Thank you to fellow Chicago area doula, Lani who is my guest blogger today! Lani has experienced home births of her own and has worked with moms who have chosen this birth setting as well. I asked her to write an informative post about what home birth is really like. Enjoy!
There are so many
choices to make during pregnancy. Should I drink coffee? Color my
hair? Eat something other than organic kale? Do we test for genetic
anomalies, find out the gender, agree to the flu vaccine? These are
just during the “growing” period of pregnancy, a whole different
list appears for labor and delivery, and yet another for the few
hours after, and the next eighteen years. Choosing the best options
for us during our pregnancy gets us ready for the thousands, probably
millions of decisions we will make for and with our child(ren) in the
future. So we read, and listen to stories and hear doctors and
professionals speak about decision after decision.
Then we choose.
For better or worse our choices affect
us now and in the future. One of the choices is where to labor and
birth our babies. Hospitals, birth centers and homes are the most
common choices (the few “Fast and Furious” lovers come in cars…
but usually not by the choice of mom and dad.) So what makes a home
birth different, what is to be expected in a home birth and the
similarities between home births and hospital births?!
Preparation for a homebirth begins with
prenatal care. Although there may be a few OBs who attend
homebirths, the VAST majority are attended either by a Certified
Nurse Midwife (CNM), Certified Professional Midwife (CPM) or Licensed
Midwife (LM). Appointment times vary greatly between OB (or
midwifery) care through a hospital and midwife appointments for a
home (out of hospital) birth. Appointments times grow from 3-5
minutes per OB appointment to 45-60 minutes with a midwife
appointment. There is more discussing of how mom is feeling, fears,
excitements, preparation, etc. at midwifery appointments, they are
not held to the high patient to doctor ratio as their
liability/malpractice insurance is not that of an OB’s.
Something to also keep in mind is that
homebirth is not for everyone. People who have higher risk
pregnancies (multiples, uncontrolled gestational diabetes, breech
births) should research more closely the risks involved with birthing
outside of a medical institution. Low-risk mothers, who have a basic
understanding of the anatomy and physiology of how their body is
going to birth a baby are more than likely going to be the most
successful.
Another difference is probably the most
obvious. When the woman goes into labor, she stays home. There is
no packing a bag, preparing a birth plan as that has all been
discussed during prenatal appointments. So instead the new momma can
work on a baby blanket, go see a movie, take a walk, bake a birthday
cake- pretty much do whatever she wants to until she can’t
concentrate on anything except her labor.
Homebirths happen differently every
time. Women are given the space, time and environment that they want
and create for their birth. The laboring momma is able and
encouraged to move freely, eat and drink as much as she wants. Labor
is hard work, and your body needs fuel to keep going! Position
changes are encouraged, the more a momma moves, the more her baby
moves twisting, turning and descending in preparation for birth!
If an emergency were to occur during a
homebirth 911 would be called, unless the laboring woman was so close
to a hospital a husband or partner driving would be faster (and
feasible). Something to keep in mind though, which will be discussed
later, is that because the midwife is looking for “red flags”
serious emergencies are rare. There are no drugs available for the
mother so labor is not unnaturally slowed causing the need for
Pitocin and stronger labor augmentation measures, cervical checks
which can increase the chance of infection are done rarely, the
baby’s heart beat is checked every fifteen minutes and continue
doppler can be used if deemed necessary for a time.
Usually as a woman begins her labor she will relax, call her midwife, let her know something might be changing (contractions are beginning, bag of water broke, more discharge, etc.). Normally the midwife will instruct the mother to rest as long as possible, take a nap, shower, eat a good meal, drink lots of water and conserve her energy.
As labor progresses an assistant will
come out, another nurse (at least an RN, some homebirth practices
employ CPMs or LMs) will come to assess the mom. A cervical check
will occur to determine where the woman is in her labor unless
otherwise discussed. If mom is in active labor, around five
centimeters or more, then the head midwife will come out.
When the head midwife comes out, she
will greet the laboring woman, the assistant will inform her of how
the mom is progressing, and she will chart progression, letting mom
labor as long as she needs to safely. The midwives primary job is
the guardian of safety for both the mother and the baby. She is the
person who, watches for “red flags” during labor that could lead
to possible complications (unsafe fluctuations in baby’s heart
rate, mother getting too dehydrated, tired, etc.), and suggests
transfer to a hospital if need be.
Labor will progress, someone will come
and check the baby’s heartbeat about every 15-20 minutes. About
every 4 hours (more or less depending on the woman) a midwife will
perform a cervical check. This is to assure progression of labor as
well as determine possible position of the baby. If the baby’s
head is cocked a certain way, or isn’t quite lined up the way it
needs to be for the birth the midwives may suggest a position change
or two to help facilitate that head and body rotation of the little
one. Eventually the woman will be pushing out her baby. The midwife
will assist in coaching with pushing if needed, allow mom the space
she needs to birth her baby, time the amount of time baby’s head is
out of the birth canal as the shoulders are delivered and correct any
complications that can come up during the second stage of labor such
as shoulder dystocia (where the shoulders of the baby get caught
behind the mother’s pelvic bones. After baby is delivered the
child will be placed on the mother's chest (if she didn’t catch the
baby when he/she came out.) The midwife will make sure baby is doing
well, breathing, checking APGAR scores, monitor the mother for signs
of extreme blood loss (hemorrhage), blood pressure, and general
well-being of both mom and baby. Again, she is paying attention for
“red flags” that may need to be addressed at a hospital. She
will help the new mom deliver her placenta, and check and repair any
tears (within reason, most midwives will transfer to a hospital for
anything deeper than a mid-third degree tear.) She will stay with
the mother until they have successfully breastfed a full session.
There are obviously many differences
between homebirths and hospital births, but there are many
similarities as well. Doctors and midwives share the same role in
birth. They are the guardians of safety for the mothers. They look
out for her best interests and those of her child. They are not
emotional support. This may be more obvious in a hospital setting,
but it is also true in a homebirth setting. That is what a doula is
for. Doulas are the witnesses of a new mother’s journey. They are
the servant, support, cheerleader for the mother. The power is the
woman’s in both the hospital and the home birth. No hospital can
force unwanted medication, a cesarean (non-emergent), and unnecessary
intervention. The choice, the power, the decisions are all the
mother’s. The birth that she desires can be hers whether in a
hospital or in her bedroom. Where a woman births her baby can be a
major decision. This choice is just one of a million choices that a
mother will make for her child. All she needs to do is trust
herself, the choice will be the right one.
