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Midwifery Care with The Nest

We believe that each birth is sacred.

Your birthing experience is an event that imprints on you forever. We recognize this space must be filled with gentleness, honor, love and respect.  The process of growing and birthing a baby is challenging work, but it is work that holds great potential for being the most rewarding and empowering experience in a woman’s life and has a lasting impact on her family. 

We are here to guide you and your family throughout the childbearing year  preparing you for this transition and an empowering birth.

We support normal, physiologic birth.

Our care integrates the art of traditional midwifery with evidence-based practices.  

Our certified professional midwives and certified nurse midwife bring over 40 years of collective experience and have helped thousands of families safely welcome their babies into the world in a variety of settings. 

The midwifery model of care is rooted in the belief that pregnancy and birth are normal life processes  while we monitor closely for variations outside of normal, we trust that the majority of women will grow and birth their babies just fine.  Pregnancy is not a medical problem and midwifery care is an excellent choice for women who are healthy and low risk. 

Throughout the care of the mother and baby, we offer many of the same labs, tests, screenings, medications, etc. that one might receive if they were under the care of a physician or hospital; in addition, we offer guidance in herbs, homeopathy, essential oils, nutrition, exercise, body work, and emotional health. 

We want to get to know you.

Shared decision making and informed consent are an essential part of our care. We will take all the time needed for you to feel fully informed and confident in your choices. After sharing information with families about many of the choices they can make, we trust that families will make the best choices for themselves. Throughout the many weeks, we really get to know your family and build relationships. As midwives we really care about women and their families and pour so much of ourselves into this work! 

Every woman deserves the loving care of a Midwife.

Our certified nurse midwife can provide warm, unrushed care for all girls and women, puberty through menopause. 

Lifetime midwifery care can include:


Midwives monitor the health and well-being of the mother and baby, but it is not as simple as only addressing physical health. Normal physiological birth works best when a woman’s space feels safe and protected.  We want to create a haven for your peaceful birth; we know from experience that this results in the best outcomes for mothers and babies.  We spend time developing and discussing a birth plan with you during your pregnancy, doing our best to tailor our care to your desires.  

You will be in close contact with our midwives as labor begins. When the time comes, two of our midwives will meet and be with you throughout the labor process.  Knowing everyone in your birth space really creates a sense of ease and allows the hormonal labor orchestra to flow.

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Home Birth

An expecting mother may choose to labor and deliver in the comfort of her own home.  Midwives honor your turf and bring all the necessary equipment, medications, herbs and supplies.  One of our favorite moments is that time after the birth when we have cleaned everything, finished the newborn/mother exam, reviewed postpartum instructions, and tucked your family into bed.

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Birth Center in Pullman

We have put a lot of intention into creating a comforting space for women to labor and deliver, full of vitality and love.  Birth centers offer a great alternative to home birth when families live far away or feel more comfortable away from home to birth.

ViviAnne Fischer

Licensed Midwife

ViviAnne brings the deep wisdom of experience to her care for women through prenatal, labor & delivery, and postpartum care.  She integrates the art of traditional midwifery and current knowledge.  ViviAnne enjoys the relationships she develops with families and often creates lasting friendships.  Women appreciate her compassionate, calm and patient nature.

Midwifery care is available at our Pullman, Moscow, and Lewiston offices!

Tina Gearhart

Certified Nurse Midwife

As a certified nurse midwife, CNM, Tina is able to provide women’s health midwifery care from adolescence through menopause! She can provide care for Well Woman exams, labs, family planning, and gynecological concerns.  Tina’s straightforward and deeply caring manner really helps women feel informed and empowered in their healthcare. Midwifery care is billable to insurance, Medicaid, or self-pay and is available at our Pullman, Moscow, and Lewiston offices!  Book with any midwife for prenatal care, or book with Tina specifically for Well Woman care.

Dr. KO

Naturopathic Doctor, Licensed Midwife

The Medicine Woman of The Nest, Dr. KO guides healing with a sense of patience, ease, and trust.  As a midwife and doula, Dr. KO brings a tender reverence for the sacred transition of birthing.  With a foundation of evidence-based care, she empowers the mother to trust her own body and intuition.  Book with any midwife for prenatal care and Dr. KO will be on your team – the three midwives rotate each week.

Dr. KO is currently not accepting new naturopathic clients; but you are welcome to call us at email to discuss options and be added to a wait list for intensive spiritual counseling.

Click below to work with Dr. KO in her weekly group offering, Meditation Circle at The Nest in Moscow Wednesdays at 6pm.

Jess Mallery, doula and student midwife

Jess Mallery

Student Midwife, Birth Assistant

Jess brings a steadying and supportive presence to births at home and the birth center. As the student midwife at The Nest, she attends office visits and births as an important part of earning her degree from the Midwives College of Utah. Her contributions to maternity care and delivery reflect her deep honor for the experiences of pregnancy, birth, and womanhood.

Jessica Smith, Doula and Lactation Consultant

Jessica Smith

Lactation Consultant, Nurse

As your lactation specialist my goal is to compassionately support you through your parenthood experience.  I apply a holistic approach to my practice, combining ancient wisdom with evidenced based science to give you a full range of information. My goal is to create a safe space for you to feel connected, honored, and supported in the decisions that give you peace and joy. This is a very challenging, vulnerable, and intimate time in life and having someone to guide you through your journey can be immeasurable. I feel humbled and honored to work beside parents in this transformational time.

Midwifery care and a home or birth center birth is drastically less costly than care with a physician and a hospital birth.  Many families appreciate the savings.

If you are in need of financial assistance for any of your costs please reach out and ask to fill out our financial assistance form.

At your complimentary consultation, we will give you information about our fees that address your specific financial situation.

Where can I learn more?

Explore the Whole Health Compendium for more pregnancy related resources!

"ViviAnne is like a warm hug and cup of coffee along the intimate journey of pregnancy and new motherhood. Check-ins with her always allowed me to feel heard, understood, supported, and most of all peaceful."
"The midwives at The Nest were absolutely crucial to my HBAC success! We received the best prenatal care and prep that lead into a beautiful, safe and healing birth at home. The postpartum care was everything it should be and rarely is in the US. Absolutely the best experience."
"ViviAnne is warm and encouraging, as well as being well equipped and knowledgeable in her craft. She is a good listener and eager to help in what ever way she can. Our family loves The Nest and can’t imagine birth without these amazing ladies."
"Tina is caring and knowledgeable. She remembers the little things."
"At The Nest I had the pleasure of receiving the most holistic, gentle and nurturing prenatal care I could have asked for. As a first time mom, I had so many questions and ViviAnne provided me with so much information & comfort as my mind was often racing! I had the absolute pleasure of having Tina and KO at my home birth. I couldn’t have asked for better support during my labor and delivery. Together they fostered a magical birthing environment including massage, encouragement, and even some laughter that kept my spirits soaring. KO delivered my baby and it truly feels like I could never express my gratitude to her or Tina for all they’ve done for my family. I have nothing but love for the ladies at The Nest. They make me want to have so many more babies!!!"
"KO was the balm to ease my breastfeeding struggles in early postpartum. She provided gentle and loving care to my baby with cranial sacral and tongue tie clipping that meant the difference between tears and cracked, bleeding nipples and the truly phenomenal postpartum bonding experience I was able to have. Truly a 'baby whisperer.'"
"With ViviAnne, you leave each midwifery appointment like you just spent an hour with a dear friend. Her passion and love for being with women and families is apparent in everything she does. The Palouse is so lucky to have her."
"I worked with Vivianne to have a home birth after a traumatic first birth. She was present to my needs and the lingering fears I held and supported me through my prenatal care, and also through the decision making process of having another home birth. She's knowledgeable, straight forward and incredibly supportive. My second birth was beautiful and so empowering and I can't imagine having that experience with any other provider."
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ViviAnne Fischer

Licensed Midwife

My journey to midwifery started early.  I was born at home with a midwife and grew up surrounded by women who used herbs, homeopathy and food to heal the body.  I was always drawn to pregnancy and birth, however, I took a few detours along the way!  My boys were born in 2002, 2005, and 2006.  I earned my Masters Degree in Human Development shortly after the birth of my second son – with a focus on families and parenting.  In 2007, I became a birth doula while also teaching at WSU.  The calling to midwifery grew louder over time and I went back to school to earn my bachelors in midwifery and become a certified professional midwife in 2015. I love connecting with families and being a part of their journey.  I am passionate about doing what I can as a midwife to facilitate and hold space for normal physiological birth, with the goal always that women will feel they were well cared for, heard and honored.  I am also excited about advancing midwifery care in the U.S.!  I serve as a committee member on the Midwifery Advisory Council in Washington and the Idaho Midwifery Council in Idaho. 

Tina Gearhart

Certified Nurse Midwife

I have been in health care my entire adult life.  I started as a certified nursing assistant working in a nursing home, became a phlebotomist, and an EMT (though, I never worked as an EMT) until I discovered my passion for nursing. I found out I was pregnant with my first daughter the same time I was accepted into nursing school. As a typical first-time mom, I was nervous, excited, and wanted to feel as though I could connect with my OB. After 3 visits of having to explain to him I was there because I was pregnant, I had lost all confidence that he’d be of any use once in labor.  A friend had suggested a CNM (certified nurse midwife), and this was life-changing.  She deserves all the credit for where I am today.  

I attended nursing school at the Colorado Mesa University in Grand Junction, Colorado and graduated with a Bachelor’s of Science in Nursing, in 2002. I started nursing school with a 3 month old, and my second daughter was 3 month old when I graduated… something I don’t necessarily recommend attempting.  While working as a medical/surgical nurse, I attended graduate school at the University of Colorado in Denver and graduated in 2006 with a Master’s in Science specializing in nurse midwifery (Nurse Practitioner, Nurse Midwife).  I would spend the majority of my career in Colorado working in the hospital and clinic setting, until crossing over to the home birth and birth center world. I finished 2021 by becoming an IBCLC (International Board Certified Lactation Consultant). 

I am passionate about women’s health, pregnancy, and birth. I believe in empowering teens to learn and trust their bodies, guiding women and their partners through their low-risk pregnancies and birth, and guiding women through and beyond menopause.  I treat women as a whole – mind-body-spirit – and believe optimal health can be achieved when all three are aligned. As a Certified Nurse Midwife (CNM), I am able to evaluate, diagnose, prescribe medications if needed, and support women throughout the life span. I provide evidenced-based education, resources and recommendations to allow for individuals to make informed decisions about their health in a non-judgemental manner. Types of visits include preconception counseling, birth control (IUDs, Nexplanon, Natural Family Planning, etc.), gynecological visits, annual physical exams, and blood work if needed, and of course prenatal and postpartum visits. As an IBCLC, I support the breastfeeding mama throughout the entire breastfeeding journey. I am also able to evaluate tongue/lip ties and revise them, if and when appropriate.  

I was born in Moscow a few years ago, and grew up on the Palouse. My husband and I live on a lovely farm outside of Palouse that has been passed down by my great-great grandparents who settled here 1913.  I have two grown daughters (22 & 19), one of which is a pharmacy tech, and the other is currently attending WSU – Go Cougs! I am also lucky enough to have two bonus boys (12 & 10); along with the true rulers of the farm, a 7yr old white golden retriever and a 6yr old German Shepard. We are looking forward to bringing more animals back to the farm in the near future.  I love lifestyle photography and more recently have delved into birth photography.  I enjoy running, reading and audible books, gardening, and might be a bit of a wine enthusiast; mostly though, I just enjoy being at home with my husband.

Dr. KO

Naturopathic Doctor, Licensed Midwife

I was born and raised in a suburb of Minneapolis, Minnesota. I graduated from Bastyr University as a doctor of naturopathic medicine. I am also in the final stages of completing a Masters of Science in Midwifery from Bastyr. I was brought to midwifery and naturopathic medicine through the desire for a life dedicated to the pursuit of the overwhelming joy of loving service. I have been volunteering with several organizations to serve underprivileged children in various countries since the age of 16.

I attended Stanford University and graduated with a degree in neurological psychology and a minor in human biology. As I gained more focus on healthcare throughout my undergraduate career, I geared my service work towards sexual and women’s health. After graduation, my entrepreneurial spirit and search for a more holistic system of medicine brought me to a career in naturopathic medicine, and training as a craniosacral and visceral manipulation practitioner and massage therapist. I am very dedicated to the power of holistic healthcare, and I believe firmly in the ability of each individual to manifest their own health. I have begun my clinical education at Bastyr; while my skills continue to evolve, the clinical style I always attempt to embody is illustrated by the phrase, ‘listening in love.’

I came to midwifery through a desire to support health from conception. I ascribe to the belief that a child’s time in the womb and experience of birth are some of the most formative health experiences, and these experiences will continue to impact the health of the individual throughout the entirety of their life.  In addition, I am drawn to the empowerment of women that pervades the field of midwifery, returning to women their dignity and power, and supporting the reclamation of birth by the women who are giving it.

I truly believe that giving birth is one of the most important events that will occur in the life of a woman; I cannot adequately express how excited, honored and grateful I am to have the opportunity to partner with women in this experience.

The foundation of my life, belief, and medical practice is this:

All illness would be eradicated if we could all remember the one essential truth-

Everything is love.

Jess Mallery, doula and student midwife

Jess Mallery

Student Midwife, DONA Birth Doula

When I was 11 years old, I attended the birth of my little sister. This experience laid the foundation for a lifelong fascination with all things pertaining to childbearing and women’s health. I received excellent midwifery care during my own pregnancies, which inspired me to become a midwife myself. I am currently in midwifery school and have been honored to learn from several local midwives, including the amazing midwives at The Nest. I’ve attended nearly 100 births and am grateful for each of these experiences.

I also work independently as a doula (find me at  My goal is to provide support that is suited to the needs of each woman and her family. Creating such support requires time, attentiveness, and honor for the unique needs of each client. Because of this, I place high value on prenatal visits in which we get to know each other, explore individual goals, preferences, concerns, and questions. I do my utmost to ensure my clients have access to evidence-based information, are honored in their decisions, and feel prepared to welcome their baby. I support labor and delivery through in-person emotional and physical care. And in the early postpartum days, I remain available to offer a listening ear, gentle advice if it is desired, and connection to additional community resources. It is my joy and privilege to support this sacred and ordinary process.

When I’m not busy with birth work, I enjoy cooking, making things with yarn and fabric, and exploring with my family. My husband and I live in Latah County, Idaho, and have five children.

Jessica Smith, Doula and Lactation Consultant

Jessica Smith

Nurse, Lactation Consultant

Hi there, I’m Jessica Smith. I offer lactation consultation at The Nest for the greater Palouse community, whether you are a Nest midwifery patient or not.  I’m a nurse, IBCLC (International Board Certified Lactation Consultant), Certified Birth and Postpartum Doula (find me at, and Certified Breastfeeding Educator. I’m also a rural, homeschool momma of four littles living on our regenerative farm with ALL the animals in Palouse, WA.

My interest in wellness, birth, babies and maternal health started from a young age. During high school and college I taught swim lessons and worked at a long term care facility as well as a special needs home. Upon graduation I worked as a school nurse, pediatric home-care nurse, and a minor-care/ready-care nurse. But, soon my passion for the healthcare, or rather dis-ease care system began to wane. I was constantly trying to get my patients outdoors to experience the world and nature around them. I wanted to help them live healthy, balanced lifestyles. My passion for getting back to nature and our roots continues throughout my own life and blends into my work. This is why I take a “holistic” approach.

When my own journey with motherhood began, I was awakened to the fact that in our culture there is a disconnect between birth and postpartum. Like many, I prepared for the birth but never really gave much thought to postpartum. While planning for birth is important, planning for the postpartum period is even more important. I found myself struggling with lack of resources and unable to ask for help. I struggled with breastfeeding, low supply, and ended up supplementing. Through help of doctors and lactation consultants we ended up saving my breastfeeding experience for two years and then was able to successfully tandem nurse when baby #2 arrived! I experienced birth trauma and postpartum anxiety & depression. I struggled to find balance and healing again after each baby. I came across Julia Jones Newborn Mother’s Collective, Ayurveda Postpartum care and found the missing link in my postpartum experience. Through the wisdom of ancient traditions and scientific role of Oxytocin, I learned what we have missed in our culture. While there’s much from ancient traditions and culture, we can’t apply to our modern lifestyle there are two culturally universal things we can do, help and support the new mother and offer nutrient dense, warm prepared meals.

Through my pediatric nursing experience, I cared for many previous NICU babies with unique challenges, in which I saw a vast difference in the ones who were fed breastmilk. This led me to dive deeper into the lactation world and fueled my love for working with families through difficult times. I furthered my education and became certified as a breastfeeding educator and birth doula.  Birth work has caused me to look deeper at my own healing so I can show up for clients with positive energy. As your lactation consultant my goal is to support you through your experience. I love working and troubleshooting through challenges with clients to apply what feels right for you and your needs. I want to guide you where necessary with an open mind well as empower you and promote healthy lifestyle.

The best to you, Jessica

Special Trainings:

  • Midwife Assistant Training | 2009
  • Lewis-Clark State College, Nursing Graduate | 2011
  • Postpartum Doula Training, Newborn Mother’s Collective | 2015
  • Certified Birth Doula | 2015
  • Certified Lactation Educator, Evergreen Perinatal Education | 2016
  • Intuitive Birth for Birth-Workers | 2019
  • Perinatal Mood and Anxiety Workshop, Perinatal Support Washington | 2020
  • University of San Diego Extension, Lactation Consultant Didactic and Internship | 2021
  • Steamy Chick, Peri-Steam Facilitator | 2021
  • Tongue Tie, A Comprehensive Approach to Assessment and Care, Melissa Cole, MS, IBCLC | 2022
  • International Board Certified Lactation Consultant | 2022