Showing posts with label midwife. Show all posts
Showing posts with label midwife. Show all posts

Friday, August 10, 2012

Tip #3: Recruiting your care team

Home birth may seem like an intimate and solitary experience - at least compared to the hustle and bustle of a hospital ward - but you'll need a lot of people behind the scenes to make sure your birth is a success. One of your most critical tasks will be lining up this all-important care team. You'll want these folks on your side.

Midwife

Your midwife is the No. 1 key player on the care team. She's the medical authority. She'll conduct your prenatal visits, refer you for prenatal testing if desired, monitor your health and the baby's health during labor, and give your newborn a quick check-up after birth. Referrals are the best way to find a midwife, but you can also try the search features at Mothers Naturally (affiliated with the Midwives Alliance of North America) or Midwife.org (affiliated with the American College of Nurse-Midwives).

Midwife’s Assistant
Your midwife should have an assistant she brings to the birth to help set up the room and act as a second set of hands.

Back-Up Obstetrician
Yes, even in a home birth, you need an obstetrician in case something goes wrong or you decide to pack it in and go to a hospital.  In a true emergency during labor, you’re going to head to the nearest emergency room and see whomever’s on call.  But sometimes, an issue emerges before labor, such as a breech presentation or a baby that’s gone past its due date.  In these unexpected circumstances, you’ll need to work with an ob/gyn to assess your options.  Your midwife probably has an ob/gyn with whom she works.  Set up at least one meeting with the ob/gyn in your last trimester. 

Back-Up Midwife
Every home birther dreads the thought of her midwife being sick or away on vacation when she goes into labor.  But your midwife should have another midwife who backs her up under these circumstances.  Meet with the back-up midwife in advance just in case she arrives for your birth.

Pediatrician
You'll need to take your newborn to the pediatrician within 24 hours of the birth just to make sure everything's okay. Meet with the pediatrician in advance and let him/her know of your home birth plans. 

Friday, July 6, 2012

Top 10 reasons to hire a doula


If you're having a home birth, you may not think you need a doula. After all, when you're laboring at home, you won't be fretting over epidurals or arguing with nurses over your kooky HypnoBirthing birth plan. But in some ways, doulas are even more important during a homebirth. And because I didn't have a doula for my homebirth, I learned this lesson the hard way.

Here are 10 reasons to hire a doula for your homebirth.

1.  Doulas understand the birth process.
A certified doula receives formal training in childbirth and hands-on experience as a labor assistant.  They learn ways to support natural birth - everything from calming affirmations to different positions to enhance your comfort. Your well-meaning friends can boil you some tea during labor and offer reassuring words, but they likely won't understand the birth process the way your doula will. And having that professional experience - especially if this is your first experience with natural childbirth (see #7) - is invaluable.

2.  They'll be there whenever you need them.
Most of us aren't lucky enough to go into labor at 9 o'clock in the morning and have it all wrapped up by lunch.  On the contrary, labor can be awfully inconvenient, and when you're laboring at home, you don't have the luxury of a 24-7 nursing staff.  Friends and family who volunteer for labor support are great, but they may not be thrilled about having to drag themselves out of bed at 2 o'clock in the morning. Your doula, on the other hand, will show up whenever you need her, even if it's at the crack of dawn, in the middle of the night, on Christmas Eve or during her cousin's wedding. She's paid to be on call, and that's good to know.

3. They're in it for the long haul.
There was a moment during my 27-hour labor when I looked around the room and realized I was alone. My mother was sleeping. My husband had crashed. And there I was, breathing through each contraction, desperately craving a glass of water and wondering whether someone - anyone - could please, please, please turn down the heat. With a doula, someone will always be there with you. If your doula can't swing a 30-hour all-nighter, she'll at least help manage the shifts so your partner can get some rest while she's on watch and vice-versa.

4. They take the pressure off your birth partner.
This one goes along with #3, but I'll take it even further. Aside from being there to physically relieve your partner, the doula is an emotional relief. Just knowing someone else is there - and someone with far more experience - is reassuring to others in the room. Your doula can answer questions, offer advice, and make suggestions, empowering your partner to be the best support he can be.

5.  Your midwife will appreciate it.
Your midwife is the medical authority during labor. Her job is to focus on your health and the baby's health, which means she'll be checking your vital signs, giving you pelvic exams, and monitoring the baby's heartbeat. Although your midwife is likely to be nurturing and supportive, that's not her primary responsibility. She's not going to sit at your side for 15 hours as you limp along toward 10 centimeters - she's there to deliver your baby. So your midwife will probably appreciate that you have someone knowledgeable about the birth process to be at your side for comfort and support. It takes the pressure off of her to fulfill that role and enables her to concentrate on what she does best: delivering healthy babies to healthy moms.

6.  They've been there, done that.
By the time your doula attends your birth, she's probably seen a lot of other labors. Which means you don't have to worry about your labor being weird or unusual - your doula can reassure you that everything's normal or suggest you call your midwife if something warrants attention. 

7.  First-time mothers need more support.
First-time mothers are overwhelmingly more likely to transfer to a hospital during a home birth - up to 40% of first-time moms compared to 10% for those who've previously had children, according to some studies. At least one midwife I know requires first-time mothers to have a doula in attendance. Bottom line, doulas provide outstanding birth support. The 2006 Listening to Mothers II survey found that 88% of women ranked their doula support as "excellent" compared to their partner/husband at 72%. So if this is your first time around, a doula can be a wise bet for you and your first-time partner.

8.  Doulas won't take it personally.
You may not know how you're going to react during labor. You might make weird noises. You might scream or moan. You might snap at your well-meaning birth partner when he tries to massage your back or sponge sweat off your forehead. But while your husband might get offended, your doula won't take your emotional outbursts personally. And she can help put your crabbiness in perspective for your bent-out-of-shape hubby.

9.  Doulas are a great resource for other assistance you might need.
Many doulas are also lactation specialists, childbirth educators, or prenatal yoga teachers. But even if they don't have specific outside expertise, most doulas at least know where to find it. Since doulas are well tapped into the natural childbirth community, they can refer you to breastfeeding specialists, babywearing experts, like-minded pediatricians, natural parenting stores, and anything else you might need. They're a good source of advice and can also put you in touch with other homebirthing mommies.

10. You might have a better outcome.
This is probably the best reason to hire a doula. Numerous studies show that a doula's continuous presence, hands-on support, and encouragement can improve your labor and increase your success at breastfeeding. One study found that women who received doula support in a hospital were more likely to have a shorter labor and fewer interventions, and my favorite study (which was randomized and controlled - hello, gold standard of research!) showed that women with a doula were much less likely to end up with a caesarean section - 13.4% versus 25% - and less likely to get an epidural - 64.7% versus 76%.  Although these studies took place in a hospital, I have to imagine the results would hold for a homebirth.

Bottom line: I've never met a woman who regretted getting a doula. To find out more, go to DONA International, CAPPA, or ICEA.

Tuesday, July 3, 2012

Tip #2: Finding a midwife

Like everything else in life, referrals are the best way to find a midwife. But with less than 1% of births taking place at home, the chances of you knowing another home birther are, well, 1 in 100. This doesn’t bode well for referrals.

So here are some places to start:
  •  The Web.  The Midwives Alliance of North America (MANA) has a search function to locate midwives in your area (go to www.mothersnaturally.org). But the list that comes back is crude, and you can't tell which midwives practice homebirth. On the plus side, this list includes direct-entry midwives and certified nurse-midwives.  The American College of Nurse-Midwives has a similar search function at www.midwife.org and you can filter by midwives who practice homebirth. On the downside, this list only includes CNMs, so if you're looking for a direct-entry midwife, you'll need to press on.  Try both of these sites to get an initial list going.
  • Natural birth advocates. Reach out to HypnoBirthing instructors, Bradley Method practitioners, prenatal yoga teachers, and doulas.  These folks are well tapped into the homebirth network and will be happy to throw some names at you.
  • Parent groups.  Seek out a breastfeeding support group or a store that caters to alternative-minded parenting (think baby wraps and co-sleepers) or find an online group dedicated to home birth and midwifery. Ask for some recommendations.
  • Ob/gyns. Okay, I realize this seems counterintuitive. But if you ask your ob/gyn for a midwife referral, he or she may be willing to indulge you. At the very least, you may learn which midwives don’t have great reputations in the medical community because of poor care or high transfer rates. 
After awhile, you'll start to hear the same names over and over again. Once you have an initial list of midwife names, it's time to make some calls and set up some interviews. Stay tuned for advice on how to choose your midwife...