Personal Interview

When a woman inquires about our services we usually provide a brief description and an interview is scheduled if she wants to know more.  The pregnant woman and her partner meet with us at the office for a tw0-hour visit.  During that time, we review our background and training and philosophy of care and discuss what it would be like to work with us.  The couple will ask all their questions and tell us what is important to them.  We do a health history and a history of previous pregnancies and births.  This helps us know whether or not the woman would be well served by having a homebirth or whether it would be wiser to seek a medically managed pregnancy and birth.  There is no charge for this visit and there is no commitment expected at this visit.  Later, if the woman decides to work with us, she will call us and schedule a prenatal visit and we will begin to work with us at that time.

Prenatal Care

We meet during the prenatal period about once a month.  I have an office in my home and we schedule an hour-long appointment.  During that time, we check the well-being of the mother and the baby by checking the physiological progress of pregnancy.  We may monitor such things as: vital signs of the mother, heart rate of the baby, growth of the uterus and baby, position of the baby in the womb during the last weeks and physical activity of the baby, laboratory studies on the mother, nutrition, exercise, supplements, illnesses, etc.  We also get familiar with the mother and her hopes and dreams.  We provide reading materials and DVDs that may help her prepare for a healthy pregnancy, birth and newborn.  We help families prepare their other children for the new baby coming and sometimes we help grandparents feel secure about the homebirth plans. One of our main goals during prenatal visits is to help women feel confident in their ability to give birth and to feel at ease with our supportive presence.
When the 36th week of pregnancy arrives, we provide a home visit.  This visit may take two to three hours and much is accomplished.  The midwives get familiar with home’s physical layout so we can be prepared.  We talk about different options for where to give birth and how to set up a birth pool, if desired.  We go through the “Birth Kit” of homebirth supplies and show the parents what is available to them to use if the birth happens quickly.  Normal labor and birth is reviewed and complications are discussed.  We talk about how complications are handled in the home and we make a plan for the complications that would cause us to want to transfer to a hospital.  We discuss the different medical options available to the family and make a plan in case we need to transfer.  We also provide a prenatal exam.
The last weeks of pregnancy we provide prenatal exams in the office on a weekly schedule until the baby is born. We take time to help the mother prepare for breastfeeding and care of the newborn.

Labor and Birth Services

When it is time for labor, we generally arrive when labor is in an active phase with regular contractions but this is individualized.  When we arrive we take some time to warm the baby blankets and set up a trash and laundry system.  We monitor the mother’s and baby’s vital signs and offer any labor support she may need.  We set up some emergency equipment for easy access if it is needed.  When it is time for the mother to give birth we provide whatever assistance she needs.  Sometimes she is delivering her own baby, or her husband is receiving the baby, or we are catching.  Our hands are near to help in whatever way is needed. Women give birth in the position that works for them.  Sometimes women are in a pool, the bathtub, the shower, on a birth stool (we provide) or the floor or couch or bed!  A birth could occur outside, as well.
When the baby arrives, we help the mother and baby and other family members be comfortable so they can all fall in love. Of course, we are monitoring the wellbeing of the newborn baby and intervening when the baby needs assistance transitioning to life outside the womb.  We are also carefully monitoring the mother’s third stage labor
(birth of the placenta) and assisting in any way necessary.  Our goal at this time is to support without disturbing those critical early moments after birth.  When the family is ready, we help them cut the cord.  Some parents are choosing to leave the cord intact and some parents are having us draw cord blood for stem cell storage.  When a mother is ready we will examine her for any birth injuries and provide stiches or other types of wound care if necessary.  Then we help her bathe and get comfortable while we show her and her family the placenta.  We perform a complete newborn exam and let the parents know what to expect for the next 24-48 hours.  Once we are secure that the mother and baby are stable, comfortable and tucked in for a rest, we pack up our gear and head home.

Hospital Transfer

When a mother or her baby develops problems during labor or just after birth that we feel we cannot adequately resolve at home, we transfer to a hospital.  The midwives call ahead to the hospital and make a report.  How we get to the hospital depends on the nature of the complication.  Sometimes, the parents just drive their own car.  Sometimes, we call the paramedics for an ambulance transfer.  After we have the transfer under way, the midwives pack up the gear, straighten the house, and head for the hospital to provide whatever support the family needs or desires.  When it is appropriate to leave, we go home and later provide follow-up postpartum and newborn care as described below.

Postpartum Care and Newborn Care

When the baby is 24-48 hours old the midwives return to the home to assess the mother’s and the baby’s wellbeing.  At this visit we examine the mother and the baby and provide any advice or support needed for postpartum comfort or breastfeeding or baby care. If the parents choose, we may collect a blood specimen for the Newborn Screening Test or provide an Rh-negative mother with a shot of RhoGAM.
Two weeks after the birth a mother returns to our office with her baby.  We check to see that the baby has gained weight and is nursing well and that the mother is happily adjusting to the demands of new motherhood.  We also provide some documents for use when registering the birth and obtaining a social security card for the baby.
Six weeks after the birth another visit is scheduled at the office.  During this visit we thoroughly assess the mother and the baby and offer any guidance that may be helpful.
We also discuss the eventual return of fertility and various ways to manage child spacing or other family planning needs.
When mothers or babies have needs in between scheduled visits, we will offer any support necessary with phone counseling, home visits or office visits.

Well-Woman Care

Annual gynecological exams, including PAP and breast exams, are also part of the servies we offer. Sometimes women come for guidance regarding fertility, menstrual health, menopausal health or general health.  We provide an overview of options for natural or alternative medicine and/or western medical approaches and help women manage their own healthcare decisions.