How do families prepare for homebirth?
What do midwives bring to be prepared for homebirth?
First thing first- Birth is simple.
Nothing is needed 90% of the time.
The "birth kits" that are distrubuted by WHO in many countries a little plastic bags that have a bar of soap, a clean cloth to dry the baby, and a sterile blade and cord ties.
The homebirth kits that US midwives have women prepare for birth are not much fancier. They include: towels, sterile cord clamps, bulb suction and things for cleaning, like a plastic bed liner and peroxide. BTW... birth is not that messy, chux pads do make cleanup easier, and the midwife gets any other laundry mess cleaned before she leaves.
Oh, and the bulb suction isn't even needed because, new flash, babies are amazing at absorbing and clearing their fluids on their own!
So, birth is usually as simple as clean hands, clean cloths, and clean cord instruments.
...but 10% of "normal births" need assistance.
- Breath coaching
- Relaxation help
- Contraction stimulation
- Maneuvering baby's shoulders through
- Repair of perineal lacerations
- Tactile stimulation
- Resuscitation breaths
- Breastfeeding help
...and occasionally, more advanced support is needed by a trained midwife.
She's trained and prepared for these "sometimes" things.
- Complications of Pregnancy
When issues arise in prenatal care, we will spend time discussing options of interventions that include nutrition, supplements, herbs, homeopathics, and other natural things to improve wellbeing. For anemia, for example, I will make these recommendations, then repeat labwork to ensure improvement. Severe anemia may involve a referral to a hematologist, and may risk you out of homebirth. For gestational diabetes, we follow testing and nutrition protocols. Depending on blood sugar levels, you may be referred to a perinatologist and ultrasound or other monitioring recommended. If medicaiton (insulin) is needed, then I don't recommend homebirth. We work with multiple Perinatologist to get you seen for risk factors and problems. Monitoring, using Non-stress test (fetal heart monitor- I can do this in my office) and ultrasounds (at perinatologist), can be used and still plan for a homebirth, or of course, if arise, risk you out of homebirth. If the condition is such that my protocols have risked you out of homebirth, then I will help you to find a practice that will allow you to transfer into their care, such as a hospital-based midwife /OB practice.
- Complications of Labor
Some of the issues that may complicate labor and therefore risk you out of homebirth in my practice include: high blood pressure, thick meconium (baby poop in amniotic fluid), prolonged premature rupture of membranes without active labor, protracted/obstructed labor, maternal exhaustion, fetal malpresentaion with failure to descend while pushing, and non-reassuring fetal heart rate. These are non-emergent, but urgent reasons to peacefully make our way to the hospital. Usually, that journey can be by car, and to the chosen backup hospital. More rarely, an EMS would be called the closed hospital used. The very rare, but emergent complications, include: abruption, cord prolapse, and embolism. In those rare instances, the life-saving interventions that are needed would be delayed due to transfer time, as opposed to if you were are the hospital. We choose together to be out-of-hospital because of the rarity of these events, and I practice conservatively, for example, rarely performing artificial rupture of membranes, in order to not increase risk of cord prolapse. VBACs do have an increase risk of complications, and I do not think homebirth is ideal because of that. Choosing homebirth is a balance of considering all risks, of considering benefits, and of considering the value of myself being your experienced midwife, vs you freebirthing solo at home (please don't do that!).
- Complications of Birth
The midwife is to be prepared for complications, and that is largely why you hire us! When babies have big shoulders and "get stuck", we are there to maneuver you and the baby. Shoulder dystocias can be very dangerous and deadly to the baby, but can usually be resolved with our skills. These babies often need a little help breathing while they get over this "stunning" event, and midwives are no stranger to giving babies breaths with an ambu bag. We breathe for baby when baby can't breathe. I have done this sooo many times. What about when a baby needs more than initial breaths? We are trained in advanced neonatal resuscitation, and my birth bag is complete with laryngeal mask airway, intubation, volume expansion, epinephrine, oxygen and CPAP equipment. I have used all of these in the past... mostly because I didn't always get the easy-resusc babies when I worked in Africa!. After baby's out, the placenta has to come out. This can get complicated when it adheres, retains, or the uterus fails to contract afterwards. We carry hemorrhage medications. However, there are risks for hemorrhage, and when we run into them, we consider the need to get to the hospital, because postpartum hemorrhage is the leading cause of maternal death, and a risk to take seriously. As far as perineal and labial lacerations, I am experienced and prepared to repair 1st, 2nd and 3rd degree lacerations at home, with lidocaine numbing.
The midwife's homebirth bag
She orders the same sterile, medical grade supplies and medications from companies like Medline that would be used in the hospital or accredited birth center. Nurse Midwives are licensed and have professional accounts.
- Labor supplies: stethoscope, BP monitor, thermometer, doppler, catheter
- Birth supplies: sterile instruments, sterile cord clamps, perineal massage oil
- Perineal repair: lidocaine, sterile instruments, Vicryl absorbable suture
- Newborn resuscitation supplies: Ambu bag, DeLee suction, oxygen, NeoTee resuscitator for CPAP, airways (LMA, laryngoscope), Epinephrine
- Hemorrhage supplies: Pitocin, Misoprostol, Herbal oxytotics, tamponade kit
- Other meds: IV fluids, Benedryl, Phenergan, Zofran, Terbutaline, Ampicillin (GBS+ prophylaxis), Sterile water papule supplies, Homeopathics, Bach Rescue Remedy
- Newborn supplies: scale, newborn stethoscope, vitamin K, erythromycin
What if a hospital transfer is needed?
If transferring prior to labor, you choose a practice that will accept you and that you prefer. I can facilitate this by asking colleagues (CNMs & MDs) if they will assume your care. Your records will be sent. Dr.Bootstaylor does offer you to hire his practice, SeeBaby, as your physician backup for prenatal and labor needs.
During labor, if there is no emergency, we can proceed by car to your preferred backup hospital. If you have hired a hospital provider, you'll begin care with them, and I will be with you as support. If you have not hired a hospital provider, then you will be in the care of the on-call group.
In the uncommon situation of emergent need for hospital care, we will call EMS and go to the closest hospital. I will accompany you/baby, give report, and give your records to the team. I will remain with you as support and guidance. You will still have postpartum
Learn more about risk criteria-
Moonlight Midwifery LLC practices evidence-based care that is consistent with guidelines of our professional organizations.
American College of Nurse Midwives
Midwives Association of North America
American Association of Birth Centers
It is my obligation to mothers and babies to uphold my standards of practice and "risk out" clients that no longer fit safety criteria for out-of-hospital birthing. This can be personal discretion- but I do engage in professional consultation, as well as peer review, to help me not compromise care standards. Requiring standard screening labs and anatomy ultrasound are required parts of my prenatal care plan. I am prepared to care for healthy mothers and babies that are appropriately planning and preparing to birth at home. Together we make this the safe place for your birth.
Learn about how birthing at home can be not only a Safe, but the safest option.