Giggle's Zoo: Home-Birthing Part 2: Home-birth Midwives

Stork, Lion, Elephant, and I just minutes after Elephant was born

Why home-birth, do you ask? Well, the answer is simple. Both my Mother – Eclectus -and Lion's Mother – Meerkat -gave birth to at least one child at home, by choice. My mother chose home-birthing for my older brother –Dragon- and would have done it again, but my Dad was not happy about it, and since he was uncomfortable with the experience, she chose to deliver me and my sister – Unicorn – in the hospital. Meerkat had Lion in a hospital, but chose home-birthing for all his –much- younger siblings, and very much enjoyed the experience, so both Moms were pro-home-birth when Lion asked if I would want to give it a try… but –as I said in Part 1- I was unwilling to "risk it" with my first child, but after Tortoise's relatively easy and uncomplicated birth in the hospital, I figured giving home-birth a shot was worth a try… especially considering that we had moved away from my home state to near the Giggle Family Farm and therefore, near Stork.

Eclectus holds newborn baby Vixen's hand.

The first step in choosing home-birth is finding a midwife with whom you can connect, and one with good references… much the same as finding an OB/GYN, most women don't simply open the phonebook and point at random… no, usually we research, we ask friends and family, then we meet the prospective doctor/midwife and ensure that their viewpoints on birth, life, pre-natal care, testing etc, line-up with your own. Finding a home-birth midwife is no different. I was lucky though, finding a midwife was no trouble at all once we moved here to Giggle's Zoo.

-Stork and newborn Elephant--

newborn exam

Stork is a home-birth midwife who has been in the "business" of home-birthing for many many years. She "caught" all of Meerkat's babies (except Lion) – including Penguin and Moose. So, she had excellent references from Meerkat. Also, Lemur worked with her for a while – as a helper delivering babies, and was present for a number of more complicated deliveries. Lemur also gave Stork excellent references. The first time I met Stork, I knew she would be fantastic… we talk about everything under the sun, and she's usually fully briefed on family stuff anytime we get together. She's more than my midwife, she's also a friend. And I'm blessed to have her in my life and as my midwife.

Stork checking on me during a contraction during Monkey's delivery.

Here are some blog posts and notes from FB written by Home-Birth Midwives that I found inspiring and/or informative for those of you that are unfamiliar with what home-birth midwives do, and how they feel about their profession:

A post written at the website "Birth Sense: A common sense guide to normal birth" http://www.themidwifenextdoor.com/?s=home+birth

-A reader recently wrote and told me she has been interested in reading information on home birth, but is understandably hesitant. What if something goes wrong? What kinds of equipment does the midwife bring? What happens at a home birth?
-These are all excellent questions; I know many Birth Sense readers have had home births or are involved in the birthing community, and are already familiar with home birth. But I hope that this blog also reaches some women who aren't specifically looking for alternative birth information, or even desiring a natural birth, and sparks an interest in learning more.
-I will share my own practice as a home birth midwife. Other midwives may do things a bit differently, and it's important to talk about routines and what to expect.
-I offer prenatal care on the same schedule that any obstetrician would offer, either at the woman's home (house calls) or at my office. Some women with small children prefer to be seen at their own home, and when this is the case, I have a bag of equipment that is easy to carry with me. We can check blood pressure, weight, urine if needed, listen to the baby with a doppler or a fetoscope, measure the uterine height, and assess the baby's position, just as you would in an OB's office.
-I do offer all tests that would be routinely given in an OB's office. The difference is, I explain to you the test, what the risks and benefits are, and then ask you if you want to have it done. Nothing is "required" because it's your birth and your body, not mine. I make recommendations, and support your decisions.
-About three to four weeks before the birth, I make a home visit for all mothers. This is so I know I can find their house (sometimes it's hard in the dark, if you've never been there before) and so we can talk about birth plans. We discuss where in the house the woman thinks she might like to give birth, and any logistics about that. For example, an upstairs room with a narrow stairway might be difficult to navigate in any emergency, or the woman might not feel like climbing up and down stairs to the only bathroom after giving birth, so might want to give birth on the same floor where the bathroom is. These are not mandates, simply advice I offer based on my experiences. I give the mother a list of emergency contact numbers with her address in bold at the top, to post by her telephone. This is an essential part of being prepared for an emergency. If I need to ask someone to call an ambulance to the house, and they draw a blank and can't remember the address, it will be posted right above the phone.
-I give the mother a list of items to prepare for the birth. Usually, these are things that she already has around the house or can easily obtain. Two sets of old sheets, some old towels and washcloths, a water-proof floor protector, disposable underpads, sanitary napkins or Depends, and something to wear that won't be ruined if it gets stained. She washes and dries the sheets and towels on "high" and immediately they are folded, put inside a clean plastic garbage bag, and tied shut.
-On the birth day, I bring my birth supplies with me. This includes a birth bag with a doppler and fetoscope, sterile gloves, bulb syringe, DeLee suction, oxygen masks for mother and baby, a bag for ventilating mother and baby, laryngyscope and ET tubes (if baby does not breathe and needs us to breathe for him while waiting for emergency transport), medications to stop bleeding, medications for baby if the mother wants them (eye drops and Vitamin K), IV bags and tubing, blood tubes for drawing blood if necessary, sterile instruments, sterile cord clamp, sterile towels, suturing material, and a scale to weigh the baby. I often bring other non-medical supplies, such as massage oil, herbs for an herbal bath, and compresses for the mother during pushing and afterward.
-At the birth, there are a minimum of two attendants that are trained in CPR, neonatal resuscitation, can start IVs, and know how to administer medication by injection. After the birth, we make sure mom and baby are doing well, and tuck them in bed together for some bonding time with the family. We check on them frequently, and between checks, we clean up any mess and prepare some food for the mother.
-After several hours, once mother and baby are both stable, we leave the house. I normally return the following day to check on both mother and baby, one day three, and I see the mother at my office on day seven, fourteen, and at four and six weeks postpartum. These visits are to ensure breastfeeding is going well, baby is gaining weight, and mother is not struggling with depression.
-If at any time there are deviations from normal during labor, I am very watchful and don't hesitate to transfer the mother to the hospital if I'm seeing "red flags". I'm sure I transfer more often than is absolutely necessary, but I believe that being cautious and watchful, and not waiting to transfer when things aren't going normally is why I have never had an emergency transfer from a home birth. (By emergency, I mean needing to call an ambulance and get to the hospital as soon as possible). All of my transfers have been for non-emergency situations where thing just weren't looking right.
-I believe that most midwives practice similarly to this description. Home birth can be a safe a viable alternative for many mothers, and is worth considering.

Stork during Newborn Exam - how much does Baby Elephant weigh??

Here's a FB note written by a midwife (Laurie Zoyiopoulos) name and note added with permission

-Most folks would say that I "deliver" babies (though I like to say "catch") and this is true, but it is a fraction of what I do....what this calling requires of me. The contrast between the jobs within my calling are surprising to me and unknown by many, if not most, who see my license plate and think they know who I am.
-I am a teacher of an age-old "profession" and this carries a lot of responsibility. It is almost a given that a midwife will train others to be midwives - this is how midwifery has survived all of these years. Though I don't feel that I am a great teacher, I know that there is much to glean from me and if someone is willing and observant enough, they will learn the skills as they sit at my side, as they lend me a hand, as they serve the women with me.
-You'll see me at the copy place as I work for hours, making copies, putting together the information that I have been given, and that I have created, that gives the best informed consent I can provide. I want all those who hire me to know who I am and what the responsibilities are when one choses to give birth outside of a hospital. Making copies, organizing folders of information, ordering books and DVDs, staying informed, myself, in all the ways available. It can be exhausting in itself, but I know it is a necessary part of being a current midwife, one who teaches others how best to interview a midwife and plan a home birth.
-I can find a fetuses heartbeat and can tell if he is breech, without a doppler or an ultrasound machine. I know of many ways to survive weeks of nausea and what is safe to take - whether herb or medication - and can explain how to time contractions and what to do if your baby is jaundiced. I know many tricks to get a baby to nurse and how to make an herbal bath.
-I keep my supplies stocked and never run out of cord bands or pitocin. You will sometimes find me making sterile packs at midnight or 1 in the morning because they didn't get done earlier in the day and a baby might decide it's not going to wait until the midwife has time to make them the next day.
-I am trained and certified to resuscitate a newly born baby - the ones that think that breathing is an option. I don't allow them this lazy notion and go to work and convince them that its not so bad here after all.
-I know how to follow directions and to be more dependable than my mother ever thought I could be. The weather can have no affect on my travel - I go when I am called and it matters not how bad the roads are. My husband knows and understands this - a midwife needs one of those, too - an understanding husband.
-Though there is nothing new under the sun I need to continue to learn and to discover just what evidenced-based care is -- and practice it.
-There is no job "beneath" my title - I wipe away vomit and clean toilets and feed the family dog. I hope to never feel that I have "earned" anything better. A midwife should always know that she is there to serve, in any way that is needed, and it has nothing to do with what her needs are.
-I am an ambassador for midwives when I enter a doctor's office or a hospital and I take this responsibility very seriously. I've learned that I will gain more trust and respect by saying fewer words and humbly admitting our need for assistance. I have worked hard, for many years, but respect has been attained and my clients get better care because of this. My mother used to be so discouraged at how easily I could cry, but I have changed and matured, I know she would be proud. A midwife has to be strong for her clients, they need to know she will not waiver. A doctor once told me, after treating me harshly without my returning his anger, but also not backing down, that when I enter a hospital I need to come with "thick skin" and he was right. A midwife needs to learn from those who may not even realize that they are teaching her. There is always something to glean and take with you for another time.
-Most of the time I truly love what I do - though my back and arms and legs may ache and I have gone without food and sleep and have had to miss a family celebration. Its a precious calling and it truly can be the easiest thing in the world, but now you know that it comes with much more than just catching babies.