THE FOLLOWING ARE COMMON QUESTIONS REGARDING HOMEBIRTH - THE ANSWERS GIVEN ARE SPECIFIC TO OUR PRACTICE
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The short answer is that we believe in physiologic birth; we do not fear birth. Pregnant women are treated as individuals, their pregnancies and labor as individual experiences, family involvement is welcomed, and interventions and technology are used sparingly.
Prenatal care typically follows the standard schedule of every 4 weeks, then every 2 weeks, then every week, with slight changes depending on your package. We come to your home for your 36 week visit. Prenatal labs are fairly standard but also individualized after informed consent. We will order a mid-pregnancy anatomy scan, but no other ultrasounds will be ordered unless medically necessary. The first prenatal visit may last up to 2 hours, and subsequent visits are typically 30-60 minutes. Wait time is typically none to minimal. While we of course assess mom and baby at prenatal visits, the majority of the time is spent chatting and getting to know each other. We do not collect urine or weigh our mothers unless there is indication to do so or they wish this information. And we never, ever perform routine cervical exams during visits.
No, we do not have students. 99-100% of your care will be attended by either Julie and/or Kara.
Absolutely. We encourage family involvement. Our office is located in a yoga studio/women’s health collective, not in a sterile medical building. Our approach is to present a homey, inviting, and comfortable place to come for visits. Many times children assist in the assessment of mom and baby during visits - they love to measure mom's belly and find the baby's heartbeat!
Whoever decided that every baby gestates for the same length of time? We believe that every pregnant woman and her baby work together to decide the optimal time for the baby to be born. As such, yes, you are "allowed" to continue to be pregnant. If you do reach the beginning of 42 weeks (2 weeks "overdue") we will discuss your options such as continued expectant management, induction by non-pharmaceutical means, or transfer for hospital induction.
Typically if your water breaks on its own before labor you will enter into labor within 24-48 hours. As long as baby and mom remain healthy, there is no definitive time limit for intervention. Of course, discussion of the risks and benefits of your options is ongoing. And we NEVER perform cervical exams on ruptured mothers before active labor and even then only when absolutely necessary. Since we opened our practice in 2015 we have had no infections in either mom or babies.
Since the beginning of our midwifery careers, we have attended moms who are attempting vaginal birth after cesarean. For many, they are pursuing midwifery care in order to avoid the interventions that they feel significantly contributed to the first cesarean. The risks of pursuing VBAC are similar or even less to that of any true obstetrical emergency, and thus homebirth is a safe choice. It also allows for a much higher success rate than pursing a VBAC in a hospital with unsupportive providers.
When labor is allowed to progress on its own terms, moms and babies work together in assisting the baby safely towards its entrance earthside. Without intervention in this sacred process there is much less likelihood of concerns over fetal well-being. Auscultation of the fetal heartbeat intermittently with the same doppler used at visits assures us of how baby is tolerating labor.
This is discussed in depth at a prenatal visit, with options of declining IV antibiotics, waiting to assess for need until the actual time arises, or receiving antiobiotics.
Most are surprised that not much is needed for birth. We do ask that you purchase an inexpensive birth kit (inhishands.com); a couple of basic shower curtains; and of course, menstrual pads. Everything else needed you probably already have - paper towels, bleach, peroxide, towels, washcloths, baby blankets, a cookie sheet, a heating pad, and a bowl for placenta.
Your homebirth fee includes rental of a birth pool if desired, however, you will need to purchase the liner, the hose and an adapter.
Most moms know exactly who they want or need at their birth. Many times birth is a very intimate affair. Other moms invite sisters, mothers, mother-in-laws, sister-in-laws, and even their other children to be a part of this wonderful experience. Unless there is obvious distraction to the mother that is impeding her labor progress, she is welcome to have whomever she wishes to her birth. And we love doulas!!
While a transfer is always a possibility and discussed in depth at the 36 week home visit, including documenting the closest hospital, in actuality transfers are very rare and typically not emergent. Again, because without interventions, complications occur much less frequently. Because transfers are not common, and every labor and delivery is unique, to give a transfer rate is not truly accurate. Rather we discuss why would there be a transfer. The most common reason for a transfer of a first-time mom is exhaustion and/or need for pain relief. We discuss early on how to avoid these reasons, but sometimes it just cannot be avoided. Other reasons for transfer, which may be necessary but not emergent, are bleeding during labor; fetal intolerance to labor; prolonged labor; bleeding after delivery that we are unable to control; retained placenta; cord avulsion; large or significantly bleeding laceration; inability of baby to properly transition. When a transfer is necessary, typically one of us will accompany you while either your partner also goes along or stays back with the baby.
While yes, there is blood, amniotic fluid, and other bodily fluids, homebirth surprisingly is not typically what one would consider "messy." Much is contained in the pool and the chux pads used for this purpose. While you are responsible for covering carpets or other items that you would prefer not to get soiled, you are not responsible for cleaning up after delivery. We clean up everything, and after we leave no-one would ever know that a baby had just been born - except that it is now present when it was not before!
You are welcome to have a family member or friend take photos and videos, or to hire a birth photographer. We also plan to take pictures of the labor and a video of the birth if the parents consent and circumstances allow.
If one of us is not available for some reason, either another midwife or a trained assistant will attend your birth so that there are two providers present.
Just as we believe that a woman will go into labor at the right time for her baby, we also believe that labor progresses at the speed most appropriate to each individual mother/baby dyad. We believe that a mother's body knows how to protect its baby during the labor process, and that if contractions too close together would stress out the baby, then her body will contract at a pace needed to keep the baby safe. Thus, we have seen mothers never contract closer than every 5 minutes, or contract irregularly, or stop and start, and still progress to delivery. Once again, putting all labors into a "normal" box is an archaic, cruel and sometimes dangerous concept. Patience is a virtue. Of course, if transfer seems appropriate it will be discussed, or families always have the right to transfer at any time.
Meconium stained amniotic fluid is very rare at homebirth, most likely because of the positive care received during pregnancy, lack of fear, and no interventions. When meconium is present it is usually light and has no impact on care or newborn transitioning. If there would be thick meconium, any need for transfer would be discussed.
When you believe that you are in labor, we assess with texting and direct phone call. One of us will plan to arrive at your home when you are in active labor. Sometimes we will leave your home and come back later, if it is felt, after observation and time, that labor is very early, slowed down or even stalled out. In labor, we assess you and baby, we support you as you need (although we are not doulas), and we assist in delivery as necessary. Cervical exams are rarely done, if at all. Nearly all of our moms that have had babies before never get a cervical exam in labor, and even many of our first-time moms, when observed and known to be progressing, simply do not need exams either. We also quietly observe the maternal response to labor and respect her wishes and needs, while at the same time using our knowledge and experience to guide the atmosphere as needed. We recently attended the birth of a first-time mom who was obviously in labor, maybe a little early, but progressing. At one point she turned the tv on and sat down to watch The Office! Our first reaction was, oh no, this is going to be too distracting, this is going to slow or stall labor, this is not appropriate! But immediately we decided that hey, if this is what she wants let's see how it goes. Well, she continued to contract, laughed between contractions, was obviously progressing and progressing quickly. After delivery, when we discussed it she stated that she needed something to distract her, and being able to laugh between contractions was exactly what she needed!
This is a good question. To answer, it is important to explain by sharing our own experiences - other midwives may or may not have a different perspective on this subject. Back in our days of hospital birthing, we made use of our midwifery training by providing labor support. There were not many doulas back then, and women chose midwifery care to attempt natural childbirth without use of an epidural. Thus, most times we would meet our mamas at the hospital when they arrived and provide hours of labor support - both physical and emotional. We also shared call with others back then and we had more freedom of time to provide such support.
As only two midwives now, on call 24/7 for all of our families, providing homebirth services to a several-mile radius in the Kansas City and surrounding areas, where nearly all of the deliveries we both attend, such time-consuming physical and emotional support is not sustainable. (People talk of "sustainable midwifery" -in order to be sustainable as a profession midwives need to be able to provide excellent care to families without straining their own emotional and physical health, as such strain ultimately causes burn out and leads to decreased access to midwifery care).
So back to the difference between a (homebirth) midwife and a doula.
Midwives provide the expertise for a safe pregnancy, labor and delivery. They typically are not involved in early labor management as early labor does not necessitate any of their expertise (even though it may be uncomfortable). Rather, a midwife becomes involved in the labor process when a mother becomes active, as this is when it is appropriate to begin fetal monitoring and to reassure that mother is still healthy and coping well. Midwives can and do provide limited physical support, and always are there to provide emotional support, but they should not be used to navigate the early and prodromal states of labor.
Doulas provide the expertise in coping with labor. They provide comfort and reassurance early on (sometimes days or weeks even); know much more about how to provide physical comfort measures when mamas are at that point; and stay up to date on many, many topics for helping mamas endure the labor process. There is absolute agreement that doula support decreases operative delivery and c/s rates; decreases homebirth transfer rates; increases chances for vaginal delivery in a hospital setting; and improves maternal birth experiences.
So while there is a small overlap of the midwifery and doula professions, midwives simply do not have the resources to play both roles in the homebirth setting and cannot bring the same type of expertise to labor support that a doula can.
After the baby has delivered, it remains skin-to-skin with the mother without interruption. We do not overstimulate the baby with rubbing down or making it cry if it is otherwise transitioning well. The cord is left attached to the baby usually for about an hour, as it continues to provide some oxygenation and thus assistance with newborn transitioning. While the mother, partner and other children if, present, are left to get to know this new life, begin bonding, and breastfeed when the baby shows readiness, we begin the clean up process. After about an hour or so, the mother is assisted to the bathroom or to shower or bathe if she so desires. We then perform the newborn assessment and dad weighs the baby. About two hours after delivery, all is typically going well and we depart.
We always laugh when we get this question. The hospital charges thousands of dollars to you and your insurance company for the privilege of delivering there. After the actual delivery, what else is there to do to earn such a sum? They have to interrupt you many times throughout the day and night to justify their charges! After homebirth, you have easy access to us if there are any questions or concerns, thus allowing you to sleep, rest, and breastfeed at your own convenience without interference and disruptions. We do return to your home within 24-48 hours to check on the two of you.
We offer newborn vitamin K injection and eye ointment, and we give you resources for circumscision if you so desire. When we return to your home for the first 24-48 hour visit, we gather information in order to submit for the birth certificate; we perform the newborn metabolic screening (the heel stick); we perform CCHD (heart defect) screening; we collect footprints; and we again assess the baby's weight and health status. We also, of course, assess the mother.
As stated, we make a visit to your home 24-48 hours after birth. In addition to basic mother and baby well-being, we assess breastfeeding. If there are struggles, we will recommend a lactation consult and referrals are given, If needed, we can return to check baby's weight. If all is going well at the 24-48 hour visit, we plan a return visit to your home at 1-2 weeks. At that visit the baby and mother are again assessed, and the baby is weighed. If further visits are needed, such as weight checks, those are scheduled. If all is progressing normally the family returns to our office for a 6 week postpartum visit. Most of our families do not take their newborn to its care provider until after the 6 week postpartum visit.
When you become our client, you have easy access to us by text or phone, or can email. We do ask that our time be respected and that non-emergent contact be kept between 9 am and 5 pm, Monday through Friday..