Bloomington Home and Water Birth
A Unique and Special Experience
Homebirth midwifery embodies in the 21st century values that pregnant women have cherished forever. Clients seeking my services are looking for a safe birth that meets their needs for privacy and personal autonomy. Understanding that labor itself is an unpredictable process, they nonetheless enjoy planning for the challenge and knowing who will be with them during their births. They are disinclined to make use of typical American medical interventions in pregnancy and labor, with a strong preference for natural childbirth. They are not naive about the risks involved, and know they need skilled assistance. Homebirth midwives employ a low-key manner of screening for complications throughout labor, listening to fetal heart tones and supporting the mother as she works with her body to get her baby born. Homebirth moms are very free to do whatever they would like to during labor, seeking comfort and relative relaxation in whatever ways work best. The midwives are ready to spell the family members assisting the mother, or to suggest and demonstrate new techniques for coping. The emotionally safe setting we create together has hormonal effects that increase the strength and effectiveness of labor.
Homebirth Services
Mine is a homebirth practice because I so prize women’s instinctual knowledge in childbearing, and home is where that power can manifest itself with the least resistance. Marital and intimate partner relationships are strengthened as a woman turns to her mate as her primary support and comfort during labor. Other family members, friends, doulas, and midwives help as needed. My services include the presence of a second midwife or trained birth assistant to work with me. She is my second set of hands, and is trained to know how to assist me in the event of complications with the delivery itself. I typically have her join me as we get close to the pushing stage of labor, and send her home once all is stable. Women push out their babies using whatever effective positions they prefer. I have a birth stool that a lot of my clients like to sit on to delivery, but honestly, if it’s a position a person can get into, I’ve probably caught a baby that way. Sometimes women like to catch their own babies, or have their partners catch. I’m happy to facilitate that.
Those first special hours after the birth are precious. Care is as unobtrusive as possible, so that mother and baby can remain together continuously. In time I will do a detailed newborn exam, help the mother up to the bathroom, do any perineal repair that might be necessary, clean up completely from the birth, start the laundry, and see that the mother is fed. I make sure the baby is nursing well, or that there is a feeding plan in place if the baby is slow to latch on.
We all know that labor can grow long, complicated, or both. Many small and moderate complications can be safely dealt with at home, but midwifery judgment comes into play when complications do not resolve, or a labor is prolonged and our ordinary methods of stimulating it are not enough. Sometimes we need medical help. By far the most common reason for a planned homebirth to relocate to the hospital is a very long labor that requires medical assistance to complete itself. Most cases will still end in vaginal delivery. I am fortunate to work with a very patient back-up obstetrician who knows my clients really hope to avoid cesarean deliveries. About 20% of our first-time moms will have a non-emergency transport due to a lack of progress in labor, combined with maternal exhaustion and the need for medical intervention. The transport rate in my practice among other mothers is <5%; and the transport rate for newborns is <1%. In all cases of transport to the hospital, I remain with my clients to provide support, to communicate with the medical team, and to continue their care. While I do not have practice privileges in the hospital, I am still free to advise my clients and help them understand the new context they find themselves in.
Safety
The most carefully designed studies examining homebirth safety have consistently found it to have risks comparable to those of hospital birth, but with a much lower rate of cesarean section and other medical interventions, under the following circumstances: when the mother is healthy and carrying a single, head-down baby; when her homebirth is planned and attended by someone skilled; and when she has functional medical back-up. The information packet I mail out to prospective clients has further data on homebirth safety studies. My own view has always been that if homebirth’s many documented benefits were coming at the cost of an increase in serious complications to mothers and babies, I couldn’t justify practicing. Happily, that’s not the case. Yet, as adults, we recognize that childbirth cannot be made risk free in any setting. We move on, then, to develop the most appropriate and personalized birth plan for the given woman. The essential responsibility of a midwife at a homebirth is to perform an ongoing risk assessment and when necessary, take action to address complications. This might be as simple as helping a mother change her position to increase blood flow to her placenta, or as dramatic as stopping a hemorrhage or getting a baby to breathe. I am trained and equipped to take those measures when necessary. It might involve the recognition that the hospital is the safer place to be under newly emerging circumstances. Whenever complications threaten a homebirth, I deal with them calmly and factually, in consultation with my clients. Most often there are choices to be made and time to make them, and to the maximum extent possible, I will support my client’s informed decision-making. But I will also take immediate action in the presence of an emergency, communicating as I work.
Interface with the Medical World
Given the nature of childbirth, planning for a homebirth includes a bit of planning for the unexpected. Even a low-risk woman can develop a complication in her pregnancy, labor, or postpartum that is beyond my scope of practice. Thus we need medical back-up care to be there for us, whether it’s to prescribe antibiotics for a second-trimester urinary tract infection we can’t beat back with natural means, or to meet us at the hospital with kind and respectful care if we need to come in during labor. The majority of my clients see Bloomington obstetrician/gynecologist John Labban, who has provided medical back-up to my clients for the past fifteen years. He is a kind and principled physician sympathetic to my clients’ wish to deliver at home. In order to establish enough of relationship to provide back-up, he would like my clients to visit his office at the 12th, 28th, 36th, and if necessary the 41st week of pregnancy. The basic labwork any provider would need happens via his office; he can also provide, for those who choose it, the full array of fetal testing. Likewise, ultrasounds are available via his office, though I recommend them only when there is a distinct reason to have one. Many of my clients seek to avoid the use of medical technology during their pregnancies and labors. I respect that, and always keep my clients’ preferences in mind when making recommendations concerning testing and technology. I think of all medical interventions in childbirth as tools, whether it’s a routine 20-week ultrasound or an emergency cesarean section. We always seek to use the simplest tool available to get information we seek, or to solve a problem – that’s the safest approach.