By Amanda Viedma-Dodd
So you are pregnant and planning a homebirth. How do you find a midwife who can provide you with the support, care and advice you need to birth your baby at home? Finding this person is an individual process. You need to find a midwife who can work in partnership with you. Your midwife is invited into your home as a professional and will join you and your closest family and friends as you welcome your baby into the world.
The person you choose to be your Lead Maternity Carer has an influence on the outcome of your birth. A Cochrane review published in October 2008 found that midwife-led care resulted in: a reduced use of regional analgesia during labour, fewer episiotomies and fewer instrumental births when compared to medical care provided by doctors or obstetricians. Midwife-led care led to more women feeling they were in control during labour and it also increased the chance of a spontaneous vaginal birth. The main point of difference between midwife led care and other models of care is their underpinning philosophy. The normality of birth and being cared for by a known and trusted person during labour is the basis for midwifery care and there is an emphasis on the natural ability of women to experience birth with minimum intervention.
Not all midwives offer or are equipped to offer home births. Your midwife should identify her midwifery philosophy and share this information with you readily and freely. Your midwife has an important role in health and wellness promotion and education, informing and preparing you and your family for your home birth. All midwives will have ways of operating with which they feel most comfortable. Does their philosophy match yours?
Choosing your midwife is an important decision. Do your research. Ask friends and family for recommendations, ask your local homebirth association or contact your local branch of the New Zealand College of Midwives. You can talk to as many midwives as you would like to before making a choice and you can also change at any time (even for postnatal care).
The following questions will help you to establish whether the midwife you are choosing has the necessary experience, skill, knowledge and passion required to achieve a positive homebirth experience regardless of the setting that you finally end up birthing in.
We posed these questions to midwife Juliet Thorpe from Christchurch Homebirth Midwives to give you an idea of answers you might expect. Included in [ ] are my comments offering more information or clarification as necessary.
Personal / Professional Background
A. What is your philosophy about childbirth?
J.I see pregnancy and birth as normal life events. As a home birth midwife I see my role as a facilitator in assisting a family to welcome their new baby into their lives in a way that belongs to them. For too long birth has been taken over by hospitals and medicine, whereas I see that when a woman and her baby are healthy and well, they both thrive in the safety of their own home environment. I believe we should not interfere with this miraculous process unless mother and baby have the potential to become unwell. It is not home birth at all cost! Being present at the birth of a baby is truly a privilege and continues to amaze and delight me!
A.What birthing options do you offer?
J. Our practice only provides midwifery care to women who are planning to birth at home or previous clients who may need to birth in hospital with a subsequent pregnancy. Should a home birth-booked woman find that during her pregnancy she has developed complications which may mean a hospital birth is required, we will still provide midwifery care for her in that setting.
A.How long have you been practicing as a midwife?
J. 17 years
A.How long have you been providing home birth care?
J. 15 years
A.How many births have you been the primary midwife? How many of these are home births?
J. In 15 years I have attended 582 births as primary midwife and 89% were home births.
A. About how many births a year do you attend? How many of these are home births?
J. I have approximately 40 clients per year [all home births]
A. On average how many clients do you have a month?
J. 4 clients per month [The New Zealand College of Midwives recommends a maximum of 5 women for any given month]
A. When did you last participate in the Midwifery Standards Review process? What was the outcome?
J. I have been reviewed every year since I graduated in 1991 and one of the outcomes of my last review was that I only need to have a review every second year. It is an incredibly useful process and is now a compulsory requirement for every midwife in NZ. The Review involves presenting a written reflection on the year that has passed, an analysis of my statistics, client feedback forms for the year and feedback from a midwife/consumer panel. It is an educational process and every midwife leaves with a Professional Development Plan for the following year.
A. Do you work by yourself, in partnership with another Lead Maternity Carer or as part of a group maternity care practice?
J. I work in a practice with a group of 4 other women who are my colleagues and also my best friends. We work very closely, meet every week for 4 hours and support each other unconditionally. We are there to back each other up at difficult labours, when we are tired or if one of our clients needs midwifery care and we have the weekend off, holidays, or just need another opinion.
During My Pregnancy
A. Where will my antenatal visits be?
J. I have a midwifery clinic at the Midwifery Resource Centre where I offer one hour appointments otherwise I will come to your home for your visits.
A. What happens if I need specialist care during my pregnancy or labour?
J. It is my responsibility as your Lead Maternity Carer to offer you a consultation with an Obstetrician should there be situations which arise which are outside my scope of practice. Midwives are responsible for providing a complete service for all well women but must refer to an Obstetrician if there are potential complications during the pregnancy and birth. This can be done privately or through ChCh Women’s Hospital Maternity Outpatients. I would still continue to provide you with your midwifery care even if you required obstetric input. Examples of reasons for a consultation: twins, breech, high blood pressure, diabetes, previous caesarean section etc.
A. Do you offer antenatal classes?
J. Yes. The Home Birth Midwives have provided antenatal classes in conjunction with the Canterbury Home Birth Association for over 20 years. They are held over two Saturdays and are great fun and a good way to meet other home birthing couples. [Many midwives won’t run their own classes but they should be able to recommend one]
A. What investigations must I have throughout my pregnancy?
You don’t have to have any investigations during your pregnancy. Nothing is ever compulsory. My role as your midwife would be to give you information on what investigations are available and then it is up to you to decide what you would like to have or not have.
During My Labour at Home
A. At what point during my labour will you come to my house? Will you have back up?
J. I always say to my clients to ring me anytime and we can discuss what you might want/need when you are in labour. You often don’t know until it is happening if you want your midwife to come right away or whether you would prefer to do your own thing for awhile. I am happy to come at any stage. I will call a second midwife to come as back up when the birth is imminent.
A. What happens if you are with another client when I go into labour?
J. That’s why I work in a practice with midwives who share my philosophical beliefs about birth. At about 37 and 38 weeks I get two of my colleagues to meet my clients in their home so that if I am unavailable to them when they labour they have met two others and one of those will go to them in labour until I am able to be there. The importance for me of working with like-minded midwives is that I know my clients will get the same level of care they would get if I was there.
A. What will you do if my labour is progressing slowly?
J. Labours progress at different rates and none are ever the same. As long as mother and baby are both well and happy then there should be no time limit placed on her. What is slow progress? Each labour is unique and should be judged as such. If a woman is becoming increasingly exhausted and there appears to be no change in the labour, any interventions including transferring to hospital should only be suggested after thorough discussion amongst the woman, her family and the midwife.
A.What will you do if my labour is so fast you miss the birth?
J. There is not much you can do other than help to calm everyone down and make sure mother and baby are both well as soon as you arrive. When a baby comes so fast that the midwife misses the birth, the mother and baby are usually pretty good, if a little stunned. Where women have previously had rapid labours, a home birth is ideal- at least you don’t have to get into a car as the midwife comes to you. I usually write in the notes a plan for the partner if the baby comes before I get there and this includes making sure the house is warm, the woman is not standing (you don’t want to drop the baby!) and that there are warm towels to stimulate and dry the baby with.
A.What drug-free techniques do you use for pain relief during labour?
J. Being at home is number one pain relief because you have the comfort of your own home. Hotties, wheatbags, positional techniques, massage, acupressure, positive energy of the support team, loving touch, steaming hot towels, showers, baths, birthing pools. All better than any drugs!
A. Are you comfortable with water births should I decide to labour or birth in water? How many water births have you done at home?
J. Very comfortable with water birth. 40% of my clients give birth in water.
A. What emergency equipment and medications do you carry?
J. All the emergency equipment you would have in a primary birthing unit. Neonatal resuscitation equipment, drugs to help halt heavy bleeding (oxytocin), equipment for suturing including local anaesthetic, IV needles and IV fluids etc.
What if I need to transfer?
A. What percentage of your clients transfer to hospital?
J. 10% require some form of hospital care during pregnancy, labour or the postnatal period.
A. Are you certified to continue care in hospital if I need an epidural?
J. I choose not to have an epidural certificate because I so rarely look after women requiring an epidural. This means that I would need to transfer midwifery care to the hospital but I would stay on as a support person and advocate.
A. What care would you give me if I need to transfer?
J. The same midwifery care you had at home just in a different setting. [Despite transferring care to hospital staff your midwife should remain with you to advise and support you. They should work in collaboration with other health professionals to ensure that where possible hospital staff respect and uphold your beliefs.]
The Postnatal Period
A. How many postnatal visits can I expect?
J. The contract you have with your midwife ensures you get at least 7 visits postnatally. As a practice we offer an average of 10-12 postnatal visits. If however you need more (e.g. difficulties with breastfeeding) I am always available or one of my colleagues if I am not. [When you birth at home it is essential that you have regular postnatal checks]
A. Between visits are you available for me to phone you for advice?
J. Yes and I also give you my email address and answer non urgent questions that way too.
Remember that the questions you ask and answers you seek are individual to you so if you have any other issues personal to you make sure you discuss them. These may include:
Q. Do you have any clients due when I am?
Q. Are you planning holidays around the time I am due?
Q. Do you leave the cord attached while I birth the placenta?
Q. Have you had any experience with lotus birth?
Q. How do you suggest we involve our children in the birth? …
Are all home births created equal? By R Hungerford available from the Homebirth Aotearoa website.
Have you considered a Homebirth? Published by the Waikato Home Birth Association available from the Homebirth Aotearoa website.
Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews By M Hatem, J Sandall, D Devane, H Soltani, S Gates available at www.cochrane.org/reviews