melissa – Page 2 – My Radiant Beginnings

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When A Home Birth Doesn’t Go As Planned – Part 2

Transport gone right

Thank you for joining me as we continue to look at transports. Today, I’d like to take a moment to look at a case when everything went well. I think it’s important to note that just because there may be need for a transport, doesn’t mean that everything is out the window! Remember, I’m not anti-hospital. I am glad they exist and that they are there to help us when they are needed. When the system works well, we can all benefit.

Let’s take a look at an example of when a transport was necessary.

First time mom laboring well at home but contractions are irregular. She’d had some prodromal labor the night before that stopped. We try various things to regulate contractions both in frequency and intensity, but she doesn’t seem to progress. The baby appears to be a little asynclitic (her head not flexed or tucked just the right way).

We take breaks, allow her to rest and pace herself and try various positioning exercises to help the baby get into a more favorable position. We discuss the balance necessary to not completely exhaust herself in labor because, while delivery is an end to pregnancy, it is only the beginning to the parenting journey.

Keeping in mind that first-time moms push on average around 2 hours, and the work that breastfeeding takes, we decide to transport before there is a medical problem. Our thought and approach is that she needs an epidural and Pitocin. She’s been at this for a while and could use the full relaxation of an epidural and the uterus could stand some harder, more consistent contractions.

After consulting with our physician we decide to head in to the hospital but must use the on-call physician because our consulting doctor is unavailable. The nurses are supportive and a couple recognize me and are familiar with some of my midwife associates. They help to get us settled and work with us toward the desired vaginal delivery my client desires.

While the doctor was cautious and made us aware of time frames and the progress he was looking for, the staff stood strong and united. He broke her water and began Pitocin and she was given an epidural. The nurses worked with us to help change the mother’s position regularly, since she was unable to do so on her own after the epidural.

The mother was able to rest, regroup and prepare for the next stages and reflect on the hard work she had accomplished. The father was encouraged and supported, which allowed him to also rest and regroup in order to best support his partner. She met each milestone and we diligently continued our cadence throughout until it was time for second stage and she was able to push with those contractions she had been working so hard to get on her side.

Each push brought more determination and resolve for what was and was about to be. And then, just like that, her daughter was born. She was overcome with relief, pride, joy, elation and never doubted herself or the decisions that took place and brought her to where she was in that moment.

When A Home Birth Doesn’t Go As Planned – Part 1

Sometime the best laid plans don’t actually materialize.  What then?

You had good prenatal care, took care of yourself and the baby, participated in childbirth prep classes, followed the advice of your healthcare provider, had a birth plan and seemingly did everything in your control “right,” but something (could be a variety of things) causes you to need to transport to the hospital for the delivery of your baby.

Let me pause here to reiterate that there are no guarantees with birth.  You can only control so much.  I have journeyed with moms who have fit the above picture of being the model client and did everything within their power to have the birth they desired, only to have a different outcome.  And, I have met women who on paper seem to have lots of room for improvement, and whom I encourage one way but choose another, have the picture-perfect outcomes that dreams are made of. It’s not fair. It is frustrating.

Those who are against out-of-hospital birth would run rampant here and argue their point that birth is scary and needs to be in the hospital. That is not my impression or what I want your take-away to be. Midwifery is safe for low-risk women. While I have had to transport, I have not personally had an emergency transport situation.

So why would a low-risk, healthy mom need to be transported in labor and it not be considered an emergency?

Remember, there’s only so much you can control. You are in control of your nutrition, your exercise and your response to labor. You are not in control of your contractions or the response of the baby.

Ideally, with all the factors working together, a mom who is set up for success in her birth approach who has effective contractions and a baby who is tolerating labor well should be able to expect an uneventful birth without complications. However, if the latter two factors aren’t cooperating then something needs to change.

While there are some techniques a midwife can use to help regulate or strengthen contractions, there is a limit to that. We do NOT use Pitocin to stimulate or augment labor. When the natural remedies and holistic tips & tricks run out, we need to transport for back-up and support so that you and baby are monitored while your labor is augmented medically.

Perhaps the baby isn’t tolerating labor well and his/her heart rate has low or otherwise unfavorable decelerations. If a change in position doesn’t immediately resolve the issue, it is time to transport mom and baby. This is no one’s fault. You cannot control how your baby will respond to labor. Typically this doesn’t happen at the very beginning of labor. It may be a result of a longer labor or when other factors are present.

Finally, another reason for non-emergency transportation in labor would be for pain relief, or an epidural at the request of the mother. This is nothing to be disappointed by. The point is, you are listened to and heard and your voice matters throughout. You are in charge and call the shots. When you say go, it is not my place to talk you out of it. Please hear me, I have had women say “I can’t do this anymore” who are 9-10 cm and just need to hear that they can make it through, and they get a second wind and work through it and I support them every way imaginable. I have also supported women who say “I’m done, I want an epidural” and based on where their labor is at, it would be inappropriate to talk them out of it and stay. This is when it is invaluable to have had a close working relationship throughout the prenatal and early labor period. If a healthcare provider was just walking in, for shift change or on rounds to check on you and there was not an established history or positive rapport, it is more likely to get judgment calls based on reaction versus relationship.

Pain Management at a Home Birth

Labor is intense and it’s hard work. What is available to help me get through it?

I’d love to address this from the perspective that you’ve already decided within yourself your reasons for choosing an unmedicated birth.  I do not feel it’s my place to talk you into or out of personal decisions. Remember, I had my first 3 births inside the hospital setting, with the use of an epidural. This is an area close to my heart and I hope to share that with you.

During a consultation, when I am asked about pain in labor, I like to use the following analogy. Let’s say someone was pinching the fool out of you. (I know, not nice, and contractions are not at all like someone pinching you, but stay with me for a moment.) Would you be better able to tolerate it if you could walk, move around, DO SOMETHING to get your mind off of it…OR would you handle it best if you were strapped in bed, hooked up to a bunch of monitors, lines and BP cuffs?

The answer is pretty obvious.

We are able to tolerate pain better if we aren’t sitting/lying in one position, only being able to concentrate on that one stimulus.

So, for starters, being home and in your own environment, where you are already typically your most comfortable and relaxed is the first component. The freedom of eating and drinking throughout labor, coupled with the ability to move as desired in this comfortable environment allows you to progress more smoothly.

Once active labor is established and your birth team is present, they are able to help facilitate changes as needed to vary your support. The use of water in labor, whether it’s using your shower or a bath/birth tub helps to alleviate some pain and make it more manageable. Does that mean you have to birth in the water? Of course not. Many people who do not plan to have a water birth enjoy the use of water at some point during their labor.

In addition to water, your support team provides touch, through massage or counter pressure in ways that you control so that it is truly a help to you and not an annoyance.

Aromatherapy with essential oils can be a part of your laboring environment either from a diffuser or added to a carrier oil for your massage. Many midwives carry special blends of herbs or homeopathy to help take the edge off, smooth transitions or to help calm or center the laboring mother.

Finally, and I don’t think this is quantifiable, the one-on-one support of the laboring mother with her support person (Doula, spouse or midwife) throughout those super intense contractions taken one at a time is invaluable. I have supported women during this time who say, “I can’t do this anymore,” and with the right encouragement, support, their trust and responses to what I am working with them to do, they are able to go on and deliver their babies without issue. It doesn’t mean it wasn’t difficult, but they did manage and they have a new respect and appreciation for their capabilities.

My Baby Is Breech – What Can I Do?

Hi!  You’re probably anxious and have a million things running through your mind if you’ve come to this blog post. I will start off by encouraging you to relax. Let’s take this one step at a time.

Your baby is breech, or isn’t head down. Is this a problem or something to be concerned about?

How far along are you? A baby who is breech at their 20 week anatomy scan (ultrasound) isn’t a cause for concern.  He/she has plenty of time to turn.

A bit further along? Let’s break it down. As a midwife, I’ve seen this before. As a mother, I’ve experienced this before with my last pregnancy. What I’ve come to find is that there is a “sweet spot” with regard for optimal time to turn baby that usually results in them staying head down for birth.  Is that ALWAYS the case? Has every breech baby I’ve encountered turned head down and resulted in a vaginal birth? No. But overall, the following methods are worth a try to see if they may help you.

So, what can you do?

  • Homeopathy
  • Optimal Fetal Positioning Exercises
  • Chiropractic adjustments
  • Acupuncture
  • ECV or External cephalic version

I’ve listed them in order of least invasive to more invasive.

When would you need to consider starting these?  That depends on how far along you are and how long baby has been in a breech position.

If the first time you’re hearing about this is 33-34 weeks, you may consider starting with the appropriate homeopathic remedy, which will depend on whether there is an issue of over- or under-abundance in amniotic fluid levels or not. Different remedies are suggested based on the whole picture, not just baby’s position. Do your research or seek out a homeopathic healthcare provider who can help.

Beginning at 34 weeks: Optimal Fetal Positioning Techniques

You may have heard of Spinning Babies?

Check out their website fo more specific exercises and to expand on this information: www.spinningbabies.com

This is also a great time to begin chiropractic adjustments with a provider who is pregnancy certified, if you haven’t already. Perhaps baby is “stuck” in a certain position due to tight ligaments.

35 weeks gestation

This is what I found to be the “sweet spot” with regard for timing. The previous times we tried to encourage my little guy to turn, he just moved right back into the position he was in. Doing the ironing board technique coupled with the cold pack on his head (top of my belly) and heating pad on my lower abdomen (above my pubic area) made him turn at that time and because he wasn’t too little, he stayed that way!

If the above tips haven’t helped baby to turn just yet, you may want to consider acupuncture.  It’s actually very relaxing and can have great results.

Finally, if around 37 weeks baby has not yet turned, your healthcare provider may have set up a consultation to see if you are a good candidate for an external cephalic version or ECV. Basically, that’s a procedure where your baby is turned or encouraged to turn by the hands of the provider, usually while monitoring baby via ultrasound.

What if baby has been consistently Breech at 28, 30 & 32 week visits? (Or 2 out of 3 of those visits)

You may consider starting the homeopathy, chiropractor and acupuncture earlier, giving yourself more time.

Remember, most babies turn before delivery.  I’d encourage you to wait rather than scheduling a surgical birth at 37 weeks for a baby who has not turned. If this is your first baby, the average is to go 10 days past your due date! That means baby would have a month to turn! Meanwhile you can be doing the above tips and techniques to encourage him or her to do so.

The After Pains

So you’ve had the baby, but you’re still experiencing contractions!?

Well, yes and no. This may be one of those areas that you weren’t warned of prior to your labor experience. What am I talking about? The “after birth” pains, or uterine contractions that follow the delivery of your baby and placenta.

More often than not, you get a break after the baby is born, but upon breastfeeding you welcome back, though not fondly, some discomfort or pain in your abdomen. These pains, that come and go, are a result of your uterus contracting in order to clamp down and continue the process of its journey to return to a smaller, pre-baby state.  While the process takes weeks to complete, the majority of women find these uncomfortable after birth pains only last up to a few days.

Does it happen to everyone?

Yes, though most first time mothers don’t notice it much, if at all. This is because your uterus was pretty toned to begin with since this was your first delivery.

Many mothers report more intense after birth cramping with each subsequent delivery. Meaning, you are more likely to notice and be uncomfortable after baby #3 than with your previous births.

Is there anything that can be done to lessen the discomfort?

Fortunately, there are things you can do to help ease your discomfort during this time.

Remember, it’s a good sign that you are noticing those sensations while breastfeeding because the nipple stimulation helps the uterus to contract. The uterus contracting helps to keep your bleeding down and to return your womb to its proper state. In addition to staying on top of the recommended pain relievers given by your healthcare professional, which may include Ibuprofen or Tylenol, you can take natural supplements. Two that I recommend are:

AfterEase

Contract Ease

Both work well, though AfterEase is an alcohol-based tincture and burns a bit when held under your tongue.  Personally, I felt this distracted me from my uterine discomfort and it made a difference in how quickly I perceived it taking effect. The benefit to these herbal supplements is that you can take them more often than you can take over-the-counter medication.

In addition to the recommendations here, taking warm herbal baths can be of comfort for this and to heal your bottom area. You could also use a heating pad set on low, or a warmed rice sock/compress for short periods of time for relief.

From First Heartbeat to First Cry

A midwife stays with you the whole way.

In my post Prenatal Care without Waiting Rooms I stated that one of the biggest pros of midwifery care for me was the difference in prenatal care I experienced as an expecting mom. I had my first three children using OBs in a conventional hospital setting and my last two births under the care of midwives at home. Second to the prenatal care, my next favorite aspect of midwifery care was the continuity of care. When you select your midwife, you are selecting your birth team.

Whether you desire to work with an OB or a midwife, you will likely spend a lot of time researching, calling, and asking friends for references as you select a care provider for your pregnancy. In the typical scenario, an OB you select will be in a group practice and you very likely do not have a choice in which provider will actually be on call and help to deliver your baby. That may not always be the case, but often it is. One of the only ways that doctors in a group office can work to avoid this disruption is to encourage or find medical cause to schedule an induction; then you are conveniently scheduled for this procedure on your OB’s scheduled hospital day.

Even if you are fortunate enough to go into labor on your own and your doctor is on call at that time, you will see him/her very little during your labor hospital stay. Upon arrival at the hospital you will have a nurse assigned to you (and others) and she/he will be your primary resource until shift change. For some women, this process works well.  Maybe labor progresses well, they have a nurse who loves their job, it was a slow day at the hospital and patient ratios are lower allowing the nurse to spend more time with the patients they do have, and the mother delivers before further interruption in their care by a shift change. I am happy for those women and their positive experiences.

What if any one of those things had been different?

Rather than listing a myriad of negative scenarios that could ensue, let’s assume you’ve heard your own stories and know that it is not always such a pleasant experience.

The crucial point is, you don’t pick your nurse(s) at the hospital!

All this work in choosing the best OB for you (or your insurance), and you see them twice during labor and delivery if things are going well:

  1. Once upon admission, after the nurses have done their assessments and asked a myriad of questions getting you into the system – while you’re laboring and trying to find “your happy place.”
  2. Second to catch your baby, after the nurses had you do some pushing without them to make sure you’re not going to take too long and that you’re pushing effectively – at least for most first-time moms.

Are there exceptions? Of course there are! These are generalities made for comparison of the common/usual experience.

How does this differ with midwifery care?

I’m glad you asked. Remember, you are typically spending about an hour for each prenatal appointment throughout your pregnancy with your midwife. If you have a question or concern at ANY time throughout your pregnancy you are given your primary healthcare provider’s direct contact information. That means you can call your midwife directly at 7:00 pm or on a weekend if you start bleeding/spotting! Not her answering service, not a nurse who will page a doctor to have him/her call you back; you will call your midwife directly.

Even if questions arise that aren’t an emergency, you still have direct contact information so that you can get the answers to your questions before your next appointment. Whether your midwife prefers email or text for such communication, she will let you know. You will be communicating directly with her, your primary healthcare provider.

Typically, home visits are scheduled around 37 weeks of pregnancy so that your birth team gets a practice run before the big day and can find your house, note any special circumstances such as entry or gate codes, review your birth plan and the roles of participants who plan to be present for the birth. All of this helps everyone to be on the same page and to anticipate the best way to help prepare for the birth of your baby. When labor begins, you will call and speak directly to your midwife.

For my clients, I am the first one to arrive to assess them in labor. Vital signs are taken, physical and emotional support given and birth set-up continues as needed. At the appropriate time, a second member of the birth team is called to assist with the birth. That means if it is early, you don’t have multiple people watching you; the person you have come to have a relationship with throughout your prenatal care is present and supporting you. There are no shift changes.

Your midwife also remains with you during your immediate postpartum period. Instead of having nurses take over, checking your vitals and helping with breastfeeding, your primary healthcare provider (midwife) will stay to do those things. The bond and information you’ve shared throughout your pregnancy is carried on and built upon instead of being interrupted. You are valued and treated as an individual versus just one of many. Your midwife is on call for you 24/7!

Hospital Birth: How can I know for sure that it’s time to head to labor and delivery?

So you’re having a hospital birth but would like to minimize your chance of intervention, being put “on the clock,” or sent back home!

What can you do to avoid this? When is it time to go to the hospital?

Regardless of your choice of delivery setting, if you are able to go into labor on your own (i.e. you don’t have a scheduled surgical birth), it is usually best to labor at home until you have moved from early labor to active/established labor.

The following applies only when you do not have reason to seek care immediately and you don’t have a history of rapid delivery

Ask yourself:

1) What are the contractions doing?

The first rule of thumb is to ignore them until you can’t ignore them any longer!

This may look different for different people.

  • Are you able to distract yourself?
  • Can you rest/sleep between contractions?
  • Can you work, do a project around the house, distract yourself with shopping, watch a movie, etc?

2) Is baby moving normally?

When is it time to go?

Regularity of contractions:

First-time moms: Contractions are 4/1/1

  • Contractions are no more than 4 minutes apart, each lasting 1 full minute* for at least 1 hour

Baby #2 or more: Contractions are 5/1/1

  • Contractions are no more than 5 minutes apart, each lasting 1 minute* for at least 1 hour; they are regular, not having one 5 minutes, then 6 minutes, back to 5 minutes and then 7-8 minutes apart.

*While some people round up on contraction length, there are others who only count the peak or how long the contraction is painful for…you need to time the contraction from the beginning of uterine tightening until the contraction is over.

TIP: Download an app on your phone! SO much simpler and user-friendly than pencil/paper!

Intensity of contractions

  • You’d rate contraction intensity as a 7 or higher on a pain scale of 0-10
    • With 10 being the WORST pain you’ve experienced and you’re on the cusp of sawing off an appendage. (but you DON’T ;-))
    • I’d say this is the most speculative as MANY first time moms originally report a 6 when I’m doing a labor assessment and then well after the baby is born and we are doing a recap, they laugh and say, “I didn’t know how intense it was going to be; looking back, I’d call that a 3!!”
  • You can no longer laugh, walk or in other ways distract yourself from the intensity of each contraction during the contraction

Remember, most first-time moms have between an 18 – 24 hour labor from first labor sign until delivery.  There are of course exceptions, but generally speaking, this means you have time.

Are you overwhelmed or confused by what to look for or do?

Having a labor support person, specifically a doula or other trained birth attendant, can be invaluable. They can be your first resource and have a few tips/tricks and tools to help with your comfort and progression. You may also want to consider enlisting the services of a monitrice (think, “doula+”), who can perform cervical checks and monitor vital signs of mom and baby.

Monitrice Services Learn More

Interview the Midwife, part 2 – On the use of drugs in childbirth

Miss the first part of the interview? You can find it here!

Wow such great answers!! I love your passion and knowledge about home birth. It’s very insightful and helpful! As I’m sure you know, there are a lot of drugs given to mothers and babies during labor in a hospital and even after. What are your views about the amount and/or use of drugs given? I recently spoke to a NICU nurse and she said that she truly believes more than half the babies that were in there wouldn’t be if they had been a home birth baby. She said most were in there due to bad affects of the medication given to them.”

High School Senior studying Child Development

My opinion here would most likely be biased because I’m not speaking from research but rather from personal or second-hand experiences.

I will say there shouldn’t be a “one-stop shop” for everyone.  What I mean by that is I don’t think we should treat human beings like cattle and just herd them in and try to quickly “turn the beds around” by getting laboring moms in, delivered and transferred to a postpartum room.

We need to approach each person and situation individually. If we did that, I don’t think there would be routine use of any medication.

The more you do (“interventions”) the more you invite the opportunity for problems to arise.

Not all interventions are bad all the time. There is a time and a place for them.

I am not anti-hospital.

I am anti-routine and anti-“we are doing it this way because that’s what we’ve always done.”

When the hospital and doctors are needed I am very thankful they exist. I just honestly feel clients would be better served by having all low-risk women see a midwife and then, if the need arises, have a backup OB available to step in if/when needed.

Behind the scenes – my answers to a student’s interview about home birth

Hello, I am high school senior taking Child Development and we’re currently discussing different birth options. I’m doing a project over the views about home birth compared to hospital births. If at all possible, I would love to get the perspective of a midwife.”

I’m happy to answer your questions! Thank you for taking the time to learn more about the birthing options available for women today, and how they differ. There’s no one “right way” for prenatal care and delivery, but there are very different approaches. It’s important to consider which one is right for you for each pregnancy. The best way to do that is to ask good questions!

Question 1) What do you do as a midwife?

I provide complete prenatal care, labor & birth support and services as well as postpartum support through about 6 weeks after the birth.

This includes prenatal visits once a month until 28 weeks, then every 2 weeks until 36 weeks and then weekly through birth. I do all routine labs, same as an OB, throughout pregnancy.

I am on call for my clients 24/7.

I go to their house when they need me in labor (this varies for each client, but keeping in touch over the phone in early labor helps us to decide together when I should come).

I provide labor support and help to deliver/catch their baby; I perform all vital signs in labor and postpartum.  I typically leave between 3-5 hours after a birth.

Between 24-48 later I return to the home for their first postpartum visit where I check on mom and baby. Vital signs are performed on both and newborn assessments including CCHD screening and the first NBS are performed.

The client and baby come to my office between day 4-5 postpartum for vital sign and emotional/adjustment assessment, and we help with breastfeeding support as needed.

Another postpartum visit is done between days 10-14 for vital signs and to perform the second NBS.

The final postpartum appointment is done at 6 weeks and includes a physical exam for mom and pap smear if needed. We discuss contraception and returning to work/pre-baby activities.

Question 2) Why did you become a midwife?

All my life I wanted to be a “baby doctor;” my father was a MD so when my parents said “Obstetrician,” I went with it.

Life happened and when my husband and I met, married and started a family right away, I knew I had a choice to make. Having lived with a doctor as a parent I knew there was a lot of sacrifice and time commitment that would need to be made, and as the “mom” didn’t feel I had that opportunity.

That being said I decided to pursue a business degree because it could be used no matter what I ended up doing.  Fast-forward a bit and when my husband and I were trying to conceive baby #4 (in the Spring of 2008), I started looking up alternatives. I didn’t want to be induced again, or have an epidural; that’s when I discovered midwifery.

After thoroughly researching, I found it answered much more than my original question of how to have a better birth experience; I also discovered this was the calling and relationship that I had wanted all along! I felt like I needed to experience it first as a client before I could become a midwife and encourage people in something I had not even done myself.

After the birth of my daughter in 2009 I enrolled in the ATM-MTP program. My heart and passion has always been mothers and babies, and I had finally found the right venue to live that out!

As a midwife I am able to educate and empower! The smaller client load and much more personalized care allows me to do that each and every time.

Question 3) What are the benefits of a home birth vs a hospital birth?

Of course this answer can vary depending on who you ask! But you asked me, so here we go.

Overall, the top benefits are:

  • Personalized/tailored care
  • The ability to choose your care providers (yes, I realize people choose their OB’s too; however, when you have a baby at the hospital you generally spend WAY more time with whatever nurse is on duty – who you do NOT get to choose – rather than the OB you hired)
  • The quality and quantity of time spent in appointments leading up to and following delivery (I spend an hour at each visit with my clients, and some postpartum visits are 90 minutes)
  • Your family being in the comfort of your home (dad doesn’t have to sleep on a chair/short couch; other children can be present if desired)
  • Your husband gets to be part of the birth and not shrink back in a corner because he feels out of his element and inferior in a hospital setting
  • You get informed CHOICE! (We don’t do things to you just because. We educate and empower along the way so YOU can choose)
  • You can wear what you want, eat/drink as you want, move around, get in a position YOU want – NOT what’s most comfortable for the healthcare provider
  • Cost (it costs less to have a baby at home vs at the hospital for self-pay clients, i.e. those without insurance)

Let me know if this jogs any other thoughts/questions for you.  I’m happy to help!

Interview the Midwife, part 2 – On the use of drugs in childbirth

Home Birth: But what about newborn care?

How a midwife checks the baby’s health

So you’ve decided to have a home birth and feel confident about your prenatal care and labor choices. But what about after the baby arrives?

During the immediate postpartum period I am assessing vital signs on mom and baby regularly, helping to initiate breastfeeding and giving adequate time and support for mother/baby/family bonding. During the time of active recovery, we are following baby’s cues that he/she is interested in nursing because first and foremost, in the absence of complications or the need to intervene, this is of vital importance.

A complete newborn exam is performed in order to assess baby’s gestational age and to verify everything is within normal limits, from head to toe. Any concerns will be discussed with the parents and a plan for next steps established. In the case of an emergent concern, we would transport to the hospital; however, most situations identified during the newborn exam are truly non-emergent and may be referred to the baby’s pediatrician during normal business office hours.

Acting within the scope of my license, a midwife is able to care for the newborn within the first six weeks of birth. I do discuss with all of my clients however, that I am not a pediatrician and I recommend the baby be seen by a doctor within the first two weeks of birth, unless they elect to do so sooner or the doctor requests an earlier visit. What I provide for the pediatrician is a one-page document containing applicable pregnancy or birth events as well as any newborn procedures prior to the first visit so that they have any information they may need easily at their disposal.

Now that you have an overview, let’s take a closer look at the details of newborn care for home birth. Assuming a normal birth, baby’s AGPARS were great and baby is robust, crying and alert, the baby spends time skin to skin with mom, dad or another family member. Midwives regularly practice delayed cord clamping; many of my clients have not had the baby’s cord cut until after the placenta has delivered, ensuring baby gets his/her blood!

Vital signs are done hourly or as needed and include assessing heart rate, breathing and temperature. Typically the newborn exam is done between 1-2 hours after birth (it is at this time that baby is weighed and measured and newborn procedures are done according to law and parents’ informed choice) and includes the Ballard Exam which helps to assess overall gestational age and is comprised of neuromuscular maturity as well as physical maturity.

It is usually at the conclusion of this exam that mom and baby are helped into an herbal bath. Once out of the bath, the baby is dried, and I demonstrate the application of olive oil to the bottom (to help ease the changing/cleaning of dirty diapers), diapering, cord care, dressing and swaddling.  One last set of vital signs is taken prior to the midwife’s departure.

What’s next? You’re left alone?!?

Not to worry, during the prenatal period, as part of your care, I will have already taken the time to review what to expect and what to look for. Between 34-36 weeks I send a document about the first few days postpartum and how to care for the baby. The document includes a chart where the parents, or other elected family member or friend, write in the information requested. During the first 24 hours, vital signs are to be assessed every 4 hours. This means taking the baby’s temperature, counting respirations and heartbeat.

Does that sound scary or overwhelming? This document is reviewed at the home visit and again after the delivery prior to the midwife’s departure. I will teach you, so you can be sure of what to do! I return for a postpartum home visit between 24 – 48 hours after the birth and am on call 24/7 during those first days after the birth.

It is at the initial postpartum home visit that the first newborn screen is performed (testing for metabolic diseases) as well as the CCHD (critical congenital heart defect screening).  I check vital signs for mom and baby again at this visit as well as provide breastfeeding support. The baby is weighed again to verify he/she has not lost too much weight. We discuss the number of wet & dirty diapers, sleep & eating patterns and assess baby’s skin color for jaundice. Goldenseal is applied to the baby’s umbilical cord as needed.

There are 2 additional postpartum visits that follow; both are back at my home office and include weight and vital sign assessment. I am able to perform the second newborn screening should you choose to have me do it instead of your pediatrician around 14 days postpartum. We review the items discussed at your postpartum home visit, plus anything new that may arise!

As you can see, I do my best to help prepare you for the next tasks of caring for your baby. I want you to feel educated, supported and encouraged each step of the way.

What questions do you have about newborn care at home?

If you’ve given birth in a hospital, what was your newborn care experience like? What would you change? Comment below!