Spotlight Series

Guest Name: Ashley Gonzalez

Credentials:  CNM

All right, welcome Ashley. I’m so excited to have you here on our spotlight series here of the Best in Utah Public Health Edition. And so I’m just going to read a little bio here and then we’ll jump right into questions.

So Ashley is a certified nurse midwife who practices in Utah County. She’s passionate about birth, pregnancy, and women’s health. She enjoys the relationship she makes while caring for women and is committed to educating and empowering them about their bodies and health.

In her free time, when she’s not catching babies, she loves to run, hike, mountain bike, and travel with her family. Sound like a blessing to my soul there. I’m like the same thing with all my free time.

So awesome. Well, we’re so excited to have you here and jump right in to the questions. Okay, first question, what made you decide to be a midwife?

So ever since I was a little girl, like 10 years old, I knew I wanted to deliver babies.

I told my mom and I actually hoped that she might accidentally have a baby at home and I could deliver it. That didn’t happen, but I always thought, okay, I’m going to have to go to med school, be a doctor, deliver babies. Well, when I got pregnant with my first child, I went and started care with a midwife and I didn’t know what a midwife was.

I didn’t know that they could deliver in a hospital. I didn’t know what kind of care they could provide. But after my experience through my pregnancy, my delivery, postpartum period, I thought, wow, I can do this and not do the med school route, but still do what I am passionate about, maybe do a little different form of care than the medical route provides.

And so that is where I was like, okay, this is actually a career for me. I worked as a nurse and obviously had to get right into labor and delivery because I love everything about it. I loved labor and delivery.

I had seven years of experience working there as a nurse before I went to be a midwife. And just to clarify what a certified nurse midwife is, because there are three different types of midwives. And what is different is about their education pathways, their training pathways, and then their scope of practice and how they can practice.

So I’m a certified nurse midwife, meaning I went to school, I obtained a bachelor’s degree in nursing. I did work for quite some time in labor and delivery. And then I went on to get a master’s degree in nursing with a focus on midwifery.

So as a certified nurse midwife, I could practice in a birthing center. I could practice doing home births, or I can practice in the hospital. And I practice doing hospital deliveries and also working in a physician’s clinic.

Amazing. Thank you for clarifying that. I know that there’s a lot of confusion around that.

And it’s important like as a patient, as the woman to know what type of provider you’re seeing, what their certifications are or their education is, and what type of care they can legally provide you and where care can happen. And it can be confusing. And so hopefully that helps a little bit with clarifying.

Yeah. Love that. Love that.

Awesome. What a great story. Okay.

Next question. What makes you different?

So I was trying to think about like what makes me different, but what I decided that I want to focus on is what I think makes a lot of newer providers different that I’m seeing as a shift from when I started in labor and delivery nine years ago to now. And what I’m seeing and what I love to see is newer providers coming out of school, med school, midwifery school, and just the shift in how we care for patients.

And what I’m seeing is it’s no longer, I’m the doctor, this is what I’m doing. And this is how it’s happening. What I’m seeing is there’s becoming, there’s more conversation happening between providers and their patients, more education, more informed care, which is so important and handing over really the autonomy to the woman.

This is her body and we have to trust that. We have to respect that. And I’m seeing it happen in newer providers.

And I think it’s great because it has been a more patriarchal system and you would go into the hospital, you have a baby and you do whatever they tell you. And it didn’t matter what the reasoning behind what that was, or if they gave you any education about why, Hey, this is what we need to do. This is why.

And so that’s the shift I’m seeing. And I try to practice like that, but I’m also seeing it in my colleagues and I think it’s great. And I think we’re just seeing a shift in birth care and it’s wonderful.

Yes, I would agree. There’s definitely a shift and I’ve been practicing 12 plus years now. And like, I’ve seen that, that same shift you’re talking about in our sphere of even collaboration with patients themselves and, and cross collaboration between providers.

Like it’s in, we talked about this in school when I was in PT school anyway, of like, this is where it’s going. We’re like, okay, yeah, yeah, yeah. And then it’s like, Oh, this is actually happening.

And it’s so cool. Yeah.

It’s so exciting because, um, as a person who’s had a babies myself, like, why was it not always this way? And patients are expecting it.

And it’s our duty to provide it and to trust them and to keep them. They’re part of the team. Just like you’re part of the team.
I’m part of the team. The nurse is a part of the team. They’re part of the team and the most important part.

Absolutely. Absolutely. Okay.

Next question. Who’s an ideal fit for you?

So, um, as far as midwives and what patients I can see, midwives are typically known to take lower risk patients. Um, however, in my practice and the way I practice, I do work with a group of OB doctors.

And so we can take women that have more complex histories, pre-existing conditions, um, as complications can arise in pregnancy. We are usually able to still care for them. However, we do consult with our OB partners to make sure that we’re providing the best care possible, ensuring optimal outcomes for mom and baby.

And we also can work with the specialists. They’re called perinatologists. They specialize in high-risk pregnancies.

And so, um, when we see that things are starting to maybe get a little more complicated, we just start involving more people in the care so that we can still be their provider, but make sure that everything is put into place so that they’re receiving the best care. Um, the, I would say like the biggest thing that we cannot do, at least in my group and most midwife groups in Utah County is we cannot care for someone who is pregnant with twins. Twins are very high risk.

The pregnancy is high risk, the delivery is high risk. And so if you came to us, we discovered you were having twins. We would recommend you see the OBGYN.

Okay. That’s good to know. Good to know for sure.

Um, okay. What does recovery look like? Whether you can, and you can take that many different ways, just like midwifery or what your like views on recovery and how long is recovery and what is like all of that.

So my views on recovery is that it is lacking in the United States.

Um, up in the last month of pregnancy, before you deliver your baby, you are in our office and we are seeing you weekly. Okay. And the current system, the way it’s set up with insurance, um, and just the healthcare system is you deliver your baby.

We come and see you 24 hours later in the hospital. And then unless we have like a really big concern, like we’ve had really high blood pressure or we have severe mental health disorders. We’re just like, bye, see you in six weeks.

And I think that’s a failure in the American healthcare system. Um, but it’s really hard to change that system because once again, we’re dealing with insurance and reimbursement. And so I struggle with that because I know as a mom personally, that first six weeks is huge.

That first two weeks can be like the hardest two weeks of your life. You’re having a shift in your family dynamics. Um, your body’s something that was seriously like childbirth is it is big deal.

And you’re also dealing with the mental health part of becoming a mom or adding a new person to your family as well as the hormone shift. And so I think it’s a really big disservice to women. Um, hopefully we can start to see change and see, be able to see these women in our office sooner than six weeks and more often.

Um, but it requires policy change. It requires negotiating with insurance. So it’s not a fast process as you know, dealing with insurance.

Right. Um, so that’s like my biggest hangup with recovery, but what recovery that I think is important. Um, and I tell all my moms after they deliver is you need to go home and I want you to just sit on the couch for a week.

Do not be out in Costco and three days later getting groceries for your family. Like what your body just went through and recovering from is huge. Um, and you really need to focus on the rest, nutrition, hydration, and then bonding with your baby.

Okay. That is like the most important time. It’s a very important time to establish breastfeeding.

Um, you shouldn’t be worried about anything else, but once again, the system isn’t designed to support that. Some moms have to return back to work much sooner than anyone would like to. Um, most parents, most fathers or partners don’t have paternity leave.

So here’s this mom with a brand new baby recovering from a delivery. And she’s also got three other kids. She’s taking care and that’s at work.

So that’s really hard. Um, but I think we all as providers and patients, we try our best and that’s all I can ask for. Another thing I’ll tell my moms when I do them for their six week visit, because we think, okay, six weeks.

Great. You’re good. Go back to normal life.

No, no, no, no. We both know that’s not true, right? The postpartum period is much longer than six weeks. Really research shows that a woman’s body doesn’t go back to normal for one to one and a half years after delivery.

And so I don’t want you to just jump back in and say, here we go. Everything’s back to normal. It’s not.

And so that is important to understand. And then bringing it to pelvic health, I recommend it to everyone at six weeks and I hope their insurance will help you for it because we know what pregnancy and pushing out a baby or having a C-section can do to a woman’s body. And really it’s essential that we try to heal that repair, any damage that was done because this is the body she has to live for the rest of her life.

This is the body that may carry another baby in a year or two or three. And so we really need to focus on getting that back to ideal health basically. Yeah.

Yeah. So important. So important.

I feel like to, similar to like kind of the little rant of like our system, it’s the same thing for us in pelvic PT is like, we’re trying to change that narrative of like actually standard of care is coming when you are pregnant to pelvic PT so that you can prep for, so you have less complications or recovery postpartum to make that transition even smoother. And I feel like that that’s a common thing, misconception from people just in general is like, Oh, I’ll just like, I’ll do, I’ll wait till after I have the baby. But it’s like, well, what if we actually prepped you for this event? Like, just like you would prep for a marathon or something like that, you will want to be like optimally set up for success.

And so I feel that same passion with you of like the system, the system, the system. And like, we so passionately are trying to be like, okay, what can we do different outside of the system that actually makes change in a systemic change?

A lifelong work, I think. And luckily though, there’s a lot of people, different types of providers that like, we all want the same thing.

Absolutely. Yeah. Okay.

Next question. What’s something that most people don’t know that they think they should know about midwifery services?

Hey, so I love this because we’ve been talking so much about pregnancy and birth, but certified nurse midwives here in Utah, I can’t speak for every state because there’s different scopes of practice. We do so much more than pregnancy and birth can provide so much more for women and midwife.

Okay. The word midwife means with woman. And I love that because that’s what we do.

And we’re with women through the lifespan. And so we can do yearly well woman visits, pap smears, birth control counseling, IUD insertions. We can help with menopausal problems.

We can help with menstrual problems, PCOS, endometriosis, STI testing. So we really can provide pretty full scope care to women throughout the lifespan. And so typically I don’t start seeing girls or women till they’re hit like their menstrual cycle.

But I’ve seen 14 year old girls in my office before that have menstrual problems. And I think people don’t understand that. They think a midwife delivers babies, but we can do so much more.

And once again, if we start seeing a patient’s having a little bit of, you know, maybe risking out of our care, we can always refer them to the appropriate care, get other providers involved to manage that aspect of their care. But I think that’s something that everyone should know. I think that’s great.

And we can really just help you through your life. Yes. Love that.

Carry your pelvis through your whole life. Okay.

Next question.

Do you have any type of special thing that you want to promote to anyone who’s listening here?

Okay. I didn’t think about this one very much. No, I think what I want people to know is that we work with all insurances.

We deliver in hospitals and we are happy to see anyone. And if you think that a midwife might be a good fit, or even if you’re interested, we’ll have patients come in like, Hey, I’m not sure. I just want to like, kind of talk to you and see like what this would look like if you were my provider.

We are happy to do that because we know that sometimes there’s education. Sometimes we know it’s, Hey, you just need to come see if we fit personality wise, or if you and I have similar beliefs about birth pregnancy. And so that’s always an option.

If someone’s like a little, like unsure, if they want to see my wife, you can always make an appointment and we can sit down and have a discussion about what the goals are.

Awesome. Awesome.

Okay. And then what’s the main thing that you want to be known for?

So I’ve thought about this really hard, but the, I think what the main thing I want to be known for is I want when people speak my name or, Oh, I hadn’t asked my wife, I want women to come to me and I want them to feel respected. I want them to feel empowered.

I want them to feel cared for because having a baby is one of the most vulnerable times of your life. And it’s also can be one of the most transformative, but we have to have respectful care. We have to have informed care.

We have to have, um, a trusting relationship with each other. But I, I really like strive to provide that for every patient I have, because I know how this birth can affect your life. It can affect your bond with your baby.

Um, it can affect so many things. It can affect the way you feel about yourself, the way you think about yourself. And so that is my goal.

And I tell people the first time I meet them, I’m here to support you. I’m here to educate you. I will make recommendations.

If I feel like it’s a safety issue for your, you or your baby, but I don’t ever want you to feel like things are happening to you without your control, without your consent. I don’t want you to ever feel like I’m making you do anything because I’m not. And I won’t, I trust that you can make the best decision.

And I’m here to help provide the education so you can do that.

Amazing. Amazing.

Okay. And then where can we find you or do you, where do you work? How do we get in touch with you? If someone wants to schedule with you.

Right now, I work at, uh, Revere OBGYN. It’s in pleasant growth.

I work with, uh, three other amazing midwives there. And we, um, deliver at Timpanogos hospital in Orem, American Fork hospital and Holy cross mountain, mountain point in Lehigh. Um, and so really the best way is just call, get an appointment.

Honestly, every, every midwife I work with is wonderful. I trust them so much. Um, and so that’s the best way.

I don’t really do much as far as social media, um, and midwifery at this point. Um, but I am definitely involved in the community. Um, and really like, this is my passion.

It really is.

Awesome.

Well, thank you so much, Ashley.

We really enjoyed chatting with you today and like diving into all these amazing topics. Um, and we look forward to seeing around.

Yes.

Thank you so much for having me.