Neil Haley: Hi everyone. Welcome to the special simulcast of the Neil Haley Show and Doc Tales with our host, Dr. Rural, Doc Allen Lindemann. Doc, what’s going on? I know you’re excited about our guests today.
Dr. Alan Lindemann: Yes, we’re really doing well here and I’m awfully happy that Paulette is willing to talk with us today. I know she’s delivered many babies, but I’d like to know, Paulette, how did you get started with this?
Paulette Efimenko: Well, I was raised in a family of 13 up here in the Turtle Mountains in North Dakota, and we were all born at home. So finally, I was number 12 of 13, but when I finally got pregnant with my first child, I decided that I wanted to have a home birth. That was 40 years ago, so there wasn’t really anybody around that was doing birth, but I just decided that women have been doing this for thousands of years, and birth is still the same. So we decided to have our baby at home. I had three other close friends that were pregnant the same time I was. They had had hospital deliveries and really didn’t want to go back to the hospital, so they asked if I would come over to their homes and be with them, and I did. And that’s how it started.
Dr. Alan Lindemann: Well, what you’re talking about is autonomy, and that’s one of the things you can have at home that you don’t have in the hospital. So that’s what your public wants. And I think right now, autonomy is where it is. There’s a lot of moms who are voting with their feet now, they don’t want to deliver in a hospital, but they don’t really know what their choices are. So thank you for making choices for them.
Paulette Efimenko: Well, I believe that that’s extremely important, especially in this day and age when there are so many things that people are kind of waking up and realizing that maybe there are some things that are not so good for them or their babies. And like you said, being able to make the choices about their birth is what is really important to them.
Dr. Alan Lindemann: Well, I imagine-
Paulette Efimenko: And of course, at home that they can choose where they want to deliver. They can choose how they want to do their labor. They get to choose the people that they have with them. And all of that really makes for a much more pleasant and normal delivery without complications.
Dr. Alan Lindemann: Well, I know that you have a wide reach. I referred a lady to you from near Harvey, and so that must be several, a hundred miles or so for you to go, so.
Paulette Efimenko: Yes, I do travel. When I first started, of course, there were just me and two other midwives in the state, and they were in the Fargo-Moorhead area. So I actually, in my work have traveled all the way to Dickinson, which is about five hours from me because I live way up by the Canadian border in the middle of the state. Right now, my farthest commute is about three hours away to a Hutterite Colony over by Grand Forks.
Neil Haley: Oh, wow. So what made you always want to do this, intrigued by this? Because again, this is an alternative way to give birth, for sure.
Paulette Efimenko: Yes. Well, when I was little, because I had lots of nieces and nephews and things, I was very interested in babies. We would get together in gatherings, and all I wanted to do was just sit and hold and play with the babies. When I was in high school, I was going to go into nursing, but I really disliked chemistry and there was a lot of that, so I didn’t go into nursing. And then when I started having my own children, I had attended a hippie friend’s birth and in her home just with no electricity, no running water, it was candlelight, and it was one of the most beautiful experiences I’ve ever had in my life. And I said, “If I ever have a baby, that is how it’s going to be.” And when I started talking about that with other people, they had the same desire. So I just felt that after my first child was born and people started asking me, I really believe that God called me as a ministry to do this for parents that want the alternatives.
Dr. Alan Lindemann: Well, I think that you made the right choice because if you had liked chemistry and gone on to be a nurse, you’d be most likely working in a hospital and you would be missing out on all of these home births and the natural birth and the autonomy that you give to moms and dads and babies.
Paulette Efimenko: Yes, definitely. I know that I would have gone into OB nursing for sure, and yeah, I kind of feel like I would’ve been stuck there and God had better plans for me, so He kind of kept me from doing that.
Neil Haley: How do you find people that want your services?
Paulette Efimenko: Almost completely by mouth. Right from the beginning, I felt like I didn’t want to advertise because I didn’t want to kind of promote myself. Excuse me. It’s just been word of mouth from one person to another, and it has been pretty amazing how some people have found me or gotten ahold of me. Lot of amazing stories how people finally were able to connect with me. But I really believe that it’s just if I’m supposed to be at your birth, I will be there, one way or another.
Dr. Alan Lindemann: When we talked last, it was blizzarding and you were driving, so you must drive through a lot of bad weather to get to where you’re going?
Paulette Efimenko: Well, I do lots of times. Sometimes I think I’m kind of crazy to stay in North Dakota and keep doing it, but… Excuse me. A lot of the other states, of course, have lots of other midwives, so it’s definitely a real big need in North Dakota for this choice for parents. And so this is my home state. I was raised on a farm just eight miles from where I live right now, and definitely have my deep roots here and will stay here until I’m not here anymore.
Neil Haley: Oh, I was going to go doc, that’s tremendous. What is the day in the life of a midwife? Kind of explain what you do.
Paulette Efimenko: Well, I guess, I try and plan checkups. I drive to people’s homes for checkups as well, the monthly checkups that I do. So at the beginning or towards the end of the week or the weekend, I set up the days that I’m going to travel and do monthly checkups. One day I’ll choose to go to the east. One day I choose to go to the west, and one day I choose to go the south or the middle section. So then that day may be planned. Most of the time I’m getting up and leaving home by seven o’clock in the morning so I can get all my checkups in in a day. I have driven 550 miles in a day, and I did six checkups in that time as well. So it gets to be really busy days sometimes. When you have several ladies that are due, then you’re kind of in your mind is always being on call 24/7.
You just never know when it’s going to happen so you can make your plans. But I always have to tell my people that I’m doing checkups, it’s like, “Okay, I have several ladies due, so I may not be able to come this day, but we will plan on that and I’ll let you know if something changes.” So it’s always, you have to be extremely flexible, and that’s one of the things that before I became a midwife, I was pretty regimented in my schedules and liked it that way. So I had to do a lot of changing in my mindset that things can change at any moment, and you have to be willing to do that and not get upset about it because that’s just the way life and babies are.
Dr. Alan Lindemann: Well, I certainly know about being available because I’ve delivered about 6,000 babies and I was available for most of them. And I think it’s very important that moms get to see the same person during their pregnancy. So you’re providing that service for them.
Paulette Efimenko: Yes. Congratulations on your 6,000 births. That’s pretty amazing. For sure.
Dr. Alan Lindemann: Well, I know what it’s like to be on call.
Paulette Efimenko: Definitely. Yes. And the winter is, I guess, probably the most stressing because you never know what the weather is going to be like or what the roads are going to be like, but that’s another thing that I really trust that it’s all in God’s hands. I could drive myself crazy trying to think about it and figure it out and all this and that, but I just really trust that He will do what is best and protect me and take care of me and orchestrate all of it, so I don’t have to worry about it too much.
Neil Haley: Fabulous. I got a question for you-
Paulette Efimenko: But yeah, it’s very important-
Neil Haley: No, Paulette, I was going to talk to rural doc about this. Why are you such a proponent of midwives, rural doc? Because ultimately you will be the one who delivered babies, especially when you were an obstetrician. Why would you not
want to be the one that ends up doing the delivery and to encourage people to be a midwife, to go to a midwife?
Dr. Alan Lindemann: Well, I like the idea of autonomy. And besides that, I worked with Jill for a long time, almost two decades in Fargo, and I know that she needed my support, and those patients that she saw needed my support, so that was the reason I did it.
Paulette Efimenko: And, like you said, it is so important for moms and dads to have the support of the person that you want to have at your birth so that you get to know them and they get to feel comfortable with you and they trust in you. They believe that you will do what is the best for them and will give them the best care that you can. And that is so important for moms to be able to relax in labor and know that they’re going to have just the people that they want there with them. It’s not going to be any strangers or any interventions that they don’t want. They don’t have to argue about whether they’re going to be in this position or that position. They have the freedom to make the choices that is their right to make in labor and birth.
And also, I’m not against doctors and hospitals, but now there are several midwives in the hospitals. And so when you go for your prenatal checkups, you see all three midwives, and then you get the midwife that’s on call when you go in labor. Well, out of three people, there’s going to be one that you like better than all the rest of and feel closer to, but then you go into labor and you don’t get that person. So to me, that’s a real setback for nurse midwives working in the hospitals. That’s a disadvantage, I believe, for parents and for the nurse midwives as well.
Neil Haley: Is it easy to work with the OB-GYNs, especially if you’re look as a midwife to give birth at home? How many of them are really proponents kind of like rural doc is and was?
Paulette Efimenko: Well, they’re in the bigger cities like Bismarck, Minot, that’s where they do birth and things, Devils Lake in North Dakota. The doctors all know me because I’ve had to transport at different times and things, and I don’t think there’s ever been a situation where they treated us real badly. Of course, they don’t agree with it and they can’t support it necessarily-
Neil Haley: Right. That’s the point. Paulette, that’s the point I want to say. Why don’t they agree with it? Why is any form of alternative medicine disagreed with in this country and, I guess, in the world somehow?
Paulette Efimenko: Well, I think, mainly because they’re not trained any differently. That’s the way that they’re trained, and they have spent how many years, up to 12 years in school learning all of these things. And then I come along that have been totally self-taught, like I got books and studied myself. I went to workshops and things like that. And I don’t have a license by anybody, and I come along and I am doing the same thing that they’re doing without the years of schooling, without the expense, and they just can’t quite understand that or think that I could be capable of doing as good of a job as they could.
And one of the other things is that they’re just not trained that way. They’re trained in all of the medical stuff. My training has been, of course, I have studied all the medical stuff, but my practice is more staying with the natural, and that’s what we disagree on. It’s kind of to them, labor and birth is a medical procedure that they can kind of control and make sure goes the way they want it to go. Labor and birth is a natural process that works absolutely wonderful if you just leave it alone.
Neil Haley: Wow. You’re right.
Paulette Efimenko: There are times when we need doctors, and I really thank God for them because they can save moms and babies lives, but I would say 98 percent of the time, if a labor is just left to progress the way it’s supposed to and how the mom’s body and mental state is handling it, it will work out really well.
Neil Haley: What do you do if there is complications? Do you end up preparing yourself for that situation that they might go to the hospital still?
Paulette Efimenko: Oh, yes. Yes. I always talk with the parents beforehand, and we always make a plan if something should come up that we need to go to the hospital. Yes.
Neil Haley: Go ahead, doc. Your next question.
Paulette Efimenko: Yeah, that’s not something that’s just a surprise, but I always… Usually the labor will indicate that there is something going on that may not be right, and so while I’m at the birth, I’m talking with the parents all the time and making sure that they know exactly what I know, or what I think is going on, or what I see they know as well because I talk to them about it. And it’s not me making the choice of running you to the hospital. It’s a choice that’s made by all of us that are there. Yes. By the time that we do go, myself and the parents know that this is a situation that we need to go to the hospital.
Dr. Alan Lindemann: Paulette, when you transfer to the hospital, is that by ambulance or do you put them in their car or you put them in your pickup, or how does that work?
Paulette Efimenko: It all depends on what the transfer is about. If it’s an emergency situation, which I’ve had maybe only, I think it’s probably been four times that we’ve actually had to call the ambulance. Other than that, I would say three-fourths of my transport switches. I think I’ve had 60 in the 40 years have been long, long labors where the mom gets exhausted and dehydrated and the labor is just not going anywhere. So we have to transport, get an epidural, a little bit of Pitocin, and mom gets rested up and a little bit of energy and then has the baby in the hospital.
Neil Haley: Let’s see. Wow.
Paulette Efimenko: So then we will just put… I mean, we’ll get stuff together and take mom to the hospital in their vehicle. I always go to the hospital with them as support and giving information to the doctors and nurses and things like that. I never just send them to the hospital without me. I go to the hospital with them.
Dr. Alan Lindemann: Well, I’d say that’s smart, Paulette. That’s a good way to do it. It really helps the patients that way.
Paulette Efimenko: Absolutely. Yes. We want the smoothest transition as possible. So the best way to do that, I feel, is make the continuity of care still available there for them at the hospital. And then they need a lot of emotional support at that point, because here we wanted to have a home birth and we are ending up going to the hospital, so then there’s a lot of emotional stuff that’s going on. So most of the time, once we get to the hospital, I’m there for the emotional support rather than doing the medical stuff at that point.
Neil Haley: Is this an affordable thing for families to have a midwife instead of going ahead and going to the hospital?
Paulette Efimenko: Absolutely. Well, I’m totally different than most midwives. I really wish that I was a millionaire, so I could do it free for everybody, because I don’t think there should even be a price set with it, which I don’t for the birth. There is a charge for each checkup that I do, but the birth, I leave up to the parents as a donation or a gift to me, whatever they can share, because I don’t believe that it would be fair for anybody to have to decide on a home birth on whether they can pay for it. And so I’m willing to just take whatever parents can share with me.
Dr. Alan Lindemann: Congratulations.
Paulette Efimenko: Well, it works really well. There are times when people can pay a lot and others that can’t, but that’s not what it’s about for me at all. It’s just being able to be available for people that want to do this and feel that it is the best thing for them and their families.
Neil Haley: All right. So Doc, any other questions do you have for Paulette?
Dr. Alan Lindemann: I just wanted to say, add a little bit about doctors and hospital deliveries versus home deliveries and midwives, but I think it has to do with a turf war. And that’s what the medical professionals, the doctors, the nurses in the hospital, the midwives who are in the hospital, I think it’s actually like, “These patients belong to me and why do you have them?” I think there’s a lot of that.
Paulette Efimenko: Yes, I would agree with you. I think that’s kind of what it comes down to is we’re taking… Well, I would hope that it would be because they want to give them the best care that they think that they can give them. Sometimes I think it might be have to do with the money situation. But yeah, I really… That’s true what you said, that it’s kind of I’m taking away their patients.
Dr. Alan Lindemann: Yep.
Neil Haley: Okay. Is there a place people can find information on you and stuff, especially if they’re in the area where you are a midwife?
Paulette Efimenko: Nope. You have to learn about me from word of mouth.
Neil Haley: Go to ruraldocalan.com and then that’s the only one of you. Yeah, go ahead.
Paulette Efimenko: I don’t have a website or anything. Actually, I am on Facebook, but I’m under a different name. It’s a name that I was before I was married, actually. On Facebook it’s under Punky Larson, but I don’t talk, that’s not a place where people would really find me for home birthing or anything. I don’t put a lot of stuff on there. I don’t have a website. I don’t have anything. I just feel, like I say, if I’m supposed to attend people or be there with them, they will find me one way or the other.
Neil Haley: Well, we appreciate-
Paulette Efimenko: And I’m plenty busy, so I don’t have to advertise.
Neil Haley: Exactly. Well, you can provide such great resources as with for rural doc, for sure. We appreciate it and thanks for stopping by.
Dr. Alan Lindemann: Thank you, Paulette.
Paulette Efimenko: Thank you so much for giving me the opportunity. I have enjoyed it very much.
Neil Haley: You’re welcome.
Dr. Alan Lindemann: You can come back any time.
Neil Haley: Absolutely. All right.
Paulette Efimenko: I will, anytime. Just let me know.
Neil Haley: All right. That was the special simulcast of the Neil Haley’s Show and Doctales.com. Guys, take care.
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