Medicinal Herbs for a Safe Holistic Pregnancy

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The midwives at MidWife360 in West Palm Beach, Florida have gathered our collective knowledge and experience in order to provide you with an introduction to using herbs during pregnancy.

Initial Thoughts on Modern Medicine

As a certified nurse midwife, I’m forever grateful for the medical advancements in obstetric gynecology. Thanks to these technologies, the outcomes of high-risk pregnancies and complications in birth and pregnancy have vastly improved. This has saved countless lives. 

There are two sides to every coin, and unfortunately some of these advancements have been, and are continuing to be overused. For example, about 1 in 3 women in the United States gives birth via cesarean delivery. Many experts agree that this is far too high.

Furthermore, the use of pharmaceutical medications for pregnant women is also excessive, and carries risks like cesarean deliver. Many medications that were thought to be safe, like Tylenol and common yeast infection medications, have been found to carry significant risks. 

Are Herbs Safe?

In comparison, the usage of herbs during pregnancy appears mild and safe. Just like anything, it’s important to be extra informed and safe when using any herbs or medications during pregnancy. The desire toward more natural and holistic solutions has been growing. At MidWife360 we aim to incorporate more gentle and herbal solutions whenever necessary. 

Using herbs for common pregnancy symptoms and discomforts is very commonplace. Using herbs for medicinal purposes dates back to the ancient Egyptians.  In all fairness, scientific research and formal evaluations of many herbs are not available or priority. 

However, pharmaceutical medications are often in the same boat. In the U.S. almost 90% of all pregnant women will be prescribed some kind of medication during their pregnancy. 

As far as herbal and botanical medicine, most of what we know is based on historical, empirical, and observational evidence. There have been some formal and animal studies. Generally, most herbs have no evidence of harm and natural remedies may be safer than typical prescription medications. 

Adverse effects are few and far between, and when they do happen it is often because the individual is uninformed. Some herbs can be toxic or are only appropriate in small doses. Keep in mind, many experts have different opinions on the use of herbs. Just because something does not have proven adverse effects, does not mean it is proven to be safe. 

Some symptoms or illnesses should always call for prompt medical care, and should not be treated at home with herbs. They are as follows:

  • Continuous bleeding
  • Initial herpes blisters or outbreak 
  • Serious pelvic or abdominal pain
  • Continuous serious mid-back pain
  • Hand and face edema
  • Membranes rupture before 37 weeks
  • Regular contractions before 37 weeks
  • Serious headaches, blurred vision, and epigastric pain
  • Fetal movement stopping

Commonly Used Herbs in Pregnancy

There are different lists and opinions among medical professionals. Some of the most common herbs used for pregnancy concerns are: raspberry leaf, evening primrose, garlic, aloe, chamomile, peppermint, ginger, echinacea, St. John’s wort, fennel, wild yam, meadowsweet, pumpkin seeds and ginseng. 

Common ailments pregnant women seek complimentary or natural remedies for are anxiety, nausea or vomiting, urinary tract problems, or lower GI problems. 

This chart is a helpful tool but always work with your doctor or midwife to be safe. The midwives at MidWife360 are well-versed in the safety and use of herbal remedies. 

Herbs for Birth Preparation

Red raspberry leaf tea and red dates are common for birth preparation. Two cups of red raspberry tea daily is safe in pregnancy. 

Additionally, studies have shown the tea causes labor to be more comfortable and reduces need for medical interventions. There are even benefits for babies! Newborns are less likely to require resuscitation. 

Red dates consumed regularly in the last trimester are safe, and also cause labor to be more comfortable. 

The good news is, both the tea and dates are delicious. Making it easy to incorporate into your daily diet and routine. This vegan red raspberry tea latte is a great way to enjoy the tea. Snacking on dates by themselves or adding a few in a smoothie is an easy way to eat them. 

Final Thoughts

Herbal remedies can offer significant relief and benefits for some common discomforts and symptoms of pregnancy and childbirth. Just like anything during pregnancy, use herbs with caution and under the supervision of your midwife or doctor. 

At MidWife360 in West Palm Beach, Florida we offer herbal recommendations for our patients when needed. Though nothing can replace a healthy diet, exercise, positive mindset, and support system. 

A Complete Guide About Shoulder Dystocia

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What is Shoulder Dystocia?

Shoulder Dystocia is a birth complication that happens during vaginal delivery. When this occurs, one or both of the baby’s shoulders get stuck inside the mother’s pelvis during labor. This causes a stall in the delivery process, which can be life threatening. In most cases, babies born with this complication are delivered safely. However, it can cause problems for both the baby and mother. 

Shoulder dystocia happens in 0.2 to 3 percent of pregnancies, and sadly, is unpredictable and unpreventable. When complications happen during labor, doctors turn to urgent cesarean delivery or surgery to avoid further issues. Although this may work in most cases, urgent cesarean delivery or surgery cannot correct this condition. 

Continue reading below for answers to all questions regarding this topic. 

Frequently Asked Questions:

What Does Shoulder Dystocia Look Like?

When Shoulder Dystocia occurs, the fetal head is delivered but the shoulders are not seen and are not being delivered with normal maneuvers. In other words, this delay in labor causes the baby to be trapped mid delivery. When this is happening, your midwife or provider tries to move your body and baby into better positions to continue natural delivery. 

The shoulder of the baby normally gets stuck behind the mothers pubic bone or sacrum. During this delay, the baby cannot breathe and the umbilical cord may be squeezed or wrapped around the baby’s neck. It is dire that everyone stays calm but acts quickly and efficiently to prevent further complications. The midwife will ask the mother to cease pushing so she can reposition her and the baby as needed.       

Why Does This Happen?

Shoulder Dystocia can occur during any vaginal birth, and without warning. Some of the most common causes for this are that the baby is too big, the baby is in the wrong position or the mother being in a restricting position. Oftentimes, your midwife or provider will change the mothers position to help free the shoulders from the pelvic area. 

It is nearly impossible to predict the risk factors of whether or not your baby will have this complication, but there are some things that can make it more likely. This includes:

  • Shoulder Dystocia occurred during previous pregnancies
  • Fetal Macrosomia (having a larger baby)
  • Having twins or multiple babies
  • Mother is overweight
  • Mother has diabetes
  • Labor induced 

Although these factors may increase the risk of a baby being born with Shoulder Dystocia, it is not clear why some pregnancies experience this complication while others do not. One statistic states that women with a history of having a delivery with Shoulder Dystocia are 10- 20 percent more likely to have a recurrence. 

What are the Complications?

Although most mothers and babies may not experience any further issues regarding this complication, it can bring about further issues. When delivering a baby with Shoulder Dystocia, a midwife or provider may have to break the baby’s collarbone to help with removal of the shoulders. This is a last resort, but may be necessary. This is only one risk that may come from this condition. 

Further risk for the baby may include:

  • Fractured collarbone (clavicle) or arm
  • Fetal brachial plexus injury
  • Lack of oxygen to the body
  • Brain injury due to lack of oxygen (this is rare)
  • Loss of baby (this is rare)

Further risk for the mother may include:

  • Maternal hemorrhage/ postpartum hemorrhage
  • Repairs for episiotomy or tearing during delivery 
  • Uterine rupture

Can You Prevent or Treat Shoulder Dystocia?

Like we touched on above, Shoulder Dystocia is extremely unpredictable and there is very little prevention. Being mindful of potential risk factors like diabetes and watching your weight during pregnancy are all things to help lower your chance of complications during labor. At Midwife360, we recommend our mothers to give birth lying on their side or on all fours to help natural movement of the delivery process. This will help prevent complications like Shoulder Dystocia. 

It is important to inform the expecting mother about the complications and risks of Shoulder Dystocia.  As well as reassure her that, as a midwife, we are trained thoroughly on how to deal with these complications in the safest and most efficient way for the safety of you and your unborn child.  

If You Have Further Questions

If you have any questions unanswered or need more information contact us at Midwife360. At Midwife360 we provide holistic gynecology and pregnancy services, including home and water birth to women throughout South Florida. Our mission and practice is designed to meet the individual needs of each woman and expecting family we care for. We believe women should be informed and educated about their healthcare options for routine care, family planning and birthing.

Headaches During Pregnancy

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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 so much physical and mental change. During pregnancy, a woman’s body experiences changes in hormone levels and heightened blood volume. These changes can trigger more frequent headaches. Other triggers can also bring on headaches like stress, dehydration, lack of sleep and not having your normal cup of joe each morning.  

Unfortunately, when most will gravitate towards using over the counter headache medication, pregnant women are normally hesitant. If you are experiencing severe or frequent headaches, always consult with your doctor. There are different types of headaches that you may experience during your pregnancy. Continue reading to learn more about these and how you can treat these headaches in the safest way for you and your baby. 

Different Types of Headaches

More times than not, the headaches women may experience during pregnancy are primary headaches, meaning that the pain doesn’t come from another underlying issue. Experiencing these during pregnancy are common and should not bring alarm. Letting your doctor know you are frequently experiencing headache pain is important to find out what can best help relieve your discomfort. 

 The three most common types of headaches experienced during pregnancy are:

  • Tension headaches
  • Migraines
  • Sinus headaches

Tension headaches are the most common type of headache you will experience. This can be brought on by stress, hunger or if you are carrying tension in your neck and shoulders. When suffering from a tension headache, you may experience mild or moderate dull pain behind the eyes on both sides of the head. Oftentimes, tension headaches will go away within an hour or two. 

Migraines are a more intense sensation of pain that throbs, and can be felt on one side of the head and neck. These types of headaches tend to last for hours and sometimes days. Migraines can also bring on other symptoms like blurred vision, light sensitivity, numbness and nausea. 

Lastly, some women can experience sinus headaches during pregnancy. With a sinus headache, women will experience intense pressure around the eyes, cheeks and forehead area. These types of headaches can also trigger a stuffy nose and occur when someone has a sinus infection. Like migraines, these headaches get worse with more movement and light exposure. 

Is Tylenol Safe?

When most people experience headaches or muscle pain, oftentimes, without second thought, they grab a bottle of Tylenol to relieve this pain. Tylenol contains the drug acetaminophen or paracetamol. Most doctors recommend the use of Tylenol rather than other over the counter medications like Ibuprofen and Aspirin. If your doctor recommends the use of Tylenol during your pregnancy to relieve headache pain, it is important to only take the dose recommended. 

Due to the fact that you are now fueling two bodies, many pregnant women choose to take the holistic route. They make healthy changes in their diet and exercise habits to ensure the health of their baby throughout their pregnancy. Oftentimes, women choose to opt out from putting things like Tylenol into their bodies to stay as natural as possible, but what are alternative options to dealing with the pain?

What Are Safe/Holistic Remedies? 

Many people choose to avoid medication if they can, especially women who are pregnant. What happens when a pesky headache comes on and the pain is not bearable? Here are some home remedies that can help relieve headache pain without all the pills. 

  • Lying in a dark room with eyes closed and minimal light
  • Cold compress over eyes and neck
  • Heating pad/ steam to relieve any pain
  • Drinking plenty of water and eating enough protein
  • Getting an ample amount of sleep 
  • Taking a warm bath with Epsom salt
  • Essential oils
  • Drinking tea (without caffeine) 
  • Meditation
  • Pregnancy massages 

These home remedies are known to help relieve headaches whether you are pregnant or not. If your pain becomes more severe or too frequent, consult with your doctor or OBGYN and discuss what the best and healthiest options are. If you are looking for holistic gynecology and pregnancy services, including home birth and water birth in South Florida, visit Midwife 360 for all of your questions and needs.

Finding The Optimal Fertility Diet

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If you’re considering becoming pregnant or trying to conceive, you’ll want to make sure that you’re staying healthy and fit. That doesn’t simply mean seeing a lower number on the scale or paying closer attention to how much time you’re spending on the treadmill—being your healthiest means taking a good, hard look inside your kitchen cupboards and at what you’re putting into your body. Practicing a well-rounded fertility diet is one of the first steps to successfully conceiving and carrying the healthiest child possible.

What you’re putting into your body each day is even more important than you think. Some foods may even be hurting your chances of becoming pregnant. To get pregnant and maintain a healthy pregnancy, you’ll need a fertility diet that increases your chances of conception and keeps you strong.

Fill Up on Fruits and Vegetables

You’re aiming for a healthy pregnancy for you and your baby. To be at your healthiest, you’ll need nutrients that take you there. That’s why eating enough fruits and vegetables is vital to optimizing your fertility.

Somehow those leafy greens and juicy fruits aren’t as familiar to the American diet as you would think. Unfortunately, many people don’t get enough of these essential foods when ordering on the run from their local restaurant or shopping for weekly groceries at their neighborhood grocery store. Although packaged foods tend to be the go-to items that people choose during a hectic workweek, they’re not the most nourishing foods for the body.

If you want to improve the quality of your reproductive system, start filling up your plate with plenty of fruits and vegetables. Here’s a simple tip to remember the portion sizes you need: At each meal, make sure half of your plate is full of fruits and vegetables. Some raw fruits and vegetables contain a good supply of glutathione. This is highly important for your egg quality.

If it feels difficult to get enough fruits and vegetables in each meal, put your juicer to good use. Juice some fresh fruits and veggies rich in vitamins each morning at breakfast. Or, try making a delicious smoothie with frozen fruits and yogurt.

Switch to Healthier Fats in Your Diet

Remember to stay away from trans fats. It’s a cruel culprit in the food world that’s considered one of the worst forms of fat you can eat. Trans fats can hide in vegetable shortening, fast-food items, non-dairy coffee creamers, and even baked goods. They can clog your arteries, and they can also increase insulin resistance. When the body experiences high insulin levels, it can cause a metabolic disturbance. This can affect your ovulation cycles, as well.

From now on, try to only eat healthy fats. Not only are they better for you, but they can also help women who are having a tough time getting pregnant. That means focus on incorporating plant-based fats that give your body the nutrients it needs as well. For example, try adding more avocados, nuts, olive oil, and grapeseed oil to your diet.

The switch from trans fats to healthier fats may be tough, seeing as these items are popular in many people’s diets. These are common foods that you may want to indulge in when you’re craving something sweet during the day. Unfortunately, these foods aren’t healthy for your body or your baby.

Strengthen Your Diet with Powerful Proteins

It’s not always easy to get enough of the protein you need to stay healthy. Also, not all protein is created equal.

When it comes to creating a balanced diet geared toward peak fertility, you’ll want to reconsider the protein sources you’re eating. First, you’ll want to cut out the fast-food meats that may be lurking in your diet. These convenience foods are never good for you. Keeping away from these foods is crucial to sustaining a healthy pregnancy. If you’re not already eating an organic, whole foods diet, start now.

If you’re getting a large amount of your protein from red meat sources in your diet, you may want to begin cutting back. When you’re creating a meal plan, notice how much red meat you’re eating. Switch to other protein sources that will be better for your fertility. That means more chicken, pork, and turkey. These foods will give you the protein, iron, and zinc you need.

Another source of protein to include? Coldwater fish. If that worries you, you’re not alone. Chances are, you may be worried about the mercury levels that physicians warn about ingesting before or during pregnancy. However, food items like salmon, sardines, and canned light tuna are fine to eat a couple of times a week.

Choose Better Dairy Options

Maybe you’ve heard about people filling their meal plans with low-fat dairy items. Or, perhaps a particular “no-dairy diet” has made enough magazine headlines that it’s made you reconsider your stance on cream and milk products.

The truth? Dairy items aren’t the “bad foods” people have made them out to be in recent years. It just depends on what kinds of dairy items you’re consuming. For example, milk is an excellent source of B-12. It’s essential to have adequate B-12 levels in your diet. Some studies suggest that low levels of this critical vitamin are associated with infertility in some women.

Experts recommended that you get one or two servings a day of a full-fat dairy item. When it comes to milk, make it a glass of whole milk. Full-fat yogurts are always better than low-fat yogurts when it comes to an optimal fertility diet. It’s ok to have a small dish of full-fat ice cream as well.

Complete Your Fertility Diet with Complex Carbs

Carbohydrates that contain the fiber you need are different from the carbohydrates that are in cookies and cakes.

The sugar-filled cookies and frosting-covered cakes that line the shelves behind glass containers in bakeries are the kinds of carbs that aren’t good for you. These foods will digest quickly in your body, and turn into blood sugar.

However, the good carbohydrates your body craves take time to digest. These are the carbs you should be focusing on adding more to your diet. “Slow” carbs are considered to be better carbs for your body. These good carbohydrates come from whole grains, vegetables, and fruits.

The fertility diet that’s best for you will include nutrient-dense foods that give your body the vitamins and minerals it needs to create life. The decision to have a child is one of the most rewarding decisions you’ll ever make. It can be a challenging, and beautiful journey. To create and maintain a healthy pregnancy, you’ll need someone who can give you the guidance, compassion, and support you deserve. Whether you’re deciding on the best fertility diet to implement, or selecting the best midwife to deliver your baby, you deserve someone you trust by your side to make these decisions along with you. Midwife360 is available to guide you through every step of your pregnancy journey. Visit our website today to see our array of services.

Birth Plan: Why You Need a Midwife and Doula

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The Birth Plan

If you are an expectant mother, then you understand the importance of having a birth plan. Each couple will have a different plan for their pregnancy and birth; this plan is associated with their wishes and values. Do you have a birth plan? Does your birth plan include a Midwife and Doula? First, it is necessary to understand how a Midwife and Doula can help you before, during and after your pregnancy.

Midwives and Doulas

Ever since the beginning of humanity, women have been giving birth, and they have had individuals who were there to support them in their birthing process. Midwives and Doulas are the individuals who help mothers to create and fulfill their desired birthing plan. Even though these specialists have job descriptions that pertain to pregnancy and delivery, their responsibilities are actually quite different.

The Work of a Doula

Doulas are individuals who are particularly concerned with the mother’s comfort and care before, during and after the birthing process. Doulas are able to give the mother the comfort that she needs. This comfort can include massages, soft music, aromatherapy, encouraging words or other techniques that will help the mother to have the best birthing experience possible. A Doula is not a medical professional and cannot perform any medical procedure. She cannot help a woman give birth, she is only there for the comfort of the mother who is in labor.

What is a Midwife?

A midwife is a medical professional who works directly with a mother who is giving birth. The job of this specialist may vary according to the state where she practices. Generally, midwives have received training from an accredited establishment that has licensed them as a midwife.  Midwives are able to help the mother in the delivery process. A Midwife also has the skills and knowledge to know when a delivery may require the skills of an obstetrician.

Your Birth, Your Choice

You have a choice when it comes to your birth plan and who attends (doctor, midwife, doula etc). There are traditional methods, holistic methods and natural methods that you can choose from for your labor and delivery. There is nothing that can be more special or personal than giving birth, and a midwife and doula will help make the experience more comfortable and personalized.
We’d love to help. Contact us today.

Natural Sacred ChildBirth

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Sacred Natural Childbirth

Natural childbirth for healthy, low-risk women is the only natural function of the human body that typically occurs in the hospital. “Why is that?”, you may ask. Because our culture has co-opted natural birth, babies, and women’s bodies for the benefit of capitalism – Big Pharma, Insurance companies, and Hospitals – the Trifecta of the medical-industrial complex. That is the only reasonable explanation as Women’s bodies have been successfully birthing live babies for literally millennia – else how would we be here? Birth has only been happening inside hospitals for about one hundred years and studies have shown that it’s safer to natural birth outside the hospital to avoid the unnecessary interventions that lead to worse outcomes. 1,2

Doctors are taught to fear birth

Medical schools have also contributed to the situation by instilling a climate of fear surrounding Birth mostly related to potential litigation. They believe that if the doctor is taught how to control birth, then they have control over being sued. In addition, natural birth is not taught to OBs because their focus is surgery. They are surgeons; the interventions they advocate frequently lead to surgery, and this is where they shine. Obstetricians are surgeons and if you are seeking the care of a surgeon, you are likely to have surgery. Very simple.

Birth cannot be controlled

Interventions in childbirth give the illusion of control over a natural bodily function that cannot be controlled. Women’s bodies will open and release the baby inside when the body and the baby are ready. This is normal, natural childbirth in a nutshell. Even the women doing the opening and releasing have no control over the process. The only control that is possible and productive is the act of surrender to this most basic bodily function. When a woman is able to fully surrender to every aspect – when and how – then when her body and the baby are ready, it will happen. The more surrendered a woman is to the process, the more efficient it is.

Thirty-eight percent cesareans in Palm Beach County

Our community (and there are many like ours) has not embraced this principle. It is very typical for women to be induced at 38 or 39 weeks of pregnancy for a myriad of reasons. We know that when labor is induced before the body and baby are ready, then things can go wrong. The body may not fully dilate no matter how much cervical ripening is chemically encouraged or how much Pitocin is given. Often the baby will not be able to tolerate the cocktail of chemicals involved between the induction drugs and the inevitable epidural. A woman may enter the hospital wanting a natural birth, but very few are able to tolerate the torture of hours of fasting, limited mobility and abnormally strong and consistent contractions, not to mention the flow of strangers into the room, the bright lights, uncomfortable bed, etc. An epidural is the only relief she can get in the hopes of maintaining her dream of vaginal birth. Palm Beach County has an average Cesarean rate of about 38%. That’s more than 1:3 women walking into the hospital expecting a vaginal birth and ending up having surgery to have their baby!This is NOT because Birth is dangerous. This is because our community has a culture of meddling with an otherwise normal, natural process. And that meddling leads to dangerous birth.

ACOG supports VBAC

The national organizations that oversee and regulate birth providers have reasonable recommendations regarding things such as vaginal birth after cesarean and breech birth. But the local OBs tend to disregard these reasonable and evidence-based recommendations. One example of how our local OB community rejects recommendations by ACOG (American College of Obstetricians and Gynecologists, the national organization for obstetricians and gynecologists), is with VBAC (Vaginal Birth After Cesarean) candidates. ACOG recommends that doctors offer vaginal birth to women who have had 1 or 2 previous cesareans. They also don’t recommend inducing labors for VBAC candidates. Yet many OBs in our community still recommend repeat surgery for these women or insist that they birth by 39 weeks. They routinely induce VBAC candidates at 39 or 40 weeks which can lead to the very complication that they fear – a ruptured uterus. Also, there is no solid evidence that a woman with more than 2 cesareans is not a good candidate for a VBAC, but there are very few OBs that are willing to “allow” these women to attempt a vaginal birth.

ACOG supports out of hospital birth

Another example of how our community defies the national recommendations is through a document is known as The Levels of Care document that was endorsed by both ACOG and SMFM (Society of Maternal and Fetal Medicine, the obstetric specialists). In this document, it is recommended that all healthy, low-risk women birth outside the hospital in Birth Centers. If the situation changes, the woman is transferred to a higher level of care – one where the ability to perform a cesarean or other interventions such as Pitocin or epidural is available. There are even higher levels of care such as Intensive Care where caring for someone who is on life support machines is available and not all community hospitals have this option for women during or after childbirth, so she would have to be transferred from the lower level hospital to a higher one. The idea is that we have lots of birth centers, less of the community hospitals and only one or two regional centers to care for the very complicated cases. However, our local OBs do not encourage their healthy, low-risk women to birth outside the hospital. Rather, they look for reasons to elevate a woman’s risk and encourage interventions such as unnecessary inductions.

Birth is sacred

Birth is a sacred event that happens to each of us only once as we enter the world. How it happens is important for the one being born and for the one giving birth. If we are going to see a world that is healed from all of the devastations of poverty, war, climate change, and abuse it has to start with how we care for those giving birth and being born. I have grown up in my Midwifery career hearing the saying that ‘Peace on Earth begins with Birth’. We have to honor the process and respect both mother and baby by not causing pain and trauma but rather supporting, facilitating, and protecting the process. This can happen more easily out of the hospital in a woman’s home or in a birth center. However, I have not given up hope that we can shift the culture of childbirth within the hospital by spreading information and demonstrating a better way. We do this by supporting natural childbirth centers and encouraging the growth in the number of birth centers in our community.

Support the ‘birth’ of Gentle Birth Centers

I’m happy to announce the addition of a new natural childbirth center in Wellington – opening soon. Gentle Birth Centers will be teaming up with Midwife360 to create an integrated practice of home, birth center, and hospital care for healthy, low-risk candidates. We plan to open this spring and are located within a mile of the nearest hospital. Let’s change birth together!

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.

The Health Insurance Rant

Palm Beach Water Birth at Home Midwife

Health Insurance A Lose:Lose Situation for Consumers and Providers

How did we come to this juncture where we are supporting the lumbering giant that is the insurance industry particularly as it relates to healthcare? I am an NPR person; I listen to NPR when I’m driving in my car and I heard a piece yesterday that really got me upset! They were talking about the rising cost of healthcare insurance. All of the big companies were planning on raising their rates next year and  Humana was going to be raising their rates higher than everyone else – like by 40%! It is predicted that for someone earning around 27K, their premium would be about $150/m. I remember when I earned less than 30K per year and paying out $150/m for health insurance would have been extremely difficult. So that’s one thing. The other, more important thing that really concerns me – and this, my friends, is the elephant in the room – is how the heck did we get to this place where we support this industry that has absolutely nothing to do with our health?

Difficult Contracting

I have been running my own small healthcare practice for 2 ½ years now. I have been struggling for recognition and compensation from these insurance companies from day 1. Achieving in-network status was the first thing. Cigna updated my new tax ID with my NPI (National Provider Identifier – a national registry that lets them know that the person is legit and bestows a unique identifying number) and we were good to go right away. I thought that all the other companies would do that. However, I found out that even though I’d been providing care for their members for nearly a decade. All of the other companies required me to apply for a contract, and most of the big guys denied me initially. Aetna came around after my national body (ACNM – American College of Nurse-Midwives) wrote a letter for me. Humana is just starting to consider a contract – after multiple Humana members applied for a gap exception for coverage for my care. Blue CrossBlue Sheild won’t even talk to me, doesn’t contract with non-MDs and is extremely difficult to deal with – even for their members. The rest of the companies fell somewhere in-between and eventually granted the in-network status.

Difficult Reimbursement

The next insult is the rates that I am bound to accept now that I have achieved the holy grail of in-network status. My clients pay their premiums and want to use their insurance plan. However, they are subject to their deductibles and co-insurance amounts which require a certain amount of investigation to discover and interpret. The industry standard requires those of us providing maternity care to refrain from billing any services until after the baby is born. This puts all maternity providers in a precarious position because everyone knows that most people are not as keen to pay for a service once the job has been completed. So the trick is to estimate what the insurance company is going to say that the client owes (the deductible and co-insurance up to the amount that is in the insurance contract for the service) and make payment arrangements for this to be paid off prior to their due date. This is irrespective of my charge for the service. If we overestimate, then we have to refund money to the client. If we underestimate, then we have to try to collect for the services that have already been performed.

The Game of Claims and Coding

Submitting forms and getting paid is the other side of this game. The act of submitting a claim is like a ritual or a game – literally. They will deny payment if the coding isn’t correct, but they won’t tell you what’s wrong with it. Most providers pay someone to do this for them and they have to subscribe to a billing platform that electronically submits the claim through one of several national clearinghouses that pass it along to the insurance company. If a paper claim is submitted, it has to be on a particular form that is printed in red ink – if the ink isn’t red, then they won’t accept the claim. All while the status of the claim is communicated to the provider through many forms that are generated, printed, and mailed. So much paper! So many people involved who are making an hourly wage!

Keep the Money Between Consumers and Providers

The bottom line is that all of this detracts from the relationship between me and my clients. The longer I participate intimately with this system, the more I am confused as to the purpose of the insurance industry in health care. Instead of paying out large sums of money for insurance premiums to people whose only job is to move paper around (accept or deny claims and issue checks or take-back letters) we could be using that money to pay for health care. Obviously, the industry is making money – record gains even – and that is off the backs of their members and their providers. I think those folks ought to find another career and we should move away from this cumbersome system.

#getridofhealthinsurance #protectsmallhealthcarebusiness #ontgetbetweenmeandmymidwife

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.