How long ago did you become a midwife?
It’s about 10 years now.
How did you decide to become a midwife?
A midwife is a calling. You get that awareness one day.
I was called to a birth as a support person. I wasn’t a doula yet but I had my own happy and healthy birth experiences, and was asked to be there. When I saw that baby being born I said “Wow. That is something I would like to do.”
I took a Doula course and then started to work a few days a week as a community doula. I liked it but after a little while it wasn’t enough. I wanted to have more responsibility. That’s when I decided to go to school and became a midwife to deliver at home births. My last few babies were born at home so I knew the impact a home birth experience can have on a woman. I saw how you could make a difference in a woman’s life.
Home birth is made for women who are comfortable in their body, who trust the process of birth, and who want to have an experience that they can own.
That is what home birth is.
When the patient and midwife develop a relationship through prenatal care, the woman feels supported; She feels heard and understood. It becomes a personal relationship that is conducive to relaxing and allowing the process of birth to happen.
Women who had babies at a hospital, and then have a home birth, will tell me it’s like two completely different experiences. It’s hard to understand because you go through labor here and you go through labor there. You have a baby here and you have a baby there. But it’s so different in every way.
People who have a home birth, birth in a place of joy which gives energy to the woman. She will take this energy with her from the birth experience into her daily life, be it as a mother, be it as a wife, be it as a woman. It gives her another level of strength.
Home birth is not for everybody. Home birth is really not meant for every woman. It is really for a specific group of women that are low risk on a medical level. This means no high blood pressure, no diabetes, not severely overweight, not severely underweight, and well-nourished.
On a psychological level, there are women who’ve heard stories from their mothers and grandmothers about how hard and painful their labor was, and of how frightened they were. These women have a hard time overcoming this language of fear that is in their brain. They can’t see themselves having a home birth for that reason. In this case we cannot go out and convince them that it is the right thing.
Home birth is right for a very few that have it in them; Who trust their bodies, who trust the process, who trust that this is how it’s supposed to be.
Then when they see a midwife we do blood work, we do a sono, we rule out any major complication. As the pregnancy advances, we reassess yes you are remaining low risk, yes your iron is good, yes your sugar is good, yes your baby is healthy.
All of these prenatal visits and testing is to ensure and reconfirm that this woman is remaining low risk and can move on with the plan of staying home for the birth.
How often do you transfer women while in labor to the hospital?
In labor it is very, very rare. I monitor closely during pregnancy in order to reduce any risks.
I once had a situation when the woman’s blood pressure started to rise at the end of the pregnancy without any adverse symptoms. Nothing that we did to lower the blood pressure helped, it just kept rising and rising. until I told her: “That’s it. We crossed the red line”. We changed our plans of planned home birth to planned hospital birth, and she had a beautiful natural birth WITH her high blood pressure, and no negative outcomes. As a certified midwife I couldn’t take a chance to stay home with this kind of elevated blood pressure.
I also had some newborn transfers.
One or two times it was just for observation.
In a home birth setting, mother and baby have to be perfectly fine by 2 hours postpartum.
I usually stay for 2-3 hours after the birth. Usually by then everything is settled. I’ve had time to check the baby. I’ve had time to check the mother. She’s had time to get up to use the bathroom, she’s had time to eat, baby has nursed, all of this takes 2-3 hours.
There’s something called “transient tachypnea of the newborn”, where the baby is breathing very fast for an extended period of time. It could be very normal or it could be a symptom of something more serious. The baby was perfect in pregnancy. Good sono, good labor, and everything went fine, and then it just took longer for baby to adjust. The baby just needed a little CPAP, which is a little forced air to push the fluid out of the lungs.
I tell mothers that by 2 hours after birth the baby has to be completely stabilized. If the baby is not, that is a sign that it needs a higher level of care or at least a higher level of diagnosis. We don’t have a pediatrician that would come do a home visit any time of the day or night to check our babies. So if a baby needs additional care or monitoring, I have the baby transported to the hospital.
One time I did have a situation that the baby actually had a cardiac diagnosis which required surgery that was not picked up at a 20 week sonogram. I picked it up on the second day. I didn’t like what I heard and I sent them to the doctor. That was the one and only time a case a baby actually had something.
What do you do on Day 2?
On day 2, a little over 24 hours after birth, I come back and check the baby’s weight to see how much the baby lost. It is normal to lose weight in the first 24 hours. I make sure the baby’s latching well. I check the mother from head to toe, the bleeding, the contractions, her nipples, blood pressure, regular vitals, temperature. I do another full newborn exam and I do the PKU test at that time. I also provide the application for the birth certificate. We talk. We review the birth experience. I make sure that she has help around her. If there are other children in the house, that things are in place. I usually return on day 5 or 6. We are also in touch by phone if she has any other questions during that first week. I always tell them in the first 7 days you call my cell phone 24-7 if there is anything. If there is a need for a lactation consultant to come in the picture, I have someone on my team who comes and does her own assessment and recommendations as needed.
When do you tell your patients to take their babies to the pediatrician?
If I find that everything is normal, my recommendation is to see a pediatrician in the first week for up to 2 weeks, but definitely not to wait longer than 2 weeks.
Anything else you want to share for women who may be nervous about having a home birth?
Outside of the United States there are countries where home birth is much more integrated in the healthcare system. For instance, in the UK when a woman is pregnant she sees her GP, which is like a PCP. The PCP will make a referral into the system for her. If the woman is healthy, the PCP needs to offer her a choice to meet a midwife who will do a home birth, a midwife who will do hospital birth, or an OB/GYN. They are very much encouraging low-risk healthy women to see midwives.
It’s interesting to see that countries who have more midwives taking care of their low risk women are ahead of the United States. There are at least 29 countries that are doing better in terms of maternal and neonatal mortality. We have such an expensive healthcare system. We are one of the largest spenders on healthcare in the developed world, but we are not showing good outcomes.
Why we do need OBs? I am a big proponent of good doctors. We need doctors to take care of women when there is a problem. But, we also need to be humble enough to recognize that pregnancy is a healthy stage in a woman’s life. It’s not a disease. We need to be able to recognize that.
Midwives are keeping women healthy and safe, and good midwives will want to work collaboratively with good doctors. Ideally there has to be a relationship when a midwife picks up something she shouldn’t think that she knows it all; She should refer and collaborate with a doctor, and when a doctor sees that a woman is healthy, he should be able to say “You might do better with a midwife.”