midwives and medical procedures

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: 

1. She takes my blood pressure.
2. She checks my heart rate.
3. She listens to the baby’s heartbeat.
4. She checks the baby’s position.
5. 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).
6. 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.
7. She ordered an ultrasound at my request and sent me to a technician to have it done.
8. 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:

1. 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).
2. 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).
3. She observes for signs of problems such as dehydration, difficulty progressing, bleeding, or poor positioning. She recommends a transfer if necessary.
4. She can perform episiotomies. She can help turn a baby with shoulder dystocia.
5. She can catch the baby (or coach mom or dad to catch).
6. She can coach pushing and positioning if the mom wants her to (but she won’t unless you request it).

Postpartum Procedures:

1. She checks AGPAR scores.
2. She can administer oxygen if necessary.
3. She can administer herbs and medicine to prevent hemorrhaging if necessary.
4. She administers a rhogam shot if you’re RH negative.
5. She examines the placenta to make sure none of it was retained.
6. She performs the newborn exam (weighing, measuring, etc.).
7. She offers optional vitamin K supplements.
8. She offers optional antibiotic eye drops.
9. 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?