Why I Felt Safe Choosing A Home Birth With A Midwife
“So, are you having your baby here?” inquired several of my nurse coworkers at the hospital birthing center at which I work as the Parent Education Program Coordinator.
I would put on a confident smile and say, “No, I’m actually planning on having him at home.” Responses usually included a slow head nod, an uncertain stare, and then, “Oh, okay.” Once or twice that was followed by, “Good for you!” One time it was, “Oh no. No, honey. Don’t do that.” Once from my husband’s doctor, “You’re braver than me. I couldn’t do that. I know too much.” (I tried not to be insulted by that one, but like this doctor, I was more afraid of having my baby in the hospital. I knew too much!) There was also this response, “It’s a good thing we were in the hospital when our baby was born because…” I always agreed with those mothers, but always wanted to know more about their stories. More often the response I received was was, “Really? Wow! Why?” with the occasional, “Will you have a midwife?”
The latter was much easier to answer on the spot. Yes. Yes, I will have a midwife. (Really?! I couldn’t help but laugh at that question.) But I never felt like I was able to fully answer the first question of “Why?” right then and there. I had my reasons, for sure. This wasn’t a decision my husband and I took lightly. It was something I had considered for years before even becoming pregnant. (The first birth I attended 10 years ago as a birth doula-in-training was a home birth. Being present for this birth was an experience I’ll never forget.)
I understood people’s concerns, especially my coworkers who cared for women with high-risk pregnancies or babies in the NICU. They’ve seen tragic, devastating experiences. Still, I felt this was the best option for me and my babies.
I usually responded to the questions with, “That’s where I feel most comfortable. I feel confident in my midwives.” In an effort to ease their concerns I would also add, “That’s the plan for now. If anything changes in the pregnancy or during labor, I definitely know where to go!” (This was true. I had great faith in my hospital of employment to handle any complications that could arise.)
I felt confident with these responses, but I still felt like I fell short of satisfying their curiosity, let alone fully educating them on what home birth is all about. Sure, there are some babies that are born “unassisted” at home, or with “lay midwives” that haven’t had any official training or limited experience. However, that is not the average home birth experience anymore, and this was not the experience I felt comfortable with for myself.
I chose to work with Certified Professional Midwives (CPMs) during my pregnancies and births (link to birth stories?) and did so for several reasons. Here they are:
1. My midwives were trained professionals.
The midwives I worked with follow the National Association of CPM Standards and Scope of Practice. My midwives are trained to recognize abnormal or dangerous conditions that would require expert help outside their scope. They are also prepared with a plan for consultation and referral if any of these conditions appear. They’re not messing around; they had a 5 page Informed Consent Form including a list of services they provide (see bottom page for reference), services they do not provide (i.e. chemical pain relief, IV antibiotics, Pitocin induction or augmentation, cesarean section, forcep or vacuum assistance, intubation of newborn), and a long list of situations that would render me ineligible for home birth (“see below?” or just add a few here?), or that would require transport to the hospital during labor. CPMs are trained to screen for and monitor any of these situations.
Of course, home birth is NOT for everyone. Like I would tell people, if anything changed in my normal, healthy pregnancy status or during the labor I would change my plan and the midwives would guide me in that process. They have good relationships with the obstetricians to whom they would transfer my care and I would have been respectfully received as a new patient.
2. Patient, Thorough Prenatal Care
One of the major reasons I chose and truly appreciated midwifery care was the prenatal care I received. Each prenatal visit (which was on the same schedule as traditional obstetrician prenatal visits) lasted about an hour, sometimes more. I never had to wait, I always entered a calm, focused environment, and I never felt rushed. Not only did my midwife do a urinalysis, check my blood pressure and heart rate, measure and feel my belly, listen to my baby’s heart rate, and ask basic screening questions (have I had any headaches, dizziness, swelling, etc.), but she asked how I was doing. She asked how I was sleeping, how I was eating, how I was feeling about my pregnancy, the upcoming birth, and adding a new member to our family. (I could be wrong, but I don’t believe this is logistically possible in the 15 minute visits with OB nurses and rotating OB physicians.) I always felt so supported after every visit. Over each of the 9 months of growing each of my boys these visits helped me prepare for more than the physical transition of giving birth, but also for the emotional and mental transition of becoming a mother for the first time and second time. To me, this was equally essential.
3. Comfortable, private birthing atmosphere
During labor with both of my sons I wasn’t able to control the birth process itself, but I was able to control my environment. I had calm music playing, lights off, candles lit, inspiring words and photos around me. Yes, these are all environmental preferences that can be set up in the hospital, too, but more important to me was knowing that the people and energy around me would be consistent unlike in a hospital. The idea of nurses, medical students, physicians, etc. coming in and out of the room at different times and changing shifts, was anxiety-producing for me. Being home gave me the space and privacy to do what my body needed to do, whether it was vomit, moan, cry, scream, or more often: get in and stay in my zone. Again, these are all physically possible to do in a hospital, too, but I knew it would be much easier and more comfortable for me in my own home. I didn’t have (or need) an IV, I wore my own clothes (or none at all), and I didn’t receive a vaginal exam until my body started pushing and the midwives wanted to confirm my cervix was ready (it wasn’t).
4. Trusting, safe environment
I trusted my midwives to know if there was any indication of the need for transfer or a surgical birth. Otherwise I had no concern of being one of the 34% (1 in 3!) of mothers going under the knife , possiblyunnecessarily. By being healthy and under the care of qualified midwives, the likelihood of having a cesarean birth was closer to 5%. ((Journal of Midwifery and Women’s Health”Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009″, http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full, (Jan 30, 2014 ) )).
My midwives also trusted me. Midwives trust in the birth process. They trust the woman’s body to birth. They also trust the woman’s mind to make an informed decision and be a partner in the care of her and her baby. I was given time and patience. There was no timetable. No rush. No watching the clock or schedules. Luckily rushing was never a concern like it often is in hospitals. With both births my water didn’t break until I was pushing. Since I was in my own home and didn’t have fingers or amniohooks inserted into my vagina unnecessarily, I wasn’t exposed to bacteria or potential infection that I could have been in the hospital.
5. I had continuous one-on-one support
My midwives were there for me as soon as I needed it and were there for the rest of the experience. They even stayed for several hours after to keep an eye on me, examine the baby, help clean up, make sure I was fed, and tuck me and my baby into bed for our first nap. My family was treated well, like many families around the world are when birth is respected and honored. Since I had this support already, I didn’t feel like I also needed a doula. My midwives played that role and I preferred as few people present as possible. If I hadn’t had their support, I most certainly would have hired a doula.
I feel incredibly grateful to have had the experiences I did. Though not every woman wants similar experiences, I truly believe that every healthy expectant mother should at least have the choice and be able to make an informed one. This, from the National Association of Certified Professional Midwives Philosophy and Principles of Practice section, is why I love midwifery care, want to protect it, and educate people about it:
“NACPM members understand birth to be a pivotal life event for mother, baby, and family. It is the goal of midwifery care to support and empower the mother and to protect the natural process of birth.”
Resources to learn more about midwifery care and homebirths in North America and Maine:
These are passages taken word-for-word from my midwife’s contract. I would like to share them with you to help you understand the great care that midwives take to make sure that home births are as safe as can be.
Conditions that may arise in pregnancy that would make one not eligible for home birth:
- Psychiatric conditions requiring medication
- Gestational Diabetes
- Breech presentation at term
- More than one prior cesarean
- Preterm labor
- Placenta previa
- Bleeding disorders
- Substance abuse
Reasons for transport to the hospital during labor (but not limited to):
- Maternal exhaustion
- Arrest of descent
- Abnormal fetal heart tones
- Abnormal maternal bleeding
- High blood pressure or signs of pre-eclampsia
- Fever or other signs of infection
- Umbilical cord prolapse
- Thick meconium-stained amniotic fluid
- Unexplained pain or unusual symptoms
- Maternal request
- Initial lab work
- Monitoring of blood pressure, urinalysis, fetal heart, uterine growth, position of baby, weight
- Hemoglobin checks, if needed
- Blood glucose screening if desired or necessary*
- Group B strep culture if desired *
- Nutritional and lifestyle counseling
- Birth education
- Other discussions as indicated
- Documentation of all interactions
- Home visit at 36wks
- 24hr on-call availability
- Labor support
- Labor assessment
- Fetal monitoring
- Management of birth of the baby and placenta
- Suturing of perineal tears as indicated
- INitial breastfeeding assistance
- Newborn exam
- Vitamin K administration, if desired*
- Antibiotic eye ointment, if desired*
- Monitoring condition of mother and baby until stable
- Two midwives present for birth
- Home visits Day 1, Day3, Day 7-10, 3 weeks following the birth
- Office visit at 6 weeks postpartum
- Birth Certificate
- Newborn Metabolic screen unless declined
- 24hr on-call availability up to 6 weeks postpartum
- Breastfeeding counseling
- Birth control counseling
- Pap smear as indicated
*true informed consent occurred for these procedures. Information was provided before a decision needed to be made and conversations took place ensuring any questions were answered. Absolutely no judgement was placed on any decisions for or against any procedures or tests.
Kara Kaikini is the Course Developer and Educator at Doula Spot as well as an International Board Certified Lactation Consultant. Besides being a mom, Kara’s main gig is the Parent Education Program Coordinator at Maine Medical Center’s Family Birth Center where she immerses herself in everything pregnancy, birth, postpartum, babies, and breastfeeding. Having spent time as a postpartum doula Kara loves providing education and support to new parents and babies as they embark on this new adventure of parenthood. She spends her “free time” on the beautiful coast of Maine in her dad’s boat or at her family’s home, and daydreaming about future family adventures. Kara lives in Freeport, Maine with her husband and her young sons Bode and Eli.