What’s a Certified Professional Midwife (CPM)?
A Certified Professional Midwife (CPM) is a trained professional certified by the North American Registry of Midwives (NARM), who is qualified to provide the Midwives Model of Care. CPMs are the only maternal care providers required to receive training in out-of-hospital settings. Midwives specialize in supporting normal, healthy pregnancies and births. They provide individualized care to women and their newborns throughout the childbearing year.
Do you offer pain medications?
Pain medications are not available at home due to the risks they pose to you and your baby. But, I offer something that helps most moms not even think about pain medications – loving support and the freedom to labor at your own pace in a comfortable environment, surrounded by people you trust. Since research shows that stress hormones increase pain and slow labor, I try to keep your environment as low-stress as possible for you. I encourage you to move freely during labor, which helps you cope with contractions and helps the labor process. You’ll be free to eat and drink as you wish, which lowers your pain threshold. Many women choose to spend at least part of labor in water, which is soothing and facilitates rhythmic movements. Having less intervention in your labor allows your body to naturally release hormones that help with pain management. In addition, I carry herbs and homeopathic remedies to help you cope, when appropriate. Some moms just need a hand to hold, eye contact, and reassurance. Others need help working through each contraction, while others merely need to be left alone. I take my cues from you during labor.
What happens if there’s an emergency or if we have to transfer into the hospital?
Although home birth is statistically safe, it does not guarantee a problem-free pregnancy or birth. If complications arise during pregnancy, you may need to consult with and possibly transfer care to an obstetrician. Both midwives who attend your birth are trained to provide immediate care for emergencies, including neonatal resuscitation (CPR for newborns). We bring all the necessary equipment and supplies, as well as herbs and homeopathics, to manage any special challenges. Since we only provide care for healthy women, and intervention during labor is limited, the chance of a true emergency is very low. In fact, most transports (to hospital) are for non-emergency situations, such as a long labor without progression or the laboring woman’s desire for pain medications. If complications develop during labor or birth that are beyond our scope of care, you will be transported to the nearest hospital. I will continue to provide support for you there, but care will be transferred to a physician. Please see this document for information from the Home Birth Summit on Best Practice Guidelines on Transfer from Planned Homebirth to Hospital.
What happens if we have to transfer into the hospital?
Yes, transfers of care happen even when planning to birth at home. Homebirth midwives are trained to identify risk factors that would preclude a family from safely delivering at home. If you or your baby begin to show signs that a higher level of care is needed, we will facilitate a transfer of care. While we do everything that we can to prevent a transport, in the unlikely event that it occurs here is what you can expect:
I will call ahead to alert the hospital of your transport. In order to assure that your and your baby’s needs are met and and medical issues are addressed in a timely manner, we provide information on your current health conditions and any relevant information to your birthing situation. We offer copies of your records and accompany you to provide support. At the time of transport your care provider becomes the medical or hospital staff and we only accompany you to provide emotional support and can no longer your primary maternity care provider. Certified Professional Midwives are not medical professionals are not permitted to practice in the hospital in Pennsylvania.
Do I need to have an ultrasound?
Ultrasound can be a useful tool but is not routinely necessary in a healthy pregnancy. Some reasons an ultrasound may be recommended include uncertain dates, vaginal bleeding, possibility of twins, abdominal pain, decreased fetal movement, or if you have previously had a cesarean. Many clients planning a homebirth do decide to have a 20-week fetal anatomy scan done. For women who choose to have an ultrasound, you can arrange to have the procedure done with physician or I can refer you to the Philadelphia Pregnancy Center for the service.
I live in a small apartment/house. Do I have enough room for a home birth?
Yes! Babies can be born just about anywhere. As long as you have freedom to move to respond to your body’s cues, you feel safe, and the birth place is reasonably clean and warm, your home is a fine place to give birth.
I’m over 35. Can I have a home birth?
Yes! As long as you are healthy and wish to take an active role in your maternity care, you are a good candidate for a home birth.
I’ve had a cesarean before. Can I have a home birth?
Probably. Uterine surgery (for example, cesarean delivery) leaves a scar on the uterus. Scar tissue is weaker than surrounding tissue, so women who have had cesareans are at slightly higher risk of having the uterine tissue tear during birth (uterine rupture), compared to women who have not had cesareans. This risk is lowest if you have only had one previous uterine surgery, had a low transverse incision, eat a healthy diet, do not smoke, allow at least a year after surgery before becoming pregnant, and labor is not induced. If the reason for surgery does not necessitate another surgery (for example, you had a cesarean for breech or for failure to progress), you may consider having a home birth after cesarean (HBAC). We can discuss this further during a free consultation. Please note that due to licensure regulations we can not attend VBACs in New Jersey at this time.
Who is not a good candidate for home birth?
Women who are more likely to have problems in pregnancy or during birth are usually safest with obstetrical, hospital-based care. I cannot accept clients with epilepsy, diabetes, high blood pressure, significant heart disease, kidney disease, liver disease, alcoholism, or significant mental illness. Also, women who currently smoke, use drugs (other than occasional marijuana), or do not take responsibility for their health are not good candidates for home birth. I offer care for women who have no major medical or obstetrical problems, who seek an active role in their pregnancies and birth, and desire minimal intervention. By maintaining healthy lifestyles – eating a variety of whole foods, being active, and avoiding harmful substances (such as tobacco, alcohol, and pesticides) – most of my clients remain low-risk and are expected to have a good, normal outcome for both mother and baby.
What do I need to do to get ready for a home birth?
Less than you might think! You’ll need to gather a few common supplies, clean sheets, towels, and receiving blankets, and have food and beverages on hand for your labor and postpartum. You’ll also need to purchase a birth kit (approx. $60), which contains disposable clean and sterile supplies for birth and postpartum. I’ll provide you with a complete list of what you will need. Your midwives will bring all the medical equipment needed at the birth.
Isn’t home birth messy?
Birth is usually not very messy. Midwives are very good at containing any mess (after all, we’re the ones to clean it up afterwards!). You can expect to have a garbage bag full of trash and one full load of laundry (which we start washing for you!) when the birth is over.
Who can be at my birth?
Anyone you like! You can have a doula, your mother, your best friend, anyone who can provide good support for you during birth and who accepts your decision to give birth at home. Children are welcome, as long as you have a designated support person for young children. I encourage family-centered birthing and have books and videos to help you prepare your children for the birth.
There will be two midwives at your birth – myself and another midwife to assist. We can be as involved or as hands-off as you’d like (pending all being normal and healthy of course). We can be by your side, or quietly sit in another room, ready and available. This is your birth experience! You decide who will be present, and how each person will support you.
How do you monitor the baby during birth?
We typically use a handheld Doppler to periodically listen to your baby’s heart during labor. Doppler is a form of ultrasound that allows us to hear the baby’s heart beat through your abdomen. It can be used under water and with you in almost any position. If you prefer, we can use a fetoscope (a type of stethoscope) instead, but you may have to move into a position that allows us to hear the baby’s heart.
What if my labor needs to be induced?
A cornerstone of my birth philosophy is that babies know how to pick their own birthdays. Your labor will begin at the time that is right for both your body and your baby. The average length of gestation is 41 and a half weeks for first-time mothers and slightly less than 41 weeks for women who have previously given birth. This means that about half of women have their babies before this time, and about half of women have their babies after this time. If your pregnancy nears 42 weeks, we will monitor baby more frequently and discuss your available options at that time. Induction with medications is risky and must be done in a hospital. See this great resource from Evidence Based Birth on Due Dates for more information.
Can my partner/husband catch the baby? Can I catch the baby?
Yes, parents are encouraged to receive their own baby! A midwife may help check for a loop of cord or a hand by the baby’s face, and if you wish, will help guide the baby into your hands.
Doesn’t a doctor need to see the baby right away?
Midwives are trained to provide care for moms and babies-both during the pregnancy and after the birth! I provide a complete newborn exam within a few hours after birth. If anything is not normal, I will let you know and we will discuss whether your baby needs to be seen by a pediatric care provider right away. I ask that all families select a pediatric care provider by 36 weeks gestation, and that you know how to reach that provider urgently. Most babies do not need to be seen immediately, and you are encouraged to get the rest you need following birth.
We offer all the care suggested in this document from the American Academy of Pediatrics regarding care for babies born at home and our families make informed decisions about what tests, procedures and medications they want for their child.
Can my baby be born in water? (Note: Waterbirth FAQ questions are largely taken from Waterbirth International’s website. Please visit here for even more info!)
Yes! We welcome and encourage birthing mothers to utilize the comfort and relaxation of water to help move through labor and often for the actual birth of the baby. Almost every laboring woman will find time in a birthing pool, shower or her own tub to be a useful tool in the birthing process. We encourage our clients to keep an open mind as to whether or not they will actually give birth in the tub as one never knows what one (or baby!) will need at the time, but we are very happy to offer waterbirth as an option for our clients. Please ask your midwife about options for tub rental (AquaDoula) or borrowing an inflatable birth pool (Birth Pool in a Box) for your labor and birth.
What prevents baby from breathing under water?
There are four main factors that prevent the baby from inhaling water at the time of birth:
- Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby’s muscles for breathing simply don’t work, thus engaging the first inhibitory response.
- Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping.
- Water is a hypotonic solution and lung fluids present in the fetus are hypertonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.
- The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemoreceptors or taste buds. The larynx has five times as many as taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
For a more complete description, please read Barbara Harper’s Waterbirth Basics
What is the temperature of the water?
Water should be monitored at a temperature that is comfortable for the mother, usually between 95-100 degrees Fahrenheit. Water temperature should not exceed 101 degrees Fahrenheit as it could lead to an increase in the mother’s body temperature which could cause the baby’s heart rate to increase. It is a good idea to have plenty of water to drink and cold cloths for the mother’s face and neck. A cool facial mist from a spray bottle is a welcome relief for some mothers as well.
How long is baby in the water after the birth?
Here in the US, practitioners usually bring the baby out of the water within the first ten seconds after birth. There is no physiological reason to leave the baby under the water for any length of time. There are several water birth videos that depict leaving the baby under the water for several moments after birth and the babies are just fine.
Physiologically, the placenta is supporting the baby with oxygen during this time though it can never be predicted when the placenta will begin to separate causing the flow of oxygen to baby to stop. The umbilical cord pulsating is not a guarantee that the baby is receiving enough oxygen. The safe approach is to remove the baby, without hurrying, and gently place him into his mother’s arms.
When should I get into the water?
A woman should be encouraged to use the labor pool whenever she wants. However, if a mother chooses to get into the water in early labor, before her contractions are strong and close together, the water may relax her enough to slow or stop labor altogether. That is why some practitioners limit the use of the pool until labor patterns are established and the cervix is dilated to at least 5 centimeters.
There is some physiological data that supports this rule, but each and every situation must be evaluated on its own.
Some mothers find a bath in early labor useful for its calming effect and to determine if labor has actually started. If contractions are strong and regular, no matter how dilated the cervix is, a bath might be in order to help the mother to relax enough to facilitate dilation.
Therefore, it has been suggested that the bath be used in a “trial of water” for at least one hour and allow the mother to judge its effectiveness. The first hour of relaxation in the pool is usually the best. We’ve seen that being in the tub during transition can be especially helpful and often help a woman achieve complete dilation quickly.