WHY SHOULD I HAVE A HOME BIRTH WITH A CERTIFIED NURSE MIDWIFE

This post was originally published on my personal blog A Day in April, and has been revised for The Vagina Blog.

Here in America, we\’re often afraid of birth. We have very little exposure to it, and the exposure we have is typically over-dramatized in movies and horror stories from friends. It\’s very easy to be afraid of something we haven\’t ever seen. I think that\’s especially true when it comes to birth at home. I really wanted to put together a picture guide of what a typical home birth looks like with a Certified Nurse Midwife and answer the question: Why should I have a home birth with a Certified Nurse Midwife?

Before continuing, please read my birth disclaimer. Most importantly-I\’m not here to argue for or against homebirth, just to show you what it looks like. If you\’re not comfortable with the idea-then homebirth is not for you and THAT IS OK!! We\’re all still friends.

Before your birth you should be receiving prenatal care with a childbirth professional such as a midwife. I worked for a CNM (Certified Nurse Midwife) and hope to one day become one myself. It\’s a lot of school because you\’re essentially a Nurse-Practitioner with a specialization in Midwifery. Not all midwives are created equal and are not well-regulated in the United States, especially in the state of Utah. Before hiring a midwife be sure to check out her credentials. This is a great article about varying degrees of midwifery and their different scopes of practice. For me a big advantage of hiring a CNM is that I was able to get my zofran prescription written by her (my main care provider) and only see her through-out my pregnancy. I have several friends that are CPMs and DEMs and many of them are very well qualified and talented at what they do.

Prenatal exams with a midwife are similar to what you\’d experience with an OB but typically last longer because midwives tend to cover additional things like nutrition, childbirth education and your emotional health. Cyndi includes a work book with lists of supplies, laboring techniques, information and other important information so that everyone that delivers with her is well educated and prepared for their birth. Labs, ultrasounds, etc are all recommended.

Typically, around 36 weeks a birth assistant delivers the birth kit and does a home visit. They look to see if your home has a favorable atmosphere, get a lay of the land and set up supplies. That way they can find your bedroom in the dark, know you have everything you need, and if you decide to deliver super fast-you\’re all ready to go.

A typical birth kit looks like this:

Everyone always asks me about the mess. EVERYTHING gets covered in chucks and plastic when you\’re close to delivery. I once had to clean up 3 WHOLE DROPS of blood off the carpet and so far that\’s the biggest mess on carpet I\’ve dealt with. Hydrogen peroxide is a dream when it comes to foaming bodily fluids out of things, but really it\’s preferred to just not make a mess in the first place.

As soon as women are starting labor they are encouraged to put clean sheets on their bed, then put on a waterproof sheet and then their old sheets that they don\’t mind getting messy. That way all that needs to be done is peel off the top sheet and waterproof sheet after delivery and drop them in the washer. Ammonia also works amazing at getting fluids out of cloth-an ammonia rinse and then a normal wash makes your sheets (if they even did get messy) back to clean.

A bowl lined with a garbage bag is used for your placenta. That bowl includes sterile gloves, nasal aspirator, cord clamp (from your birth kit) and then before the birth a sterile pack that includes everything needed to cut the cord and examine for repairs is added.

A stack of receiving blankets and most little hats are folded up and put in a pillowcase with a heat pad to be plugged in during early labor. This way the baby has nice warm blankets immediately after the birth.

Some additional birth kit supplies:

It\’s also a good idea to put together a postpartum care pack with the super sexy MESH PANTIES!! (everyone\’s favorite), a peri bottle for squirting while peeing and the super thick pads of hugeness. Some padsicles chilling in the freezer isn\’t a bad idea either.

Once everyone arrives for the birth a crock pot full of washcloths is set up and used for heat on the lower back and then later for softening the perineum at pushing. Cyndi carries her own olive oil, KY and arnica oil as well for extra lubrication.

Everything is charted in a program similar to how they chart at a hospital using an iPad. Women are simply monitored regularly with a doppler to check out baby\’s heart rate instead of the cumbersome continual monitors that wrap around their belly. There\’s no bother with a contraction monitor…because it\’s SUPER obvious when women are having contractions.

Labor is managed with The Office (distractions), heat, massage, pressure points and water. Placing an IV is absolutely an option if needed BUT it rarely is. Women are monitored to be sure they are drinking enough fluids.

Partners are by far the best form of pain relief in labor.

I love her wall of birth affirmations!! I highly recommend something like this for encouragement in labor!

Being able to walk through your new baby\’s nursery has proved to be an amazing motivation as well when it comes to long hard labors.

A few additional bags that are stored out in the hallway: Oxygen, resuscitation equipment, emergency medications, suturing kits, IV bags & equipment, and other emergency needs.

To get into more details, this was actually my sisters birth (she was kind enough to let me share). She labored for 27 hours before delivery, so we had a lot of time to help her work through her labor (I would say most we attend last between 4-8 hours so 27 is a LONG one). Because of the length of her labor she requested an IV because she was feeling dehydrated and having a difficult time eating/drinking. We regularly monitored her vitals, regularly monitored the baby and kept her as comfortable as we could.

Her husband was an incredible support during the entire thing! This is something I love-partners being a part of the entire experience. They are expected to learn just as much as the mamas and help every step of the way. He was there to rock with her, put pressure on her hips, encourage her and cry with her during the rough spots. I love seeing partners every bit as worn out as the woman after a labor-they should experience it all too!

After a whole lot of work, this sweet baby boy was born! He is hooked up to an sp02 monitor (to see how well his blood is oxygenating) and his vitals were checked right there on Mom\’s chest. Usually they wait at least an hour to take baby away from Mom unless there is a reason to separate them.

The cord is cut after it is done pulsating. Once again, baby is never taken from Mom, all of our examinations are done on right there. Mom\’s bleeding is monitored closely and treated if necessary. After clean up, stitching up (if necessary, and YES numbed stitching!), nursing, and finishing notes stats are performed on the baby. By that time vernix has usually soaked in (you\’ll notice he looks very clean in the pic below-that just happens! No need to wash babies.) A full newborn physical is performed. Eye ointment and VIT K are offered. If at any point in this process ANY red flags appear they are quickly treated or transferred.

I love that the babies are weighed with a fish scale instead of a cold hard plastic one! It\’s such a cute little stork bundle! Partners get to dress them for the first time!

Before leaving postpartum instructions are reviewed. New Mamas get fed, showered and snuggled up into clean sheets. It is wonderful to see a new family all snuggled in bed together.

No one leaves until Mom and baby are doing amazing. Cyndi then visits in the next 24 hours and 48 hours to check-in on everyone and make sure both are doing well. If anyone isn\’t they head in for further help. Ideally they see their pediatrician within the first 48 hours as well and have a PKU done and any vaccinations.

COMMON MYTHS/QUESTIONS:

Isn\’t everyone going to die if you have a baby at home?

I haven\’t seen anyone die yet and I\’ve been doing this for a year and a half. Cyndi also hasn\’t had a surprise death and she\’s been doing this for 30+ years. You have to be a good candidate to have a baby at home and you need to hire a competent midwife that can tell the difference. Cyndi only accepts LOW RISK deliveries-no twins, no breech, no pre-eclampsia or any other complication that could affect labor. If red flags come up at any time during the duration of your pregnancy/labor she has no problem with a transfer (and I\’ve only seen one of those and it was for exhaustion, she rarely has emergent transfers).

The two big surprise factors in birth that can happen to ANYONE are postpartum hemorrhage and baby not breathing at birth and we treat those EXACTLY the same way they do in hospital. Our entire birth team is certified in Neonatal Resuscitation and we carry all of the equipment to perform it (and all of us have had to resuscitate before). Because Cyndi is a CNM she carries the exact same drugs they would administer in hospital for postpartum hemorrhage.

Ok, but isn\’t homebirth such a HUGE MESS??

I covered this a little bit above, but seriously, we\’re pretty on top of it. Disposable plastic is definitely our friend.

I couldn\’t possibly handle an un-medicated childbirth.

You can. I promise. If you have the right birth team, the right circumstances and the drive to do so, you can absolutely have a baby without the use of drugs for pain relief. The women I help deliver are not all big toughies. We cry together. Sometimes we yell. Sometimes we sit silently and meditate. It\’s a pretty amazing experience and I would absolutely recommend it (I\’ve done both and I can honestly say I prefer my un-medicated birth).

My partner could never handle this. He\’s super grossed out/scared/doesn\’t want to.

That\’s a hurdle. It\’s really important for you to have your partner\’s support when it comes to decide on a homebirth. Some are definitely more hands on than others but it\’s still important that he support you through this. Labor is enough of a battle by itself. I really love seeing the involvement that we encourage from partners in the home setting that you don\’t always see in other locations. I\’ve seen many partners change their mind after research and I recommend several books that are great reads for labor support such as The Birth Partner.

Have any other questions about homebirth? Ask me! I\’d love to add them to this post!!