The Midwife Answers – My Radiant Beginnings

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Newborn postpartum home visit

What to expect during your first Post-Partum Home Visit (Baby)

Thank you for reading about what to expect during your first postpartum home visit for the mom! Now, it’s time to look at what that first visit looks like for the baby. During the pregnancy and after baby’s arrival, I remind my clients that I am not a pediatrician. The law does allow for midwives to care for babies for up to six weeks, but I encourage the parents to find a pediatrician and discuss how soon they should be seen. Most often, I am still the first one to see the baby by this 24-48 hour home visit window.

Lots of things happen during this visit for the baby. It is important to do a nursing check and help if there have been any difficulties with latch. If nursing is going well, then not as much time is needed there. We check baby’s vital signs including his/her heart rate, respirations, temperature, and review the chart that the parents have been using to track how baby has been doing in the time the midwife was gone. We review how many wet and dirty diapers that the baby has had, how much indirect sunlight the baby is getting (this helps to break down bilirubin levels and can help to prevent jaundice), and how baby is sleeping.

This is the ideal window to collect that first sample for the newborn screening and to perform the CCHD (Critical Congenital Heart Defect) screening. The baby is of course weighed, and we discuss how much weight loss is okay versus too much, as it is NORMAL for the baby to have dropped weight during this time. Because I do not have the equipment to perform the hearing screen, I remind the parents they will need to have this done either by their pediatrician or through another provider I refer.

As mentioned in the previous post, following baby’s checkup, he/she may be brought into the herbal bath with mom. If the baby will be in the bath, we delay applying the cord care powder to the umbilical cord until after the bath. I also use this time, if we didn’t already review it during the first herbal bath following the birth, to show the parents how easy bathing a newborn while in the tub with them can be. You’d be amazed at how overwhelming it can seem to bathe a new baby! I want everyone to feel comfortable and confident in this time! The baby is dried, diapered after applying olive oil to his/her bottom (GREAT tip for helping that tar-like meconium to slide right off!), the cord is examined and treated, and the baby is dressed and wrapped or ready for skin-to-skin with mom or dad.

Similar to my departure following birth, I like to leave mom and baby resting comfortably together in bed, well attended and nourished.

Postpartum home visit

What to expect during your first Post-Partum Home Visit (Mom)

You were able to deliver your baby at home, everything was normal and stable, and the midwife left you and baby snuggled up, resting in bed. I like to remind my clients to call me after their recovery sleep and after they’ve had some time to settle in a bit to let me know how nursing is going and to ask any questions that may have popped up in this time. Letting them call me helps to avoid me waking them with a phone call and instead allows the new parents time to adjust and do things on their schedule. If we didn’t set a time following the birth for the postpartum home visit, we typically schedule it at this time. The timing of the first home visit to check on mom and baby is anywhere from 24-48 hours following the time of birth. Of course, if there are any concerns, the midwife returns as appropriate.

While the particular timing is mostly due to the ideal time to collect a blood sample from the baby for the purpose of the first newborn screening (the test used to check for a myriad of metabolic disorders), it is also a great time to check in on mom to be sure she is remaining stable. Keep in mind that mom and dad (or perhaps another family member who was appointed for the task) have been keeping note of some vitals for the mom and baby in the time between immediate postpartum period and this first home visit. I work to make sure parents feel equipped for this and are not overwhelmed with this responsibility.

When I arrive, after washing my hands and greeting my clients and the new baby, I set out to boil another pot of herbs so that mom can take another herbal sitz bath. I didn’t used to do this routinely at this postpartum visit, yet I found all too often that when I asked if they had done any more herb baths since the birth, the answer was typically that they had not. My initial focus is on mom, addressing any questions or concerns she has.

I check her vital signs, feel her fundus (the top of her uterus), we discuss how her bleeding has been and any pain/discomfort she may be experiencing (from breasts/nipples to a sore bottom). We discuss her nutrition and her supplements since the birth. It is important to remember that a nursing mother needs more calories when breastfeeding than she did when she was pregnant! (A pregnant mom typically needs about 300 calories over what her normal was prior to pregnancy. A breastfeeding mom typically needs about 500 calories over her pre-pregnancy allowance.)

Many times it is through the discussion about supplements that a mom is reminded she should be continuing to take them. For many, it is an “out of sight, out of mind” issue. We have been encouraging moms to rest and take it easy, which typically means they are remaining in the nest of their room. This has pros and cons for sure! This protected isolation from the world can also deter some of the self-care they were so careful to instill during their pregnancy.

While discussing and addressing the various topics above, I am getting a sense of how rested mom is and a glimpse of her outlook and emotional state. I also ask directly how she is doing emotionally and whether or not she’s been able to fall asleep during her rest periods or if she’s just putting her feet up and taking it easy.

Following the mom’s assessment, we help her into her herbal sitz bath, bring her something to drink, and give her some time to herself while dad stays with the baby during his/her assessment. I have seen mothers light up with this opportunity to have some uninterrupted time in the herb bath. This is addressing her physically as well as emotionally. Sometimes, I have brought the baby to them at the conclusion of the baby’s exam and procedures, and sometimes they prefer that I don’t. The choice is yours. Those that choose to have the baby brought into the herb bath may choose to nurse the baby while in the tub, or simply hold the baby and help them to float, enjoying the warm bath.

Once mom and baby are ready to be helped out of the tub, the baby goes to dad and I help mom to the bed. During this time I demonstrate an abdominal massage and binding to help the mother feel supported and to encourage healing. The partner gets to see how they can be a part of this healing process and look forward to being in charge of providing the massage for the next couple of days.

To my former clients who are reading this and thinking things sound a bit different, you are right. Some of you are currently with me for another round and you WILL experience this. I am putting into practice new things as I grow and learn. I am blessed to have the opportunities to share this and find it providential that these changes occur and benefit the postpartum period. If you are “done done” having children, stay tuned…there is more.

The postpartum home visit is more than just a checkup. You are addressed physically as well as emotionally. I want to leave you feeling as though you matter, you are important, you are more than your birth, you are more than “just a mom”, you are (insert your name here)!

It’s a blessing to serve you!

Past the Estimated Due Date (EDD)

You’ve reached your estimated date of delivery. Now what?

Last fall, one of my clients reached out about waiting. This was her third pregnancy, but she had already delivered by this point during her previous pregnancies. She stated she didn’t understand why this time was different. She understood there wasn’t a rush; however, there was a fear about the possibility of needing medical intervention to get the ball rolling.

Pregnancy is a process. While not everyone’s experiences are the same, I think most women would agree they learned something about themselves during their own journeys.

Some women are pleasantly surprised to find they go into labor unexpectedly days or weeks before the BIG EDD! Others of us know, from day one, that is not likely to happen for us, due to our own previous experiences or a family history of holding onto those babies for days or weeks longer!

From my own experience, I understand completely! During my third pregnancy, I was working a corporate job and couldn’t wait for the day after my due date to arrive so that when I was asked again “When are you due?” I could smile and respond “Yesterday,” just to see the looks on people’s faces. Priceless. Interestingly, most people aren’t used to that response, especially in work environments, for numerous reason (scheduled deliveries, people taking leave at or prior to that time, etc…).

Perhaps you are one of the frustrated momma’s who went into labor weeks early with your first, and now you are shocked and beside yourself for going past that special date. I believe this is the most frustrating position, because you could literally be pregnant a month longer than your previous experience! All I can say is, I’m so sorry! I do speak with those clients up front and throughout their pregnancy about this possibility, to help to keep the angst down as much as possible.

Let’s say you find yourself here, 40 weeks on the dot, without any reportable signs or symptoms of impending labor…now what?!?!

I like to take a 3 step approach, in order to address your mental outlook, your emotions and your physical needs.

First, most people like to have a plan in place. It helps them feel prepared and a little more in control. I know there is very little that can be controlled in life, let alone in pregnancy, but for myself I find that it helps to do what I can to help as much as I can. So, I review what things look like now that we’ve reached 40 weeks. For some, it may mean prenatal visits two times a week instead of weekly, though for others that doesn’t happen until 41 weeks. I recommend clients have a BPP (biophysical profile) done at 41 weeks. (Read about this in an upcoming post). We discuss a general overview of what to expect at those appointments, and any steps that can be taken between appointments to help ripen the cervix (supplements/activities). I also explain what happens if in fact we make it to 42 weeks, and the process of a medical induction. Personally, I feel exploring the upcoming two weeks at that time is more assuring because then my clients know what to expect. I also feel that discussing it all minimizes the likelihood of needing to go that far, versus not talking about it and everyone being frustrated, upset or confused if indeed we end up there. I educate in order to empower.

Second, I address the emotional component. It’s one thing to know in your head logically what is happening and what is to come, but that doesn’t address your feelings about it. This is a bit more difficult to quantify, because this is when my relationship with my clients comes more into play. One client may have fears about the “what ifs,” another may be anxious, while yet another may be actually angry about the wait. There are LOTS of emotions that come out in pregnancy and typically if you don’t see it early, you see it towards the later part.

I was taught and like to use the analogy about a piece of fruit. Fruit is best when it is ripe, and sometimes it feels as though that will come any day, and sometimes you keep checking back only to have to wait a little longer. Then, you have this window of time where you can enjoy the fruit at its peak, when it is at its best! If you happen to go past this time, the fruit turns rotten. While for fruit purposes you’d throw it out because it wouldn’t be so pleasant to enjoy it, when you turn the analogy back to an expectant mom who has crossed this ideal window emotionally in her pregnancy, this is the time she realizes she is ready and she’s willing to do anything (Endure Labor!!) to get this baby out! Why does this help? Because sometimes emotionally we are holding on a bit, perhaps fearful of labor, of pain or of the unknown.

Separately, I encourage my clients and build them up, ideally so that they leave with hope and uplifted spirit. I also encourage a date night, no matter when the last date night had been, so that they can get some uninterrupted time with their partner. This connection shouldn’t be taken for granted. Oftentimes, after a date day, labor is just around the corner. This is good for SO many reasons, but mostly the communication that takes place helps to unlock some things that were meant to be talked out before baby comes.

Lastly, we address your physical needs. Again, this is tailored to each client, but may include suggestions of getting some “you time,” a night out with friends or time alone to take a long bath or read. Overall, my recommendation is to have something planned each day. I’m not talking something big and crazy, I’m just talking one appointment to set for yourself – it could literally be a reminder on your phone to have lunch with a friend, not necessarily a massage appointment, but that works too!!!

With my first pregnancy, my mom scheduled a hair appointment on my due date, feeling pretty certain I would need the distraction. While I was a little bummed to still not have my baby in my arms, the appointment gave me something to look forward too and I felt really good about myself afterwards! The idea here is to have something to look forward to each day, even if it’s knocking another item off your “to-do” list that you wouldn’t mind cancelling, if in fact you were to go into labor.

Outdoor activities or anything out of the house is ideal since it may be a little while before you are venturing out after baby arrives. I am VERY careful to stress balance at this stage, which is why I recommend just the one thing or appointment a day. Balancing activity and rest towards the end of your pregnancy is key in setting yourself up for being as well-nourished and rested as possible before going into labor. Remember, it could happen any day and while we are trying to shift your focus temporarily from that, it is a reality that you need to be prepared for.

On average, first time moms go into labor 10 days following their expected date of delivery, or 41.3 weeks!  Remind yourself of that and take the above suggestions and adapt them to make them work best for you.

Many Blessings!

When A Home Birth Doesn’t Go As Planned – Part 5

Welcome! You made it to the end of the series on transports and what happens when things don’t go as planned! Thank you again for joining and for sharing anything you found to be helpful with others! We’ve looked thoroughly into what happens in a transport, including some reasons why it might take place. Now let’s look at what can be expected after delivery.

Generally speaking, I stay with my clients until breastfeeding can be established with the new baby. It is important to allow family bonding and ample time for mom’s and baby’s recovery sleep after the baby has latched and is nursing.  Each woman is unique, and we discuss my next visit within the next day or two.

Often, I come up to the hospital prior to discharge to do an emotional check on mom and to allow her to process the birth. Some may choose to have me wait and come instead to their home a day or so after being discharged. The important thing to note is that the post-partum care continues beyond the birth at the hospital. I care about my mothers and their babies and I want to continue that continuity of care. If a mother chooses instead to only follow up care with her delivering OB at the hospital, she is free to choose that as well. I have only seen that happen a handful of times, mostly with individuals who utilized a birthing center or who didn’t have the rapport with their midwife that they had hoped for.

I typically see clients four times following the birth of their baby: between 24-48 hours, 4-5 days later, 10-14 days later and the final post-partum visit at 6 weeks. While these visits may be very similar in timing and structure following a hospital delivery compared to a birth completed at home, the emotional or recovery aspects would be tailored to each situation.

When A Home Birth Doesn’t Go As Planned – Part 4 (Cost)

For some, cost is the aspect of attempting an out-of-hospital birth that makes it the least appealing, and sometimes an all-out non-viable personal option. The short and quick of it is, payment is required in full prior to 37 weeks, or the point at which an out-of-hospital birth is possible. If you had paid for your delivery, and then went on to labor and needed to transport for any reason, you would also need to pay any associated hospital fees. Again, for some people, that does it.

Why should it not completely dissuade you?

Many people who choose to birth outside the hospital do have medical insurance. While this does not necessarily cover the costs of home birth (more to come in a future post), it is helpful in the event of a transport or emergency.  The medical insurance would cover the costs of the hospital according to your policy. So, even if the entire amount of your midwifery care has been out-of-pocket, the hospital bill may only be a fraction or percentage of total costs in regard to what you are responsible for after insurance adjustments and payments. Both will likely be applied to any deductibles.

What is the value of peace-of-mind?

Though impossible to quantify, I would argue that with the support of a healthy birth team, it is priceless. I cannot know upon meeting an individual what type of birth she will go on to have; however, if the couple is educated and supported throughout their journey and not filtered through a system or process, then they are set up for optimal success.

Personally, I would much rather be set up for success with a variety of tools available and know that I tried it all even if the outcome was different than my expectations than to save some money, become a number and lose my individuality.

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.