I'm A Homebirth Midwife Ask Me Anything

What do you do in emergency situations requiring immediate medical care? Breech presentation, placenta previa, etc. And do they train you with at least basic Neonatal Resuscitation techniques in cases of newborns with poor APGAR scores?

We are not legally allowed to do breech in FL though we're trained to. Placenta previa is usually caught way before hand and those mom's are sent in for hospital birth (usually section). Yes we have to renew our NRP every 2 years. We carry oxygen down here.

Good to hear. Hope you haven't had to use any of your NRP skills. :) Are you worried about any legal responsibility if anything goes wrong during birth that results in long term health defects for the baby?

I do at times. I carry malpractice insurance. But getting as attached as I do to my clients I worry more about my emotional reaction if something were to go wrong. I can't imagine how I would feel if something were to go wrong because I did something wrong. I wouldn't doubt it would be my last birth.

So what happens when you have prolonged labours, shoulder dystocias, or severe postpartum hemorrhage? Particularly in the last case, there are things that can happen very suddenly and require urgent critical care. If you run into a medical crisis in someone's home, how do you ensure the safety of both patients?

Depends on certain factors. Prolonged rupture of membranes are limited to 24 hrs in FL. Shoulder dystocias can usually be fixed with movement of the mother or episiotomy. I have medications and I've fluids in the event of a postpartum hemorrhage. Throughout the pregnancy an emergency plan is designed. In the event of a severe emergency I stabilize and call 911. There are a lot of regulations in FL that we have to follow and it usually filters out mothers who are not healthy enough for a home birth.

I mentioned prolonged labours, not prolonged rupture of membranes. The HELPERR acronym can cover most difficult delivery cases but not all - i'm curious as to what you do when you run into trouble and sincere medical help is required. Are midwives trained in episiotomy and vaginal repair? If so, what sort of training do you receive and how do you prevent post-repair complications? (infection, improper suturing, etc?). My biggest concern is for the health of the mother and baby. I think there is a very useful role for midwifery but I am also aware of the complications that arise during pregnancy and how quickly patients can decompensate. What medications are you licensed and trained to use, and what training in IV fluid administration do you have? I'm not asking to be difficult but to ensure that any patients I have who choose home birth have the safest care possible.

If I anticipate a problem I have a backup physician that I work with whom I can contact for consultation or transport if necessary. If it is a dire emergency I call the paramedics. A prolonged labor is not an issue unless the membranes are ruptured, the baby is in danger or the mother begins to develop a fever. I am trained to both preform an episiotomy and repair it. I use a perry bottle with betadine for after care. I am also trained to run IV fluids and carry both antibiotics (the type depends on allergies) and pitocin as well as cytotec.

However, depending on the state that you are in different midwives are allowed different things. The best way for you to ensure a good outcome for your patient is to question the midwife of their choice directly and work in conjunction with her. Trust me that almost every midwife would like the safety of a trusted physician to turn to in the event that things aren't going as expected. I'm blessed to work in a state where midwifery is legal and regulated but not all midwives are so lucky and they are often too afraid to be found out to ask the important questions.

Do you use a fetal heart rate monitor? You mentioned you carry medications and fluids, what do you carry? Do you have a PulseOx in your kit? What do you carry for resuscitation equipment?

I have 2 o2 tanks. Mask for baby and mom and ambu bag. I always have a bag of lactated ringers, 5% dextrose and saline. I have antibiotics, pit, and cytotec. I use a doppler throughout the labor for monitoring of the baby. I do have a pulse ox. It's now part of our law to monitor at the 24 hrs mark as well as immediate post part up.

I thought Neonatal Resuscitation involved things that a midwife can't do or carry, and that's why they can't do true NR.

The only part of nrp I can't preform is a tracheotomy. I carry an o2 tank (2 actually 1 for mom and 1 for baby) as well as ppv and delees.

You might be a expert at delivering kids at home, but can you see why kids love the taste of Cinnamon Toast Crunch?

I can't :-( it scratches the roof of my mouth and leaves an odd after taste. I prefer fruity pebbles.

What are the benefits of delivering at home? What requests have you had that were at of the norm? Have you delivered in/under water? What is the benefit of underwater birth?

Having the birth that you want as opposed to the "norm" without outside interference. I had a mom once that refused to have her baby until night time and held of pushing for 3 hrs until sundown. Yes I prefer water birth actually. It's a midwife's "epidural". Helps ease the contractions.

I had a mom once that refused to have her baby until night time and held of pushing for 3 hrs until sundown.

Uh, isn't that really dangerous?

She was well monitored believe me! I didn't really get it but it was important to her.

Vampire Baby?

All babies are vampires lol

She was well monitored believe me! I didn't really get it but it was important to her.

That just seems sooo bizarre. Granted, all my kids have four feet so I don't know much about childbirth, but I think if it were me, I'd want that kid out of there as soon as humanly possible! ;)

Yeah serious will power!

She was well monitored believe me!

How often do you want to just...(is murder to strong a word?)...really annoying, and emotional about-to-give-birth mothers.

Often and then I realize how crazy I was during my own pregnancy and births and reconnect with my compassion ;-)

Omg the water. I gave birth with midwives in a hospital. Each time the pain got too bad to stand I went back in the tub. The pain was immediately cut in half- water is amazing

I see the effects over and over. It hasn't failed yet!

Thanks. I'm clueless about birth and I'm a woman. My friend just described her birth in detail to me. I learned a lot... What does one go through to be a certified mid wife?

It's a three year program which includes apprenticeship in FL. Every state has its own laws. FL happens to have the toughest. By the time I got licensed I had attended 250 births.

My mother is a midwife in New Zealand where they are usually the first choice for giving birth. I have heard that there is still somewhat of a stigma in some countries about choosing a midwife is that the case in the states?

Unfortunately yes. It's really frowned upon here. Consumers are changing things but the powers that be don't make it easy. This only makes midwifery hard to regulate and in some states where there are no laws people just decide they want to and can go out and start delivering babies with no training and no experience.

That's just crazy to think that people could do it without training. It's a complete culture shift to here midwives are usually the first choice.

I know :-( women are trying to take back control of their births and they'll take whatever help they can get in their desperation.

When you're doing a water birth, how do you get the dookie out of the pool?

https://zapp.trakt.us/images/episodes/4192-3-1.jpg?1

LOL we use those mini fish nets like for a fish tank.

My gf is due in dec, I am really hoping to provide some quality support when that time comes. What are some things I should be focusing on?

Being OK with her discomfort. I find that for dad's seeing their partner in labor they want to "fix" it. There's nothing to fix. Reassure her constantly that she's doing an amazing job. Somewhere around 8 cm she will want to give up and you'll want to let her but that's when she's almost done. Reassure her even more.

I would say that you should accept that you and your girlfriend can't come prepared to the wonderfull chaos that is childbirth, so the best thing you can do is to take a deep breath and go with the flow. I gave birth to me and my boyfriends first child at may 13 this year and when I was in the middle of it I would have lost my shit if my boyfriend or any other family members there would have told me I was doing a great job over and over again. I needed peace and quiet around me so I could concentrate about the task at hand. So talk to your girlfriend and ask her what thoughts she has about the up comming birth. Ask her if she ever have had some kind of situation or pain she couldn't escape from and how she reacted in that situation. That might give you a slight idea of what your in for. A birth is just as much a psycological pressure for her because you know that the pain will not go away untill it's over (unless she gets an epidural.. but even in this case the pain will return when she has to push) No births are a like what works for one would be completely wrong for another. I needed to be quiet and for everyone to leave me alone but in the delivery rooms on either side of mine were two women who needed to scream all the way through.

Very true but you often don't know what a mother needs till the time comes. Allowing her to tell you when the time is right without taking it personally is of up most Importance.

That is true.. I know now that next time I need to be more clear about what I want. When we talked about what we wanted we agreed that my mother in law should be there to support me through the whole thing, because my mother and I are so alike that I thought that she might irritate me, but when the time came she was the one that knew what I really needed. I also tried to accommodate my boyfriends wishes and that ended up making me feel like me and my family was pushed aside. When I was finally in labour my boyfriend was there and so was his mother, his sister and my mother... but one of the most important people in my life (my sister) was told to come when it was over... and that kind of pissed me of after the whole ordeal was over. So next time i'm going to be crystal clear about what I want. In stead of trying to please everyone.

Your birth is not a time to please others. It is an event that shapes your future. Only your voice counts. I believe it is the beginning of mothering, learning how to speak up for yourself so that you can later speak up for your baby.

Have you ever heard of the dad getting naked during a water birth? I saw a video and it showed it. Serious question.

I had a dad in tidy whities once...super uncomfortable I would not stay if he got totally naked but there's someone for everyone lol.

Ok because I saw a Youtube video and he was butt naked. I thought it was rather a unique experience.

Yeah I wouldn't be OK with that but I'm sure there's midwife that wouldn't mind somewhere.

Yeah I wouldn't be OK with that but I'm sure there's midwife that wouldn't mind somewhere.

Not only is there one who wouldn't mind, there's also one who'd later go on her blog and rhapsodize about the "beautiful experience" she'd just had! ;)

LOL no comment

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Where is what at? Naked dad's in tub?

what kind of certification is the most trustworthy for midwifery?

I believe the FL license to be the best. You can't just wake up one day and decide you want to be a midwife. It's a tough program and tends to weed out the posers.

How do you handle cleaning up after the birth? I know things can get messy. :)

Lots of hydrogen peroxide and clorox ;-)

Have you watched Call the Midwife on Netflix or read the books? You should - they are awesome.

I had a male midwife (!!!) until my son made a mad dash for freedom at 24 weeks and I became high risk. I would have much preferred to have kept the midwife, but the doctor was adamant. Do all high risk pregnancies still end up losing midwives?

I have! I love it! They did a good job keeping it accurate.

Unfortunately yes. God forbid we did a preme baby at home we'd have no way of keeping it alive.

The hospital is necessary in some cases.

What are the most children you have delivered from a single patient? Is patient the right term in your line of work, or is there a more appropriate term? Finally, have you ever had an awkward situation where the baby that came out was obviously (or likely) not the father's? (such as two african american parents and an asian baby pops out) I'm just curious how you would handle yourself in that sort of situation. I see it in the movies all the time, but have never heard of it happening in real life, and certainly not from a healthcare professional.

We call our people clients as a reminder that ultimately it's her body, her birth. I've been to a sixth birth but I'm a youngin I wasn't at the first 5. I personally am on 2nd babies now.

No never LMAO! I would probably laugh. Unfortunately I'm afflicted with diarrhea of the mouth.

How about any disinterested fathers? Perhaps standing off to the side or off in the other room going about their day as if it were any other day; watching tv, playing on the computer, doing yard work, etc.

Yeah sadly I've had a good share of those. I tend to get a little snappy with them. I attempt to bring them in hoping it's just nerves but not always :-(

When I was born (in a hospital) the nurse came out of the room to my father, as at the time men didn't really go into the delivery room, and told him that his son had been born.

My dad asked for a minute as a cricketer was bowling for the last time and he wanted to see it.

The good news is my dad hasn't been a bad dad raising me so I'm sure, most of the time, even the disinterested ones get better.

Thank you! That gives me hope.

Do you administer vitamin K to newborns after a home birth? Have you found the amount of parents agreeing to the jab is reducing?

I highly recommend it. I don't find that the research against it is strong enough and though the chances of hemorrhagic disease of the newborn are slim to none, the effects are not worth risking. However I will not give it without the mothers consent.

Is the uptake of home birth vit K injections lower then the up take after a hospital birth?

No not at all. We use the same meds. Same dosing.

What is the craziest/grossest/strangest thing that has ever happened during a home birth?

Honestly if you had asked me that 5 years ago I would have 50 different answers but now I'm so used to it I don't find anything gross. I've been peed on, pooped on, I even had my hand in vomit once but it no longer bothers me.

What are your thoughts on squatting during delivery? I heard its the most natural position for it as opposed to laying on your back, which is more medically convenient.

Love it. I usually ask the mom to stand once she's crowning. In my experience it great for bringing the baby down but tends to cause rather large tears.

Can you expand on that? You love it, but it tends to cause rather large tears. That is horrifying.

I find that squatting pulls the skin too tight and doesn't allow for good stretching. That's only been my experience though. There may be other squatting techniques that I haven't been privy too. For some women it's the only way but like I said once they crown I have them stand supported.

Thanks!

:-) NP

Hm, tears are no bueno. But thanks for your input!

Unfortunately they are sometimes unavoidable but there are ways to minimize. It all depends on the mom's anatomy and the babies position. There is no one answer.

Yeah, there's always risks so I think I'll stick to squatting when its my turn to pop one out

I hear ya.

What are your thoughts on the Duggars?

I have no idea what that is.

Oh I just looked it up haha! I thought this was a question like my favorite dinosaur. I really don't know. I personally think it's a bit excessive to have that many children in this day and age. I have no concept of how you can provide undivided attention or financial support to 19 children but they most certainly must have found some system that works for them. I know a few women that have 7 and they do pretty well but they're extremely conscious of their diet and exercise regularly.

Did you ever have to deal with SIDS of a baby you helped bring into this world? If yes how did it affect you?

Forgive me if I'm wrong but I believe SIDS is classified as death within a month or so of the baby being born. A baby born dead is a stillborn. Both tragic.

Yes that's right. It's my worst nightmare.

No thank goodness!

What's your favorite dinosaur, pupuhead?

Leopluradon

My fiance and mother of our daughter has a love for everything that has to do with child birth. We don't plan on having another for about 2 years but, she is constantly looking up birthing videos different types of births and everything else she can. She is at a crossroads in her life where she doesn't know what to make into a career a couple of months ago I suggested midwife as a career and she really liked the idea. What suggestions would you give to someone who may aspire to be a midwife? Also a not so important question that I need to ask what kind of income could she expect? Thanks in advance!

Income depends on the state you're in. Becoming a midwife is a difficult road and can be complicated by small children at home. It's important to have a good support system so you are not worried about your little one while you're gone. I've been at births for days but my children are bigger and they drive so I don't worry about them anymore but when I started my training my heart was always divided.

Just like childbirth itself though the end result is totally worth it!

Thanks for the reply! Our daughter is only 16 months we do have a great support system and I work from home and I would definitely support her in any way I could. This may be something that could truly make her happy is there anything that you think would make this anything less than a dream career?

What state are you in. Look into the laws of your state. Mana.org and narm.org are good places to start your research.

Michigan I will be looking into it a bit more for sure thank you for all the info may you be blessed with many successful clients!

Thank you! All blessings welcome ;-)

I have a few questions! I have considered becoming a midwife, as my best friend's mom is a freshly-retired midwife and an inspirational person in my life. She took me to see a documentary about Ina May Gaskin a year or two ago and it completely changed my perception of childbirth and the power of my body.

First, what part of midwifery training is the hardest? By that I mean, what is it that is most likely to convince students that midwifery is not for them?

What do you find most rewarding about attending births and delivering babies?

Do you find that women trust midwives more if the midwife has had children of their own?

Also, do you have a scariest birth story (that still turned out well)?

The hardest part for me personally was going to school, working my butt off going to births and not getting paid. My children were so supportive. We shut down the cable and Internet and sometimes I couldn't even buy toilet paper. I had never been that broke. It takes so much of your life that if you try to get a job it will take you twice as long.

My favorite part of every birth is the look on a mom's face when she realizes what she has done. She trusted herself to build and birth a baby and watching that realization dawn on her is awe-inspiring.

I do find that women tend to trust those midwives that have gone through the process most but I know many midwives who started without any children and still have successful practices.

My scariest experience was a 6 time mom who had a shoulder dystocia. Thankfully it was manageable. The baby turned out to be 12lbs 15oz.

How did you manage the dystocia in that case? I'm in awe of the mom!

The managing midwife performed the woods corkscrew maneuver successfully.

That's fantastic. Human bodies and human knowledge!

:-) It never ceases to amaze me!

Is it true that women who had very bad cramps with their period tend to have less-painful births?

Anecdotally, NO.

Dammit.

Sorry :-( there really is no tell tail sign of how your labor will be. Often times you labor as your mother did. It's the best predictor.

No lol. But the cramps often do get better after giving birth.

What are your rates, an how many of your clients are able to pay partially or all with insurance in FL?

I personally charge $4500. This includes all labs and a sonogram. Most of my clients have health insurance. Those who don't and can't afford it we work out a payment plan based on their income.

Have you been to any births of multiples? If so, what were the challenges of that birth?

No sadly we can't legally attend a multiples birth down here.

I see. Apparently it's similar here in WI as well. I found out I'm pregnant with twins (I'm due early March), and I had to give up my midwife. It makes me kind of sad, but I understand why.

When you say "attend", do you mean you can't be responsible for the birth, or you can't even be present for them?

I would say I'm sorry but what a blessing! I can't even be there unless it's in the hospital for course. I can lose my license.

Thank you for you responses!

Anytime ;-)

This is sweet, how much do you usually charge per pregnancy?

The rate down here is between $3,000-6,000 for the entire 9 mths. Most midwives take insurance but a lot of them have had to stop taking medicaid due to the new changes.

What are your preferred type of canned beans to accept as payment?

LMAO I'm partial to pinto beans!

Hi, my wife wants to find a mid wife local and have a home birth. I on the other hand am concerned for the safety of her and our child. What would you say are the pros and cons of home birth?

The only con really is transport. Unfortunately the divide between the hospital and home birth is large. Unless you find a midwife with a good relationship with the hospital, transporting in an emergency can be a pain. The hospital staff will often be unfriendly. Depending on where you live your midwife should be able to do almost everything they would do in the hospital except an epidural or a c-section.

That is really messed up, surly a home birth that has become an emergency should be a priority for coming into hospital?

Yes they have to treat you but they don't have to treat you nicely.

I honestly cant see why they would be rude to you! Are they at least nice to the mother?

It depends on the hospital and whether there are a lot of midwives in your area. Some hospitals are used to us and will gladly do collaborative management. I would call the hospital before hand and get an idea of where they stand.

Question coming from someone who aspires to be a midwife, how did you get to where you are? What's steps and schooling did it take?

I went to a certified midwifery school but ultimately my lessons came in the birth room. I never said no to a birth. I went to as many as I could physically make it too.

Did you go to Florida School of Traditional Midwifery?

No.

Have you given birth yourself? And; how has being a midwife changed your views on childbirth? (as opposed to what they were before you began)

As a 25yo male I think I would completely freak out seeing a human head coming out of a vagina as it tears.

LMAO first of all not all vagina's tear. Yes I have 2 children one is 17 the other is 15. I had them both vaginally but midwifery wasn't as popular at the time. If I had to do it over I would absolutely have a home birth. I've seen too much beauty to look away at this point. There's no denying the romance in a home birth.

Haha! Thanks for your answer! I'm so glad to hear not all vaginas tear. Do women have less feeling during sex after giving birth vaginally? So many female friends my age say they'd never want to give birth vaginally due to worrying about how it would affect them afterwards.

Not in the least nor does it stay baby size. Just like the penis isn't a long sleeve when it's not hard. The vaginal grows when needed and contracts back down afterwards. I know women that have 7 children and their husbands are not complaining ;-)

Do you give the baby vitamin k after birth?

Only when the parents want me to.

I have hip dysplasia, basically my hip dislocate. Would I be able to have a home birth or a water birth? Not expecting yet but hoping soon!

I don't see why not. Save your x-rays to show your practitioner for confirmation.

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Not sleeping for days on end is definitely the most difficult part!

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No thank goodness. Just had 2 in a row.

I know I'm really late and you may be finished, but if you come back maybe you could answer me! I'm about 5 ish months into my 2nd pregnancy, and during my first was given a lot of intervention that I don't think was necessary. I also had gestational diabetes. This time I most likely have it too. (I have done the 1 hour glucose test, but not the 3 hour due to controlling my sugar with diet and knowing that once I have that label, I would be considered high - risk and forced into a bunch of expensive intervention yet again) . It was completely controlled with diet before and my baby was a completely normal size, 8 lbs, even though they forced me into an induction because "the baby was going to be huge"

Anyways... Long question... Do you guys ever do home births for women who may or may not have gestational diabetes? Or is that completely ruled out immediately.

We do but only in conjunction with a physician and it has to be signed of by them before we can proceed. It's considered out of our scope.

Thank you for the answer <3 I think you guys are awesome and appreciate all of the hard work you put in

:-) thanks. I'm glad to see that you're taking an active role in your pregnancy and not being led around blindly.

What is your perspective on doulas? It seems to me some are reAlly helpful but others (although they know they're not supposed to be giving medical advice) can't help give their "perspective" on treatment issues.

So, doulas: for a midwife, good to have around or bad?

And why on earth do those women choose the Greek word for slave for their profession??!?

I've had a few doulas that had to give their opinion and unfortunately it made it very confusing for the mama. Most will refrain though when they realize you have a midwife. They don't have to "fight" for their clients natural birth.

No idea on the name though hehe hehe!