Childbirth is fluid and has a life of its own. We can’t guarantee an outcome, but we can prepare ourselves throughout our pregnancy by making the best choices for our babies and our bodies.
We can choose a place of birth that gives us space to be private, and where we feel safe, and find a care provider who listens, answers our questions, and works collaboratively with us throughout our pregnancy.
For most families in the United States, due to accessibility, and medical insurance, that will be a doctor and hospital, but for a growing percentage, that means birthing at home with a midwife.
Jocelyn Brown is a licensed midwife who delivers babies in Los Angeles. Read on for her insight on midwifery and home birth.
Becoming a Midwife
What motivated you to become a home birth midwife?
It was more of a gut thing and not a conscious motivation. I think I was drawn into the mystique of it all, that there was an “alternative” to doctors and hospitals and I wanted to be that. Then I learned that other countries use midwives as mainstream sources of maternity care and have *better* outcomes than we do in the US. So now I don’t want to be on the fringe – I think it’s an injustice to our pregnant population that midwives are considered the “alternative.” We should be the go-to.
Midwifery Model of Care
What can a family expect from midwifery care that is different from the care they receive from an obstetrician?
Time. And more of a relationship with your care provider. Most midwives can offer up all the same low-risk prenatal testing and screening options as OBs do, but we actually sit with you, explain your options to you, give you alternatives if you want. We also are highly invested in keeping your pregnancy low risk, so we are going to give you tons of nutritional and lifestyle advice for good health. Many OBs have little choice but to see 20-30 patients a day. They don’t have time to talk to you about nutrition and yoga poses for your sciatica and building your emotional support network. It’s bonkers!
Some midwives have offices that their clients drive to. I personally do all visits in clients homes, so that’s a huge perk. You get all the same care, but in your home with your kids and your pets and your spouse around. It makes the home birth aspect so intuitive.
Is Home birth Right for My Family
How can a family determine if they’re a good candidate for a home birth?
A family can determine if you are a good candidate for home birth by interviewing 2 or 3 midwives and by being completely forthcoming about their health history, listening to what the midwives have to say and then doing their own research as well. A midwife may state she feels comfortable taking one person on, and the client may have a gut feeling it’s not the right thing for them. Or, one midwife may say, “No, I can’t do that for you…”, but another midwife might hear the same information and say, “Yes, I have lots of experience with this particular issue you have, and I’m confident in dealing with it as long as we lay down these boundaries…”
Then of course, please respect the boundaries and know that all people in home birth care – even very low-risk people – may need to seek a higher level of care at some point. And plenty of my “high risk” clients have ended up never seeing the inside of the hospital! It’s just not a very predictable thing – for anyone.
Risk Factors
Will you consider mothers who’ve had a previous pregnancy or delivery that was high risk?
There are of course some cut-and-dry risk factors that are just plain inappropriate for home birth, such as pre-eclampsia, very low platelets, preterm birth, babies with very severe anomalies, etc.
Sometimes a client will present with a health issue that I have no experience with, but a visit with a specialist will confirm that a home birth is fine under certain parameters. Each client-midwife dyad has to gather information and make a plan, which may include co-care with a higher license.
So a lot of risk factors need time – time to work with them and time to see if they resolve, stay the same, or get worse.
Knowing a person’s pregnancy history, and whether those pregnancies were high risk is important, but that doesn’t automatically mean this pregnancy will be high risk. The phrase “high-risk” is admittedly a little triggering for me because there are *so many* things that can arise during pregnancy and birth, and they all exist on a spectrum. Some issues are very emergent and life-threatening, some are very manageable outside the hospital, and everything in between. And each pregnancy is different unless the pregnant person has a pre-existing condition, in which case, see above about how we evaluate that on a case-by-case basis.
Home birth Transfers
What is a transfer rate and why is it important for families to know the transfer rate of their midwife when planning a home birth?
My overall transport rate in labor hovers at around 15%. The vast majority of transfers are non-emergent, meaning we go to the hospital based on red flags that indicate an emergency is more likely, not because an emergency is happening right now. We want to have a calm, non-traumatic trip to the hospital and time to settle in before things become critical. Of course, under those circumstances, things might never become critical and you may have a perfectly healthy birth in the hospital! This is something to be celebrated of course, but I also allow that we all feel some disappointment about going to the hospital, no matter what.
I think it’s important to know your midwife’s transfer rate and normalize it. If you are in the 15%, I want you to have a decent experience and to get what you really need from the hospital. If we don’t need something that the hospital has, why are we even going? During pregnancy, I ask my clients to choose an appropriate hospital that is near their home, that’s covered by their insurance, and that has a good NICU. Then I ask them to do a dry-run there before labor so they know how to get there and where to park and what entrance to go in. Anything you can do to make the transport less scary is going to improve your experience of birth, even if you never need the hospital. I don’t want my clients spending their entire labor terrified of unknowns. That’s just a waste of energy.
Emergencies
How do midwives handle emergencies at a home birth?
We handle emergencies much the same way doctors do. We do many of our emergency trainings alongside OBs and nurses and medics. Some of the emergencies we occasionally see are: Maternal postpartum hemorrhage, shoulder dystocia, and a baby not breathing right away. Midwives are trained to safely get a stuck baby out during a shoulder dystocia. We carry several different medications for bleeding, as well as IV fluids and oxygen for maternal shock. We keep our skills current on resuscitation of babies, which isn’t as rare as it sounds – something like 1 out of 10 babies will will need a little help to breathe. So we help them.
Birth Education and Doula Support
When families hire a midwife do you encourage them to take birth classes and have birth doula support? If so, why?
I really, really push childbirth education. On the one hand, you can’t prepare for what sensations you feel and how intense it will be. On the other hand, just understanding the basics of what’s normal and what’s not, and learning the physiology of birth can really help reduce fear. Your body is amazing and you should learn how it works. I guarantee you it’s very cool. And sitting in a room with 8 other pregnant couples who have just as many seemingly silly questions as you do is so validating and comforting.
I also really recommend doulas. People feel confused, like, “Wait, but aren’t you my doula?!” Unfortunately, I can’t be the doula because I am responsible for your medical care. The doula is responsible for continuously helping you and your partner to stay grounded and nourished over a potentially long labor, or to help you deal with intensity of a fast labor. While I am able to offer reassurance, encouragement, and suggestions for a difficult labor, I can’t be the one who massages your back for 16 hours straight, because I have to also take your vitals and monitor your baby.
When your baby is born, I will need to be very alert to be a safe care provider for you, which means I can’t be at your house for the entirety of your early labor; instead I arrive in active labor. If you feel that you need the guidance of a professional at your birth during early labor, and you know you want a lot of hands-on support during active labor, please hire a doula! So many first-time parents don’t know that contractions can literally last for days. A doula is a very useful resource if that makes you nervous.
Resources and Education
What is your favorite resource for families looking to educate themselves more about home birth and midwifery?
Well, I just started my blog! https://gestationalrage.
If you think a home birth might be for you at all, don’t be shy – go interview a couple of midwives or go to the open house at the birth center or whatever is going on in your region. You can do all the internet research you want, but in the end you still have to sit face-to-face with the person who’s going to help you have a baby. Just make the appointment. You’ll get a good idea quite quickly about whether this is a good thing for you – or not!
When I first got into birth work, there was a dogma about natural childbirth being “the best” and anything else being something that is to be feared and avoided. These days, the zeitgeist is that while natural childbirth is beautiful and evidence-based, we know that the WHO recommends a 10-15% Cesarean rate for the safety of all mothers and babies. Besides, not all birthing people even *want* a natural childbirth. So, the culture is really embracing and validating that women are doing the best they can, that women deserve better than what the US is giving them right now, and that all births are beautiful.
Jocelyn Brown