Prenatal Visits with a Traditional Homebirth Midwife

For anyone who is curious about what prenatal care with a homebirth midwife can look like!

It's important to note that most homebirth families choose to do some testing and ultrasounds, so this isn't necessarily what typical homebirth prenatal care looks like. I choose to opt out of most of the routine tests and procedures based on the research I've done and my philosophy of pregnancy and birth.

What is my philosophy on pregnancy and birth? I believe that this is an inherently safe process for most healthy women and babies. I believe that much of the routine testing and procedures can actually cause more harm than good and they certainly are not without risks. Sometimes the results cause worry and stress (which can be harmful to the baby) and additional tests and procedures without any improvement in the outcome for mom or baby.

When any issues arise, I prefer to try natural things first, which typically have fewer side effects, before moving onto medical solutions. For instance, my iron has been low this pregnancy (I haven't had a blood test but have had some symptoms of anemia) so I am raising my iron levels with iron rich foods and a food based supplement.

Of course there is always an element of risk during pregnancy and birth because just being alive is risky. Most of us don't walk around in our everyday lives in fear of dying, even when we do something statistically risky such as driving a car. I view my pregnancy and birth in the same light: I don't walk around worrying that something is wrong with me or my baby or stressing about the 'what ifs.' It's an unusual view to have in our society, but I do trust my body, my baby, and the pregnancy and birth process itself.

A typical prenatal appointment for me:

I hear my midwife drive up to my townhouse in her car and my dog goes insane, barking at the door (yes, you can have a homebirth in a townhouse or even apartment!) After containing him, I let her in and she says hi to Audrey and I, who always has something exciting to share like "I colored a picture!"

Audrey plays with toys or watches tv while we sit at my kitchen table and talk. This is often the most important part and is sometimes closer to a therapy session than a medical appointment. My mental and emotional state play a huge role in pregnancy and birth and it's vital that we address anything that is affecting me. This didn't seem as important during my first pregnancy but this time I have had some unexpected emotional issues I am working through and being able to discuss this openly with one of the people who will be there during my most vulnerable time (birth) is essential. I personally need to feel that I can absolutely trust everyone who will be present for my birth and I definitely don't trust strangers I have never met before. For me, talking about my thoughts and feelings is how I build that trust. Talking through things also helps me prepare emotionally to birth this baby. Giving birth is a huge, life changing event not only physically but also mentally and spiritually.

My midwife and I also discuss how things are going in pregnancy physically and she gives suggestions for discomforts as needed. If certain physical symptoms arise that require further action, we discuss it at this time. We talk about my desires for birth and I consult her on various things. She advises me on decisions, but does not tell me I absolutely can or cannot do something. She is more of a partner than an authority and I have the final say in any decisions. Since she is an independent midwife her practice is not dictated by policies or rules put in place by others, such as happens with a birth center or hospital.

For the medical side of the visit, my midwife visually checks me for swelling and takes my blood pressure. Then I lie down on the couch and she measures my fundal height (how much my uterus has grown) which indicates the growth of the baby. My midwife also palpates my uterus with her hands, which tells her many things such as the baby's size and position and my amniotic fluid levels. Palpation is a difficult skill that is essential for a good homebirth midwife to be well trained in.

A care provider palpating, also called Leopold's Maneuver, to determine baby's position

The last thing my midwife does is listen to the baby with a fetoscope. This looks similar to a stethoscope and is the only way to listen to the baby's heartbeat without using ultrasound. This type of fetal heart rate monitoring is very accurate but it does take some skill. She can also tell the approximate placement of my placenta by listening to it with the fetoscope. I have my own fetoscope that I purchased to show in my childbirth education classes and I've had a lot of fun listening to my placenta and baby on my own this pregnancy!

A midwife using a fetoscope at a prenatal

That's pretty much it! Prenatal visits are usually 45-60 minutes long This pregnancy I have chosen for many reasons to opt out of routine:

• Ultrasounds or doppler use
• Blood tests
• Genetic Screening
• Gestational Diabetes Screen
• Group B Strep Test
• Urine Tests
• Vaginal exams

I chose not to do these tests and procedures based on research I've done during Audrey's pregnancy and as a Childbirth Educator, along with my philosophy that pregnancy and birth are inherently safe. (I'm not going to go into all the research and my reasoning here because that would be an extremely long blog post! If you are curious about why I choose not to do any of these things let me know and I can send you some research.) A big factor in my decision is that routine use of most of these tests or procedures do not improve outcomes for mom or baby and each of them carries different risks. If my midwife would deem one of these necessary at any point we would discuss it further and I may choose to do it at that time. I do take steps to stay very healthy before and during pregnancy, which certainly helps my body to perform optimally and my baby to be healthy.

Although I have opted out of these, my midwife is able to order certain tests and procedures if her clients want or need to have them done. For example, I had two ultrasounds during my first pregnancy which were ordered by my midwife through an independent diagnostic imaging center. Although if I knew then what I know now, I'm not sure I would have opted to have either ultrasound but it was great to have access to that technology while still seeing a traditional, homebirth midwife.

I have found that during this pregnancy, it has been very empowering and freeing to simply gestate and trust my body, my baby, and the process of pregnancy and birth. 

My good friend, also a homebirth midwife, doing henna at my Mother Blessing Ceremony

Preparing Big Sister Audrey for Birth and Baby

We are planning on having Audrey present during the actual birth of her little brother or sister and have been preparing her for that experience. It may not work out (she may decide she doesn't want to be in the room at the time, for instance) so we are being flexible about it. But we are hoping and planning for her to be there.

We have also been preparing her for her role as big sister and life after the baby is here. It will certainly be quite an adjustment (for everyone!) and will take some time and patience for us to find our "new normal" as a family of four.

Preparation for Birth

Audrey has known about my pregnancy since early in first trimester. I was too excited not to share it with her! She actually helped share the news with all her grandparents. Every few weeks during pregnancy we talk about how the baby is developing and I show her pictures from a pregnancy app or the book A Child is Born, which has actual pictures of babies in utero.

She loves this page and talks about how the baby is playing with his umbilical cord

One thing Audrey and I have enjoyed doing since before I was pregnant is watching homebirth videos. She really likes these, especially the ones with big brothers or sisters! I explain in simple terms about the "mommy working really hard to get her baby out" and that it takes a long time. If the woman is vocalizing we talk about how being noisy can help the baby come out. During the actual birth part I talk about the baby's head coming out first and that there can be a lot of "water" and blood (but the mommy and baby aren't hurt). She knows that babies grow in the uterus and come out of the vagina. (She's actually corrected people who ask if there's a baby in my "belly!") And then we see the baby's body born and I point out the umbilical cord. Later we discuss the placenta (if shown) and the baby getting "nursies" or breastfeeding. Some videos show the older siblings holding the baby and she loves that part!

A big part of her preparation for the birth has been me practicing being in labor! The last few weeks we've pretended mommy is having contractions and I will go in various positions, such as sitting on the birth ball or leaning over the counter. I remind her before the contraction starts that I will be focusing and can't talk to her for a minute. The "contraction" lasts 30 seconds or so and I will usually vocalize during them. She isn't always able to let me go through the contraction without talking or trying to climb up on me, but I just remind her. And that is one reason we are having our good friend be our "sibling doula!" A sibling doula is a doula for the older siblings and will take care of Audrey during labor and birth so Ryan can focus on me. Our sibling doula will also explain what's happening, answer Audrey's questions, etc. And she's going to prepare my placenta for smoothies after birth, but that's a topic for another post!

We've been reading this book too! It's not perfect but was the best one I could find about homebirth for children. There's a few home water birth books but I didn't like the illustrations or how the midwives were so hands on. This book focuses more on the family and the midwife is in the background (which is how our midwife practices).

 This is my favorite page. :)

Preparation for the Baby

I talk about how babies needs lots of "nursies," they sleep a lot at first, and cry sometimes. We've talked about how mommy will be in bed for many days after the baby is here and she and the baby will need to sleep during the day. She knows about wearing babies and bed sharing - she sleeps in the master bedroom on her own mattress.

This book has been a great resource and is geared towards natural parenting practices, such as breastfeeding, co sleeping, and baby wearing. Most conventional books for older siblings depict bottle feeding, separate sleeping, and baby in what I refer to as "containers."

One really big project this pregnancy has been making Audrey a "busy box" for every day of the week. These are boxes that contain many different learning activities that she can mostly do on her own, although I'm sure she will want adult interaction with them sometimes! I'm planning on utilizing these all throughout the coming months as part of her preschool-at-home education. Some of them I made and some I bought. Here are my favorites:

Various puzzles and matching

Literacy: putting a story in order and telling it, letter matching, name writing practice (that's a laminated tracing sheet with her name)

Felt activities: make a pizza, make a snowman, play yard for small animals. And build a pen for a dinosaur using popsicle sticks

Lacing - fine motor skill practice

Math: patterns, match the numbers, match the shapes

One box with a variety of activities for every day of the week!

Next week I will be writing a post about my prenatal care, which looks very different from conventional prenatal care. (Think less technology, more hands on skills)