Obviously, I can only speak for myself here, and I'm aware that circumstances vary, but I’m hoping to bring awareness to some things you may not be aware of that are part of planning an out-of-hospital birth.
1. Your midwife can’t be your doula. Midwives wholeheartedly support unmedicated, out-of-hospital birth, and we have a LOT of ways to help you achieve that. But we can’t be your pain relief and be your midwife, too. It’s important to understand that the midwife has to be alert, and quick to intervene if an emergency comes up. Even if there is no emergency, there are a lot of things going on during and around the moment of birth that require us to be quick and clear headed. We cannot exhaust ourselves with all night massages and hip squeezes. We will be there. We will be supportive, attentive, and caring, but we cannot do the job of multiple people for a long period of time. The midwife’s obligation is clinical care and safety. Out of hospital birth is not safe if the attendant is not clear-headed. You need to set yourself up with the education, tools, support team, and resources to cope with labor. Consider taking a comprehensive childbirth education class with your support team, and/or hiring a doula.
2. Birth is a many hands job. In the hospital, there is usually a L&D nurse, the OB, the scrub nurse, and a baby nurse (not to mention additional staff like respiratory therapy, NICU, administrative staff, and housekeeping). So that’s one person (L&D nurse) to do the hands-on care for the laboring person: helping with position changes, helping them with their body’s needs, administering medications, and giving instruction and information. One person (OB) who oversees the clinical care, and provides emergency interventions and procedures. One person (scrub nurse) whose only job is to assist the OB. And someone (baby nurse) to care for the baby.
Now, out-of-hospital settings are much lower tech, and if any advanced procedures are needed, you would transfer to a hospital. But still, it is unrealistic to think one person should or can do all of these jobs. Your midwife will have at least one person with her to assist, probably more. The midwife needs her staff and the staff is there to help her. These people are not your doulas or support people. They are not able to prepare meals or supervise your children or rub your back all night. You need to have your household and support needs covered.
3. Midwives get worried when we arrive for labor and see a bunch of cars at your house. I know I just said birth is many hands work, however, a large party of people is not always conducive to the privacy that most people need to labor effectively. The midwife’s staff is well trained to be unobtrusive and respectful of the atmosphere. Your team needs to be just as carefully curated. Everyone needs to have a job, and everyone who plans to be there needs to be willing to support you in whatever way you need. If they are the kind of people that will get their feelings hurt if you ask them to leave the room, they are not the right people.
4. Pregnancy is the time to enforce boundaries with family and friends, and to discuss expectations with your partner.
Our culture DOES NOT respect the autonomy of a birthing person or new parents. People will butt into your business and say inappropriate things and tromp all over your boundaries. Many want to be helpful, but don’t understand how to do that without intruding. Any blurred boundaries or patterns of manipulative behavior that already exist in your relationships will be amplified.
Also, I find many couples do not have a clear understanding of how they can work together or even what their expectations are. Those first few weeks (months?) with a new baby can be EXTREMELY stressful for both partners. You will be under stress and operating in survival mode. It is imperative that you and your partner have extensive conversations before the baby comes about how to make your household work and make sure that both of your needs are supported through this period. Hire a therapist if you need to. It will be worth it. 5. You really, really need childcare for your older children. Many people want their older children to experience the arrival of their sibling in some way. This is a precious part of home birth. However, birth can be stressful for kids, and kids have constant needs even under normal conditions. You are going to have a hard time working through your labor if you are constantly switching into parent mode and concerned about your older children. Partners will find themselves very busy if they are trying to support their laboring partner and their children at the same time. Divided attention like that is exhausting and frustrating. You need to have someone on hand who can focus on the kids. They will need a lot of attention. They will need a lot of information and reassurance. They may need a change of atmosphere. Find someone your kids can trust, be comfortable and have fun with. Cultivate that relationship before you are due.
This support for your kids should include the postpartum period. Too many times older kids are dropped off at the house immediately after the baby is born. At this point, the birth team is cleaning up and making sure the parents have everything they need. The birth team is at their most exhausted and have yet to turn to their own needs and recovery. The parents and baby need to rest—in fact they likely can’t do anything but rest, and here come the children who are wired, cranky, and having to cope with a huge life change. Please please please make generous, loving, beautiful arrangements for your kids, during and after the birth.
6. Obstetricians are not the enemy, and it’s a huge red flag to us when a client is not open to seeing one. It indicates a rigidity or need for control that can extend into the midwife/client relationship. That kind of rigidity puts unrealistic expectations on the midwife and sets the client up for disappointment. Pregnancy and birth are bigger than all of us and not something that can be controlled. The way you mitigate this lack of control is to be flexible, and that flexibility requires access to resources. An OB is a resource for advanced or additional care. Don’t cut yourself off from this resource.
7. Taking care of yourself really will make a difference when it comes to labor, birth, and postpartum recovery. It is imperative that you exercise daily, eat as healthfully as you possibly can, stay well hydrated, get plenty of sleep, and spend time in meditation, prayer, mindfulness, and/or mental preparation. Midwives specialize in helping their clients develop a custom self-care plan, and the reason we offer such long prenatal appointments is to get a true picture of our clients’ needs and circumstances so we can help them stack the cards in favor of an efficient and uncomplicated birth. But we can’t exercise, eat well and drink water for you. You have to make it happen and it will make a difference.
8. Midwives need time to get to you. We keep ourselves prepared to get to a client’s house efficiently, but we are not emergency services like EMS or the fire department, fully staffed with teams who work in shifts, who can speed to your home with lights and sirens. Midwives are usually individual providers who cover immensely long call periods (up to 5 weeks per client when you consider we are on call from 37 weeks until 3 days postpartum), and large call areas.
The benefit is you get one-on-one, intimate, individualized care. It’s a beautiful model of care. But it also means we don’t have a network of people available at a moment’s notice. We have our equipment packed and ready. We keep our cars gassed up. We stay within a certain radius of home. We have on-call childcare. We keep a set of scrubs in our car. We sleep with our phones like they’re teddy bears. But we are wherever we are when that call comes. We wake up in the middle of the night, keurig ourselves a cup of coffee, and take off to a birth. Or we drop our kids off with the sitter, grab our bag, and bolt. Or we park the lawnmower, wash up, change into scrubs, and go.
It simply is not possible for a midwife to have an immediate turnaround time. The general rule is an hour or so. That typically gets us there in plenty of time before the baby is born, but you need to plan accordingly. Discuss a plan with your midwife for when to call in labor. And if you have an emergency, make use of the system that is already in place for that…. call 911 or go to the emergency room. 9. A midwife isn’t a one-stop-shop. Our skill set includes things like breastfeeding and breast care, infant care, nutrition and exercise, and postpartum recovery. However, you have to keep in mind we are not lactation consultants, marriage counselors, psychiatrists, nutritionists, chiropractors, massage therapists, physical therapists, pediatricians, orofacial myologists, etc. These are HUGE fields of study, and these professionals spend years learning their skills, just like your midwife spent years in her field of study learning her professional skills. If you need additional services, we will refer you. 10. Your midwife cannot guarantee you an out-of-hospital birth. When you hire a midwife, you aren’t paying for a home birth. You are paying for a midwife’s care. There is a difference. If a complication arises during pregnancy or labor, you may have to switch to a hospital plan. I think clients understand that, but are sometimes surprised when it turns out to be the case for them. They have the impression it’s one of those things that only happens to other people under super rare circumstances, when in actuality non-emergency transfers are far more common than people realize. Sometimes it happens because pain is disproportionate or labor is particularly slow. Other times small things that might not be a problem individually add up to a labor that has some risk attached to it. Any number of variables can play into these scenarios.
Midwives have lots of wisdom on how to mitigate these situations, but we also have wisdom and experience that helps us know when hospital care would be beneficial. This is the heart and soul of midwifery: having the knowledge, training, experience, expertise, intuition, connection, and wisdom to be able to see the nuances of what is happening with the laboring client and baby. A midwife knows enough about birth and enough about you to help you make these kinds of decisions.
Again, you’re paying for a midwife’s care, not an out-of-hospital birth. Transfering to the hospital, where more resources and more staff are available, before the client and baby become exhausted or distressed, can help a client achieve their goal of a vaginal birth. It does not mean you are a wimp or that your body is dysfunctional, or that your midwife is impatient. It simply means that this birth requires more or different resources. Birth is a journey no matter how it happens. Midwives are not birth snobs. We do not judge our clients or anyone else for giving birth under anesthesia or surgically or any other variation. The transition a birthing parent makes is epic no matter how it happens, and all birthers are super star, super strong, amazing rock star birth warriors. However it happens, your midwife is your midwife and will be there for you. #exploringbirthoptions #homebirthmidwife #communitymidwife #louisianamidwife #shreveportmidwife #postpartumisforever #midwifelife #siblingsatbirths
Jennifer Courtney, CPM, LM is an experienced, licensed home birth midwifery provider in Louisiana. Laws, rules, and general practices may differ in your area. Consult with your care provider for information specific to you.