What Does Homebirth Care Entail?
Updated: Jul 30, 2019
Assuming the route chosen is one with a homebirth midwife, and not the “freebirth” route, a mother's care begins much the same way as it would with an OBGYN. She will have an initial meeting, the midwives will recommend a dating ultrasound and blood panel, they take your history, talk about any questions, and mom gets to pee on a stick to see a bunch of different things like if there is any protein in her urine. The big difference at this and every appointment is that there are no cervical checks or pap smears performed, unless requested by the mother. The simple reason for this being they are wholly unnecessary and even increase the risk for infection, as well as PROM (premature rupture of membranes) (AMN Healthcare Inc). Even in labor, routine cervical checks do nothing but put added stress on the mother, prolonging the process, and even reversing progress as the mother’s mental state changes. Another surprising and a bit initially off-putting difference is that with the midwives, typical appointments take about 45 minutes to an hour. It is not a question, answer, question, answer, out-the-door format, but rather both parties getting to know one another and nurturing a relationship, which in this day and age might feel uncomfortable at first to those who are used to efficient and minimal care.
From the beginning of the pregnancy the midwives recommend doing an initial blood panel for baselines and a dating ultrasound to get the most accurate “due date,” to work around. Appointments are monthly, then every two weeks from 28 weeks, then weekly from 36 weeks, at which point the midwives will also do a home visit to ensure the family has everything needed for the birth. When the mother experiences signs of labor, she or a designated person such as a partner or doula will text the midwives to let them know it is early on in the process, or call if there are any emergent signs or if labor is progressing quickly. The midwives will listen to the mother as she goes through contractions over the phone to determine where in the process she is, and they will determine when to arrive (Bell 2018). During the labor process, the midwives use a fetal doppler to keep track of the baby’s heart rate between contractions as well as keeping track of how labor is progressing and assist the laboring mother in any way needed/requested. Some mothers prefer to feel left alone, and some prefer a hands-on experience.
The midwives will either catch or assist in catching the baby, and perform all the same tests as the hospital such as the APGAR scores at 1 and 5 minutes, temperature and measurements, assessment of reflexes, metabolic screening test, etc (Bell 2018). All the testing will be performed while the baby is skin to skin with the mother, unless for some reason they must be performed on the portable resuscitation tray. If needed, midwives bring with them suction equipment, oxygen, and a neonatal bag and mask among other things. Prior to the birth, the mother also goes and picks up emergency medicines including Pitocin, Misoprostal, and Methergine (McClurg 2019). At any point, if a transfer to a hospital is required, the family and the midwives will have set up a transfer plan to follow and the midwives will accompany the laboring mother the entire rest of the process, although they can not practice in a hospital setting. In the majority of transfer cases, it is non-emergent, and rather, due to exhaustion of the mother (McClurg 2019).
Following the birth of the baby and those initial first moments, first measurements and tests, administration of Vitamin K and erythromycin if the family so chooses, and making sure the family is settled in and the mother seems to be able to care for herself and baby, the midwives clean up everything from the birth, tuck mom in for a nap, and leave. They are available 24/7 should any questions come up, and will even pop back to the house to help if it is needed. Standard postpartum practice includes follow up home visits at 24 hours, 3 days, and 10 days, where they weigh and look over the baby, ask the mother how she is feeling, offer to check her for healing, answer any questions, and talk about anything the family wants to talk about (Bell 2018).
"It's not just the making of babies, but the making of mothers that midwives see as exciting." -Barbara Katz Rothman
* Bell, Pam. “Home Birth FAQ.” Women's Wisdom Cincinnati , Women's Wisdom Cincinnati, www.womenswisdomcincinnati.com/home-birth-faq.
*Bell, Pamela. New Client Packet. New Client Packet, Pamela Bell, 2018.
“Home.” RN, AMN Healthcare Education Services, www.rn.com/rn-news/are-vaginal-examinations-in-ld-an-infection-risk/.
*“Home.” RN, AMN Healthcare Education Services, www.rn.com/rn-news/are-vaginal-examinations-in-ld-an-infection-risk/.
*McClurg, Lesley. “Home Birth Can Be Appealing, But How Safe Is It?” NPR, NPR, 11 Mar. 2019, www.npr.org/sections/health-shots/2019/03/11/700829719/home-birth-can-be-appealing-but-how-safe-is-it.