As a certified nurse-midwife with a full-scope group homebirth midwifery practice, I am often asked what the homebirth midwifery model of care actually is. I can speak for my philosophies, which are shared in general by many of my colleagues. We provide prenatal, labor, delivery, postpartum and newborn care, as well as breastfeeding support for healthy low risk families planning to give birth at home; we also provide gynecological and some primary care services to well women. We offer a unique, comprehensive model of maternity care that provides an exceptional level of holistic support and services to achieve optimum health. We believe there are several ingredients that contribute to a deeply positive and healthful pregnancy, homebirth and postpartum experience, in addition to our midwifery care. These include wholesome nutrition, whole food supplements and healthy joyful living, relevant health education with books, movies and childbirth classes, connection with a supportive community, regular exercise as well as an ongoing practice of yoga and meditation and other such methods to reduce inner stress and increase inner calm; we often draw on the expertise of additional professionals, such as doulas, childbirth educators, lactation consultants, acupuncturists, massage therapists, chiropractors or osteopaths, and mind/body medicine practitioners to name just a few. We also encourage each woman and partner to take advantage of the many classes and support groups we recommend – from prenatal yoga, yoga for labor workshop, and postpartum mommy and me yoga classes, positive birth story pregnancy circles, community new mother blessing ceremonies, annual family reunion, postpartum mom circles, pregnancy retreats and a variety of other educational, supportive, and fun events, classes, and ways to connect with other likeminded people and build community – in an effort to bring back the needed village it takes to raise a new baby, and new parents.
While we continue to expand in our academic, clinical and intuitive knowledge and wisdom, we are also growing in understanding, appreciation and awe of the sanctity of life and its many facets, transitions and phases. Most women are candidates for midwifery care and homebirth; over 92% of pregnant women in our practice will have a homebirth, and we maintain a cesarean section birth rate of less than 5%. Ongoing individualized care determines the needs of each childbearing family. We have developed practice guidelines in conjunction with other homebirth midwives, evidence based research and the current midwifery literature; they reflect our philosophies and professional standards for practice, and they are reviewed and evaluated periodically as needed. We follow these practice guidelines to protect the health and safety of each individual in our care; and we try our absolute best, within our human capacity, to give our utmost attention and care with integrity, honesty, and heartfelt commitment and dedication.
We firmly believe that pregnancy and childbirth are normal natural bodily functions, profoundly spiritual, truly inspiring and an empowering rite of passage for women and their families. We also believe that childbearing families are best served by caregivers who promote and encourage a loving, respectful, supportive, family-centered environment, and maintain trust and calm confidence in the normalcy of the process, until proven otherwise. We have taken and will continue to take every reasonable precaution to ensure safety, comfort, and deep satisfaction, which are our top priorities. A safe and wonderfully positive birth experience requires the joint cooperative efforts of both the expectant family and health care providers, with a relationship based upon good open communication, mutual respect, and shared responsibility. Education of women and their families is an integral part of our services, so that women are able to assume this responsibility for health maintenance and effective utilization of health care. Opportunity is offered to our clients to participate in the planning and implementation of their care, as emphasis is placed on an outcome that satisfies emotional, educational, family and spiritual concerns beyond the obvious physical needs.
We feel that every individual has the right to safe and satisfying health care by the provider of their choice, given with respect for personal preferences and cultural variations. We believe that normal, healthy women have the right to birth at home if they choose to do so, and as licensed practitioners, feel an obligation to make birth as safe and satisfying as possible for them. For the overwhelming majority of families, the childbearing experience is one of health rather than illness, and there is a need for preventative and loving supportive care that is not only safe, but also sensitive, compassionate and empowering. We believe in enhancing the normal processes of the female reproductive cycle, pregnancy and birth through education, physical and emotional support, and involvement of significant others according to the choices of each expectant mom and those she chooses and wants to be involved.
Our responsibilities include review of each woman’s complete health history, physical examination findings, and lab results to determine her eligibility for continued midwifery care and homebirth, as well as ongoing evaluation and guidance throughout pregnancy, labor, birth and postpartum with attention to signs of normalcy and/or signs of complications. All findings are discussed openly; and there will be no routine procedures or interventions unless medically necessary and mutually agreed upon. While childbearing is a healthy, normal and natural process for the vast majority of women and babies, problems can infrequently occur, and need to be recognized and attended to. Although many complications can be prevented or handled simply within our practice, some do require consultation with a collaborative physician or transfer to medical and hospital care to increase the likelihood of a safe outcome. It is our philosophy that decisions regarding each woman’s care are informed and collaborative, and ultimately hers to make; however, rare emergent situations may arise in which the professional judgment of the midwife and/ or consulting physician must be relied on exclusively for the safety of mother and baby. We are grateful for life saving hospital medical and surgical care when there are serious complications and illness; and it is my hope that the homebirth midwifery model of care can be applied as much as possible in all birth settings, including the operating room, if surgical birth is needed.
There is an overwhelming cultural belief in the United States that hospitals are the safest place to give birth, regardless of the extensive scientific data that planned homebirths with skilled midwives suggest otherwise. Numerous studies around the world have documented the safety of planned homebirth by trained professional midwives, with outcomes at least as good, if not better than those occurring in a hospital. This is especially true of women who have delivered vaginally before. The total slight increase newborn mortality risk of home birth is estimated to be 10 per 10,000 babies born at home, and that 1 in 1000 babies born at home may be adversely effected by the extra transport time in reaching advanced care in the hospital; the absolute risk is small however. Despite spending the most money on obstetric care, the United States ranks among the lowest of industrialized countries around the world in neonatal mortality and morbidity, and ranks quite low in maternal mortality and morbidity as well. Countries that consistently demonstrate the best maternal and newborn outcomes have a large percentage of midwife led maternity care for healthy women experiencing normal pregnancies - which constitutes the vast majority - a higher percentage of homebirth midwifery care with supportive hospital/medical transfer arrangements when needed, while the obstetricians attend to the women with high risk complications and serious illnesses, which is how they are educated as surgeons and medical doctors. When midwives and obstetricians work together as a team, both using their unique skills, knowledge, expertise and training, the outcomes for moms and babies are far superior. Midwives are trained in guarding the normalcy of pregnancy, birth and postpartum, not disturbing it when all is well, knowing when to compassionately observe with loving support, and when and how to use holistic remedies, or medical intervention only when necessary as a last resort; they are also educated in prevention, assessment and treatment of complications, which most times can be managed simply and naturally, but sometimes involves consultation or referral to an obstetrician. Although unforeseen events and emergencies can occur in any birth setting, some of which can be best handled in a high risk hospital, a low risk healthy woman entering the typical U.S. hospital expecting a normal vaginal birth is subjected to a routine barrage of procedures and interventions that dramatically increase the risk of complications and problems, with potentially longstanding physical and emotional ramifications for both mother and baby.
There are many other benefits of homebirth midwifery care, in addition to safety, which provides an alternative to the impersonal, fear based, law suit prevention oriented medical and hospital care that has become prevalent in our society. These benefits include but are not limited to the power of the human touch and presence, of being surrounded by supportive people of a family’s own choosing, security in birthing in a familiar and comfortable environment of home, feeling less inhibited in expressing unique responses to labor (such as making sounds, moving freely, adopting positions of comfort, being intimate with her partner, nursing a toddler, eating and drinking as needed and desired, expressing or practicing individual cultural, value and faith based rituals that enhance coping) -- all of which can lead to easier labors and births, not having to make a decision about when to go to the hospital during labor (going too early can slow progress and increase use of the cascade of risky interventions, while going too late can be intensely uncomfortable or even lead to a risky unplanned birth en route), being able to choose how and when to include children (who are making their own adjustments and are less challenged by a lengthy absence of their parents and excessive interruptions of family routines), enabling uninterrupted family boding and breastfeeding, huge cost savings for insurance companies and those without insurance, and increasing the likelihood of having a deeply empowering and profoundly positive, life changing pregnancy and birth experience. Getting holistic prenatal through postpartum care and birthing in one’s own home attended by a skilled midwife, is a refuge for those who want to protect the normalcy and sanctity of pregnancy and birth. But focusing on the normal does not mean that problems go unrecognized or unattended; rather they are viewed as imbalances that need to be righted, not expected or feared.
That being said, certain hazards do exist however, in all settings, whether childbirth occurs in or out of the hospital; and there are risks unique to each setting. Some of these risks will never be eradicated no matter what our state of technology or medical advancement. The safety of home birth is well documented, but childbirth by its nature is a threshold passage for the mom, and the baby. Some babies are born with defects and injuries despite all the technology, tests, and skills of the attendants. In spite of the fact that that hospitalization of birth has failed to eliminate fetal or neonatal death, there is a cultural expectation that doctors and hospitals can guarantee a “perfect baby” every time. This is a pervasive myth. It is impossible for any provider to guarantee much of anything. Birth defects may or may not be detectable by prenatal testing. The practice of midwifery, nursing and medicine are not exact sciences and no assurances can be made regarding the results of examinations, diagnostic tests, treatments, procedures, or interventions. It is impossible for any provider to guarantee a normal healthy birth, mother or baby. Part of the wonder of the miracle of birth is the inherent lack of guarantees in life and birth, and the surrender to a power far bigger than ourselves. Part of life is death, and we often do not know why a person lives or dies. We do have a spiritual perspective, and believe that while we can do our best to do what is humanly possible, most of life, birth and death are ultimately not in our control; we do believe that everything that happens is meant to happen, because it did, and that it happened for our benefit, even if beyond our understanding, as we are souls temporarily residing in bodies, and know that G-d/Spirit of our own understanding is only good. Conception is the beginning of life, yet every life must end sometime. Part of pregnancy is the excitement of new life and the fear of its loss. This is normal human reality and is in part why pregnancy deepens and matures a woman and man spiritually and emotionally.
We try our hardest to give the best care that we possibly can, pray we make the right decisions and that our hands are blessed. But we are all only human. Midwifery and obstetrics are such humbling professions. And I would choose no other.
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It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy.