This, my friends, is just the beginning of many posts about homebirth and 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.
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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:
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.
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.
We expect you to have receiving 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.
Some additional birth kit supplies:
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!
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.
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.
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.
Partners are by far the best form of pain relief in labor.
I love her wall of birth affirmations!! I highly recommend something like this for encouragement in labor!
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.
Out in the hallway we usually have the remaining bags: Oxygen, resuscitation equipment, emergency medications, suturing kits, IV bags & equipment, and other emergency needs.
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.
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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!
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.
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.
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.
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.
Partners get to dress them for the first time!
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.
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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.
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!!
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 🙂
Tessa, I’m so glad to hear you say that!
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 🙂
I watched Roseanne during my homebirth with my daughter 🙂
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!
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!
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.
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!!!
Midwives do VBAC’s all the time-you’ll have to interview and see if you can find one that is comfortable with it. I know the one I work for wants to know the reason for the c-section and details about the entire thing before she accepts VBAC clients, but a VBAC is not a reason to not have a homebirth or deliver with a midwife 😉
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
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.
I’m dying to have a homebirth whenever we have our second child. I had a c-section with my first, and there are no hospitals around here who “allow” VBAC. Thanks for providing a concrete post with pictures that I can show my husband. Most reactions to my desire to give birth at home have included lectures on how I’m going to willfully kill myself and the baby, so thanks for addressing that right off!
Great post. I am preparing for my third baby in June (and first homebirth), and this was exactly what I was looking for — a visual walkthrough and ideas of more things to get ready. You can kind of feel left out of the labor/delivery time “nesting” since you aren’t “packing a bag” and all of that – (in the best way possible), so this was lovely to read through and think about. I especially love the birthing affirmations and will be likely borrowing a few for my own birthing time. Thanks.
I’m so glad I could help in any way! Good luck!!
I have question about twins, you mentioned that if you are pregnant with twins than thats one of the times you persue with a transfer, is that the case for every twin birth? Or is it still possible to have an at home birth with twins?
You can have a homebirth of twins with an un-licensed, un-certified midwife but I personally wouldn’t recommend it. If something goes wrong at a twin birth it can be extra catastrophic because there is an additional baby to care for. Twins are considered high-risk for good reason. I have known midwives that have done twins at home, but most of the DEM’s I know that can do them, don’t because of the additional risk. If it were me personally I would look for a good OB that supported vaginal twin birth that was comfortable delivering a breech-twin (some will c-section you if the second twin is breech, RIDICULOUS!!)
So many people say that if you have a breech birth it needs to be done by ceserian. My oldest child was ‘double breech’ as he came into the world penis first with one leg up his back and the other under his arm. I was blessed with a quick labor then a very quick delivery….total time was 48 minutes!! I did have both of my children in the hospital but had them without medication
I had a home birth 4 months ago and this is spot on! 🙂 it was hands down the most amazing experience of my life!
This is a wonderful article & post, loved it so much. I had a midwife in a hospital & she was great, except for the fact that they forced me to induce because I was at 42 weeks – very long induced labor & ended up having an epidural after 20 hours….and still went 16 more hours. My question for you is, if I had planned a home birth for that labor, would the CNM have had to induce me at 42 weeks as well? The midwife I had basically said that if I wanted to wait past 42 weeks, she would no longer be able to be my provider & I’d have to transfer to a male OB who I had never before met…and I am sure he would have been like, well let’s schedule surgery. So I chose to be induced instead & avoided a csec, thankfully. I have always wondered what would have happened if I had planned a home birth instead….thanks in advance.
It depends on the midwife. I know that for a CNM (in or out of hospital) they have to transfer care at 42 weeks. If you were with a CPM I’m not sure what their standard of care is and DEM’s can usually do whatever they want. It’s such a hard call because I know baby’s health can deteriorate after 42 BUT we’ve had a few clients that just go that long-and that’s their normal.
Thanks!
Thank you for this well-written article. I provide homebirth in Northeast Illinois and it was fun to see how you gals do things there! Turns out everything was the same except that I use a digital baby scale (Bass Pro shop digital fish scale!)
Thank you for everything you do and for providing this safe and wonderful option to the women in your area!
Debbie
I love hearing from other cnm’s in homebirth! Thanks for saying hello!
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What do women who home birth typically plan for their older children? Do they have them at home or plan for them to be out of the house?
I would say 90% of the time births happen in the middle of the night/wee hours of the morning (at least in my experience) and the older children typically sleep through the whole thing. Even with some of my noisiest mamas their older kids have slept all the way through and wake up to a surprise sibling in the morning! If it’s during the day it’s not a bad idea to have another caretaker on standby, but usually mama’s like to labor in their own bedroom and doors can be shut. It’s completely up to you as to what your comfort level is with having your children around. I think for me personally I would line someone up to be on call to come take them if it’s a day time labor, but truly it’s less impeding that you would think!
Getting a home birthday was awesome.
You feel empowered and safe;
plus you choose the ambiance to own choice and getting a professional douala and cnf to the delivery the baby.
And to have a closed family member to help coupe with the pain during the whole labor
Congratadualtion to my husband to be there scone the beginning and hopefully until the end our baby life
My childbirth was OK
The only mistake the I regretted will be no follow my intuition to stay in labor position until the baby crwons and to move to the pushing position
to push my baby
The will safe 6_ 8 hour of labor
And prevent a perennial restaurant in.
Even our baby was induce we came through will all this time a focus and my personal meditation the help through the pain ask your douala for this teniques and choose your favorite and stick to it until you get your precious baby in your arm.
26 hours of labor total
???
Please would you can cancel my comment I try to fixed the errors by mistake appears scone instead every second other small errors thanks you for understanding
How do I find a CNM? My doctor’s office has midwives, but they don’t deliver. At this point I’m not happy with my doctor and need to switch. I love the info on homebirth. Might try to convince to hubs!
I would ask other women in your area, do some googling-even reach out to everyone on facebook to see what you can find out!
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I had two homebirths with midwives back in 1978 and 1981 and I enjoyed spending a rainy day today reading this and looking at the photographs. I hope you don’t mind the school teacher in me mentioning that you misspell “receiving”, as in receiving blankets in several places 😉
Thank you for the spell check!!
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April,
I know this is an older post but I wanted to comment because I think you just helped me find my answer on who to have as my midwife ? (I’m in Southern Ut and have been debating transferring from another midwife to Cyndi) I have been really anxious about this birth even though I’m only 16 wks because the hospital I delivered at with my first left me a little scarred (literally and emotionally). I had a C-section. And I have been even more anxious about who to have as a midwife since my current midwife just isn’t what I was hoping. I met Cyndi in a consultation but my mind has been bogged down with the anxiety of WHICH midwife to choose. I feel really confident now that Cyndi is the kind of midwife I’m looking for. Sorry for the novel ??
You will love her and I’m so happy I could help!!
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I had my last baby as a homebirth and it was amazing! The only thing I wasn’t prepared for was all of the clutter! The actual bloody gross stuff was handled by my birth team but I had mounds of laundry afterwards. My midwife really stressed that I needed to stay in bed for 5 days but I just couldn’t handle all of the piles of laundry and my sweet hubby couldn’t get it done and take care of everything else so about 12 hours post delivery I started washing. When midwife came for the 24hr check up she was so impressed that hubby had the house under control and then she checked me. it was obvious that my bleeding was too heavy bc of being out of bed to much. As much as I loved my home birth I am seriously considering a hospital birth next time just for the convenience of bringing home my nrw baby to a clean and clutter free home.