In the midwifery model of care in the United States, prenatal visits provide the opportunity to establish a trusting relationship between mother and midwife. Midwives provide holistic care, listening carefully to the mother and providing her with physical and emotional care. Visits with a midwife are typically between 30-60 minutes long (compared to the average 7-15 minute visit with an obstetrician), and they usually follow a standard schedule: an initial visit in the first trimester, which is followed by visits every 4-6 weeks in the first two trimesters; then, between 28-36 weeks gestation, visits are every 2-3 weeks; between 36-40 weeks, they are every week. Sometimes visits may be twice a week between week 40 and the birth of the baby.
At these visits, the midwife will check the mother’s blood pressure, pulse, and fundal height as well as the baby’s heart tones and position. She will monitor fetal growth and weight gain by taking the mother’s weight and palpating the size of the baby in utero. She may show the mother how to do her own dipstick urine analysis. Typically, she will refer the mother for lab work, which involves a blood draw and blood testing, and advise the mother of her options for prenatal testing. She will provide support, information, and referrals as needed, encouraging informed consent or refusal, and she will emphasize the importance of good nutrition, exercise, and emotional self-care for the maintenance of well-being and the prevention of complications. As the English proverb says, “An ounce of prevention is worth a pound of cure.” If maternal or fetal health risks emerge in the course of care that are beyond the midwife’s scope of practice, she will refer the mother to another provider. A midwife’s care is personalized to the individual needs of the families she serves.
Resource: The Essential Homebirth Guide
Childbirth Education & Preparation
When it comes to preparing for childbirth, fear is your enemy, but wisdom is your friend. Childbirth education classes are one way for expectant parents to learn more about pregnancy, childbirth, breastfeeding, postpartum, newborns and early parenting alongside other parents. Well-known natural childbirth programs include Lamaze, Bradley, BirthWorks, Birthing from Within, and Hypnobirthing. My childbirth classes emphasize holistic preparation for childbirth emotionally, physically, mentally, and spiritually. In class, we learn together that birth is instinctive, women labor best where they feel safest and most loved, and that birth is a natural, transformative process for the whole family. Some topics covered in class include:
- feelings, beliefs, hopes and fears about childbirth
- nutrition, hydration, exercise, relaxation and life-style choices for healthy pregnancy
- choosing a birthplace and birth team
- the physiology of normal birth, including the magic of mama’s oxytocin, optimal fetal positioning and optimal pelvic positioning
- physical and emotional comfort measures for labor and birth, including the benefits of a fully informed birth partner and childbirth doula
- the BRAINS (Benefits, Risks, Alternatives, Intuition, Now/Never/Nothing, Safety/Satisfaction) approach to medical drugs and procedures, including interventions like induction, pitocin, narcotics, epidural, episiotomy, cesarean, and newborn procedures
- grieving and healing from any prior pregnancy loss, cesarean, or traumatic experience related to our birth or identities as men and women
- learning the art of breastfeeding, including the SOFT (skin-to-skin, open eyes, fingertip exploration, and time) beginning, infant feeding cues, latching, positioning, breast care when milk comes in, safe co-sleeping, babywearing, and the life-saving benefits of long-term breastfeeding for mother and baby
- rest and recovery in the first six to eight weeks, including attachment parenting, elimination communication, and newborn baby care
- fertility awareness and beautiful sex after childbirth
In class, parents are encouraged to formulate their birth plan based on their own choices and values, not fear or pressure from others. Pelvic bodywork helps us discover that women’s bodies are perfectly physically designed to give birth while artwork allows us to explore our thoughts and feelings about childbirth. Visualizations help us to prepare mentally, spiritually, and emotionally for labor, birth, and breastfeeding. Educational resources in the form of books, DVDs, and referrals to pregnancy and childbirth caregivers are always available. We bring healthy snacks to share, watch short birth videos, and do interactive partner exercises. Our thinking, feeling, remembering babies in the womb are treated as important members of the class: acknowledged, affirmed, and included in our activities.
Does it matter what position the baby is in when a mother is ready to give birth? Yes, it does! It is usually easier to give birth to a baby who is head-down, facing mama’s spine, and slightly turned to the left (LOA – left occiput anterior). So if a baby isn’t in an ideal position to be born, there are ways to encourage babies to turn. But babies can be born from almost any position! Positional differences are variations of normal. It’s good to understand these variations (OP, frank breech, complete breech, footling breech), so both midwife and mother can be prepared for labor and birth.
Resource: Spinning Babies
Labor & Birth
Women labor best where they feel safest and most loved. Labor is often described as unfolding in phases: early, active, and transitional. It is characterized by uterine contractions (or rushes) that usually become longer, stronger, and closer together. Labor progress can be measured externally by many different signs. It can be measured internally by cervical ripening (softening and positional change), dilation (opening), effacement (thinning), and the rotation and descent of the baby. Fetal station can be measured in relation to the ischial spines of the mama’s pelvis. It’s good to limit cervical checks during labor, however, to avoid discomfiting the mother, interrupting labor, and introducing risk of infection. A mother laboring naturally will know when she has a strong urge to push, which generally indicates that the baby’s station is low. When the cervix is completely dilated (or nearly so), the mother can follow her urge to push as it comes.
Childbirth is often described as unfolding in stages: labor, birth of the baby, and release of the placenta. It is an emotional as well as physical experience, and it has the power to transform families. In my view, it is a natural, normal physiological process beautifully designed by God to bring babies from the womb into the world.
Resource: Childbirth Connection
VBAC & HBAC
VBAC vaginal birth after cesarean and HBAC (home birth after cesarean) are healthy options for most women who have had a prior cesarean. VBAC is safer for both mother and baby than repeat elective cesarean. A midwife is an excellent caregiver for a mother planning a VBAC or HBAC because she listens to a mother’s fears and needs, sharing hope, love and reliable resources for decision-making as needed. She believes in the surpassing excellence in the design of a woman’s body for giving birth and in every mother’s strength to bring forth her baby.
Homebirth & Waterbirth
Less than a century ago, almost all American women gave birth in their homes in the care of midwives. Historical developments changed that. But today, homebirth is choice that more and more families are once again making in order to welcome their children with love.
Waterbirth is common in the American homebirth setting. Laboring in water often provides pain relief to mothers through simple hydrotherapy and, when the birth pool deep enough, through the sensation of floating. Giving birth in the water can be a wonderful way to help ease the baby from the womb to the world calmly and peacefully.
Resource: Waterbirth International
Breast-feeding is the natural, normal way to feed a baby. It facilitates emotional bonding between a mother and her child, and it provides a strong foundation for health in the new baby and postpartum mother as well as the early parenting relationship. What are the benefits of breastfeeding?
for the baby:
1) skin-to-skin contact releases oxytocin in the newborn, fostering calm, connection, contentment, happiness, and the feeling of loving the mother and being loved by her
2) provides nutritious food for the baby to eat, feel full, digest, and use for healthy growth
3) breastmilk proteins and fats foster baby’s brain development and results in higher IQs
4) antibodies in colostrum and breastmilk strengthen the baby’s immune system and protect against viruses, resulting in substantially reduced rates of ear infection, stomach flu, colic, constipation, diarrhea, respiratory infection, asthma, obesity, leukemia, tooth decay, and SIDS
for the mama:
5) skin-to-skin contact and suckling releases oxytocin in the mother, fostering calm, connection, contentment, happiness, and the feeling of loving her baby and being loved in return
6) increases the mother’s sense of well-being and confidence in the significance of her care of her baby
7) helps restore the mother’s body after pregnancy by contracting the uterus, expelling the placenta and lochia, and facilitating gradual weight loss while usually suppressing ovulation if the mother breastfeeds exclusively
8) hormonal and synaptic changes in the brain associated with breastfeeding improve spatial memory, learning, and IQ
9) glucose and cholesterol control results in reduced risk of diabetes and hypoglycemia, enhanced mineralization of bone reduces the risk of osteoporosis, and breastfeeding also reduces the risk of ovarian, cervical, and breast cancer
better than formula!
10) if the mother is eating well and staying hydrated, breastmilk contains the right balance of nutritious food for the baby
11) breastmilk contains antibodies that protect the baby’s health
12) breastmilk changes as your baby changes to meet the baby’s needs at each stage of physiological development
13) breastmilk changes flavors to stimulate the baby’s taste buds
14) breastmilk is easier to digest and results in less gas, fewer tummy aches, and better smelling poop (seriously!)
15) breastmilk is available from the mother’s body in the middle of the night (or any time) so she does not have to get up to prepare formula … she can respond to her baby’s hunger cues quickly without having to wait until the baby is really upset
16) breastmilk is created by the mother’s body so it is easily available, does not have to be carefully prepared, stored, or thrown out because of unsafe bacteria, and does not cost average of $1200-$4000 per year
17) breastmilk makes mothers and babies healthier and less prone to illness, resulting in reduced medical costs, fewer absences from work and school, and greater productivity
18) breastmilk does not contain contaminated water that is sometimes used when preparing formula and then resulting in moderate to severe infant illness
19) breastfeeding does not create the trash and plastic waste that formula cans and bottle supplies do; it is environmentally safe and sustainable.
Breastfeeding saves two lives!
Resource: La Leche League FAQs
In the immediate postpartum period, when baby’s skin to skin with mama and the placenta is delivered, it’s good for mama and baby to stay together for a few hours. Breast-feeding and bonding can be initiated well this way. Later, the cord can be cut, the baby weighed and measured, and special care can be given to the baby if the family has decided to accept antibiotic eye ointment or the vitamin K drops (or a shot). Blood can be taken from the baby’s cord for initial screening.
The midwifery model of care provides special attention to families in the extended postpartum period. Unlike the hospital-based obstetrician, who sees the mother 6-8 weeks after the birth for the first time, homebirth midwives typically visit new mothers on day 1, day 3, day 7, three weeks and six weeks after the birth. This helps to ensure excellent continuity of care.
Resource: Postpartum Support International
Well Newborn & Early Parenting
The well newborn is a delightful, demanding little person whose needs are simple and easy to meet, but so consistent and frequently expressed that most new parents find themselves very tired from waking up in the night to feed, burp, change, comfort and put baby back to sleep. This too shall pass! Safe co-sleeping and breast-feeding help ease the new family through this time of change.
As baby gets older, it is important to make decisions about how to parent. Some new parents had loving, attentive parents of their own who set a great example that they can imitate. Others may wish to do things differently from their families of origin. Attachment parenting is a wonderful approach to a child’s early years, and I encourage people to learn more about it.
*A Word about Childbearing in Developing Nations
The wonderful benefits of the midwifery model of care are expressed differently in developing nations than in the United States. That’s because prenatal care, childbirth education, and even frequent postpartum visits are much harder to make available to mothers living in poverty. Nevertheless, midwives seek to provide healthy, loving care to women at high risk of complications so that more families may live and thrive.