Recently my mother started worrying about my blood pressure. I suppose it’s her job to worry when I’m pregnant. She asked my husband whether my midwife takes my blood pressure at prenatal visits. My husband, who hasn’t come to any prenatal visits this pregnancy, replied that he didn’t know.
I was annoyed when he related this conversation, not just because of the implication that something might be wrong with my pregnancy, but also because of the implication that my midwife doesn’t do basic medical procedures. Sorry, Mom; this isn’t directed at you, but a lot of people seem to have this view of midwives. Honestly, I can hardly blame them. When I first decided to start seeing a midwife, I couldn’t mention her without feeling like I had jumped back to the Middle Ages. I suppressed a giggle (and irrepressible thoughts of Karen Cushman) every time I mentioned my midwife’s apprentice. It all just sounded so archaic and quaint.
And it’s true: home birth midwives are central to the movement to reduce the medicalization of birth. The whole point of a midwife is that she believes birth is a natural process which, under normal circumstances, does not require medical intervention. But that doesn’t mean that she’s a crazy hippie who does nothing but light incense and chant while gazing at my baby’s aura. She actually does do medical stuff. There is a reason, after all, why Certified Professional Midwives are accused of “practicing medicine without a license” in states where the CPM license isn’t recognized.
But aside from the strange ideas that many people have about midwives in general, this question is a valid concern for many pregnant women who consider home birth. Can a midwife handle medical emergencies if they occur during a birth? What situations is she prepared to handle? Would she have detected the complications that occurred in my last birth? These are factors that a woman should consider before she decides to have a home birth. So in case you’re wondering, here’s a brief (although far from exhaustive) list of some of the medical procedures and situations my midwife handles.
Prenatal Procedures:
- She takes my blood pressure.
- She checks my heart rate.
- She listens to the baby’s heartbeat.
- She checks the baby’s position.
- She tests my urine for glucose, ketones, blood, protein, pH levels, bilirubin, nitrate, specific gravity, and leucocytes. She also examines it to check for hydration (and that I’m taking my prenatal vitamins, which makes pee fluorescent).
- She had me get a prenatal blood panel from my doctor. She didn’t do this herself, but she gave me a list of the tests she wanted done. Technically my doctor didn’t do it either since she had sent to a lab.
- She ordered an ultrasound at my request and sent me to a technician to have it done.
- She questions me about diet and exercise. She recommends supplements and changes as necessary, based on our conversation and my urine test results.
Procedures During Labor:
- She checks my cervix for dilation (although she’s happy not to do this if the mother doesn’t want it; she can judge how far labor has progressed by simply observing).
- She checks the baby’s heartbeat at regular intervals (this is the only procedure that my midwife insists on doing. She’s happy to “attend” a birth by sitting in the next room if you want her to, as long as you let her in periodically to make sure the baby’s heartbeat is fine).
- She observes for signs of problems such as dehydration, difficulty progressing, bleeding, or poor positioning. She recommends a transfer if necessary.
- She can perform episiotomies. She can help turn a baby with shoulder dystocia.
- She can catch the baby (or coach mom or dad to catch).
- She can coach pushing and positioning if the mom wants her to (but she won’t unless you request it).
Postpartum Procedures:
- She checks AGPAR scores.
- She can administer oxygen if necessary.
- She can administer herbs and medicine to prevent hemorrhaging if necessary.
- She administers a rhogam shot if you’re RH negative.
- She examines the placenta to make sure none of it was retained.
- She performs the newborn exam (weighing, measuring, etc.).
- She offers optional vitamin K supplements.
- She offers optional antibiotic eye drops.
- She clamps and cuts the cord (or coaches whoever you’ve chosen to cut the cord–usually Dad).
As I said, this is by no means an exhaustive list. It’s based on my first (completely complication-free) birth with her, as well as conversations I’ve had with her about situations she has experience handling. I’d love to hear what other medical procedures home birth midwives commonly perform. Share in the comments!–did your midwife handle a complication at your home birth? Midwives, what routine procedures am I forgetting?
Your midwife also brings pitocin (in addition to time-tested herbal tinctures such as shephard’s purse) to births in case there is any post-partum hemorrhaging. She can also stitch you if you tear, though most would argue that you’re less likely to tear if you’re relaxed and able to deliver your baby in whichever position your body wants (e.g. squatting, kneeling, utilizing gravity as we’re meant to do)- conditions unlikely to be met in a hospital setting.
I just had my 2nd home waterbirth and I too felt like everyone was always trying to make feel more concerned I wasn’t receiving enough medical intervention. I lost 20lbs in my 1st trimester w/baby #2 and I think half of it was from stress everyone else was putting on me rather than from the vomitting every day! Its not a coincidence that as medical intervention has increased over the decades so has pre-mature births and other childhood diseases.
We have the same midwife. 🙂 (Not that you don’t know this, but for the benefit of other readers!) I had a pretty bad second-degree tear, probably because Fitz came FLYING out all at once instead of the usual thing you hear about the head delivering and then waiting for the next contraction for the body to deliver. I was pushing on my hands and knees and she was supporting my perineum; when he came flying out her options were continue with perineal support or catch the baby, so she caught the baby! She gave me lidocaine injections and stitches. To me it felt like the stitches took forever but I have no idea how long it actually took. My husband held the baby for part of this and then I held him.
At my one-week postpartum visit she felt I was still bleeding too heavily and recommended I make a tea from shepherd’s purse and nettles (can’t remember the proportions… it was 1 to 3 but can’t remember which way). It tasted awful but it worked *immediately*. I only had to drink that nasty-tasting tea once and the bleeding had almost completely stopped.