A Complete Guide to Miscarriage at Home

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Is Miscarriage Normal?

Pregnancy and miscarriage carry a ton of emotions, and one may feel devastated or uneasy when going through a natural miscarriage. Although this is can be an extremely tough time mentally and physically, it may be comforting to know you’re not alone. 

An estimated 10%-20% of women who know they are pregnant will have a miscarriage. Also, most women (87%) who do experience a miscarriage will have a successful pregnancy and birth following that miscarriage. 

Maybe your pregnancy test was positive after missing your period, or some women have that gut feeling without having missed a period yet. Feeling excited, scared, happy, nervous, or just numb are all in the normal range of emotions when you first discover a pregnancy. Or maybe you’ve been trying for months to get pregnant and now you finally are. 

Just when you feel like you are beginning to get comfortable with your pregnancy, you start to have some spotting, maybe a little red bleeding, and then some light cramping. 

Next Steps

Contacting your health care provider and making them aware of what is going on is important. They may offer to have an ultrasound or blood work done. The bleeding becomes heavier and the cramping gets stronger and you no longer have the pregnancy symptoms you were starting to feel prior. Unfortunately, you are most likely experiencing a miscarriage. 

If your body is already starting to bleed and cramp, this is a sign your body is getting ready to expel the products of conception. Sometimes there’s not an actual fetus present. This means it could be a chemical pregnancy with no fetus, just a gestational sac. 

If there are no complications, you can safely miscarry at home. You may want to have some ibuprofen on hand and a hot water bottle. Soaking in a warm bath can also be very soothing. The worst of it can take about 2 hours with some pretty intense cramping and heavy bleeding. 

When to Seek Help

You would need to seek out medical care if you have pain that you cannot tolerate, or if you begin to hemorrhage. The definition of a hemorrhage is, soaking a maxi pad to where you can wring it out, and doing this for 2 hours. Of course, if the bleeding is much heavier than that or you feel unsafe, don’t wait to get medical help. 

Missed Miscarriage

A ‘missed miscarriage’ is where the fetus stops growing but there’s no signs of bleeding or cramping right away. It’s usually during the first ultrasound that this will be diagnosed. Or if you were following the beta HCG hormone, and it isn’t doubling or rising appropriately in the first 10 weeks, a miscarriage can be diagnosed this way, as well. 

If you do have a missed miscarriage, do not wait before seeing your provider for an intervention. It is dangerous for the pregnancy to sit in your womb for months, as it can cause some dangerous bleeding when the natural miscarriage begins. You will most likely be given several options, depending on the preference of the provider. It is always best to be informed ahead of time, in case your provider does not offer all the common or available options. 

Intervention Options for Missed Miscarriage

  • D&C or Dilation and Curettage

A D&C is a fairly common procedure to eliminate uterine lining and pregnancy contents. This procedure is very safe and complications are rare. Light spotting and cramping is common in the first few days after a D&C. 

  • Medications

Medications like Misoprostol are also an option, which cause your uterus to cramp. This process usually takes about 24 hours to complete. This option is also very safe and complications are rare.  

Miscarriage is Common

Miscarriage is very common, you would have to have 3 in a row before it is considered a medical problem. An option is to see a Maternal Fetal Medicine doctor to have a consult regarding any specific blood tests needed to determine if you have a genetic predisposition to miscarriage. These may include: Anticardiolipin, TSH, Lupus anticoagulant, beta 2 glycoprotein, and maternal karyotype. 

Some providers will recommend taking a baby aspirin every day to reduce the risk of miscarriage. And sometimes they may recommend taking progesterone to help you maintain the pregnancy. These all depend on the results of the blood tests and the actual medical diagnosis that is causing the miscarriages.

Next Cycle and/or Pregnancy After Miscarriage 

You can have your beta HCG levels checked, or simply wait for your next cycle. You should have a period by 4-6 weeks after the miscarriage. If you don’t have your cycle within 4-6 weeks, contact your care provider for further testing or ultrasounds. It is recommended to actively prevent pregnancy for 2 cycles following a miscarriage to lower your risk of having another miscarriage right away.

Holistic Gynecology and Pregnancy Services

If you are looking for holistic gynecology and pregnancy services, including home birth and water birth in South Florida, contact Midwife 360 for all of your questions and needs.

The Best Pregnancy Podcasts of 2021

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Having a baby of your very own can be a very exciting experience. However, that excitement may come with a certain level of stress and worry as well. Whether you’re on your first child or your fourth child, there are many online resources to help you through your journey.  Pregnancy Podcasts are easily accessible and appeal to a very wide demographic of parents. There is an endless range of topics, so no matter what you’re looking for there is a pregnancy podcast for you. It can be helpful to hear information and advice from someone who has been in your shoes.

There is a lot of stress and uncertainty surrounding pregnancy and parenthood, but the right pregnancy podcast could help to lighten the load. Plus, the convenience factor of a podcast can’t be beaten. You can easily turn on a podcast while you’re cooking dinner, running errands, or curled up in bed. Whether you prefer to hear real-life stories from families or factual advice from medical professionals, there’s a pregnancy podcast fit for you.

How to Choose the Best Pregnancy Podcasts For You

There are tons of pregnancy podcasts out there that cover a wide range of topics. Therefore, choosing the right one is very important. Searching for specific topics, styles of parenting, and lifestyles will help you choose. Here, we have preselected a few of our favorite pregnancy podcasts that may be beneficial for you.

Best Pregnancy Podcast for Breastfeeding

The Boob Group: Judgment-Free Breastfeeding Support

This pregnancy podcast has over a hundred episodes offering information and support for breastfeeding mothers. It features stories from women who share their personal breastfeeding triumphs and tribulations. The podcast also discusses the impact of society on breastfeeding, which relates to breastfeeding in public and pumping at work.

Listen to The Boob Group: Judgment-Free Breastfeeding Support.

Best Pregnancy Podcast for Gay Parents

 

Rose and Rosie: Parental Guidance 

Comedic duo, Rose and Rosie, launched their podcast back in 2020 as a way of documenting their journey of same-sex parenthood. They discuss various parenting and gender debates, the highs and lows that come with trying to conceive, and eventually, their success with pregnancy. You can follow their journey to parenthood by checking out their podcast below.

Listen to Rose and Rosie: Parental Guidance

Best Pregnancy Podcast for First-Time Parents

 

Pregnancy Podcast‬

A resource to support expecting moms and their partners. Host Vanessa Merten brings listeners evidence-based information to help them navigate the awesome adventures of pregnancy, birth, and becoming a new parent. With 300 episodes and counting, Pregnancy Podcast is your​ evidence-based resource to help you make informed decisions about your pregnancy and your baby.

Listen to Pregnancy Podcast

Best Podcast About Home Births

 

Doing It At Home: Our Home Birth Podcast

A weekly podcast about home birth and one couple’s decision to go from a traditional hospital birth to a natural birth at home with midwives. This show is all about adding an empowered conversation to the topic of home birth and natural birth, while keeping it real and fun.

Listen to Doing It At Home: Our Home Birth Podcast

All in all, there are many online resourses for pregnant women and their families. Pregnancy podcasts are a great option for those wanting to hear real stories and advice from experienced mommies and experts. If you have more questions about family planning, pregnancy, or overall women’s care, contact Midwife360 today.

Midwife360 Turns 7!

Insurance Midwife360 Updates

On April 1st, Midwife360 will be celebrating it’s 7th year of practice. As I sit here savoring my morning cup of herbal tea, enjoying the sunshine and beautiful weather only south Florida springtime can bring, I am remembering the early days – my big ‘why’, the successes and setbacks, the various people who helped (or hurt) along the way and the current state of affairs. 

MIDWIFE360 OVER THE YEARS

I started this practice to offer something different to the women and families of my community. After working in the hospital and OB office for 8 years, I know that many women, especially the millennials, want something different when it comes to the care of their gyn health and pregnancies. And I wanted something different and better for the babies. They don’t have a voice; I am their voice and I am shouting that babies want to come into this world gently, with love and respect.

“We” started out as “I” for years, along with various students that worked with me along the way. Most notably, I was able to help Rosalia Cannava become licensed after 3 long years of apprenticeship. Mandy Rojas (currently owner of Palm Beach Maternity Center) trained with me for a bit. And then in 2018 Lauren Danella, CNM moved to Florida to begin working with me. Last February Lauren left to work with Bliss Birth Center, but came back in November when we were getting so busy. Marlie Honorat started with us in September, and will continue having 2 office days a week. In addition, the people that have helped with keeping all of the details working smoothly have been essential to our success. These include Vanessa Scoz, Sandra Alandete, Kayleigh Taylor and Bruna Possobon. 

CHALLENGE IN BIRTH SERVICES

One of the consistently biggest challenges has been dealing with insurance companies. Like any business that sells services, the key to success is being able to charge appropriately for those services and to get paid for that work. Sometimes when I’m driving around and I see a landscaping truck or construction vehicles with the company logo or even the pool guy, I am envious that those people are providing services and getting paid. The healthcare industry is unique in the world of business in that most providers (if they work with insurance) do not do the work and then get paid. I am constantly shaking my head at the system that we have inherited from the last century. 

HOW INSURANCE WORKS WITH MIDWIFES

In case you didn’t know, here’s how it works. A provider has to go through a lengthy application process to become credentialed with an insurance company. They may have to wait 60-120 days to be approved. And one can be credentialed, but not invited into the network. If they are out of network, some folks with that insurance cannot see them and use their benefits or a request can be filed to have the services covered as if the provider were in network – this is called a GAP exception or single case agreement. This usually only works if the service is something no one else is providing – like home birth with a Certified Nurse Midwife (CNM). And this can be beneficial as the provider is allowed to balance bill the client for the difference between the contracted rate and the actual charges.

That’s another eye-opener. The provider’s charges are not what the insurance company pays. For instance, my charge for self pay full journey for pregnancy care with birth at home is $7000. This covers everything, no hidden fees. The rates that have been offered to me from insurance companies vary from $2300 – $3600 for what is called Global Maternity. AND the provider may not bill for the services until after the birth. So we provide 8-9 months of regular services, but cannot get paid until well after the main event and are lucky to receive half of our normal fees. In addition, some companies require us to apply for authorizations in order to qualify to be paid for certain services – services that are part and parcel of what we do, that they cover, and are part of our contract to be compensated. 

In addition to all of this, the system for filing claims is complicated, CPT (procedure) and ICD10 (diagnosis) codes must be accurate and present, and they only accept electronic claim filing through an electronic data clearinghouse. Therefore, a provider has to turn over a percentage of the already low amount of money they receive to a third party to file the claims and appeal any denials – which happen regularly. I’ve been told that insurance companies deny a percentage of all claims in the hopes that some of them won’t get appealed. It’s all part of the game. These are some of the headaches and drawbacks for the provider when playing the insurance game.

DOWNSIDE FOR PRIVATE INSURANCE PATIENTS

From the client’s point of view it’s just as bad. People get insurance thinking that they will be covered if they get sick or, I don’t know, have a baby. They are paying a monthly premium usually $300-500 per month and are always shocked at the sticker price when we do the breakdown of what their financial responsibility is even with insurance. If they have a deductible, they must pay up to the entire amount before the insurance will cover anything. In addition, if there is co-insurance then once the deductible is met, they will have to pay their percentage of what’s left according to the contracted rate. Then there are things not covered by insurance (birth tub rental, second licensed person at the birth, supplies, home visits) and this fee is added. They are typically paying us an average of $4000 in addition to their monthly premiums. 

Through the years this system has consistently been the limiting factor for Midwife360. I went through 7 different billing scenarios (including doing my own electronic filing for about 14 months until I couldn’t keep up with the appeals process) before settling on the current company that we use. Innovation Billing (thanks guys!) And they are great – really help me feel that they care about our success. However, all of this paper chasing has taken the joy out of the work. The constant need to keep up with figuring out who needs to have an authorization and following up on them. And the length of time that payment can take if there is a denial or any problems with the claim makes it impossible to know what the actual revenue is for any specific period of time. It’s a ‘keep churning out the work, fingers crossed and hope for the best’ situation. 

MIDWIFE360 IS A CONCIERGE PRACTICE

Another consideration – we are a concierge practice. We offer hour long prenatal visits with at least one home visit during the prenatal period. The client has prenatal care with the provider that will attend the birth. We come to the home for the active labor and birth and stay 2-4 hours after, providing immediate postpartum care to the mom and immediate newborn care to the baby. We come to the home twice in the first week of the baby’s life. We draw labs in the office. We can perform some simple ultrasound procedures. Clients who have had standard OB care in our community are familiar with the 5-10 min prenatal visits after waiting an hour in the waiting room, sometimes having to go to the lab for blood draws, getting a provider at the birth they’ve never met, and another stranger to care for the baby. And on top of all that, insurance companies are paying the OB providers more for that level of service than they pay us for the concierge level services we offer.

NO LONGER ACCEPTING INSURANCE

In light of all of the aforementioned issues, Midwife360 is going to discontinue working with insurance companies as of November 1, 2021. We will continue all of our current contracts through October 31, 2021.

We encourage prospective clients to come in for an hour long consultation. We charge $50 for the hour, and apply that to the fees once the client has decided to come in for care with us.

We will do our best to make our services affordable for everyone who decides that they want this level of care for one of the most important days of their lives! 

Pieces of a Woman – Commentary by Fadwah Halaby

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On Friday this week, I had the privilege to watch this trending Netflix movie with Jen Kamel of VBACFacts and a few other birth workers. I enjoyed the movie as it invoked many emotions while watching this family unravel around the loss of their baby at a home birth. Pieces of a Woman.

I don’t typically pay attention to trending movies on Netflix, but my daughter – who is soon to graduate Medical School and enter her OB residency – alerted me to the movie with concern that it could harm my practice since it was a ‘home birth gone bad’.

At first I was worried as I thought the same thing, but after watching it, I don’t feel the same way. Yes, it depicts a scenario of a baby in trouble and ultimately dying that was born at home. It also is not very true to reality in regards to the amount of monitoring that we do at a home birth, so that part could be harmful as folks don’t know what we do and might assume that the amount of monitoring is just like the movie. But I also know that no amount of monitoring would have changed the outcome. And the outcome would have been the same if the baby had been born in the hospital. Bad outcomes happen in the hospital, but folks don’t typically say “if the parents hadn’t chosen to go to the hospital this never would have happened”. Yet they say that if there is a bad outcome at home without knowing the details of the case. The parents are blamed for their unconventional choice.

But this movie wasn’t a statement about home birth as unsafe. This movie was a poignant and powerful statement about the isolation and grief that parents suffer when faced with the loss of a baby. We watch the relationship between the couple completely break down as neither one is able to deal with their grief and it drives a wedge between them. We watch the mothers family grapple with their grief and their attempts to “do something” to obtain justice as some sort of compensation for their loss. We see relationships break down and we see relationships heal.

I recommend watching and hope that it highlights the need for more resources for postpartum people and families who are dealing with grief from birth trauma – which can happen even when there is no loss of life.

5 Benefits of a Home Water Birth

Throughout your pregnancy, the one thing that lingers in your mind often is the time of giving birth. There are a variety of birth options available today. Depending on your overall health and preference, you can choose to give birth from home, and a highly recommended method is a water birth.

Did you know today, thousands of women worldwide are choosing home water births? To find out why, keep reading.

What exactly is a home water birth? It is merely a birth that happens at home and is attended by a qualified midwife or doctor. In this case, the baby is born in the water, usually a birth pool. You may choose to labor in the water and get out to deliver, or you could decide to deliver in the water. The concept behind a water birth is that it will be gentler for the baby since it has been in the amniotic sac for nine months.

Are you thinking of having a water birth? Or are you still unsure whether it’s worth it? Let’s dive into some of the benefits of home water births to help you make an informed decision.

Benefits of a home water birth

Water births are becoming more popular each day. Wondering why? According to the American College of Obstetricians and Gynecologists, water births comes with some incredible benefits, making them a worthwhile pursuit. These benefits include:

Increased relaxation

Most women choose water births because of the relaxation benefits the water gives. How so? The answer lies in the water temperature and motion that helps in relaxation throughout the labor. Contractions usually lose their rhythm if you are tense. Once you are in the warm water, you feel relieved and relaxed, making contractions less stressful and shorter.

Being fully immersed in water also lowers your blood pressure, giving you a more relaxed feeling. Water birth is also less stressful for your baby.

Pain relief

If you want natural birth pain relief, then water birth is your friend. Many women opt to deliver their baby in the water because they won’t need pain relief medication like an epidural. Being in the warm water makes it easier for you to manage your painful contractions.

A higher sense of privacy

A birthing pool and a dimmed room is privacy on another level. Who would not feel relaxed in such a situation? Compared to bright labor wards, the ambiance in your home is significantly more comforting. Your focus is solely on labor with this form of privacy. For some people, quietness is pivotal to keeping them calm.

Increased sense of control

The water’s buoyancy effect lessens your body weight, allowing you to move freely and switch angles until you find a comfortable position. In a nutshell, being in the water makes you safer, secure, and more comfortable.

Reduced chances of episiotomy

An episiotomy is a surgical cut performed to enlarge your vaginal opening while giving birth. To avoid tearing and stitches, water birth comes in handy. It makes the perineum to be more relaxed and elastic. As a result, it reduces the incidences of tearing and enlarging the vaginal opening.

Water births present a gentler welcome to the world for you and your baby. Delivering in a birth pool comes with tons of benefits that make it a worthwhile option to consider. Benefits range from reduced labor pain and increased relaxation, to the privilege of giving birth surrounded by your loved ones.

Contact us today for more information about home water births.

Midwife360 Partners with Care Credit

Care Credit for Maternity Services Palm Beach

Introducing Care Credit at Midwife360!

Having a natural birth at home is becoming more and more appealing as the COVID numbers grow and healthy pregnant people begin to question the automatic choice to give birth in the hospital.

However, home birth is not always covered 100% by insurance (think deductible and co-insurance) and even with Medicaid, there are some out of pocket expenses that Medicaid does not cover. With Midwife360, the lowest out of pocket amount is currently $1200 and many folks with private insurance may have to pay around $5000 when the numbers are crunched for their particular benefit plan. Our self pay rate is $6700. While even that is a small price to pay for one of the most beautiful and memorable days of your life, not everyone has that kind of cash available or even that much credit.

Enter Care Credit. Care Credit is easy to apply for and most people are approved and the staff at Midwife360 will help. It allows for a 4th option (other than cash, debit, or traditional credit card) to pay for your care without breaking the bank. Depending on the program chosen, there is an option for 6 or 12 months credit with no interest, or a low interest 24 month credit card.

Midwife360 pays a small percentage and we get paid for our services while the client gets to pay over more time for no extra cost (when choosing the no interest option).

We are happy to be able to help our clients be able to pay for their care without causing undue financial stress. Contact us today to find out more!

What to Expect From a Home Birth

So you’ve decided to have your baby in the comfort of your own home. What should you expect? As a CNM who has provided home birth services for nearly 6 years, I am going to provide you with an overview of the general expectations that await you in this experience.

We visit your home 

Your provider will come to your home at least once during the prenatal period to assess home readiness for birth. We like to see that our clients have acquired all of the supplies that were recommended, including the kit of supplies that was provided by our practice. Some examples of supplies provided by the practice are sterile gauze, sterile gloves, a peri bottle, chux pads, a fish net (for pooper scooper if having water birth), a waterproof mattress cover, and potentially other items depending on the practice. The items that you are responsible for include a drinking water safe water hose, adapter for the faucet, receiving blankets for the baby and towels of various sizes, snacks for the laboring person and birth team, adult diapers or maxi pads, a waterproof covering for the floor and extra padding for under the pool. We like to see that the intended birth space is clean and clutter-free and in an intimate space where the birthing couple can get privacy if desired. It should be in close proximity to the bed and bathroom.

What happens when you go into labor? 

Once you have decided that you are in labor you will be in contact with your midwife and doula. We like our clients to set up a group text with their partner, doula, midwife and assistant so communication is transparent for all involved. This way the laboring couple are not asked the same questions by different people and everyone knows what’s going on. Typically the doula will arrive first, and if the laboring person desires a cervical check to see where things are at, the midwife or assistant will come to do a labor check. We will assess her contractions, her coping, when she last ate/drank/used the bathroom. We listen to fetal heart tones, take vitals and get an overall feel for what’s going on – including the emotional environment. 

Sometimes we have to reassure the partner more than the laboring person of the normalcy of the situation. If the cervical exam isn’t 4-6cm and the labor doesn’t seem to be progressing quickly, the midwife will leave and the doula may stay to help the couple perform some Spinning Babies circuits. Usually the doula will help to set up the tub when it’s time and let the couple know when it’s time to call the midwife back. At any point, if the couple wants the midwife to come, we will come and assess the situation.

Active Labor 

Once the laboring person is clearly in active labor, the midwife or assistant will stay and perform checks on the baby’s heartbeat and mother’s vitals on a schedule at least every half hour. We listen for a period of time through and after the contraction to get a feel for the response of the baby to the contractions. We are watching for anything outside of the normal range as well as for specific things like maternal bleeding, fever, or lack of coping. We have many tools we can employ – depending on the midwife and her range of experience. 

Our Toolbox 

We use herbs, homeopathic remedies, essential oils, posture changes, and of course, hydrotherapy. We make sure she stays well hydrated, well nourished, and well rested – these three elements are crucial to avoid exhaustion which is a laboring person’s enemy. Sometimes we use alcohol to aid relaxation and sleep if mom becomes exhausted and her labor is stalling out. Once she gets rest she is much more capable of continuing and usually the labor will pick up on its own. We have found that labor has its own waxing and waning rhythms much like each individual contraction and it works much better to flow with it rather than trying to force it to conform to some ideal pattern.

A note on hospital transferring 

If at any point along the way the laboring person changes her mind about being at home, for any reason, we will shift gears and transfer to the hospital setting. Of course we first assess if she is in transition as many people have doubts about their ability to birth in the crucial moments just before the baby makes his final descent. However, if we determine that she is no longer comfortable at home we will get her quickly into the car and to the hospital of her choice. We call ahead to give report and accompany her to the hospital.* Once there, we would stay until her care is fully transferred to her new care provider or until the baby comes if financial arrangements have been made.

Staying home 

Most people are happy to stay home as this has been something they have prepared for physically, emotionally, and spiritually, sometimes for years. Most also birth in the tub if they have rented one and are comfortable in it. 

Whether in the water or on land, baby comes out as slowly and gently as possible with lots of encouragement and coaching from the team. We have found that the slower the expulsion of the head and body, the less trauma to the mother’s vagina, labia, and perineum. Contrary to what we hear from our clients who transfer to us, we are well equipped to sew almost any tear that happens during birth. We carry Lidocaine for numbing and sutures for sewing.

“Self Starters” 

Most babies are what I like to refer to as ‘self starters’. They will spit or cough and utter a birth cry and then they are breathing. Most of them do not cry as their birth has been so gentle they have no reason to cry. We know when to employ helpful measures such as postural drainage, stimulation, rescue breaths, and suctioning and are fully equipped to perform a full on cardiac resuscitation on the newborn if necessary. 

I have seen 1 instance out of 250 home births, and 0 instances out of the over 1600 hospital births that I have assisted in my career of babies needing full on cardiac resuscitation. BIRTH IS A NORMAL, PHYSIOLOGIC FUNCTION OF A WOMAN’S BODY THAT RARELY NEEDS HELP FROM OTHERS. As long as the body is healthy with no underlying medical problems, giving birth outside the hospital is actually safer for the mom and the baby.

Post Birth Procedure 

We keep a close eye on both mom and baby right after birth, assessing vital signs and mom’s bleeding every 15 minutes or more often as needed. We carry 3 different drugs to treat hemorrhage, and one of them, methergine, we have both pill and injectable form. We will not hesitate to call 911 if there is any emergency event that requires hospital intervention. We stay for 3-4 hours after the baby is born, assessing vital signs and the baby’s transition. 

Once the placenta is birthed, we ensure that mom has eaten, showered and urinated. We perform an Eldon card so we know the baby’s blood type and can make recommendations for jaundice prevention or give Rhogam to the mom as needed for Rh negative moms. We make sure the baby is breastfeeding well and the parents are comfortable in their new roles. 

Postpartum Visits 

After the birth we make sure our clients know that they can call us for any problem with mom or baby and that we will be coming back to the house between 24-48 hours after the birth. At that visit, we perform the CCHD**, jaundice, and weight checks. We give the Vitamin K injection if the parents have chosen to have it. We would give the Rhogam shot if Mom is Rh negative and baby is Rh positive. We assess breastfeeding again and refer to the pediatrician if there are any concerns with the baby. We assess moms bleeding and comfort and any issues with depression. We return again to the home at 1 week postpartum to reassess all of the above concerns for the mother. And we will schedule the final postpartum visit at 5-6 weeks in the office to talk about family planning, pap smear schedule and any other concerns that arise.

This article gives an overview of what to expect when planning a home birth. Stay tuned for more educational articles from Midwife360!

*There have been a few instances where we have not accompanied a client to the hospital. These were rare and individual circumstances and not the normal scenarios.

** CCHD = Critical Congenital Cardiac Defect A screening test performed on the baby between 24-72 hours after birth to rule out any critical congenital heart defects.

High-tech Childbirth is Not Always Better

Baby girl few minutes after the birth

America excels in high-tech medicine

When it comes to healthcare and medicine, America is the greatest country in the world. If you get into a car crash or have a heart attack, or need a life-saving surgery, then you are very grateful to have that happen in the US of A. However, this statement is not true if you are pregnant and healthy. It is well known that the US scores shamefully low on the two standards used worldwide to evaluate how well a country is doing in the area of childbirth – infant mortality and maternal mortality. And it’s not a mystery as to why this is the case. We know that the standard interventions performed on pregnant women in the hospital on low-risk, healthy moms and babies are not evidence based. Withholding food and fluids by mouth.  Limiting movement and positioning in labor.  Use of continuous fetal monitoring for low risk labors.  Non-medically indicated inductions.  Immediate cord clamping.  Overuse of Pitocin for labor augmentation. All of these standard interventions can lead to perceived and real problems that trigger the cascade of events leading to an operative delivery – forceps, vacuum extraction, or cesarean (and occasionally a cesarean with forceps or vacuum delivery!).

Low-tech better for physiologic childbirth

When it comes to childbirth, high tech is not better than low tech. I have been privileged to attend many out of hospital births and many more in hospital births. Even a ‘normal’ birth in the hospital typically comes with continuous fetal monitoring and epidural. And unless it is the middle of the night and the lights are kept dimmed, the nurses use intermittent monitoring, the cord is left alone for at least 10-15 minutes, and the baby is kept on the mother AT ALL TIMES, no hospital birth worker has truly witnessed natural birth. There are many, many videos of home birth on the internet and it can be seen time and again the beauty and wonder of birth as it is meant to be.

Out-of-hospital birth should be first-line care for all low-risk childbirth

We have such great prenatal care standards, that any significant problem with the mom or the baby will most likely be detected prior to labor so that a baby that may need more high tech assistance can be born in a place where she can receive that assistance in a timely manner. It is so unlikely that a healthy mom and baby will have a major life-threatening problem during the birth process, that out of hospital birth and midwifery have been approved through legislation in most states. And statistics have proven that most transports from an out of hospital setting are done for non-emergent reasons. The American Congress of Obstetricians and Gynecologists have suggested that the out of hospital Birth Center should be the first level of care for healthy pregnant women. They recommend only moving up the chain to a hospital capable of performing a cesarean if there are risk criteria that have been demonstrated.

Low-tech interventions for childbirth

So that means in order to fix the problem, more doctors need to be trained in the low tech hand skills that are truly helpful to laboring women. These include Leopolds maneuvers (feeling the baby from the outside to determine it’s position), which, when performed properly, can assist the provider to be able to tell not only the baby’s position but if there is adequate fluid around the baby. Keeping hands out of the way other than to provide warm compresses during the actual birth. Turning a breech baby to avoid a breech delivery. Even being able to perform a breech delivery – these are skills that are slowly being lost to us because they are not being taught in medical schools. And delayed cord clamping is probably the single most important non-intervention that can be supported at a birth! We have been complacent, and have allowed an intervention – immediate clamping and cutting of the umbilical cord (that typically happens in the course of surgical birth) – to become standard of care for all births without studying the effects. It is part of the OB culture and doctors and CNMs are taught to do it without question. This is what happens when you put surgeons in charge of a physiological event.

Women’s complacency has really been the main cause of our loss of control over our bodies and our labors. It is time for us to stand up and reclaim our bodies, our labors, and our births. Support your local midwife, demand respect and evidence based care. Maintain a healthy lifestyle and prepare yourself for an out of hospital birth – it will transform your life!

 

Birth Similar to Love Making?

Pregnant couple relaxing on bed at home
Pregnant couple relaxing on bed at home

Birth Similar to Love Making?

Pregnant couple relaxing on bed at home

Birth Similar to Love Making?

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headaches_during_pregnancy

Headaches During Pregnancy

Headaches are one of the most common discomforts during pregnancy, especially during the first and third trimester. As a pregnant woman, our bodies go through

I believe that giving birth is similar to making love.

Normal, low-risk childbirth is very difficult to achieve in the hospital setting. Even when you have the most amazing provider, the very atmosphere prevents it. I believe the reason for this is related to the fact that childbirth is similar to making love. It’s not really such a wild idea if you think about it like this… For most people with a natural pregnancy, lovemaking is the act that starts the whole process. Pregnancy ensues and the body nurtures and grows the seed into a baby and through the maturation process until the appropriate time to release it into the world.

There is believed to be a multifactorial triggering process that is not well understood. However, it is common knowledge that once it gets going, labor responds well to dim lighting, quiet surroundings, and the soothing, loving support especially from the birthing person’s partner. Sound familiar?

What doesn’t work

When frightened, our mammal cousins have been known to stop their labors in order to move to safety. The same is true for humans, which is why there is an epidemic of Pitocin in use in most hospital Labor and Delivery units around the world. Normal labor does not respond well to bright lights, loud noises, and strangers. This has been discussed at length by obstetric greats such as Grantly Dick-Read and Michel Odent – both ardent proponents of unmolested birthing. Imagine trying to make love and achieve orgasm with all of that activity going on around you!

Your Partner

Another parallel between love-making and childbirthing has to do with the birthing person’s partner. Of course, the partner is included and involved with all aspects of the process as they were an integral part of making it happen. (What other hospital-based care takes place with the ‘patient’ AND their partner? No surgical procedures or any other procedures are a family event unless it’s a small child who needs a parent present for comfort.) In the majority of cases, the partner was present and responsible for planting the seed, and therefore is integral to the birthing process.

They have a bond in their union making the partner the one unique person in the room who is intimate with the birthing person. When the partner lovingly strokes and massages, whispers loving words of encouragement and is just completely present to the process, it causes the birthing person to release oxytocin which in turn causes the labor to intensify. Also, just like in love-making, the need for single-minded concentration is paramount to achieve the level of trust, openness, and surrender that is necessary for birth to happen.

Uncomfortable & Fearful

The combination of poorly designed rooms and standard interventions that are not evidence-based has created the need for using a dangerous drug on nearly all normal labors! When birthing people are not comfortable or if they are fearful, they will not be able to achieve the level of relaxation and focus required for efficient birthing.

Pitocin

Pitocin is the synthetic version of oxytocin – also known as the ‘love’ hormone. It is produced by our bodies when we hug another person (or animal) or make love, and it is this hormone that causes the uterus to contract and expel the baby.

We have discovered that we can give the synthetic version to pregnant individuals to start labor or make contractions stronger and closer together. But it is not without risks. It is a dangerous drug that can cause contractions that are too close together and too strong creating distress for the baby.

Pitocin is the reason for many emergency cesareans in labor. Having Pitocin creates the need for other non-evidence based interventions such as continuous monitoring and IV which in turn lead to another non-evidence based intervention – immobility, being stuck in the bed, usually on the back – all of these being extremely unhelpful to the laboring person. Another downside to Pitocin is the accompanying liters of IV fluids that the laboring person tends to receive.

It is not uncommon for someone to get 4, 5, even 6 liters of fluid during an induction, especially if they elect to get an epidural. All of this fluid can cause swelling and difficult breastfeeding due to the extreme engorgement that occurs. So instead of giving a dangerous drug to augment labor when people come into the hospital, why not redesign the physical space to encourage natural labor to do the job?

Let’s change things

We have birthed successfully without Pitocin for millennia before birth entered the hospital in the early decades of the 1900s. Let’s alter the external physical space and encourage practices that support the human body and psyche to birth naturally. The only people who require drugs to enable lovemaking are those with hormonal imbalances, it should be the same for normal, low-risk childbirth.

I propose that labor and delivery units set aside a block of rooms with dimmers on all the light switches, electronic candles sprinkled throughout the room, handheld dopplers for intermittent monitoring, multiple options for hydrotherapy including showers big enough for 2 people and a birth ball or shower chair and labor/birth tubs. They should have a welcoming attitude for partners and doulas; no standard IV or continuous monitoring; and healthy snacks. I believe that providers would find less of a need to augment labors and we could reduce our overall cesarean rates while improving client satisfaction.

Share:

Share on facebook
Facebook
Share on twitter
Twitter
Share on pinterest
Pinterest
Share on linkedin
LinkedIn
On Key

Related Posts

headaches_during_pregnancy

Headaches During Pregnancy

Headaches are one of the most common discomforts during pregnancy, especially during the first and third trimester. As a pregnant woman, our bodies go through

I believe that giving birth is similar to making love.

Normal, low-risk childbirth is very difficult to achieve in the hospital setting. Even when you have the most amazing provider, the very atmosphere prevents it. I believe the reason for this is related to the fact that childbirth is similar to making love. It’s not really such a wild idea if you think about it like this… For most people with a natural pregnancy, lovemaking is the act that starts the whole process. Pregnancy ensues and the body nurtures and grows the seed into a baby and through the maturation process until the appropriate time to release it into the world.

There is believed to be a multifactorial triggering process that is not well understood. However, it is common knowledge that once it gets going, labor responds well to dim lighting, quiet surroundings, and the soothing, loving support especially from the birthing person’s partner. Sound familiar?

What doesn’t work

When frightened, our mammal cousins have been known to stop their labors in order to move to safety. The same is true for humans, which is why there is an epidemic of Pitocin in use in most hospital Labor and Delivery units around the world. Normal labor does not respond well to bright lights, loud noises, and strangers. This has been discussed at length by obstetric greats such as Grantly Dick-Read and Michel Odent – both ardent proponents of unmolested birthing. Imagine trying to make love and achieve orgasm with all of that activity going on around you!

Your Partner

Another parallel between love-making and childbirthing has to do with the birthing person’s partner. Of course, the partner is included and involved with all aspects of the process as they were an integral part of making it happen. (What other hospital-based care takes place with the ‘patient’ AND their partner? No surgical procedures or any other procedures are a family event unless it’s a small child who needs a parent present for comfort.) In the majority of cases, the partner was present and responsible for planting the seed, and therefore is integral to the birthing process.

They have a bond in their union making the partner the one unique person in the room who is intimate with the birthing person. When the partner lovingly strokes and massages, whispers loving words of encouragement and is just completely present to the process, it causes the birthing person to release oxytocin which in turn causes the labor to intensify. Also, just like in love-making, the need for single-minded concentration is paramount to achieve the level of trust, openness, and surrender that is necessary for birth to happen.

Uncomfortable & Fearful

The combination of poorly designed rooms and standard interventions that are not evidence-based has created the need for using a dangerous drug on nearly all normal labors! When birthing people are not comfortable or if they are fearful, they will not be able to achieve the level of relaxation and focus required for efficient birthing.

Pitocin

Pitocin is the synthetic version of oxytocin – also known as the ‘love’ hormone. It is produced by our bodies when we hug another person (or animal) or make love, and it is this hormone that causes the uterus to contract and expel the baby.

We have discovered that we can give the synthetic version to pregnant individuals to start labor or make contractions stronger and closer together. But it is not without risks. It is a dangerous drug that can cause contractions that are too close together and too strong creating distress for the baby.

Pitocin is the reason for many emergency cesareans in labor. Having Pitocin creates the need for other non-evidence based interventions such as continuous monitoring and IV which in turn lead to another non-evidence based intervention – immobility, being stuck in the bed, usually on the back – all of these being extremely unhelpful to the laboring person. Another downside to Pitocin is the accompanying liters of IV fluids that the laboring person tends to receive.

It is not uncommon for someone to get 4, 5, even 6 liters of fluid during an induction, especially if they elect to get an epidural. All of this fluid can cause swelling and difficult breastfeeding due to the extreme engorgement that occurs. So instead of giving a dangerous drug to augment labor when people come into the hospital, why not redesign the physical space to encourage natural labor to do the job?

Let’s change things

We have birthed successfully without Pitocin for millennia before birth entered the hospital in the early decades of the 1900s. Let’s alter the external physical space and encourage practices that support the human body and psyche to birth naturally. The only people who require drugs to enable lovemaking are those with hormonal imbalances, it should be the same for normal, low-risk childbirth.

I propose that labor and delivery units set aside a block of rooms with dimmers on all the light switches, electronic candles sprinkled throughout the room, handheld dopplers for intermittent monitoring, multiple options for hydrotherapy including showers big enough for 2 people and a birth ball or shower chair and labor/birth tubs. They should have a welcoming attitude for partners and doulas; no standard IV or continuous monitoring; and healthy snacks. I believe that providers would find less of a need to augment labors and we could reduce our overall cesarean rates while improving client satisfaction.

Creating Value in Childbirth

young pregnant woman

Costs of Care Creating Value Challenge

In 2007, the Institute for Healthcare Improvement (IHI) proposed a framework for optimizing health system performance known as the “triple aim”. The three components are:

  • Improve the experience of care
  • Improve the health of populations
  • Reduce the per capita costs of healthcare

At Midwife360 we hit the bullseye on all three! Now, where is that friendly OB who wants to play with us?

It’s time to apply the IHI triple aim to childbirth!

It is well known that the American childbirth culture is very expensive with very poor performance AND little of what happens to birthing people in hospitals is evidence-based.

Childbirth for low-risk healthy women (who comprise the majority of people giving birth) benefits from less, rather than more technology. It is, after all, the only physiologic human function that has been relegated to hospital care. Achieving good outcomes usually goes hand in hand with a positive experience of care and this can be done in a very low-tech, inexpensive way by creating teams of home birth midwives and OBs.

Comfort is key

ACOG approves of home birth under certain conditions – choosing the appropriate client, with a CNM, in an integrated environment. As giving birth is much like making love, it is easier to imagine this happening in an environment where the birthing person feels the most comfortable – whether that be her home, a birthing center, or a hospital. So creating a culture that truly supports choice for birthing people without removing the option of access to a higher level of care can be accomplished by having a care team of a homebirth midwife and OB with hospital privileges.

Recreating home

Short of that, making hospital labor rooms more homelike – dimmers on the main lights, several options for water immersion (large shower, birthing tubs), small refrigerators in the room, and a second bed for family members or the doula to use – and updating care to reflect the evidence and patient preference are all absolutely necessary to achieve the IHI triple aim.