02

Oh, right across the hall.

Kathy 55:04

the hall from the old

Katie 55:05

From the old office. The office, just to put it out there, was in an apartment building that was right in front of Union Hospital. Yes. And it, it was an interesting building. It has a very special place in my heart. Apparently at one point it had shag carpet that some of the medical students would talk about, the condition of said shag carpet. We did over time, update some stuff, but you guys had been in there by the time I got there. That, so I got there in oh 7, 0 8, 0 8 and, you guys had been there since when? Forever.

Kathy 55:40

Well, we, well we started sharing, using a backroom of a pediatrician up the way until Hopkins bought the building and then we'd had to move down to that office and, there'd always been a doctor's office there in that, before.

Katie 55:56

that now. Yeah. Mm-hmm. But there also, it was an apartment, There were also people that actually were living there. And we would, as you had, I'm sure since the second you moved in there, we would check patients in the middle of the night there, which was nice with it being in an apartment. It was actually strange to me when I, when I moved to Delaware and I was with a physician practice in, the very, very distinct office hours. And I was like, I would go here at two in the morning, we'd go into this apartment building and, and the parking was good, which was nice.'cause that can be a safety issue when you're going in a city at two in the morning somewhere. So funny. So anyway, you moved there. Across the hall with Trish. Mm-hmm. And another midwife or just yourself?

Kathy 56:39

Uh, Hillis was with

Katie 56:39

Hillis came with you.

Kathy 56:41

So there were three of us setting up the new practice across the hall. And, basically, I tapped, my retirement fund, for some money.'Cause I'd been with Hopkins since 73. So I had had a good bit of cash there. So I kind of took a loan against my retirement fund and used that. And of course, she never thought I had the money or the means to, to do this. And lo and behold,

Katie 57:12

was that when you called it Kathleen Sloans and Associates? Mm-hmm. That's when that name was born.

Kathy 57:18

It, it was previously midwifery Associates.

Katie 57:21

Yeah.

Kathy 57:21

Yep. And so, at that point, very early on, because Trish had not been an office manager before, but she's good with computers and she's intelligent so early on, there, I remember just one conversation we had and as we had done when we had set up that experimental practice and the office manager was always part of the conversation in the group dynamics when we, we had office meetings, I continued to do the same because it was a very useful tool that the office person is the, Expert in running the office. And she was to keep the rest of us on, on target we're the expert in midwifery and doing the patients and generating income. And there was this one time when Trish was asking me, are, are we gonna be able to get a paycheck this week? And I looked at her and said, did you collect any money this week? If it's, if there's no money in the checking account, there is no checks for anybody. So right from the get go. It's like you, you're not just filling a job and you're gonna get paid no matter what happens. You're here as an expert and you've gotta get the billing out. You've got to pursue the billing gets paid and get after those insurance companies to cough it up. And you've got to collect that money. And so you're the expert on that. And we're, we're, we're working our butts off to generate income. It's up to you to collect that income so we all get paid.

Katie 59:03

Yeah. And they became very good at that. Kim became very good at that.

Kathy 59:07

And ev and everything I ever said to, to Trish went through to Kim.

Katie 59:12

Yeah.

Kathy 59:13

But you know, the insurance companies had different processes. For example, the Blue Cross Blue Shield, FEP, federal employee, insurance. When I started, they would pay for a midwife to do all the prenatal care and the delivery, but they would not pay for a midwife to do a routine annual exam. They would not,

Katie 59:36

Mm-hmm.

Kathy 59:36

because it was like, you have to go to a routine provider for that. You can't go to a midwife. And we did get that. I don't say we, but I think enough people called them on this that they changed that policy. And then after that, other insurance companies began to see the financial benefits of having midwives. Well the other thing is, is we had also managed to, get rules and regulations, and the law changed in Maryland. When I started in 73, midwives were operating under a rather ancient, law. Regarding birth as to what a midwife could do. And the first day I put a hand on a patient, I broke the law. But I hadn't had my oral exam yet, so I technically it wasn't, I had my certification, but, I could, I was allowed to practice while they waited to have enough new midwives in the state to take the oral examination to get their Maryland license.

Katie 1:00:43

So you're talking about the, the license with the board of nursing? Okay. So that didn't happen right away. For, for you that, because my guess is the board of nursing wasn't regulating midwives initially.

Kathy 1:00:54

no. They were,

Katie 1:00:55

were okay.

Kathy 1:00:56

But, basically under the law, the law was designed for lay midwives really. And, When, when they had enough, prospective new midwives, they would have them all come and, and one by one would be, interviewed and questioned by an obstetrician who saw a few, answered your questions correctly, and therefore we're then, certified to be, up to snuff for the law, to function, to, to practice midwifery. But just even doing a pelvic exam broke the law because under the original law you could do a birth, but you could stitch

Katie 1:01:40

Wow.

Kathy 1:01:41

You could only catch babies and, file your birth certificates basically.

Katie 1:01:47

so what year was, is

Kathy 1:01:49

Um, it was about, I'd have to look up to know the exact date, but, very quickly I wound up working with the local ac and m chapter and wound up being on the legislative committee. And because there was a move to change the law and, it was about. Probably about 1980, that the law actually wound up being changed. To make it, to bring it up to date, the head of Environmental Matters committee that would be making that decision happened to be Dr. Tory Brown, who was the medical administrator for the Homewood campus, who had asked for midwives to do the GYN care at the health services. So when I was giving testimony in front of the legislative, the legislative committee that was gonna make these decisions, the room was loaded with lots of parents talking about the, the wonders of their wonderful midwives because we. Had, we had mobilized our call tree, so we had loaded the room with people who spoke for midwives, but everyone was talking about obstetrics and birth, and I got up and I said, well, everyone has spoken about, the role in obstetrics, I think I'm gonna be opening a can of worms here because We developed an alternative phrase which would cover routine GYN And while I'm giving, giving my prepared testimony, I gave Tory brand my look and said, now I, I've been doing gynecology for the university Student Health service since 73. And if this law says that we are not qualified to do GYNI guess I won't be doing that anymore. Well, when we left, the thing, the other midwives were saying, oh, it went so bad, so they're gonna just do us. And then I went out there dancing and singing. We won. We won, we won because the right person got the message.

Katie 1:04:05

That's all it takes. Mm-hmm.

Kathy 1:04:07

Mm-hmm. I, I, as soon as I saw who was the chair of that, it was like, we're winning.

Katie 1:04:13

Well, that's wonderful. One of the things I haven't really talked about with you is you did do home birth for a while. Were you doing that through your private practice? Was Kim involved in this at that time or was this before you came Kim?

Kathy 1:04:28

With arm twisting. Some of my long-term clients would push to get a home birth. The other midwives were very uncomfortable with it. But,, I had learned to have a rather complete bag that I towed with me because we would often do a home check, if, if it sounded like someone might be early in labor and we would go and do a home check, and then decide when they would go in

Katie 1:04:57

So instead of bringing them into the office, you would

Kathy 1:04:59

go

Katie 1:04:59

their houses back then. Right.

Kathy 1:05:01

And sometimes, the child would be in a big hurry up. So I learned very quickly to, then expand the home kit from just gloves, et cetera, to A BOA kit. Just in case I went to do a home check in. The child was already arriving. So having done accidental home births a couple of times, then it was like getting arm twisted to do it. But I was pretty much, I was the only one in the practice that would do that. But it's hard because you're on 24 7 and until whoever you've agreed to do has birthed.

Katie 1:05:42

That is difficult. That has always been actually what has stopped me from wanting to do home birth. Yeah. As I've said in other podcast episodes, it's not, it's never been the belief that I thought it was a good idea. It's,

Kathy 1:05:55

it is such a DD dance and a balance because, I still, I believe very strongly that it should be a safe birth. And there are some things that can come up suddenly that are not safe. And there may be home birth midwives that disagree with me. But, you have to have a good sense of knowing how close to the birth is your cutoff, because if you've passed that point that no matter what happens, you're stuck with being where you are for that birth. And so, in my own mind, I'm always there, are we okay or not, you know, listening to the baby, monitoring the baby and. Am I still certain that this is okay? Or do I have to pull the plug now and say we're going to the hospital and, it's a stressful thing and until the baby's actually out and everything's fine

Katie 1:06:53

and your practice got busy enough that I'm imagining it was hard for you to be in the call rotation with everybody that wasn't doing home births and then be doing home births. And by the time I got there, you had stopped doing them.

Kathy 1:07:08

I, I really only ever did a handful a year. And my, my motivation was there's no reason, you know, given how much I had gotten things to change at Hopkins, there was no reason that we could not get the system to bend. Let us create an environment that was a positive environment for our families. So, birthing in the same room you were laboring in, having your, having the spouse or significant other with you for the birthing process and later limited other family, if you had someone else that was important to have them with you. Minimal, if any separation of mom and babe, We got those things to change.

Katie 1:07:59

By the time I came, the practice was known easily an hour and a half away from, where we were because we were the only place around that was doing in-hospital water, birth. And we really were doing intermittent monitoring and we really weren't bringing people in until they needed to come in. And we really were discharging early and we really were doing VBACs, so it it was unique. So you, I always said that very much set up a scenario where, at, in that practice, in that model, in that setting, it wasn't so different.

Kathy 1:08:35

But e each of the changes came with a lot of, as I said, the people around me are saying, Dr. King's just giving her enough rope to hang herself. And every now and then said, Ms. Sloan, could you just kind of take it easy for a little while and let the, let the wave settle down for a little while?

Katie 1:08:55

No,

Kathy 1:08:55

he never told me not to do it. Because, and this is where. We were bringing in a lot of clientele and we more than paid for ourselves many times over.

Katie 1:09:08

And you brought a good reputation actually to wherever you were. When you have as a hospital, this was with a bunch of private practices because that's not existing as much anymore. There's definitely movement towards hospitalist, laborists. Um, but at that time there were all these private practices. But what a bragging right for a hospital to be able to say that they have all kinds of practices delivering there, and oh, by the way, we have this practice and yes, it's small, but if you, want a water birth, in the safety of the hospital, we have that for you. You just have to go there. And I know that on more than one occasion, our group was talked into taking a patient that we wouldn't have deemed low risk necessarily because the chief of obstetrics was like, this person really needs you guys. I will handle, the higher risk part of this. But they really, they need your compassionate care.

Kathy 1:10:05

Our TLC.

Katie 1:10:06

Yes, there was a lot of TLC in that practice. And it started from the front desk, like the second the phone rang, Keisha answering the phone and Kim and, I have. Things that Kim told me or told, or I overheard her telling patients that I still quote Kim used to say all the time, you have to be flexible to get a baby out. And I still tell people this, so Kim was out there while they were waiting for us talking to these patients for God knows how long, especially with you, Kathy, sometimes there was a bit of a wait for, for Kathy by the point that by the time I came to you, I think you had decided you didn't care how long visits were anymore. You were just over watching the clock. And so however long that visit needed to take, it needed to take. And people were okay with that'cause they would get that care when they got in, And so there was definitely some childbirth education happening in the waiting room of the apartment. cause we were in an apartment. So, Kim was approximately, I don't know, three feet away from, from all of the patients sitting in the couches. And I think there were subtle signs in that practice that you still had control as a patient. We made them take their weights, we made them do their urine dips. Like there was a lot of self-motivated pieces to their care. And, They loved you Kim as well. I mean, I'm sure that kept you around.

Kathy 1:11:28

Mm-hmm. Kim has the most phenomenal memory because someone would walk in, she, and she'd say, call out their first name and she'd know all of their kids and it was phenomenal.

Katie 1:11:41

Agreed.

Kathy 1:11:42

And I, I still talk to a lot of those people and up until retirement the same we took all of our patients with us when we went St.

Katie 1:11:51

Yeah. And then you retired, but you were still around. So it was like that last connecting piece probably for people. And congratulations on your retirement actually. That is something I want to talk about in, I think it's, it's, probably for another episode.'cause I have lots to talk about retiring as a midwife and what it feels like to be on the, the end of that. And, I think I'm gonna have to come back for a part two on this.

Kathy 1:12:17

Too bad. Always love to see you.

Katie 1:12:19

Yes. Well this is like,, another, another home for me. But, thanks for being on this first part of this, podcast and we'll, we'll definitely have to reconvene next time I come over. It's always a good excuse to have dinner together. I hope you have enjoyed this episode of Mindful Midwifery Presents, the Labor Behind Labor with my guest, Kathy. A special shout out to Kim for hosting us and being a part of the episode. After the recording of this episode, we had a nice dinner with Bayla who was in a previous episode, and Keisha our secretary from that practice. During this recording, we didn't come anywhere close to finishing Kathy's story, and I love going back to Baltimore and reconnecting. So next season, look out for another episode or two on Kathy. In two weeks, I will be sharing Holly's episode with you. Holly was in the final stages of midwifery school when I met her years ago. She transitioned from being a student midwife with my practice to a midwife peer. I wanted to showcase her journey as a mother and wife becoming a nurse, followed by becoming a midwife, becoming a midwife. Brought about many life challenges for Holly, but spoil alert, she's happy with the woman she has become. I look forward to sharing her episodes with you in two weeks time. And if you are loving these episodes, please share with someone. You know, one of my favorite things about podcasting is that it is still mostly marketed by word of mouth. My audience reach is largely dependent on my listeners spreading the word, and honestly, I can't think of a more fulfilling way of advertising.