Ask Melissa Bates, CPM

What does homebirth prenatal care look like?

Prenatal care for home birth is comfortable and comprehensive.  We meet in my home office for prenatal appointments and clients enjoy the relaxed atmosphere.  Yes, we do check vital signs on mom and baby during each appointment but we also address mom as a whole person.  We work together on nutrition, activity, mental wellness and preparedness and how things are going in general.

What is the role of my partner in a homebirth?

Ideally your partner is free to operate in any role they desire for your homebirth! We encounter some partners who seem to be naturals and this and their knowledge of their significant other is evidenced by the needs they are able to anticipate and some who feel more comfortable being present but would rather maintain a hands off approach.  We want to work alongside you both for the experience you desire and don’t force more or less upon you.

​​What happens if we have to transfer during labor?

​While a transfer of care in labor isn’t in the original plan, we are able to facilitate a smooth transfer because we have prepared for and discussed this possibility prenatally.  Part of preparation for the homebirth includes an Emergency Transport Form and we discuss and review which hospital we would transport to in an emergency as well as which hospital we would transport to if the situation were not time sensitive and you could pick.  In addition, we have discussed what happens in a transport and what my role in the hospital looks like so that everyone has had time to process instead of letting fear take over in the moment.

Is homebirth safe?

Homebirth is a safe option for low risk clients.
If you haven’t already I recommend watching the “Business of Being Born” and “Why Not Home”
You can read more at: https://mana.org/blog/home-birth-safety-outcomes

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​Is unmedicated childbirth painful?

 ​While we can’t say natural childbirth is easy; we can say that you would be amazed at what you can do when you are equip and surrounded by support.  Labor has been compared with running a marathon; the training and preparation help you to reach your goal much better than if you had skipped practice!

​Will I get a birth certificate?

 
Absolutely! We file the necessary documents to process the birth certificate.

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Will students be at my birth?

You have a choice about who is at your birth.  At times I may be working to train students or members of the birth team in order to better serve my clients and continue the tradition of midwifery education.  Ultimately though, the choice is yours and we honor and respect your desires.

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​Who can I invite to my homebirth?

This is YOUR BIRTH!  You may invite anyone you’d like to your birth.  We have attended births with only the expectant parents present and births with a whole team of support complete with friends and family members.  We’d love to discuss this with you and your partner prior to those invitations as it is much easier to invite people at the end than it is to UNinvite people after reconsidering your wishes

What does postpartum care look like?

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Postpartum care after a homebirth is a welcome respite. We come to you for your initial postpartum home visit where you and baby remain in the comfort of your home without obligation for traffic, travel issues and packing up a newborn! We take our time evaluating you and baby, helping you to transition and process your birth experience.  In total we see you 4 times following the birth through the final 6 wk postpartum visit.

​Does a midwife help with breastfeeding?

Yes, midwives help with breastfeeding! In the event you and baby need additional support we have a great network which includes IBCLC lactation consultants who would be happy to meet with and support your family.

Common Pregnancy Discomforts 

• Backaches
• Carpal Tunnel Syndrom
• Constipation
• D​yspareunia
• Edema
• ​Heartburn
• Leg Cramping
• Nausea & Vomiting
• ​Pruritis gravidarum
• Round Ligament Discomfort

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Why?

It is common to experience some aches and pains in the upper or lower regions of the back because of the anatomic changes occurring during pregnancy. Enlarged breasts and a growing uterus contribute to a change in weight and the center of gravity. Add to this poor posture, inadequate muscle tone and an exaggerated curve of the lower back (lordosis). Aggravating factors include a posterior fetal position, standing in place for too long and bending forward at the waist.ce for too long and bending forward at the waist.

Prevention

• Exercise – without overexerting!
• Maintain good posture.
• Wear comfortable and supportive shoes and bra.
• Sleep on a supportive bed (one that doesn’t sink or sag) supported with pillows.
• Execute proper lifting techniques (squat don’t bend).

Remedies

• Belly band
• Rest
• Pelvic rocks
• Chiropractic adjustments
• Use back support while driving
• Massage
• Ice packs
• Warm baths/showers/compresses
• Castor oil pack: After soaking flannel cloth in castor oil, place on area of discomfort, cover with plastic and apply a heating pad for 30 minutes.
• Apple cider vinegar: After soaking cloth in apple cider vinegar and ringing out the excess, place cloth on area of discomfort for 15-20 minutes.

Call Your Midwife If:

In the event you have any questions as to the normalcy of your pain, please do not hesitate to call. In the case of severe back pain that is not alleviated by any of the above recommendations, call immediately! If the ache/pain is located at waist level we need to rule out kidney infection or the possibility of liver or urinary tract infections. Referral will be made to the back-up physician.
(Davis, 2004; Frye, 2008; Myles, 1975; Varney, 2004)

Altered sensations, including tingling, numbness, pain, stiffness and weakness in the thumb, index, middle and radial portion of the ring finger that can travel upwards affecting the arm and shoulder.

Why?

While carpal tunnel syndrome can exist outside of pregnancy from repetitive hand/wrist movements (typing), the weight gain, fluid retention from hormones and subsequent swelling during pregnancy sometimes compress the medial nerve in the wrist.

Prevention

• Use of ergonomic keyboard (if applicable).
• Periodic movement or breaks during periods of repetitive hand/wrist activity.

Remedies

• Rest (being careful to avoid supporting head with hand/wrist during sleep)
• Splinting or stabilizing the wrist with a support at night and while typing
• Exercise
• Acupuncture
• Warm, moist heat
• Drinking fresh pineapple juice (anti-inflammatory properties)
• Skullcap infusion, drink to heal affected nerves
• Vitamin B6 (25 mg/day) in addition to B complex supplement
• Childbirth – Cases of carpal tunnel syndrome appearing only in pregnancy are typically corrected after delivery!

Call Your Midwife If:

In the event you have any questions as to the normalcy of your pain, please do not hesitate to call. Referral will be made for symptoms not attributable to median nerve.
(Frye, 2008; Myles, 1975; Parker, 2008; Varney, 2004)

Infrequent and/or difficult eliminations as stools become hardened and back up within the intestinal tract

Why?

Although it is not considered normal, constipation in pregnancy commonly occurs as a result of the hormone progesterone and its relaxing effect on the peristalsis of the stomach and intestinal tract. The additional transit time allows more water to be absorbed in the intestines. A poor diet, iron supplements and the pressure of a growing uterus, which displaces the organs beneath, also contribute to constipation.

Prevention

• Proper diet & fluid intake
• Regular bowel habits
• Go with the urge/try not to hold it
• Avoid foods known to cause constipation

Remedies

• Increase water intake
• Increase fruits/veggies/fiber intake
• Daily physical activity
• Rest
• Drink prune juice or black cherry juice
• Drink a hot liquid then a cold liquid OR drink a warm liquid upon standing/rising
• Move E-Z (TriLight Herbs:½ tsp 2-3x/day) for stimulation of bowels
• Use of glycerin suppositories
• Yellow dock root (a liver stimulant with laxative effects)

Call Your Midwife If:
​In the event you have any questions as to the normalcy of your pain, please do not hesitate to call. In instances of persistent constipation with no relief from the above suggestions, it becomes necessary to rule out the possibility of fibroids.
(Davis, 2004; Frye, 2008; Myles, 1975; Parker, 2008; Varney, 2004)

​Painful sexual intercourse.

Why

Physical changes in pregnancy, abdominal growth and a descended baby can cause vaginal crowding and impaired circulation. Emotional concerns of fear regarding trauma to the baby can also play a role in dyspareunia.

Prevention

EducaEducation to dispel misconceptions that intercourse harms the baby (in normal circumstances).tion to dispel misconceptions that intercourse harms the baby (in normal circumstances).

Remedies

Swelling of the lower body extremities, legs and ankles (can include fingers) evidenced by indentations (from footwear/socks) with possible feelings of tightness.

Why

Swelling can be caused by a variety of reasons. Typically the more common reason is due to the normal, healthy expansion of blood volume and hormones. Other causes can be diet related (not enough salt, fluids and/or protein), duration of standing/sitting and increased perspiration.

Prevention

• Changing positions (not sitting/standing for prolonged periods)
• Adequate salt, fluid and protein intake

Remedies

• Rest (this will alleviate the more common hormone/blood volume related swelling)
• Walk
• Improve diet (adding deficient items)

Call Your Midwife If:

In the event you have any questions as to the normalcy of your swelling or accompanying pain, please do not hesitate to call. While swelling in the extremities is typically not a cause for concern it should be reviewed and discussed at each visit in order to determine that it is not a sign of something more severe. Specific things to look for include a generalized (all over) swelling that increases and does not fluctuate with activity or time in the day. The inability to note distended veins could indicate fluid is leaving circulation as it is drawn into the surrounding tissues. Potential complications include: pre-eclampsia, cardiac or renal disease.
(Frye, 2008; Myles, 1975)

Burning sensation in esophagus due to reversed peristalsis.
(may be felt in chest or neck)

Why

Progesterone, a pregnancy hormone, affects the cardiac sphincter (top opening) of the stomach by relaxing it and decreasing the movement of the stomach, which prolongs the emptying time. This issue combined with the effects of a growing uterus that pushes and displaces the stomach cause digestive fluids to enter the lower esophageal tract causing an uncomfortable, burning sensation.

Prevention

• Avoid consuming liquids with meals (drink throughout the day)
• Avoid cold, spicy, over seasoned, greasy and fatty foods
• Avoid eating large meals, especially before bed
• Avoid poor posture or a position that puts pressure on the stomach
• Avoid caffeine

Remedies

• Walk after eating
• Raise the head of bed (30 cm) or use extra pillows
• Eat small & frequent meals, slowly
• Eat plain, baked potato
• Chew raw almonds or cashews
• Sip milk, hot water
• Good posture
• Stretching (give stomach room)
• Use digestive enzymes or papaya enzymes
• Take a calcium/magnesium supplement (1 tsp – 1Tbsp as needed)
• Take comfrey tablets with pepsin
• Slippery elm bark powder (capsules, as needed)

(Davis, 2004; Frye, 2008; Myles, 1975; Parker, 2008; Varney, 2004)

Sudden pain causing a tight pulling sensation in the leg.

Why

Leg cramps can occur because of deficiencies in the diet, including inadequate salt intake. While there is evidence that too little sodium, calcium, magnesium, potassium and phosphorous can be responsible, it is interesting to note that excess calcium has also been attributed to leg cramps. Additionally, the weight of the growing baby and uterus exert pressure on veins and nerves from the pelvis running below, which contribute to the possibility of leg cramps.

Prevention

• Maintain diet rich in variety of vitamins & minerals
• (Sodium, Calcium, Magnesium, Phosphorous & Potassium)
• Avoid carbonated beverages

Remedies

• At onset: Straighten leg and flex foot (heel toward the floor)
• Lift toes up – do NOT point toward floor
• Elevate legs above the heart
• Shift weight while standing
• Walk daily to increase circulation
• Apply heating pad and manual pressure

Call Your Midwife If:

Do NOT massage the cramp if varicose veins are present, or there is reason to believe they could exist. In some instances this effort could unintentionally dislodge a clot! Reviewing additional factors in addition to the occurrence of leg cramps may lead to the need to screen for anemia.
(Frye, 2008; Varney, 2004)

Common between 4-14 weeks of pregnancy, this queasy unsettled feeling, which may or may not include vomiting, can occur at any time of day or persist throughout the entirety of the day.

Why

Various influences can be attributed to the nausea and vomiting experienced by 1/2 to 2/3 of pregnant women. In the first trimester the influx of hormones, such as estrogen and HCG (human chorionic gonadotrophin), along with their concentration as the blood volume has not yet expanded can negatively affect some women. In addition, changes in dietary needs versus intake, decreased blood sugar and conflicting emotions have been linked to nausea and vomiting as well. Late in pregnancy, nausea & vomiting can be caused by the increasing pressure and discomfort from the growing uterus.

Prevention

​

• Avoid prolonged periods of not eating
• Eat before rising each morning
• Eat a high protein snack before bed
• If up during the night, have a snack
• Avoid spicy/greasy food
• Avoid strong odors
• Lower fat intake
• Avoid taking supplements on an empty stomach

Remedies

• Eat boiled egg in AM
• Reduce stress
• Rest
• Get support from family/friends
• Exercise
• Eat small, frequent nutritious food every 2 hours
• Raspberry leaf tea
• Chew anise or fennel seeds
• Consume foods that settle stomach
• Prevent dehydration: Adding lemon to water to make more palatable
• Use cold cloth on head (if dizziness occurs)
• Take B6 (50 mg) in AM and before bed
• Ground ginger capsules/Ginger root tea
• Try wearing acupressure wristbands (seabands)

Intense itching, usually occurring in the third trimester, can begin on the abdomen and spread generally all over; form of jaundice in pregnancy.

Why

The increased amount of hormones, estrogen and progesterone can effect the liver’s ability to excrete bile salts. As this condition is related to the liver, it can also occur if the liver has been compromised because of other circumstances not related to hormones.

Remedies

• Oatmeal bath
• Anti-itch creams
• Massaging yogurt topically
• Usually resolved within days after delivery
• Dandelion root & Yellow dock root (liver support)
• Consuming liver cleansing agents (beets, dark greens, lemon juice, olive oil)
• Consuming foods rich in choline (egg yolk, wheat germ, brewer’s yeast)

(Davis, 2004; Frye, 2008; Varney, 2004)

Can be described as a sharp pulling pain or cramp, felt on one or both sides of the uterus extending into the pelvic area (or solely occurring there).

Why

The round ligament is made to stretch with the uterus; therefore as it grows the stretching and pulling itself can be uncomfortable. Pressure from the enlarging uterus in addition to the frequency of contractions toward the end or pregnancy, make triggering this spasm more likely.

Prevention

Avoid sudden rising from seated/lying position

Remedies

• During a cramp: breathe deeply, relax and bend toward side of pain
• St. John’s Wort tincture (5-20 drops with cramp) – for all spasms
• Caster oil compress + heating pad (30 minutes)
• Hot water bottle/Heating pad or warm bath
• Maternity abdominal support garment
• Pulling knees toward chest
• Use pillows to support abdomen when laying

Call Your Midwife If:

In the event you have any questions as to the normalcy of your pain, please do not hesitate to call. Before treating with heating pad, appendicitis, gallbladder infection and peptic ulcer should be ruled out.
(Frye, 2008; Varney, 2004)