Home Birth

WHY CHOOSE  HOMEBIRTH?

In my practice I have chosen to care primarily for families planning to give birth at home.This decision is based on several factors including the current lack of homebirth practitioners, requests for homebirths, plus my own observation that women giving birth at home tend to have a higher rate of spontaneous, natural deliveries.Home is the traditional place of birth and modern research has repeatedly demonstrated  the safety of birth at home, especially when the birth is carefully planned, with a trained caregiver in attendance. Homes are uniquely equipped to provide a comfortable and protected environment that promotes a great degree of physical and mental relaxation for the laboring mother...factors that we now understand to be essential to an optimal unfolding of the birthing process.This results in much lower rates of  cesarean section, forceps, vacuum, induction and augmentation of labor for home birth mothers.This in turn really decreases morbidity rates - in other words complications such as infection, bleeding, and postpartum depression : all of these things occur more often when labor is interfered with unnecessarily.

This however does not mean that birth at home is easy! Labor is usually hard work no matter where you are. Birthing at home allows the mother easier access to a variety of external supports that may be highly individualized for any particular woman - a situation more difficult to achieve in a hospital. In addition, laboring in a space that is felt by the woman to be private and protected facilitates access to her own inner resources.- a normal, powerful and profound part of human birth. This experience of learning how to connect with with the wisdom and intuition of her deep inner body  enables a woman to enter the early weeks of parenting with unusual confidence and skill - another benefit of the natural process of birth.

PREPARATION FOR HOMEBIRTH

Preparation for a birth at home involves discussion about risks and benefits during prenatal visits..In addition to making available a wide variety of resources that include books, research articles, videos, and referrals to other clients, I also offer a free one-day workshop that reviews the following: normal birth, pain in childbirth and resources for coping/integrating pain in labor, variations of normal birth and how these are handled at home, true complications of labor and birth and how these are dealt with.We discuss hospital transfer: when and how this is done.We view  videos of normal birth and more complicated scenarios.This workshop is not intended to be a substitute for regular childbirth education classes but is offered to help prepare homebirth families for the realities of birthing in that environment.It is important that parents understand both the benefits and  limitations of homebirth as well as the strengths and limitations of their caregivers at home.We discuss the fact that hospitals and obstetricians, although currently much overused for normal birth, exist for good reasons - not all of which are predictable beforehand even with excellent prenatal screening.In order to have a peaceful and rewarding birth at home I believe it is essential for parents to work towards an integrated understanding of the appropriate place of physicians and hospital backup.Parents are requested to secure the services of a physician for the duration of pregnancy, birth, and the first six weeks postpartum in case medical services are required. I usually make contact with the physician once or twice during the woman's pregnancy to review her plans and her current state of health; after the birth I call to inform him/her about the birth particulars and to discuss the mother's plans for the postpartum.If indicated, a referral for furthur medical care is made for either mother or baby although usually mother and baby spend their first two weeks together in their home before seeing their physician for a check-in visit.

  In the last few months of pregnancy homebirth parents are given a list of supplies to gather, most of which are already found  within their home!.We discuss other family members or friends that the parents may wish to be part of their birth experience plus whether or not  the mother wants any other children to attend her birth.A home visit is done around the 37th week to review the layout of the house, to meet other family members, and to make sure that I can make my way to the house confidently! Proximity to nearby clinics or health centers is also noted, along with any obstetrical services that are offered there.If required, transfer in labor or birth is usually to a regional health facility that has obstetric/pediatric backup but other health facilities can be used  to help a woman access furthur medical care.

LABOR BEGINS!

I ask mothers to call me as soon as they think labor may be beginning so I can start getting organized to eventually leave for their birthing. Usually we speak on the phone a couple times as early labor progresses and I leave when active labor is underway. Once I arrive at the home I will do an assessment of mother and baby within the first hour, check on what coping techniques she is using and give feedback if necessary, make sure other family members are feeling integrated with what's going on, and generally make any necessary provisions for the mother's comfort, security, and safety.I will check in with the mother's physician if she would like this done. Otherwise my main focus is to support the woman and her family as they experience the unfolding of this very human miracle of birth. Medical monitoring is done as necessary and vaginal exams are usually kept to a minimum to decrease the amount of discomfort to the mother.Decision-making is a shared process between midwife and parents: the only exception. to this arises if an emergency situation develops and the midwife must act quickly .This sort of situation is discussed prenatally when there is ample time to go over details and parents and midwives can lay a good foundation for trust and respect between each other.

During labor I ensure that the mother eats and drinks as she feels the need; I suggest position changes and provide emotional/physical support or help chosen family members provide these essential comforts to the mother.As the time of birth approaches I set up the birthplace the mother has selected and call the second midwife/birth attendant to come.During second stage I again offer suggestions about positioning and effective breathing/bearing down.When the baby is being born I can receive the baby or help the mother or other special person catch the baby.I assess the baby's immediate condition and help the mother with breastfeeding if necessary.After the placenta is delivered and, provided bloodloss is normal, I offer the family some private time to welcome the new baby.If there is any perineal tearing I will provide suturing within the first hour or two.A newborn exam is done when the parents are ready and the backup physician called to let him/her know about the birth.I stay in the home a minimum of 4 to 6 hours before leaving for my own home, and I leave postpartum guidelines with the parents for them to refer to as they need.

After the birth I return within 24 hours to check up on mother and baby plus the well-being of other family members. I visit on day 3, 5, and 7 and again on day 14( two weeks after birth). Newborn testing is done on day 5 at the request of the parents.Bloodwork that is reqired by Rh- mothers can be done at home and taken to the nearest hospital lab. I check in with the parents often by telephone and am usually always available by pager or  phone.I ask mothers to return to my office for a final visit between weeks 4 and 6.After this the mother and baby return to their family physician for care.I fill out a provincial birth record and give this to the mother for inclusion in her chart and the baby's chart at the physician's office.                                                                            

SAYING GOODBYE

                                                                                                                                                                    Saying good-bye at the last visit is often difficult as midwifery care creates opportunities for intimacy and trust that are sometimes rare in our hectic modern lives...there is no easy resolution for this situation, given the time and .distances involved with people's lives.However, it is my hope that women will take the initiative to create new supports for themselves and other parents in their home communities when they feel they have the time and energy! Giving birth - no matter where the birth occurs - gives women an initiation into the marvellous and complex world of mothering - a world that is often severely undervalued and misunderstood by contemporary society. It is one of my dreams to see families access personal resources for change through their midwifery care, and then be able to use these strengths to help shape a culture that understands, supports, and deeply respects the dignity and responsibilities of mothers, fathers, and families.