![]() Safety is often a question that comes up in regards to home birth. How do we know if there is a problem? How do we decide when to transfer? What do we do during prenatal care and labor to monitor? These are important questions! Let’s break it down into what home birth midwives do to monitor during each prenatal care, labor, and postpartum. Monitoring During Prenatal Care: We see you on the frequency as an OB/Gyn during pregnancy, and we take vitals as a part of every visit to make sure you and your baby are safe and well. Here are the things we are tracking:
We can run standard prenatal blood work, do urinalysis in office, order ultrasounds, and consult with a doctor or perinatalogist if there are any concerning signs in your pregnancy. Monitoring During Labor: We check your vitals every 2-4 hours during labor, more often if there is anything concerning. We check blood pressure, pulse, and temperature to make sure you are handling labor well. For your baby, we use handheld dopplers to listen to their heart rate about every 15-30 minutes unless we hear anything concerning. We listen more often if needed and see if we can resolve any minor issues easily at home before recommending a transfer. Did you know “continuous EFM (electronic fetal monitoring) is associated with many known medical risks to women, without providing any benefit to the fetus in low-risk pregnancies (Alfirevic, Devane, & Gyte, 2006; ACOG, 2009)”? Continuous monitoring requires you to be strapped to a monitor and your movement is quite restricted. We use intermittent monitoring, which allows for freedom of movement, utilizing water, and is adequate in low risk, unmedicated settings to monitor your baby. We are able to follow you around and listen as needed, in water, or out of water during labor. Monitoring During Postpartum: Immediately postpartum we are monitoring your blood loss and vital signs and we are also watching baby’s vitals as well. We count baby’s respirations and heart rate, and we assign APGAR scores based on how your baby is transitioning. For the average smooth, low risk births, vitals remain steady and normal for both you and baby, and we monitor for 2-4 hours after birth. If all is well, we go over things to watch for that could be signs of distress for you and baby and we tuck you into bed to get some rest. You have our phone numbers to call at anytime if you have a concern. We return in 24-48 hours to check vitals again on you and your new baby. We track your baby’s weight, feedings, diaper output, respiration rate, heart rate, and temperature. We can do the newborn metabolic screen where we take a blood sample to make sure your baby doesn’t have any rare metabolic disorders that need to be addressed early on. We use a pulse oximeter to screen for congenital heart defects and make sure your baby is oxygenating well. During the first six weeks, we see you and your baby 4-5 times to make sure breastfeeding is well established, your baby is gaining weight normally, and to monitor both of your vitals. We spend a lot of time talking about how you’re coping with postpartum and run labs if needed for you. Each time we see you in those first six weeks, we monitor for any signs of postpartum depression or anxiety, we check in about your bleeding, any pain you’re having, and refer you to any support that may be needed to relieve any problems you may be facing. Our monitoring is thorough through all phases of our care, and we are trained to recognize whether you are having a low risk, normal pregnancy, or if there are circumstances that would make it safer for you to birth in a hospital setting.
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![]() The short answer is yes. Whether you are birthing at home or elsewhere, I’m going to offer you some thoughts on minimizing pain during labor and birth. So home birth is really appealing for a lot of people these days, but one of the things that prevents people from jumping in is the fear of not being able to handle the pain. I’m not going to lie, labor and birth are really hard work. There is an intensity to it that is quite unique to giving birth. And also, not sugar coating, it is manageable. It’s really hard for awhile, and then it’s over and gone. I have seen people roar, shout, hum, growl, rock, dance, laugh, and breathe their way through, but I have never once had anyone tap out of home birth during labor because of the pain. Not that there would be anything wrong with that at all, but in those moments at home, people seem to just handle it. I’m going to give you some reasons why I believe that labor pain is more manageable at home:
Being at home in general lends itself to a more comfortable birth. There are also plenty of things you can do to help you cope during labor at home or in any setting:
So is there really anything that can be done to minimize the pain in labor? There is no magic bullet in unmedicated birth. No one can take the intensity away, but you can be supported through it by preparing yourself well. The choices you make leading up to labor and the team and location you choose are what can help you have a labor that is more comfortable and manageable. 9/6/2020 0 Comments "But what about the mess?..."“How messy is it? Is it going to look like a horror scene afterwards?”
This question pops up all the time during my home birth consultations. And ok, it’s a fair question right? So here is the answer. Birth can get a little messy, yes. But by the time we tuck you in your bed and leave your home, no one would ever know a baby was just born in your room. Home birth teams are total pros at cleaning up after births, and that is not your job in any way. You will be enjoying your baby in your bed and sipping some tea while we put the towels in the wash with peroxide to get out any stains. We will change your sheets while you shower and clean up any little spots that might have escaped the absorbent chux pads we throw down around you while you give birth. If you used a birth pool, it will catch the majority of the mess, and then we just pump out the water into your toilet for you while you rest. We will get that tub taken down and put away so it’s not taking up your space. During labor, when you are nearing the time to birth your baby, we will be throwing down chux pads under and around you to catch the mess. We put plastic backed sheets on the floor around your bed to keep your carpet clean. We do our very best to protect your space and make for easy clean up. So can it get a little messy? Sure, but not horror scene messy, and we are ready for it. It’s not as messy as you may think, and we won’t leave any mess for you to clean up while you’re trying to settle in with your new baby. Most pregnancies are spent planning for the baby and the birth, but not the mother. Most often the baby is showered with gifts, but not the mother. And in the postpartum, the baby is held, but not the mother. This country forgets about mothers. It forgets to celebrate them, thank them, honor and support them. But not in my circle of birth workers. The mother comes first. We care for her and support her because we know that if she is healthy and well that the baby will be too. Have you ever been to a baby shower? What about a postpartum shower? Or a Mother’s Blessing? Most of us have been to plenty of baby showers, but what about the other two? I recently had the honor of helping throw a postpartum shower and Mother’s Blessing for a friend and here is how it looked: It was beautiful and loving and supportive for this woman. She knows she can call on any one of us during her postpartum days for support, a meal, or encouragement. With this event, she sealed her circle of support. None of us were there about the baby. We were all there about the mother and THAT is where our attention needs to be in order to truly support those around us. And I’m sure if you tend to the mother first, she might even let you have a chance to hold that cute new baby.
![]() By Alyssa Johns, LM, CPM I’m a midwife. I thought I knew things. Pregnant with my second baby, I was sure breastfeeding was going to be easier than with my first, because I have learned things as a midwife that I didn’t know when my son was born. Breastfeeding him felt like breastfeeding an angry piranha. He chomped, screamed, but would not suck. After two weeks of my six week maternity leave had passed, I was marked with cracked and bleeding nipples and the feeling of defeat. I decided I was done spending my short leave crying and stressing over breastfeeding and I decided to just pump for as long as I could before switching to formula. That was 7 years ago. Since then, I have become a doula, a HypnoBirthing instructor, and a midwife. I have seen so much in the breastfeeding world. This time, I was sure I would be able to bypass the difficulties I faced with my son because of the experience I had. Right after my baby girl was born, she latched on and ate and I felt elated at the thought that this time it was going to be smooth sailing. But 36 hours later, my nipples were damaged and flattened after every feeding. No problem, I thought, I have resources and support. So I called them in. I took her to see a consultant at three days old to have her tongue tie revised. It turned out she also had a lip tie and a cheek tie which I had never even heard of. So much for me knowing things! She was tiny, at 6lbs 4oz and those restrictions were making it so hard for her to open her already small mouth wide enough to eat. I had all three ties lasered and she latched on beautifully immediately after the procedure. I felt that relief and elation again. It lasted until the next day, when suddenly she wouldn’t latch at all, instead just screaming at me. Turns out some babies really take a long time to recover from those revisions. All of her muscles were now working differently and she was too sore and weak to breastfeed. That was the beginning of a five-week journey involving chiropractic appointments, lactation consultant appointments, pumping, bottles, and tears. Why was breastfeeding so hard?! Every feeding involved my latching her and nursing her for as long as she could handle, then bottle feeding her and pumping. I felt like I was on a rollercoaster, with some days taking two steps forward and the next day one step back. It was practically impossible to go anywhere, it was hard to handle visitors with all of that feeding business, and I was quickly beginning to struggle mentally and emotionally with this challenge. The first consultant I saw who revised the tongue tie gave me a very interesting thought to ponder when I asked her why so many babies struggle to breastfeed and have tongue ties. She said she had read some research that suggested that formula, bottles, and pumps have kept alive many babies that would not have survived in the past due to their struggles to eat. As a result, these poor little eaters have survived and passed on their genetics. For the first time I stopped cursing my breast pump and gave thanks for it and for the formula that had kept my babies alive. I had many days where I felt ready to give up. I grew so frustrated at the idea that I was a midwife that couldn’t get breastfeeding to work. My husband reassured me time and time again and reminded me not to put that extra pressure on myself to breastfeed just because of my job. Either way, I just couldn’t give up when I was always telling women not to give up! Working in the field that I do, I had many knowledgeable women checking on me, supporting me, and encouraging me. I had a wonderful, compassionate lactation consultant friend reminding me that it wasn’t me doing anything wrong and that it would eventually come together. One particularly low day, where I was really struggling and trying to decide how long to keep trying, I posted on my facebook page that I was struggling and asked for success stories. So many women posted about the similar struggles they had of having to pump, spoon feed, syringe feed, or supplement while facing issues like bad latches, tongue ties, and supply issues. I realized that breastfeeding struggles are so incredibly common. These women had stuck it out and they said to give it six weeks. If they could do it, I knew I could too. So that day I decided that as long as I was seeing forward progress, no matter how slow, I would stick with it for at least six weeks. People encouraged me, but also reminded me the importance of my sanity. They reminded me that fed is best and that whatever happened, it wouldn’t make me any less of a mom if I decided to stop and switch to formula. Breastfeeding problems can feel so big when you are already exhausted, overwhelmed, and unsure. My friends wanted to make sure I knew that my mental and physical health mattered too. At the end of week four, I noticed that my baby was starting to take more gulps and breastfeed for longer periods. I slowly started letting her just nurse and started weaning off the bottles. By the middle of the fifth week, she was eating exclusively by breastfeeding and my heart was soaring. The ease of breastfeeding without having to worry about pumping, bottles, and carting around so much gear was astounding to me. I had never had the experience of being able to just pack myself and my baby and a couple of diapers and know that we were set not matter what rolled our way. The struggle we had to go through to get there was rought and I do not ever fault a single mom for giving up during that struggle. Our sanity is important and thanks to our modern times, our babies can be fed in many ways. But support is out there. Every mom I talked to that had successfully breastfed had words of wisdom and support for me. They had empathy for my struggle. There is so much lost breastfeeding wisdom that we are slowly regaining. I don’t know how many times I tearfully said I wanted to give up. It would have been ok if I had, but I am so glad I didn’t. For the mothers out there struggling, if you want to breastfeed, reach out. If I hadn’t, I am confident I would have quit. There are caring consultants, support groups, and mothers that have been there and can help. I still don’t know why breastfeeding can be so complex and difficult, but I also know that leaning on the support from others made all the difference for me and my little one. Update: This blog led to an opportunity to be interviewed for the podcast All About Breastfeeding. Check it out here! ![]() By Alyssa Johns, LM, CPM I’m a midwife. I thought I knew things. Pregnant with my second baby, I was sure breastfeeding was going to be easier than with my first, because I have learned things as a midwife that I didn’t know when my son was born. Breastfeeding him felt like breastfeeding an angry piranha. He chomped, screamed, but would not suck. After two weeks of my six week maternity leave had passed, I was marked with cracked and bleeding nipples and the feeling of defeat. I decided I was done spending my short leave crying and stressing over breastfeeding and I decided to just pump for as long as I could before switching to formula. That was 7 years ago. Since then, I have become a doula, a HypnoBirthing instructor, and a midwife. I have seen so much in the breastfeeding world. This time, I was sure I would be able to bypass the difficulties I faced with my son because of the experience I had. Right after my baby girl was born, she latched on and ate and I felt elated at the thought that this time it was going to be smooth sailing. But 36 hours later, my nipples were damaged and flattened after every feeding. No problem, I thought, I have resources and support. So I called them in. I took her to see a consultant at three days old to have her tongue tie revised. It turned out she also had a lip tie and a cheek tie which I had never even heard of. So much for me knowing things! She was tiny, at 6lbs 4oz and those restrictions were making it so hard for her to open her already small mouth wide enough to eat. I had all three ties lasered and she latched on beautifully immediately after the procedure. I felt that relief and elation again. It lasted until the next day, when suddenly she wouldn’t latch at all, instead just screaming at me. Turns out some babies really take a long time to recover from those revisions. All of her muscles were now working differently and she was too sore and weak to breastfeed. That was the beginning of a five-week journey involving chiropractic appointments, lactation consultant appointments, pumping, bottles, and tears. Why was breastfeeding so hard?! Every feeding involved my latching her and nursing her for as long as she could handle, then bottle feeding her and pumping. I felt like I was on a rollercoaster, with some days taking two steps forward and the next day one step back. It was practically impossible to go anywhere, it was hard to handle visitors with all of that feeding business, and I was quickly beginning to struggle mentally and emotionally with this challenge. The first consultant I saw who revised the tongue tie gave me a very interesting thought to ponder when I asked her why so many babies struggle to breastfeed and have tongue ties. She said she had read some research that suggested that formula, bottles, and pumps have kept alive many babies that would not have survived in the past due to their struggles to eat. As a result, these poor little eaters have survived and passed on their genetics. For the first time I stopped cursing my breast pump and gave thanks for it and for the formula that had kept my babies alive. I had many days where I felt ready to give up. I grew so frustrated at the idea that I was a midwife that couldn’t get breastfeeding to work. My husband reassured me time and time again and reminded me not to put that extra pressure on myself to breastfeed just because of my job. Either way, I just couldn’t give up when I was always telling women not to give up! Working in the field that I do, I had many knowledgeable women checking on me, supporting me, and encouraging me. I had a wonderful, compassionate lactation consultant friend reminding me that it wasn’t me doing anything wrong and that it would eventually come together. One particularly low day, where I was really struggling and trying to decide how long to keep trying, I posted on my facebook page that I was struggling and asked for success stories. So many women posted about the similar struggles they had of having to pump, spoon feed, syringe feed, or supplement while facing issues like bad latches, tongue ties, and supply issues. I realized that breastfeeding struggles are so incredibly common. These women had stuck it out and they said to give it six weeks. If they could do it, I knew I could too. So that day I decided that as long as I was seeing forward progress, no matter how slow, I would stick with it for at least six weeks. People encouraged me, but also reminded me the importance of my sanity. They reminded me that fed is best and that whatever happened, it wouldn’t make me any less of a mom if I decided to stop and switch to formula. Breastfeeding problems can feel so big when you are already exhausted, overwhelmed, and unsure. My friends wanted to make sure I knew that my mental and physical health mattered too. At the end of week four, I noticed that my baby was starting to take more gulps and breastfeed for longer periods. I slowly started letting her just nurse and started weaning off the bottles. By the middle of the fifth week, she was eating exclusively by breastfeeding and my heart was soaring. The ease of breastfeeding without having to worry about pumping, bottles, and carting around so much gear was astounding to me. I had never had the experience of being able to just pack myself and my baby and a couple of diapers and know that we were set not matter what rolled our way. The struggle we had to go through to get there was rought and I do not ever fault a single mom for giving up during that struggle. Our sanity is important and thanks to our modern times, our babies can be fed in many ways. But support is out there. Every mom I talked to that had successfully breastfed had words of wisdom and support for me. They had empathy for my struggle. There is so much lost breastfeeding wisdom that we are slowly regaining. I don’t know how many times I tearfully said I wanted to give up. It would have been ok if I had, but I am so glad I didn’t. For the mothers out there struggling, if you want to breastfeed, reach out. If I hadn’t, I am confident I would have quit. There are caring consultants, support groups, and mothers that have been there and can help. I still don’t know why breastfeeding can be so complex and difficult, but I also know that leaning on the support from others made all the difference for me and my little one. 7/3/2019 0 Comments A HypnoBirthing Birth StoryA HypnoBirthing Birth Story |
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