Hours after I started pushing, I finally listened to my midwife and stood up. My baby came rushing out one contraction later, and the next thing I knew I was sitting on the end of my bed, breathless and staring into the eyes of my child. A few minutes after that and I was snuggled in bed, feeling alternately exhausted and euphoric, but mostly in awe of my newborn and safe in the wisdom and care of my birth team. I had just had a homebirth with my first baby – and I have since had six more babies, all at home.
Homebirth is still an uncommon choice in the United States, though it’s increasing in popularity. Worldwide rates of home birth are higher, with many countries incorporating homebirth and midwives into their standard maternity care system. Great Britain, for instance, just made a universal recommendation that low-risk women on their second or subsequent birth should opt to give birth at home 1.
I’ll cover important information as you consider homebirth and also point to helpful resources to help you make the right choice for yourself and your baby.
Homebirth has been normal for women throughout time. There are records from many cultures detailing wise women attending mothers as they prepare for and give birth to their babies. Many cultures have special rituals or periods of separation for birthing women. These protective traditions often gave new mamas time and space to get used to motherhood, rather than being restrictive. Though not all cultures had a positive outlook on childbirth, many saw it as an important part of a woman’s life.
As doctors began to assume a larger role in society, they also started attending births with more regularity. Doctors encouraged women to birth in hospitals, and often convinced families that a hospital birth was the only safe birth. In reality birth in the hospital was much more dangerous for many mamas and babies, especially in the early years of obstetrics when doctors dismissed germ theories and often carried disease and death to women and their newborns. Once widely accepted, however, increased sanitation, hygiene, and nutrition improved outcomes for all mothers and babies.
Why then are more and more women seeking homebirth? Why are task forces concerned with the health of mothers and babies looking increasingly at recommending home births in some countries?
Once basic advances in hygiene and nutrition were made, rates of maternal and infant mortality stagnated. We have not seen mortality rates continue to drop – in fact, we’ve seen maternal mortality rates begin to climb again2. Why? Why with all the state-of-the-art hospitals available (often even to the poorest of mothers) are we still seeing maternal mortality rise, and many, many babies dying? Here’s an important consideration:
Medical technology does not equal safety.
Being in a hospital with lots of beeping machines, blinking lights, and dripping IV lines does not innately create safety for a mother and her baby. In fact, we know that birth is actually meant to work. In other words, childbirth is meant to function well and result in a safe mother and baby. There are many, many measures you can take during your pregnancy (and birthing time) to keep yourself healthy and build health for your baby – all of this creates safety for birth before you ever go into labor. Modern obstetrics just isn’t talking about this, however, because they view birth as a medical emergency.
What care providers don’t realize (or don’t want to admit) is that by trying to “control” birth, they have created the very dangers they seek to avoid. As neonatal resuscitation instructor and midwife Karen Strange says about the natural pattern of labor 3:
Every single thing is there for the optimal survival of our species
Regardless of your worldview or belief system, you fundamentally recognize that birth was designed by something (Creator, evolution, something) – and that design was meant to work. In fact, I will quote Karen again:
I just know that the design is perfect
That’s not to say we never need interventions in birth – there are times when intervention is life-saving. But life-saving interventions shouldn’t be routine at every birth. When they are used routinely, “life-saving interventions” become dangerous interruptions that undermine the natural safety of labor and birth.
Home birth circumvents many of these issues because the standard interventions are not available. That’s not to say home birth is always perfect – and pushy midwives, family members, etc. can still cause issues.
But as midwife Carla Hartley says 4 :
A home birth is the decision to make all the decisions
You call the shots during a home birth. It’s your fundamental right to birth according to the pattern, the sequence, the blueprint your body already knows (think of this – who had to direct your body to prepare for pregnancy? Who had to tell your baby how to grow? Who had to tell your body how to change and adapt every major system inside of you to carry this pregnancy? That innate wisdom was and is already inside of you). It’s likely you want to discover more about giving birth – taking classes, consulting a care provider, etc. But those things just bring out what is already within you.
You probably already know that birth works a particular way physically (the “stages of labor”), but giving birth goes beyond that. There’s also a hormonal blueprint (click here to read more about it). These hormones help make labor go faster. They reduce pain. They protect baby during labor. They stop bleeding after birth. They are literally the force that drives labor and makes it safe for mama and baby. They’re also really delicate. Procedures and interventions can totally derail the hormonal blueprint for labor – and pumping a mom full of hormones via IV just doesn’t work the same way.
When you’re at home, safe in your own space, your birthing time is far more likely to go the way it’s meant to, creating safety for you and your baby – and giving you precious, uninterrupted time to bond together after birth. There’s no rushing, no procedures for baby. Just time for you to catch your breath – and catch sight of your beautiful baby.
Overall, giving birth at home is a great choice for most mamas and babies. There are some situations where a hospital birth is best, however:
Moms choose to birth at the hospital for many reasons, and many of them are good. I do urge you to fully research where to give birth, however. The hospital is the “default” choice – many people don’t even realize that you’re “allowed” to give birth at home! As I shared above, medical technology and hospital policy greatly disrupts birth, usually creating a slower, more painful labor. It often creates the very complications it needs to solve. Every family should be completely educated about how birth works (physically, hormonally, emotionally, etc.) and how the hospital can interrupt that before choosing the hospital.
Remember, too, that being in a familiar, quiet, and safe environment can help you relax and give birth with less pain. The hormones of birth are meant to work with you, helping you through each and every contraction. At home you can be active and work with your baby, rather than be stuck in a bed with multiple monitors strapped to you. Changing positions can ease pain. So if you’re worried about the pain, know that there are real steps you can take to handle that – without drugs (drugs that really do cross to the baby and really do impact how labor works).
It’s also possible to prevent many complications during your pregnancy. A complication-free pregnancy is not just “luck” – there’s a lot you can do to keep yourself and your baby healthy.
But again, there are times you’ll want to be at the hospital. You can find a supportive care provider who will help you have a good natural hospital experience. Taking certain steps, like waiting until labor is well-established before going in, can also help if you know that you need to birth at the hospital.
Giving birth at home unassisted (sometimes called “family birth”) is actually a totally legitimate option that many women choose. Other women want someone there.
Remember that birth itself works – having someone there doesn’t create safety. But having a skilled, birth-trusted attendant there can give you peace of mind. They can also bring experience and expertise in the event that help is needed.
Doctors do not usually attend births at home. This is partly because many doctors truly feel that a home birth is dangerous because you don’t have immediate access to surgical tools (remember, most “emergency” c-sections take 30+ minutes to happen – meaning someone has that much time to transport from home, too). Many doctors are also limited by politics – the hospitals they have privileges at won’t “allow” it – and their insurance rates would skyrocket if they attended home birth. Hospital boards and profit-seeking insurance companies make the decision, and they don’t make it based on research-based evidence. They make it based on what will cost them the least if you sue. Your country may also play a role (countries that are positive about home birth often have doctors who will drop in).
Homebirth is usually attended by midwives. There are many different types of midwife, and titles are not standardized. Some titles indicate a particular level or type of education. Other titles are political in nature.
For example, a CNM is a certified nurse-midwife. She’s gone through nursing school and has also completed additional study in midwifery (often a master’s degree). A CPM is a certified professional midwife. She may have attended a college program for midwifery, or she may have gone through a rigorous apprenticeship/academic study model. She must have attended a certain number of births and sit for an extensive and intensive exam to receive her credential.
An example of a political title is an LM, or licensed midwife. This means she’s been licensed by a governing body.
A DEM is a “direct-entry midwife,” meaning she’s not a CNM and has not gotten her CPM (perhaps by choice).
These are labels common in the United States – other countries have different titles and labels, but in general they are all midwives!
Some midwives only attend hospital births, some attend only home births, and some attend both. Homebirth midwives may also be affiliated with a free-standing birth center you could opt to birth at (or may only attend births in their birth center). You’ll have to check with the midwife you’re interested in to see where she attends births.
Doulas are women dedicated to supporting families during the birthing process. A doula is there for you and you alone. She’s not a “care provider” so to speak, but can be an important part of the team. Doula care is evidence-based and shown to reduce use of pain medications, interventions, and increase the safety of birth. Many doulas accompany women in the hospital, but almost all doulas attend home births, too. A doula can be a great option for a first-time birth or a first-time home birth. A doula works with you and your birth partner – she won’t take your birth partner’s place (unless you’d like her to or need her to).
I only touched the tip of the iceberg with describing midwives above because the range of women (and a few men) serving as midwives is so great.
The midwifery model of care is far superior to regular obstetric care – your midwife spends time with you (often giving you an hour for prenatal appointments, for example). She really gets to know you and is almost part of your family! This is an excellent way to build strong trust with someone.
I want to encourage you to look at your midwife as a person, not a label. Having lots of credentials is no guarantee she’s competent, or even a personality fit for you. Having no credentials doesn’t necessarily mean that she’s incompetent (many traditional midwives practicing within their own ethnic community don’t agree with the labels, for instance). A lot of midwifery has become political, and sometimes the midwifery model of care is compromised by the bureaucracy and politics in a region.
Know your midwife.
Know her personality (so you know she’s a good fit), and know her professional experience. That gives you a much better idea on how qualified she is to attend your birth than the letters after her name. Sometimes the letters after a name are given to those who have the most money, or the most political clout. We like to think that those letters are a guarantee, but the reality is that credentials are often granted to those with the most privilege or political savvy (this is true in any profession, not just midwifery). You may choose a credentialed midwife (my own midwife is a CPM) – but again, I just encourage you to look past the letters to the person, her personality, and her actual “real-world” experience.
Also consider how much your midwife trusts birth. If your midwife is going to try and control your labor and birth pattern, suggesting induction, breaking your waters, imposing time limits, etc., she may be bringing an obstetric “control model” into your home. The truth is, if you’re going to mess with birth, you’ve got to have the technology to fix your mistake – and that’s not available at home. If interventions are truly needed, they’re needed at the hospital.
This doesn’t mean your midwife should stay silent. It doesn’t mean she shouldn’t make suggestions. A midwife suggesting you walk a bit, or that you get into the shower, or stand up to push, for example, is not suggesting something that fundamentally changes the way labor works (like induction with herbs or drugs would, for example). An experienced midwife will have many helpful strategies to help you work with your birth and your baby.
The bottom line is to know your midwife.
I’m going to tell you another little secret: your midwife or doctor doesn’t do your prenatal care – you do.
What do I mean by that?!
Here’s the scoop: you’re pregnant for roughly 280 days. You’re going to see your care provider for how many of those days? 15? Maybe 20? That means you’re the only one taking care of you and baby for about 93% of your pregnancy.
That’s a fundamental reality that I wish more women realized (I wish more care providers emphasized it!). I’ve quoted Jan Tritten and Carol Guatschi before:
Prenatal care is what you do between the visits to your midwife!5
You are the one providing your basic prenatal care: nutrition, exercise, relaxation, and all the mental and emotional work of pregnancy and birth preparation. I talk much more about this in my article Does Prenatal Care Really Save Lives? and I encourage you to read it.
Having said all of that, unless you’re choosing unassisted prenatal care, most women do see a care provider during pregnancy. If you’re planning an unassisted birth, you might have completely unassisted care, but if you’re planning a home birth with a midwife, she provides prenatal appointments. Some women, for whatever reasons, choose to have obstetric care with a doctor too, but that’s not common and I’ll cover what prenatal care looks like with a home birth midwife.
Many home birth midwives have you come to an office for appointments. They may have an office space, or they may have an office area as part of their home. Other midwives come to your house. Most midwives offer the option to come to you, but may ask you to reimburse travel expenses.
All home birth midwives do at least one prenatal appointment at your house, called the home visit. This gives her a chance to see your space (and for you to show her where things are located in the house!). It also gives her the chance to drive to and find your home in daylight 😉
The first thing to realize is that home birth care means relationship, and relationships are built with time. Your midwife will give you plenty of time for your appointments. Appointments are generally an hour long, with only about 10-15 minutes of that time devoted to the physical portion of the exam.
Most of your time is spent talking.
If you’re a first-time mama or new to home birth, or you have particular concerns, your midwife may spend quite a bit of time on education and answering your questions.
She most likely has a checklist to go over for each appointment, so she can know she’s covered what’s important for you.
But much of the appointment will be guided by you – what are your thoughts and feelings? What are you wondering?
Prenatal appointments look different for every single woman! If you’re used to appointments at a doctors office, this can be really different! In a doctor’s office, you come in and are weighed and have your urine checked by a nurse. Then you wait until you’re able to have a 10-15 minute appointment where the doctor listens to the baby, says a few things, and asks if you have any questions – that’s it! It’s very impersonal.
At this point I’ve had prenatal care for 7 babies, and I’ve been able to attend prenatal appointments for many other mamas. No two appointments look alike, and it’s very interesting to see how an appointment unfolds. Often there is talk of the baby, and discussion about discomforts or pregnancy questions.
But there’s also a lot of talk about home life, older kids, what’s going on around town, etc. – it’s really what you want to talk about! In my first couple of pregnancies, almost all of my questions were about birth and babies… but now I usually talk about my older kids and what’s going on our life as a family.
That’s what I need at appointments.
Your midwife makes sure your appointment covers what you need.
Many midwives ask about nutrition at each appointment, too, since it’s so important. And, again, if you (or she) has any concerns, those things are discussed.
Of course, part of every appointment is checking on your baby! If you’re very early in your pregnancy, it’s unlikely that your baby’s heartbeat can be heard, even on Doppler. But once you’re at 11-12 weeks or so, you can request to listen to baby with Doppler (you can usually hear with a fetoscope at around 16 weeks or so).
Some midwives wait to palpate, or feel your uterus and baby, until 16-20 weeks, but others like to palpate from the first appointment so they have a sense of how your uterus and baby are growing. It’s harder to feel your baby in the first half of pregnancy (though the uterus can be felt very well by 12 weeks in most women, and even earlier for some) – but by the second half, baby can be felt and by the third trimester, your midwife can generally tell your baby’s position by palpation!
Most midwives track your weight and check urine, just like a doctor’s office does. Your midwife also checks blood pressure. Your midwife may also measure fundal height beginning around 16 weeks. The “fundus” means the top of your uterus, and fundal height is measured from the pubic bone to the top of the fudus. It usually corresponds (in centimeters) with your weeks of pregnancy, though not always, and usually increases at a regular rate for you.
Midwives do not generally do vaginal exams as you may be used to with doctor’s offices, though you can request an exam (I don’t think there’s much point to them… ever!).
So your appointment covers physical things like listening to your baby, palpating your baby/uterus, checking urine, blood pressure, weight, and fundal height. It also covers how you’re doing emotionally, preparing for a new baby, and more.
Your midwife may also order lab tests (like initial pregnancy blood tests) or request that you have them done through another provider. Some home birth midwives may offer or recommend prenatal screens and testing – you can ask your midwife about these things and discuss if you believe they’re right for you.
You’re probably most interested in what it “looks like” to give birth at home! Many of us have a vague idea of what happens at the hospital, thanks to television, movies, and reality TV-shows. But homebirth is a mystery to many 😉
I honestly think the best way to get a feel for what a home birth may be like is to read birth stories from other mamas. Click here to access my birth stories page (opens in a new tab – you can jump to the home birth and unassisted birth sections).
In general, birthing at home goes much like birth is designed to because there are few interruptions! It’s important to realize that birth is just as much hormonal as it is mechanical, and that hormones can be easily disrupted (for an easy example, think about a passionate lovemaking session where your baby starts crying in another room… or your kid slams the door open while screaming “Mama, Daddy!!” – the mood fizzles pretty fast!).
When the hormonal flow of labor is interrupted, it disrupts the pattern. That happens almost all the time with a hospital birth, and probably to some extent with any interruption to labor (driving to a birth center, having people call to ask if you’ve had that baby yet, etc.). But with a home birth, it’s less likely that interruptions will impact.
Your birthing time can begin in any number of ways, and out of 7 babies to date, I’ve had a lot of different experiences. My first baby was pretty “textbook” with slightly crampy sensations starting in the morning, followed by a bloody show (mucus tinged pink, red, or brown – this “plug” sealed the cervix), then contractions picking up around 3am and getting progressively stronger throughout the morning. I pushed for about two hours and she was born just before 1pm.
My second baby began with water breaking (the only one out of 7 babies), then strong contractions starting about 10 minutes later. This was around 11pm, and he was born after about 20 minutes of pushing around 9:30am.
I experienced more “prodromal” labor, or labor that seems to be starting but then fizzles out, with a few babies (but not with my 7th, interestingly).
I’ve had bloody show with some and not with others.
Most have started with light contractions (or rushes, or pressure waves – please use the terms you feel comfortable with) that picked up – some slowly, like with my first and second, and some very quickly, like with my 4th, 5th, 6th, and 7th!
There’s a wide range of ways things can get started, but you will know when this is IT.
My best piece of advice is to ask yourself “what do I want to do now?” if you think things are beginning… do enjoyable, restful things. Go to sleep if it’s nighttime. Take a leisurely walk, eat a snack, watch a funny movie, etc. if it’s daytime. Don’t get anxious, because you will know when things are picking up and you don’t want to wear yourself out when you’ve got a birthing to get down to doing 😉
As things pick up, it’s important to keep yourself hydrated, and eat lightly if you feel like it (birthing a baby takes energy – read more in IV vs Drinks in Labor).
Sometimes things build slowly and sometimes they move more quickly – it really depends on your birthing and this baby. But generally you’re given a chance to work with your baby, figuring out strategies that help you move through the energy of labor.
If you find that things are really uncomfortable or hurting, you can change positions and move around – that’s one of the benefits of being at home and relatively unrestricted!
I don’t think that birthing at home guarantees you an “easy” labor, even with all the hormones on board. We don’t get a lot of education about birthing before getting pregnant, and most of what we see is really negative. It’s important to prepare yourself for your birthing time – what you do to prepare beforehand (both emotional and mental preparation, as well as learning particular skills and techniques for managing labor) – comes back to you during your birthing time. Those are useful skills you want to have. My MamaBaby Birthing class is an online natural childbirth series you can take a look at if you’re interested in something convenient yet still with personal input from your teacher (me :D).
Sometimes it starts getting really, really intense as you get close to your baby’s birth. It may feel like nothing helps at all – and it’s just intense. A good birth partner and your midwife’s team are really helpful at this point, just being present with you and reassuring you that You Are Amazing!
It’s typical for contractions to slow down during the pushing stage, getting more spaced out. Your hormone levels are at a peak and this time between contractions is what many women describe as “labor land” – a place where you feel calmer and almost in a “daydream” state (this is caused by the beta endorphin hormone). Adrenaline becomes your friend during the pushing stage (you don’t want adrenaline early in labor, where it can cause stalls), helping your body do the work of pushing.
Usually first-time mamas need to push a bit longer – a few hours is not unusual. Subsequent babies often come more quickly (even in minutes).
Up to this point your midwife has probably been fairly “hands off,” letting you work with your baby and your birth partner (and doula, if you’ve hired one). She checks your baby’s heart rate regularly (about every half an hour), and she’s there to provide you with support and encouragement as you need it. She keeps a watchful eye on everything going on. Once pushing starts, she starts to monitor your baby’s heart rate more frequently (every 5 minutes or so) and she’s generally right there with you.
Exactly where she is depends on your preferences – with my first few births, I wanted my midwife right there, helping me and watching my baby’s progress. Now I prefer her to be near the tub, but let me push out my baby and bring my baby up with no other hands nearby. Talk with your midwife beforehand, explaining what you’d like from her. She’ll also explain what she watches for and when she’ll step in.
Your baby’s head is born, then rotates so his or her body can be born. This is the most intense point of pushing, when your body is soft and wide for your baby to pass through. You may or may not have to push your baby’s body out, but once out you will feel an immediate difference! Your baby can come right up to you (though some mamas breath for a moment before picking up their baby… that’s OK!).
Then it’s time to snuggle and get to know your new baby! This is the “quiet alert” time when your baby is focused on you, and you on baby. It’s normal for your baby to snuggle, nuzzle, lick, etc. but not nurse quite yet. Your midwife watches for signs of the placenta coming, and monitors your and your baby’s well-being. When you feel contractions begin again, you can push out the placenta and you are done!
Your midwife will make sure you’re settled comfortably into bed while continuing to monitor you and your baby. She’ll check vital signs and make sure your bleeding looks good. She’ll also feel your fundus to be sure the uterus is getting firm like it should. After getting the two of you settled and safe, she’ll probably leave you, baby, and Daddy alone to have some bonding during the “golden hour.” She’ll be nearby in case you need her, and will likely make you something to eat (you’ll be hungry!)
Most midwives stay for at least 3 hours after birth, and may stay longer. Many midwives also do the newborn exam just before leaving. They do a complete, head-to-toe examination of baby, checking for newborn reflexes, heart, lungs, ears, eyes, etc.
Remember, every birth looks quite different, which is why I recommend you read many home birth stories. I also recommend you picture how you’d like your baby’s birth to go – this visualization is enjoyable and it’s also “practice” for the big day (I’ve found it really helpful, even if birth didn’t go quite as I’d pictured).
This is my kids’ favorite birth video – a really lovely home birth to give you an idea of one birth:
Many mamas-to-be, and especially daddies-to-be, wonder what happens if a complication happens at home. How are things handled?
One important thing to consider is that home birth prenatal care is very much geared towards prevention.
Prevention is a hard sell today, but as the saying goes, an ounce of prevention is worth a pound of cure.
The reason your midwife spends so much time with you during pregnancy is because she knows the Midwives Model of Care6 has been proven to make a difference in the outcome of birthing women. Taking that time to get to know you really makes a difference in the outcomes for your birth and your baby.
Focusing on nutrition is one example: your body undergoes amazing – and massive – changes during pregnancy. These are systemic changes, meaning that they impact every system of your body: cardiovascular, respiratory, digestive, urinary, etc. Those changes are supported by what you eat. Your body needs the “raw materials” to maintain of that – primarily through your blood supply. Good nutrition facilitates blood supply expansion (it will increase by about 60%!).
Of course, good nutrition also helps you grow a healthy baby and a healthy placenta. And a well-nourished uterus is a strong uterus. Baby and uterus are less susceptible to infection. A strong uterus = an effective labor and a strong uterus gets firm quickly postpartum (protecting you from bleeding). Extra blood on board is nice, too.
Nutrition is important to ALL of that – so midwives often really stress nutrition.
They’ll also talk to you about handling stress, what supplements to take, how to prepare for birth (they may recommend birthing classes for this), etc. They’ll educate you on sleep and on preparing for your baby.
In other words, much of your care is geared towards education, and education is geared towards action that equals prevention. A healthy mother and baby are far less likely to have any complications that need intervention.
Having said that, sometimes things do happen, even to the most well-prepared mother and baby. It’s good to know what to do, and many women want a midwife there for her knowledge and expertise. A midwife can also advise you when she thinks it makes sense for you to transfer to the hospital.
Sometimes you and your midwife will decide before the birth that a hospital birth is safest for you and your baby. That’s often called “risking out” and it’s something you and your midwife can discuss. Ask her why she might “risk you out.”
At times these “risks” are more political in nature than they are evidence-based (risking out for a VBAC is a debatable reason, for example), but sometimes there are legitimate reasons that a mother and baby will be safer at the hospital. If any of these reasons have been determined beforehand, you can opt to birth in hospital.
Many women worry about having a “stalled” labor, but that’s much less likely to happen at home. There’s just not the pressure you get when you go to the hospital. As we discussed above, hormones have a big impact on birth, and that hormonal flow is (usually) less disturbed in a home birth.
You’re also able to get up and move around, working with your baby and helping him or her do what s/he needs to do. Remember, your baby is really active during birthing, rotating and moving down. When you walk, rock on hands-and-knees, move, etc, you help baby come on down.
You can also drink (and eat) when you’re at home, helping keep your energy levels up and labor moving along. Sheer lack of energy is often a cause of a stall – just like marathon runners need to refuel at stops along they to avoid “hitting a wall,” laboring mothers need energy!
Sometimes babies do get into tricky positions, or a mama just has to wait for her body to open. Then your midwife will work with you, giving you advice to get baby moving down. Or she’ll help you find a comfortable way to rest as your body does what it needs to do. Sometimes emotional or mental “blocks” can hold things up, and a midwife can help you talk through those, too.
You can also pay attention to your sense of well-being during all of this and baby’s heart rate can be monitored. Sometimes birthing take time and that’s OK 😀
Having a cord around the neck is almost never a problem.
Having said that, if the midwife does feel it’s an issue, she can loosen the cord slightly (no need to clamp and cut). Then the cord can be quickly unwound (sometimes baby can be brought through the cord loop) as baby is being born, or just after birth, as is often the case for a water-born baby.
Again, the cord is generally a non-issue – but since many parents wonder about it, I included it here!
People generally think that a baby is “stuck” when pushing takes a long time. But that’s generally not the case. Pushing can take awhile, especially for first-time mothers. 3 or 4 hours is not unusual. And sometimes a mama really has to work to bring out a baby (again, especially a first baby). I’m a huge fan of the “fetal ejection reflex” – where adrenaline and the uterine fundus (the thick top of the muscular uterus) do the work of pushing baby rapidly down and out… but I also realize that some babies needs a little more oomph.
Sometimes position changes really help – my midwife suggested I stand up to birth my first baby. I was scared of the pain. Two hours later, when she suggested standing up again, I was just ready to get that baby out! I stood, pushed, and out she flew 😉
“Back in the day” when X-ray was used during labor, women would be told their babies were “stuck” and sent for an X-ray. They had to walk to radiology. Almost all of them had their babies just after getting back to labor and delivery. Why? The movement created room for baby to come down and out!
So it’s OK for baby to take some pushing time. And it’s OK to change positions while pushing.
Sometimes the worry is that the baby is stuck once the head is born.
First, understand that it is normal for the head to be born and then stop. While coming down the birth canal, your baby turns his or her head to navigate through your pelvis. It’s like your baby is looking to the side.
When the head is born, it rotates back to looking straight ahead (this is called restitution in medical and midwifery lingo). Once this happens, the shoulders are born (usually one, then the other) and baby’s body comes out. Sometimes baby slides right out, and sometimes it takes a push to get the body out.
Generally it’s OK to wait a contraction or two for restitution and the birth of the baby. The baby’s head should not be pulled on (or really even touched) during this time – doing so can lead to brachial plexus injuries and lifetime disability for the baby.
Sometimes a baby will have “sticky shoulders.” If that’s the case, your midwife will help by encouraging you to change positions (which generally works very well). If that doesn’t work, she can use her fingers to hook under the baby’s arm and help bring him or her down. It may take more pushing and a team effort, but these sticky babies are generally always resolved by skilled care providers.
It’s very likely that a breech baby will be detected during pregnancy. Breech babies are not head down, but rather bottom down. Some midwives are comfortable attending a breech baby at home, while others are not. Your midwife will discuss this with you.
If you didn’t know baby was breech going into labor, some midwives will ask you to transfer once they realize baby is breech. Others may attend a breech baby at home. In general “hands off the breech” is the rule of thumb. Standing positions and bearing down hard once baby’s belly button is born are often recommended. Your midwife may push up on your bum muscles and tissue to raise them away from the baby’s face as s/he is born.
Talk with your midwife about the possibility of a breech birth and decide if it’s something you both feel comfortable with.
If distress is detected during labor, your midwife will have you transfer to the hospital (most home birth transfers are not for fetal distress, but rather because Mama runs out of energy – just FYI – and why it’s important to eat/drink!).
Many parents also worry about babies after birth. Again, it’s important to understand what “normal” is. “Normal” babies who have just been born are not rosy, pink newborns!
A “normal” baby fresh out of the womb is generally slightly blue in color, because oxygen saturation in the womb is only about 60%. Baby is bluish, then turns purplish and pinkish. This transition does happen quickly, but lingering blue (cyanosis) can often be seen in the hands and feet for a little after birth – what you want is to see baby’s chest and head pinking up quickly. Most parents are also reassured by a strong cry from baby, but not all babies cry. Quiet alertness and good breathing are good signs.
Normal newborns also have good tone – meaning you see their limbs well-flexed.
If your baby is white in color and limp, that’s a time when action is taken. Your midwife will have a complete protocol for this situation – generally beginning with stimulation and moving on to giving your baby breaths (perhaps mouth-to-mouth, but most likely with an infant-sized “bag and mask” device). She’ll use room air for this because it has been proven safer for newborns (oxygen can actually cause brain damage). Often babies just need a breath or two to help inflate their lungs, then they breath fine on their own. If your baby needs more extensive breaths, your midwife will monitor carefully and call emergency responders.
This is a situation that skilled midwives certify for regularly, and also practice regularly. Midwives are also skilled in adult resuscitation.
Another specter over birth for many women is postpartum hemorrhage. In fact, many women have experienced a hemorrhage with a previous birth.
As I said above, prevention is a huge piece of this puzzle – being well-nourished, with a fully expanded blood supply, makes hemorrhage much less likely. And if there is extra bleeding, you have about 60% extra blood volume (equaling roughly two quarts of extra) blood.
Maintaining the natural hormonal flow of labor is also an important preventative for hemorrhage. Hormones control the action of the uterus, including how it behaves after birth.
Picture your garden hose for a moment. You’ve pulled it alllllll the way across your back yard to your garden. You ask your child to turn on the water. Nothing happens. You sigh heavily and walk along the hose to where – you guessed it – there’s a kink. You unkink the hose and water flows.
After your baby is born, your uterus is designed to clamp down, which kinks all the blood vessels and prevents further bleeding. The postpartum bleeding you experience is shedding the uterine lining (the same thing that happens during your period – it’s just that the lining is thicker). The kinking effectively stops all uterine bleeding.
So it’s vital that the uterus can do what it’s supposed to do.
If, despite good nutrition and hormonal flow, bleeding happens, your midwife will step in. She has skills, including hands-on-the-uterus skills, that can help stop bleeding. Some midwives also do carry medications to stop hemorrhage (such as Pitocin). Others a combination of things such as herbs, a piece of placenta, etc. Your midwife will have a carefully created protocol to handle the situation – ask her about it so you’ll be comfortable and aware of it.
Obviously these are just a few situations that can occur with birth, but the reality is birth is safe, and almost always works just the way it’s supposed to.
If you’d like a succinct guide to handling issues during labor, click here for a copy of Emergency Childbirth and a copy of the emergency cheat sheets to go along with it:
Giving birth at home is a great choice for most mamas and most babies. Birth is not a medical event – it’s something women do naturally, beautifully, awesomely.
Women and babies are resilient, and with preparation and planning, birth is actually an energizing, exhilarating experience that primes the mother-baby bond in a way only nature could have designed so well 😉
I will admit that I am very biased – I have birthed all 7 of my own babies at home. That decision was carefully considered, and each birth carefully prepared for. Each birth was beautiful in its own unique way, and I appreciated the skill and presence of my midwife at each of their births.
I encourage you to do your research and consider home birth for you and your baby :