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:

• Blood Pressure
• Pulse 
• Weight
• Baby’s growth by measuring your fundal height (the distance from the top of your uterus to your pubic bone)
• Baby’s heart rate
• Baby’s position

One of the most beneficial things we look at in midwifery care that is often not monitored in other settings is the position of your baby. Every visit we palpate your belly to feel for the position of baby. If your baby is not in an optimal position as we get closer to the end of pregnancy, we can recommend lots of exercises and techniques to encourage your baby to be in a great position during labor. Positioning plays a huge role in how labor can go, so we pay a lot of attention to it!

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.

“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.
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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.


​

Wednesday morning I woke to some strong surges around 1:30am. I was still just waking up so I wasn't sure if it was a practice surge or the real thing. I knew I would be going into labor soon as the day before I started to have my birth show. So I laid awake for awhile to see what was going on. About 10 minutes later another came, really strong in my lower belly, would travel to my back and the tightening pressure in the belly usually felt with practice surges. So I practiced allowing myself to just drift away and let my body do what it was made for. The discomfort went away after my first breath but the tightening pressure remained, so I wasn't sure if it was still practice or actual labor surges. I practiced with a couple more still about 10 minutes apart. Then I made myself go to sleep so I could conserve my energy. 

Later, I woke around 6:00am for the day, but laid around to see what was going on, this time I used those contraction timers, just to see if things had progressed. So from 6-6:40 I was having surges roughly every 5 min for just under a minute each. But I also went 10 minutes between one and 3 minutes between another, so not consistent. I got up to start my day and continued to practice during each surge and I was good, so using my experience with my previous labor I thought I was still really early. 

My daughter had a doctor appointment at 8:45am and after that we went to Wal-Mart for a few last minute things before baby was to come. We were thinking that night or early Thursday. So between 7-11:30a I tried to have a normal day and planned to even come home and clean (haha).

When we got home I realized how tired those couple of activities made me so I decided to try and sleep again. I don't know if it was sleep or just deep relaxation, but I got through a few hours that only seemed to get interrupted 1-2 times an hour with a particularly strong surge, which after a few breaths I was relieved from discomfort but the tightening pressure remained. This made it difficult to decided if I was actually having real labor surges, because, well, I remember them to be painful with no relief until they ended. These were only a brief moment of discomfort relieved after a good breath, but tightening lingered.
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Around 1:30-2:00pm I got up and decided to time them again. I called my midwives office before 3:00p to get in and see how far I have come, if at all, to make the judgment on whether to go to the hospital or not. When I told them I had only been timing them for about an hour and the were pretty consistent at 5 min apart, they wanted me to just go to the hospital. But with my stubbornness and past history lingering in my mind, I insisted on being checked first. They made me an appointment for 4:00pm. We started loading up the truck with our bags just in case the hospital was in our near future and planned to take my daughter to my parents. She just got her shots that morning and a dental visit the day before. With her share of doctors, I knew she wouldn't like the hospital, so there's one thing that changed in my plan. My husband dropped me off at my appointment at 3:40 because we weren't going to make the appointment time of 4:00pm if we dropped my daughter off first so he took her and was to come back. I patiently waited to be taken back to be checked out and had about 5 surges during that time where I continued to practice my breathing, at this point though my exhales were loud and just trying to release as much discomfort at the peak of those surges. Still nothing terrible, but I could feel the end of those breaths using that little push we've talked about. Uh- Oh! They finally call me back, during a surge no less, so I take my time standing and what do you know, my water breaks! My husband returns and I got checked. I was at 7 cm! 7 cm, can you believe it?! I couldn't, except I felt my body wanting to bear down with those breaths! 

The midwife said ok let's go to the hospital, I said I'm not going to make it. Luckily they are just across the parking lot so she pushed me in a wheel chair surpassed the ER, they were asking if we registered, she responded we don't have time for that and I'm feeling like I have to take a poop now! We get to a room, nurses are asking what I want, if they need to give me an IV? So after a surge I told them I'm going natural and directed them to my birth plan in my purse. The attending midwife, after learning I was practicing HypnoBirthing and knowing how far I was, just stood off to the side and directed me to continue to listen to my body and ignore everything going on around me. (Putting the sensirs on my belly etc.) A few, not very graceful, surges later my son was born! I tried in those last moments to use the breathing we practiced but my body wanted more and there was some grunting and feeling like I had a really big bowel movement to pass, luckily it was only my little boy! 

My husband announced the sex with such excitement and we all shared a tear of happiness and relief on my end! 
Oh and my mom had made it in just as I could feel my baby's head about to crown! 
I knew this was possible and just as the author of the book knew that the birth of a baby was meant to be a beautiful thing, I have always wanted that and long before kids I knew I wanted a natural birth with no meds. I was very unprepared for the birth of my daughter but still knew it was possible. I am so thankful I found you and your class because it allowed me to have the birth I wanted and to trust and allow my body to do what it was perfectly made for.

Everywhere I look, including my own home, I see mothers struggling. Exhausted, depressed, anxious, at their wit’s end. I hear the words “How you feel right now is normal. Most moms feel this way.” And while I agree that these feelings are the norm, I’m not sure I agree that they’re normal. The more I read about postpartum practices in other cultures, I see quotes from different studies about how postpartum mood disorders, including the expected baby blues, are practically non-existent in cultures that have strong postpartum traditions that care for the mother. These cultures recognize and honor that it is the mother that needs to be nurtured by the community during the postpartum period. She is expected to rest and bond with her baby while everyone else takes care of everything else. Not only do they take care of the household needs and other children, they nurture this new mother, bringing her healthy nourishing foods, teas, providing daily body massage, herbal baths, the works. The extreme life change and physical changes that motherhood brings are recognized and cared for. They do not look at this type of care as a luxury, but as a necessity to bring healing and vitality to the mother after all her body has been through. They recognize that a thriving mother equals a thriving family. 

Now what do we do here in the United States? Families often receive support in many ways. Meals are brought or sent over, visitors come by to help with the baby, families show up and often help with other children and housekeeping. However, nurturing the mother is rarely the primary focus from the stories I hear. Often I hear new mothers say they have been overwhelmed with visitors, or that they didn’t know how to get visitors to leave sooner so they could get the rest they needed. They watched visitors hold their crying baby wishing they could have some time alone to work on establishing breastfeeding. They watched visitors hold their sleeping baby, wishing they could be sleeping too instead of entertaining visitors. The meals brought, while helpful, are often fast foods or foods not often eaten by the mother so they could actually cause some gastrointestinal discomfort which is more likely immediately postpartum. This was highlighted for me when I received a phone call from a postpartum mom with shooting pains in her belly. After running through her symptoms and ruling out anything serious, we came to conclude that the problem was just gas and constipation, likely due to all the fried and unhealthy foods well-meaning friends had been dropping off for her. All of these families want to help, the problem is that our culture has lost the wisdom of how to truly care for mothers in the postpartum period.

We live in a world of efficiency and productivity. Postpartum mothers struggle to slow down, rest, and be ok with not being productive. They may have only a short window of six weeks or sometimes less before they are expected to be back to work. Many countries have paid maternity leave, sometimes for as long as up to a year. Imagine how much more our mothers could rest and take care of themselves and their babies if they weren’t up against a clock.

With my first baby I had six weeks of unpaid maternity leave. I quit breastfeeding after 2 weeks of  struggling to get through the rough patches because I knew I was going to have to pump when I returned to work anyway. I didn’t want to spend my whole maternity leave struggling to bond with my baby while we stressed over eating, so I skipped the breast and went straight for the pump for the next several months. With my second baby, I had eight weeks of unpaid maternity leave, but would be taking her to work with me for several months. We spent six hard weeks getting breastfeeding to work and at the six week mark, I marveled at the thought that most moms were returning to work at this point because breastfeeding was just finally smoothing out. It makes perfect sense why so many moms give up on breastfeeding. We just don’t have time to give it a fair chance before returning to work. And with both babies, my return to work also signaled the beginning of a period of depression and anxiety. It’s no wonder as it is so difficult learning to balance the demands of a newborn with work and pumping, all while being sleep deprived.

So yes, these feelings of loneliness, overwhelm, exhaustion, inadequacy, depression, anxiety, fear, hopelessness are all common, but I don’t buy into the idea that they are normal. I think we are feeling these things because our culture is missing the mark in a big way when it comes to caring for mothers. We are missing a village and we have lost the wisdom of how to nurture new mothers. I often day dream about living in a little village where all the kids are just running around and all the moms are hanging out together caring for the babies and supporting the new mothers. I think we struggle so hard partially because we are so isolated. Living in a big city, my closest friends and family are at least a fifteen to thirty minute drive away. I don’t know any of my neighbors, because I have moved so many times. I imagine how different life would be if I could just walk out my front door to talk to another mom friend when I need to not be alone with my baby all day. Our society is not set up in a way that supports families.

The best shot at a solution I have found was when reading the book Seven Sisters for Seven Days: The Mothers’ Manual for Community-Based Postpartum Care. In it, the author Michelle Peterson talks about preparing for postpartum by setting up seven people to help care for the mother in the six weeks after the baby arrives. These people are set up in advance with the intention of nurturing the mother. Each person volunteers to take one day a week for six weeks to bring a meal, do a chore for the mother, or serve the mother in some way. They are not there to hold the baby or chat with the mom. They expect that some days they might not even see the mother or the baby as they are intended to be in bed resting often.  This set up makes it effortless for the mother as she is not having to ask for anything. People are readily checking in with her and have a plan for how to support her before she is in the depths of postpartum struggles.

One thing people keep telling me during my postpartum period is to ask for help, but if you have ever been in the throes of depression, you know that reaching out for anything feels nearly impossible. And while I might ask someone to help watch my kids, I would find it extremely difficult to ask someone to come over and make me a specific meal, clean my house, or make me some tea while I’m resting in bed with my baby even though at times those were the very things that would have helped me the most. In countries where postpartum rituals are a part of the culture, these mothers aren’t having to reach out and ask for things, those things are being readily brought to them by neighbors, family and friends, because part of the cultural belief is that mothers need to be nurtured so that they can nurture the baby. That is not our current cultural belief, so it has to be set up intentionally in order for it to become a regular part of our postpartum lives. The mothers I have talked to that set up the Seven Sisters in advance had a postpartum period that they described as healing and nurturing. Those aren’t words I usually hear used to describe this difficult period of time. These mothers had learned something very important: just because they could do some of these tasks themselves doesn’t mean that they should.
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I am a midwife that has grown weary of seeing so many mothers struggle quietly, thinking that is just the way it has to be. It’s not the way it has to be and I am working in my practice to promote a change in how my clients experience postpartum.  My hope is that we can help mothers thrive during their postpartum days instead of just surviving them. 

All photo credits: Alyssa Leon at Cherry Blossom Doula Services