Monday, October 13, 2014

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

This, my friends, is just the beginning of many posts about birth that I'll be writing.  Believe me.  They're all rattling around in my head, I just have to sit down long enough to write them all down.

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 how it all works!


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.

Ok.  Here we go.

Before your birth you should be receiving prenatal care with a childbirth professional such as a midwife.  I work 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.

Around 36 weeks we (birth assistants) like to come out and deliver your birth kit and do a home visit.  We're looking to see if your home is a favorable atmosphere, get a lay of the land and set up your supplies.  This way we can find your bedroom in the dark, we 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:

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

Everyone always asks me about the mess.  We cover EVERYTHING 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 we really like to just not make a mess in the first place.

As soon as women are starting labor we encourage them 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 we have to do 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-we do an ammonia rinse and then a normal wash and your sheets (if they even did get messy) are back to clean.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

We borrow a bowl and line it with a garbage bag for your placenta.  In that bowl we include sterile gloves, nasal aspirator, cord clamp and when we get there for the birth we add a sterile pack that includes everything needed to cut the cord and examine for repairs.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

We expect you to have recieving blankets and most kits come with the little hats for after the birth.  All of those are folded up and put in a pillowcase with a heat pad.  When we arrive for the birth we plug in the heating pad to warm up the blankets, towels and hat so baby has nice warm blankets immediately after the birth.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

Some additional birth kit supplies:

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

We also put together a pack with the super sexy MESH PANTIES!! (everyone's favorite), a peri bottle for squirting while peeing and the super thick pads of hugeness.  Ideally they've got a batch of padsicles chilling in the freezer!

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

Once we arrive for the birth we set up a crock pot full of washcloths and use them for heat on lower backs and then later for softening the perineum at pushing.  We pack our own olive oil, KY and arnica oil as well for extra lubrication.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

We chart everything we do in a program similar to how they chart at a hospital using an iPad.  Instead of confining women to holding still with a monitor we simply monitor regularly with a doppler to check out baby's heart rate.  We don't bother with a contraction monitor...because it's SUPER obvious when women are having contractions.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

We manage labor with The Office (distractions), heat, massage, pressure points and water.  Placing an IV is absolutely an option if needed BUT we rarely need to.  We just monitor that women are drinking enough fluids.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

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

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

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

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

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.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

Out in the hallway we usually have the remaining bags: Oxygen, resuscitation equipment, emergency medications, suturing kits, IV bags & equipment, and other emergency needs.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

We kind of move in when we have long labors.  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.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

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!

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

I love this picture of all 3 of us!  I'm in the mirror, Cyndi is smiling and Cyndi's other assistant Lisa, a NICU RN is getting things ready.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

After a whole lot of work, this sweet baby boy was born!  We have him hooked up to an sp02 monitor (to see how well his blood is oxygenating) and we check vitals right there on Mom's chest.  We wait at least an hour to take baby away from Mom unless there is a reason to separate them.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

After the cord is done pulsating, we cut!  Once again, baby is never taken from Mom, we perform all of our examinations right there.  We monitor Mom's bleeding and treat if necessary.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

After we have cleaned up, stitched up (if necessary, and YES we numb you!), nursed, and finished notes we come in and find out all the stats 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!  We don't wash babies.) We then perform a full newborn physical.  Eye ointment and VIT K are offered. If at any point in this process ANY red flags appear they are quickly treated or transferred.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

I love that we weigh babies with a fish scale instead of a cold hard plastic one!  It's such a cute little stork bundle!

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

Partners get to dress them for the first time!

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

Before we leave we read off postpartum instructions.  We get the new Mom fed, showered and snuggled up into clean sheets.  It is wonderful to see a new family all snuggled in bed together.

We don't leave until we're sure Mom and baby are doing amazing.  We then come back the next 24 hours and 48 hours to check-in on everyone and make sure both are doing well.  If anyone isn't we send them in for further help.  Ideally they see their pediatrician within the first 48 hours as well and have a PKU done and any vaccinations.

INSIDE HOMEBIRTH: WHAT DOES A HOMEBIRTH LOOK LIKE?

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!!


9 comments:

tnrosales said...

I love this, its so perfect. I also loved seeing the affirmations I made Christina hanging!! Her wall is awesome! I will definitely be referring this post out to peeps :)

APRIL DAVIS said...

Tessa, I'm so glad to hear you say that!

Stacy said...

I have watched The Office while in labor with both my labors. I am having a home birth this time and will probably watch The Office even if just out of tradition :)

Anonymous said...

This is beautiful! I just delivered my 3rd baby at the hospital but I've always wondered about home birth. I've had so many questions and this has answered a lot of them. Thank you!

Genene said...

This is really quite a wonderful post. I enjoyed the thoroughness & the perspective you provided. I'm rooting for people with the same mindset to find this post & go with a natural, empowering birth process if at all possible. GO YOUR TEAM!

Genene said...

This is a wonderful post giving a clear perspective on home birth imo.

GO YOUR TEAM!!!

I encourage more & more women to enter into childbirth with knowledge & feeling empowered in doing what their bodies really can do. The experience can teach you so much about yourself & the power you have in you. How wonderful to be able to have a team of understanding, experienced women there to assist & empower the laboring woman.

Just brilliant.

dani said...

How often do midwives do vbacs? Saw your post on ig. I've had a csection although I wanted a natural birth. Felt pressured by my obgyn and felt robbed of my birth since then. Loved this post, this is exactly what I want. Have a super super knowledgeable and supportive hubby. It's right up my alley but nervous about finding a supportive provider in Texas. (Dfw, if that helps) thanks!!!

Anonymous said...

Congratulations!! Happy birthday! Thank you thank you thank you. We just met our homebirthin midwife today...our first homebirth. ..3rd baby. I was so upset and drained from fighting with insurance for 3 weeks that I needed a 180 to get back on track and this was it!! =)♡♡♡ I've been feeling amazing and excited for this new journey. Thank you so much for this post. I'm sending it to my husband! =) God bless you and your family. AM

New Daddy said...

If this is a double post I apologize. I played the partner role at our homebirth. We decided to do a VBAC with our daughter. I have to say it was a truly amazing experience. Yes, it was exhausting for all of us (baby came at 5:26am) but it was so nice to be home. When everyone left we got to lay in our own bed, eat our own food, and just enjoy each other. Our midwife was amazing and assured us through the whole labor (vs scare us like the hospital tends to do). I am so happy my wife went this route.

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