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Why Choose Home Birth? Part 3

Editor’s Note: This is the third in a multi-part series asking families to tell us in their own words why they chose home birth. (Read Part 1 and Part 2)

Photo credit: Megan Crown Photography

“So peaceful. So calm.”

We chose to have a home birth with our second daughter after birthing our first born in the hospital. In our hospital birth with our oldest we were still able to have her naturally, as we had hoped. However, the hours after her birth and the following days led us to desire something different. She was quite healthy and was doing just fine but they continued to do unnecessary evaluations that would wake us all up and disrupt our nursing pattern.

When we found out we were expecting again we decided to look into other options. That is when we found our home-birth midwives and were thrilled with the possibility of doing this differently. Our second baby came rather quickly on a cold December morning and by mid-afternoon, when all was said and done, we were tucked into our cozy bed snuggling with our new baby girl. I will never forget that first day. So peaceful. So calm.

Our dreams of a perfect birth were far surpassed with Audrey’s arrival and we couldn’t possibly imagine having a baby any other way. Our son is due any day and we can’t wait to enjoy this experience again. We feel this decision has been incredibly impactful not only for our immediate family but also for the people closest to us. Their ideas of home births are changing now and we feel so glad to get to share it with others!

Emily and Dan

“My midwives brought care and tenderness to one of the peak events of my life. “

I had two top reasons for desiring a home birth. One, I didn’t want anyone I didn’t know at my birth. Birth is much more than a medical event. It’s personal, sacred, emotional, and powerful. I wanted my birth to be by invitation only!

Two, no unnecessary interventions–or at least greatly minimized. Can’t get out of unnecessary interventions at the hospital. Even in best cases where they’re minimal, they’re still there. I knew that with Trillium, I would trust that any interventions that took place were necessary. For example, the Pitocin shot after the placenta came. I trusted that the medicine was in my best interest. If I was given a Pit shot in the hospital, I would question its necessity just because of being in the hospital.

I chose home birth for the birth I hoped for, but ended up valuing the prenatals greatly. It was always a joy to spend time with our midwives Emme and Clare. Another amazing benefit that came to light was how this pregnancy and birth was a whole family affair. That wouldn’t have happened within other models of care. My boys were present for prenatals and the birth, and I believe their involvement helped them welcome Louisa with joy and love. They are so sweet with her.

I am blessed that the reality of my home birth was everything I hoped for. I was struck by how normal it all seemed– of course birth IS normal. But generally in our culture families who choose home birth are viewed as reckless or extraordinarily brave, and the birth itself rather wild or unfathomable. Well, I don’t view myself as reckless or brave. I’m just a woman who had a baby, and it was so normal and comfortable (not always physically comfortable, ha ha).

My midwives brought care and tenderness to one of the peak events of my life.

Lindsay

“…supposed to be about love and tranquility and family.”

In February 2009, just months after getting married, I was diagnosed with multiple sclerosis. As I sat in the neurologist’s office and listened to him tell me to get used to the idea of living in a wheelchair and that I could continue drinking alcohol in mass quantity without any negative effects beyond what anyone who drinks too much would experience, something changed in me. I knew he had to be wrong. There had to be SOMETHING I could do besides daily injections, steroids, and frequent doctor visits. I left his office feeling unsettled and distrustful of his advice. I changed my life completely within 3 days – I read countless books on natural healing, scoured the internet for success stories, and became raw vegan and a non-drinker. I essentially healed my MS.

After my diagnosis but before a lot of my healing, I read horror stories of women with MS and how childbirth often triggers an attack. I told my mom that maybe I’d never be able to have kids. I cried a lot. About a year later, feeling great, healthy, and in the best physical shape of my life, I told my husband I wanted a baby. So we made one!

I had read about home birth on a raw vegan blog. It was a new idea for me, but it triggered a, “yes, yes, yes!” reaction in me as much as my neurologist’s advice has triggered a, “no, no, no!” one. It just made sense. Birth wasn’t supposed to be about fear and surgery and intervention – it was supposed to be about love and tranquility and family! And those are things that are at HOME. Luckily, I married a man who had always been suspicious of the American medical model and who was on board with a home birth.

We prepared ourselves as best we could with a Bradley class and discussions with other parents, always holding in the back of our minds that I might have an exacerbation of my MS symptoms postpartum. In October 2010, we had our first baby, at home, in our bed. In the best way possible, it was fairly uneventful. My sweet girl, Violet, came out forehead-first, a “star-gazer.” Only now, looking back and after many discussions with my wonderful midwives, is it really clear to me that had I been in a hospital I very possibly would’ve ended up with a c-section.

Although I have had some MS symptoms since Violet’s birth, they have been minor and few and far between. I know they will disappear once I can concentrate a lot of time on myself. I am so thankful, every day, for my dis-ease and the path down which it has lead me. I never would’ve known about home birth without it.

We welcomed our second daughter this past December, in a tub in our living room, on the birthday of one of our beloved midwives, with her older sister watching.

In many ways, my dream of my home births IS my reality – they were warm, happy, exciting events shrouded in a hormone-induced haze of forgetfulness. And, I have to admit, I love that my beautiful, incredibly healthy children are a walking “fuck you,” to everyone who told me that I was going to kill myself and/or my baby by choosing to have them at home.

Jess McNab

Check back tomorrow for part 4 in our series!

Why choose home birth? Part 2

Editor’s Note: This is the second in a multi-part series asking families why they chose home birth. Today, we start with voices of the birthing mothers. Part 1 can be found here.

Photo Credit: Megan Crown Photography

“Life was happening all around me…”

Why did we choose home birth? The impetus for me was my OB telling me that she’d grudgingly allow me a trial of labor with my 2nd child, but didn’t feel that I’d be able to deliver since I couldn’t birth a 6 lb 6 oz baby vaginally. After that I searched for a different way, I wanted a VBAC. Hospital just wasn’t an option in Nevada, and no hospital midwife could take me. That left a clinic or home birth. I started researching and ended up meeting with a midwife for an interview. She allayed much of my fears. I wanted to have a more natural birth for my child and for myself – one without doctors forcing drugs, inductions, interventions, monitors, c-sections. I wanted it to be peaceful, I wanted my first child there. I wanted to hold my baby right away, nurse her, not have her taken from me to be weighed and goop stuck in her eyes. I wanted the option of what would happen with my placenta and the cord blood, the doctor cheated me of that in the hospital opting not to take cord blood even though we had made it clear we wanted it. So many reasons to choose home birth, many more that I haven’t written.

My dream for my home births…..well, I didn’t have it all planned out in my head. I didn’t want to. My plan was healthy baby delivered at home safely. That was it really except that I did want a water birth, which never did happen! I’d say that plan succeeded, all 3 times. It was immensely better for us as a family – to be home, lower stress, be together, have the new baby fold gently into our lives, our children being right there the process not hidden from them. I remember very distinctly during my first home birth, my oldest running around playing near me as I laid draped over the birth ball inching toward transition. She ran giggling past me once and the soft breeze of her movement fanned my cheek and tousled my hair. I don’t know why that moment sticks with me so much, but it does. I was beautiful. Life was happening all around me…our normal family life and our new baby’s birth folded in.

Kim

“…both positive and negative for my family.”

I chose a home birth because I thought I would have more control over the circumstances of my son’s birth and the situation than if I were in a hospital. I discovered that although I had more ability to make my own choices I couldn’t really control my labor and how it unfolded – it still turned out different than I envisioned. In choosing to take more responsibility for the birthing process I found that it was a lot scarier than I thought when I was actually beginning labor. I was deciding how I wanted to proceed rather than having someone tell me “you’ve been having contractions for days you need to go to the hospital,”or “you need to have a cesarean.” While it was scary when I was in that in-between time between pregnancy and full labor, I also experienced the opposite end of the spectrum. I felt all throughout my pregnancy that everything was as it should be, pregnancy and birth was a natural process that doesn’t need a lot of intervention (in most circumstances), and that I could have a relaxed experience as a pregnant woman. I really enjoyed my pregnancy for the most part because of meeting with my midwives out of a clinic setting and developing a relationship with my caregivers.

The decision to have a home birth was both positive and negative for my family. It was positive for my older son because he was able to be a little more involved in the pregnancy and also was not disrupted in his routine after the baby was born because we were all at home. My husband was supportive about my decision to have a home birth but would have preferred a hospital birth. Our home birth experience ended up having a few unexpected and not necessarily pleasant surprises and really caused my husband to wish we hadn’t had a home birth after the fact. It all turned out fine though and in my mind I would have had the same issues in a hospital but I would have felt forced to take actions that I did not necessarily want to take. It’s like anything in life that has an unexpected twist, you never know if you had made a different choice how different the outcome or process would have been.

Maureen

“I knew there was another way”

We chose a home birth because we researched it thoroughly and decided that it would be a safer option for us. I visualized my birth experience to be fast, private and calm and in the middle of the night and that’s exactly how it happened! We had candles lit during a dark February night. I was in the warm birthing tub and it felt so cavelike and private which I felt really helped to keep me “open”. I attribute that to my very fast labor and birth. My husband was my birth coach. We felt like we welcomed our little one into our family as a team which is a great way to begin!

The support that the midwifery team gave us was exactly what we were looking for – they were genuinely warm, encouraging and caring which was the exact opposite of the experience I had for the first few months of my prenatal care at a big practice in downtown Minneapolis. When I was with the large OB practice, I realized quickly that they lacked optimism and confidence in me and I began to internalize their frenzied doubt. I knew there was another way so I stopped going and transitioned my care to home birth midwifery care – it was a great decision for me and my family!

Steph and Jon

Check back tomorrow for part 3!

3rd Time’s a Charm: The HBAC Waterbirth of Bryce

by Robyn Hustrulid

Before starting this birth story, I feel the need to mention my 1^st and 2^nd births. They are the beginning of my journey and very much effected how I gave birth to my 3^rd child. My first came a couple weeks early with my water breaking in the middle of the night. I went to the hospital before contractions started and after walking around a bit, they started me on Pitocin. It took the whole day for contractions to get strong, and after 2 hours of strong contractions, an epidural and a cervical check resulting in little progress, the OB recommended a cesarean. Besides asking if we could wait, I didn’t know enough to fight this recommendation, so my first baby came to me via an unplanned, and what I have come to realize, an unnecessary cesarean. The reasoning was “failure to progress,” or maybe we could call it “failure to wait.”

The cesarean wasn’t easy for me to accept. I was happy I had a healthy baby, but not happy with how things went. Breastfeeding started off rocky and recovering from major abdominal surgery was not what I had planned for. I knew I wanted something different for my second birth. I started asking about VBACs (Vaginal Birth After Cesarean) at my 6-week postpartum visit. And then two and a half years later when I got pregnant, I read more books, watched the essential movies, attended some parent topic nights, became a regular at Blooma, switched to a midwife, and hired a doula. I felt prepared and knew that I could accomplish a safe and rewarding VBAC. My labor started at 41 weeks, again with my water breaking in the middle of the night. I stayed home and waited for contractions to get intense, and then went to the hospital. There were a few hiccups of back labor, stalled progress and an epidural, but eventually I welcomed my 2^nd baby into the world via a VBAC!

After that experience, I fell in love with the role of the doula, because I knew my first birth would have been different if a doula had been with me. I decided becoming a doula was the right path for me and dove in headfirst. After 2.5 years of witnessing strong mamas welcome their babies into the world, I decided it was time for me to do it again. But again, from all that I had learned and witnessed, I knew this time would be different. I decided to have a homebirth. I hired 2 midwives and 2 doulas. I focused on eating healthy, working out and doing yoga. I also went to the chiropractor regularly to make sure my pelvis was balanced and my body was in alignment. After hearing amazing reviews, I decided to give Hypnobabies a try as well. I was very committed to doing all of the homework and listening to the tracks daily. I was a believer but wasn’t sure if it would work for me until my birthing time came.

On Mother’s Day 2013, my guess date, I decided I wanted to have a low-key day and spend some time with my own mom. I took a nap and listened to the “Come Out Baby” track from Hypnobabies. Then I went for a walk in the afternoon with my mom and a movie after. I had been having Braxton hicks daily for weeks, but started to notice some waves (Hypnobabies term) coming more regularly during the movie. Later I realized this was my early birthing time, but during I dismissed them because they didn’t seem to be getting stronger. These waves continued on through the night as I ate dinner with my kids, did the dishes (while listening to Birthing Day Affirmations) and then put the kids to bed. I went to bed thinking nothing was happening, but decided to listen to my “Deepening” track. I wasn’t able to fall asleep because the waves were getting a bit stronger. Around 11:30, I felt some fluid leak a couple times and thought I was peeing, so I decided I should go to the bathroom. When I stood up, I felt a gush between my legs and knew exactly what was happening. I sat on the toilet and felt a bit stunned, excited, anxious, and in disbelief. I called to my husband that “my water broke.” It took him a bit to wake up, but then he got up, and we started getting things together.

I made my phone calls; told my mom to come over to sleep, and I let the midwives and doulas know that it was happening, but I didn’t need them yet. I could feel the waves but they weren’t very strong, so we decided to get everything ready and then go back to bed. David set up the birth tub and got me some water. I got the camera, some snacks, the Hypnobabies scripts and my iPod out. My mom got to our house around 12:30. I told her “this one is sure different.” I had a few waves in the kitchen and leaned over the counter while breathing through them. They still felt somewhat mild to me or just like pressure. I was sure there was a lot of time left.

Around 1am, after we felt like things were gathered and set up, I asked David to do the rebozo for a bit. I was feeling some of the waves in my back so we wanted to encourage baby to get in a good position. After a couple waves, I got up and sat on the ball and David turned on the “Fear Clearing” track. The waves started to get a little more intense, so I decided to call my midwife around 1:30am. She asked how close they were, and we had no idea. So she asked that we time a few and call her back. After timing them and seeing that they were 3 minutes apart, I realized that things were moving faster than I thought, but I still felt like it was early in my birthing time. My midwife decided they should come, so I also called my doulas to come. My midwife also suggested we do an initial fill of the birth tub, because it would probably take a couple, and we would need time for the water heater to heat more water.

With every wave, I was leaking a lot of fluid, so I decided to get in the shower. I let the hot water run on my breasts in between the waves and drew peace signs and hearts on the steamed up shower door. During the waves, I leaned over and let the hot water run on my back. My mom got me my water bottle, and I put it in the shower with me. I could hear some of the Hypnobabies in the background, and I was saying, “Open, Open, Open.” After the waves I would burp, and I smiled as I remembered my midwife telling me that was a sign of active labor. I loved the shower and the routine/rhythm I had created. But sadly, because we were also filling the tub, the hot water ran out. I got out and sat on the toilet around 2:25am. My mom started to boil some water just in case. I didn’t realize it at the time, but my mom and David started to get a little anxious for the midwives to get there. My mom asked David if he could deliver the baby if need be. He just grinned and put his hands out like he was catching a baby.

One of my doulas arrived around 2:30. She took note that waves were about 2 minutes apart, and I was listening to Birthing Affirmations. I remember using my peace cue during waves, and feeling like it was really helping. My doula said relax, and I could feel my shoulders melt and my body soften. Around 2:45 one of my midwives arrived, so my mom was able to relax. My doula suggested I eat something, so David went and got me some yogurt and an Emergen-C drink. The midwife in training arrived shortly after, and then my other doula. One of my doulas came and put her hands on my shoulders and forehead and told me to relax.

My midwife tried to hear the baby with a fetoscope but wasn’t able to get a good angle while I was on the toilet. My other midwife arrived and also tried to listen to baby while I was on the toilet, but it wasn’t working, so they asked me to stand up. I stood up and leaned over my sink. My doula did some double hip squeezes and massaged my back, which felt wonderful. My midwife was still unable to find the baby with the fetoscope, so she asked if I wanted to get in the bed or use the Doppler. I couldn’t imagine lying down, so I said Doppler. She found my baby’s heartbeat, and it was perfect. I remember hearing on the Hypnobabies track, “say your baby’s name.” And I said, “I don’t know your name.”

At 3:24 I asked if I could get in the tub. It wasn’t ready yet, so one of my doulas went downstairs and helped my mom bring the boiling water up to fill the tub. David and my other doula were checking to see if the water was warm enough to start filling it with the hose. Around 3:30, I started to feel like I needed to poop; my doula mind knew what that meant, but I wasn’t ready to admit it out loud yet. As the pressure built, I asked again if I could get in the tub, but it still wasn’t ready. One of my doulas suggested I sit on the toilet while I waited. When my first wave came while on the toilet, I felt my whole body start to push and I couldn’t resist it. I had about two waves like that, and heard my midwife say, “she is going to have that baby on the toilet.” I said, “I NEED to get in the tub.”

Around 3:40 I got in the tub, and my mom was still dumping hot water in it. When the first wave started to build, I got into a froggy squat position. It felt like the rise of a roller coaster, excitement, nervous, anxious and joy in the anticipation. I knew once I got to the top there wasn’t anything I could do. This baby was coming down, and I was just along for the ride. I felt my whole body start to involuntarily push. It was such an unusual feeling, and I knew I had no control and needed to surrender. The “Pushing” track was on, and I remember sending peace down and out in front of my baby’s head. After the wave, I leaned over the side of the tub, rested my head on the edge and asked for cold washcloths. David held one on my forehead and someone put one on my neck. While pushing I could feel the baby’s head moving down and then rocking back up in between waves. My midwives told me I could reach down and feel the head during the next wave, and it was then that I finally believed I would meet my baby soon.

Just before 4am, one of my doulas asked if I was ready for the kids to come in. I said I didn’t know and asked if they thought the kids could handle it. Everyone said yes, so I said ok. My mom woke up Kyle and Jolie and they came around the corner sleepy eyed and smiling. They got pillows and blankets and lied in the hallway. They would sit up and watch as they heard me making grunting and pushing sounds. Kyle asked my mom, “What’s all the drama?” Apparently I was making more noise than the women in the movies I had showed them. In between waves, I asked Kyle if he was ok and he said yes and didn’t look the slightest bit scared.

My midwife suggested I tilt my pelvis during the next wave so the baby could get past my pubic bone. What a difference that made, I could feel the baby move down even further and stay down. During the next wave I sat back and thought in my head I’m going to keep pushing even if I feel burning. I reached down to feel the head coming out, and then the wave stopped. I asked, “is this ok,” even though I knew it was. My midwife assured me it was just fine and the baby’s color looked great. During the next wave, I could feel the shoulder come out and then the rest of the body slide out. I brought my baby up on my chest and felt the most incredible rush of emotions. “Oh my God, oh my God, oh my God, this was awesome! Everybody should do it!” And then I heard my son say, “it’s a boy!” My sweet little man, Bryce David Hustrulid, came into this world in such a beautiful way at 4:04am and changed our lives forever!

Bryce David Hustrulid born May 13, 2013 at 4:04am

8lbs 14oz, 21 inches

Midwife: A documentary about home birth

Local birth photographer turned filmmaker, Allison Kuznia, writes about the making of her new documentary.

For the past decade, through my births, as well as in my work as a birth photographer, I have been intrigued by the world of home birth midwifery.

So I decided to make a movie about it.

My goal in making the movie was to show the art, beauty, and compassion within home birth midwifery. But, as I went through the process of filming and conducting interviews with women and midwives from other states where home birth midwifery is not legal, a bigger message emerged from the movie as well.

I talked with a midwife from Iowa who was arrested in 2007 for practicing medicine without a license. I talked with the women behind Birth Matters in South Dakota, a state where their home birth midwives received cease and desist orders, and the women who wanted to birth at home were left with options they didn’t want to face: 1) birthing in a hospital, 2) having an unassisted birth, or, 3) crossing the border to have a hotel birth with a midwife from another state. I talked with a couple who described what they went through in finding an underground home birth midwife while they lived in Nebraska, and comparing that to how easy and accessible it was to find a home birth midwife after they moved to Minnesota.

Through these interviews, the message behind this movie started to come together on its own: Families deserve the right to choose where and with whom they birth.

While the documentary follows Twin Cities home birth midwife, Sarah Biermeier of Geneabirth, through her first year, from prenatals, to births (including a wonderful VBAC2), to postpartums, it also examines what the birth environment looks like in states where home birth midwifery is not legal and families are faced with fewer birth options. In an act that should be simple, giving birth has become a human rights issue and a political event.

Other communities around the country, especially those in states where groups are working toward the decriminalization of home birth midwifery, have requested and are hosting screenings of the film. The premiere screening will be here in Minnesota. The film will be available for purchase on DVD and online streaming after the new year.

Midwife Documentary – Trailer from Allison Kuznia on Vimeo.

Midwife is premiering at The Heights Theater on Tuesday, September 24 at 7 pm with a 30 minute Q&A following the film. Visit www.midwifethedocumentary.com for more information and to purchase tickets.

Home Birth? Me? No Way!

by Liz Hochman, CD(DONA), LCCE

If you would have asked me, newly pregnant with my first baby at age 27, if I would ever have my baby at home I would have thought you were crazy. I mean, homebirth just isn’t safe! There are no epidurals there! Only hippies and crazies would do that kind of thing!

During my first pregnancy I read everything I could get my hands on, and I mean EVERYTHING. My bedside table was 20 books deep at any given moment. Being the type A, analyze-everything, trust-the-data person that I was, I treated preparing for my childbirth like I was getting a degree in how to have a baby. I attended a standard childbirth education class and learned all about when I could get the epidural, how the epidural worked, and any other interventions and medications that were available to me. At no point during this learning did anyone ever mention to me, “Hey, you’re planning a natural unmedicated normal low risk birth? You might want to consider a homebirth.”

Fast forward to after that birth and into the first year of parenting my sweet new baby girl. I found myself questioning a lot about the whole experience. I began my path towards becoming a doula and found myself pregnant with my second child. It was during this process that I realized homebirth was the logical next choice for me. I wanted to KNOW who my provider was going to be at my side during this very vulnerable day. I wanted to not have to drive anywhere during the most intense parts of my labor. I didn’t want to try and negotiate and fight with the staff regarding tests, procedures, and monitoring. I respected those people a lot, as I worked with them nearly every week attending hospital births as a doula. But I knew that I didn’t want them to have to “make an exception” on my behalf as I asked for fewer and fewer items I knew they were required to implement.

So I began looking into this whole crazy homebirth thing. Me! The type A, ex-research-manager-turned-doula, suburban mom – having a homebirth. My husband had many questions about safety so we reached out to a few midwives and interviewed them. He asked all the “what if” questions he could think of. They were all so lovely and thoughtful in their answers. They had clearly done their work, studied, learned, and were qualified to be compassionate and competent medical providers. Each question we asked about safety was answered in a way that made total sense.

Q. What if our baby needs help breathing?

A. We bring oxygen and everything needed to resuscitate a baby.

Q. What if there is a shoulder dystocia?

A. We would do the same thing at home as they would do in the hospital for a shoulder dystocia.

Q. What if I bleed too much after birth?

A. We bring the same medications they have in the hospital to help stop the bleeding.

The biggest selling point for me, came from the numbers – once again! The data and numbers person from my past just can not be ignored. So I found the research, and it was a clear choice.

The biggest selling point for my husband was that it was cheaper than the hospital birth and we could all sleep in our own beds after the birth. Originally when we called our insurance company they stated that they did not cover any out-of-hospital providers for birth. So we decided we were just going to have to take this financial hit and deal with it. Turns out they ended up covering nearly 1/3 of the expenses and it was STILL cheaper than an unmedicated normal birth at the hospital.

As I lifted my second-born from the water with the sunshine pouring in my large window in my living room I exclaimed “I DID IT!” In retrospect, I think I was talking about a lot of things when I made that exclamation. Yes, I created and birthed this beautiful child, that part is definitely part of that “I DID IT” statement. The other part was the piece where I trusted myself, my body, my instincts, and my yearning to have birth happen a different way. A way that allowed me to be WITH my family, WITH my home, WITH support, and WITH safety.

I guess that means I’m one of the hippies and crazies now?

Liz Hochman is a doula, Lamaze-certified Childbirth educator, and mama of two sweet girls. She teaches childbirth education at Blooma.

Citation:

http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

Sweet Moments in OOH Birth: A Doula’s Perspective

by Anne Ferguson, CD(DONA), HCHI

A homebirth mama is comforted by her partner and her doula as her midwives look on.

Amazing, beautiful and empowering birth can happen anywhere, that’s for sure. But there are some special things I’ve witnessed as a doula in out-of-hospital birth that you really don’t see in a hospital setting. Here are just a few of the amazing things I’ve had the honor to be a part of in some of the birth center and home births I’ve attended as a birth doula.

The doula waking the older children in the middle of the night just moments before their Mom pushed their new sibling out in the world so they could witness the birth, and the children announcing the sex of their new baby sibling.

The entire birth team and family enjoying chocolate cake and pink champagne at 6 am after a beautiful home birth.

A strong Mom pushing her baby out into the world just as she envisioned, in the birth tub in her backyard as the sun rose on a beautiful summer morning.

Enjoying Pizza Luce for lunch while sitting around the dining room table in a comfortable and cozy birth center with a Mom in early labor, waiting for her body to move into the next phase, without any expectations around timing or a need to rush the process along.

A beautiful, quick birth during a power outage, because it turns out you don’t really need power to have a baby!

In general out of hospital birth offers the following perks:

Taking a bath or shower in your own bathroom and then climbing into your own warm, comfortable bed not long after giving birth.

A homemade meal made just for you, right in your own kitchen or in the birth center kitchen, made just to your needs and tastes.

Midwives who you know and trust because you’ve been meeting with the same people for months, and you know who is going to be there when the times comes for your baby to be born. (This happens sometimes in hospital birth with small groups of care providers.)

Moms being able to trust their bodies completely, knowing when it’s time to push their babies out without any cervical checks.

Control over who comes in to your postpartum space, instead of the constant flow of traffic that usually happens in the hospital setting.

Out of hospital birth is a safe and wonderful option for low risk mothers wanting a low-intervention birth. In the Twin Cities we are incredibly lucky to have three free-standing birth centers and many, many wonderful, skilled home birth midwives. If you are planning to have a low-intervention birth, it is well worth your while to consider your out-of-hospital options!

Anne Ferguson, CD(DONA), HCHI is a birth doula, Hypnobabies instructor and placenta encapsulator who has two sons, one born in the hospital and one in the comfort and safety of her own bedroom. You can find her at www.bywaterbirth.com.

The Lowdown on Out-of-Hospital (OOH) Birth

by Kate Saumweber Hogan, CPM, LM

A homebirth mama gets support from her midwife.

What is OOH Birth?

Out-of-hospital (OOH) birth refers to births occurring outside of a hospital, such as at a home or a free-standing birth center that is not connected to a hospital.

Planned OOH births can be in a house, townhouse, apartment, trailer, hotel, friend’s house, birth center, or even a back yard! Most homebirth midwives are pretty flexible with space needs, and can make almost any “home” work. Ideally, there should be running water, electricity, and a phone (or cell phone service), but even those can be negotiated!

Weighing the baby at a homebirth

What do all of those letters mean after midwives names?

There are two general kinds of midwives in our country. There are nurse midwives who are primarily trained in a hospital setting and most often attend births in the hospital; they are called Certified Nurse Midwives (CNMs). Some CNMs gain additional experience to offer OOH care as well.

The second type are direct entry midwives; these midwives are primarily trained in the home birth or OOH setting and provide care in this setting. Some direct entry midwives earn the national credential of Certified Professional Midwife (CPM). In Minnesota, CPMs also have the option of becoming licensed by the state, which also gives them the title of Licensed Midwife (LM). It is a good idea to ask your midwife what her credentials are, especially in Minnesota where there are so many possible combinations!

A homebirth midwife helps a mama welcome her baby earthside.

It is safe to birth at home or at a birth center outside of a hospital?

Midwives are experts in normal. So for normal, low-risk, healthy moms and babies, YES, research shows that with a trained care provider, it is as safe or safer to be OOH than being in a hospital setting. However, OOH birth isn’t for everyone. Your midwife will help determine if you are a good candidate for OOH birth, and will continue to monitor you and your baby during pregnancy, labor, and delivery to ensure that it is still safe to be at home.

If you would like to read the research available regarding home birth, a thorough review is available through Midwives Alliance of North America.

The question is often, “is homebirth safe?” but rarely, “is hospital birth safe?” This article looks at the other side of the coin.

What equipment do OOH midwives bring?

Each midwife will have a little variation in her birth bags, but in general, most midwives are certified in neonatal resuscitation and CPR, and will have equipment pertaining to those certifications. She will have medical supplies such as oxygen, suction for baby, medications for hemorrhage, a fetoscope and doppler to monitor baby’s heartbeat, a baby scale, and equipment to check mom’s vitals (blood pressure cuff, stethoscope, thermometer, a watch).

Some midwives carry IV equipment, suture and lidocaine for perineal tears, a pulse oximeter, a variety of herbal and homeopath remedies, and a birth stool. Some midwives also rent birth tubs and have additional equipment relating to the tub. Be sure to ask your midwife what you can expect her to bring to your birth.

Most midwives have families purchase a birth kit, which will have all of the disposable things that are needed for the birth, such as underpads, gloves, gauze, and a peri bottle. Families will also be asked to gather a list of supplies to use at the birth, such as towels, baby blankets, and extra pillows.

A new family snuggles in their own bed just after birth

Is homebirth messy?

This question comes up a lot! Surprisingly, birth is not at all like it is portrayed in the media and it really isn’t very messy. Your midwife uses supplies from your birth kit to help protect your bed and floor. She will start the laundry and clean up any sign of your birth before she leaves your home so your visitors won’t even know where the birth happened! There isn’t even very much trash, often barely enough to fill a kitchen sized garbage bag. You may have a second bag of trash if you are using a birth tub with a large plastic liner.

A mama meeting her baby in her own home.

What about labs, ultrasound, and newborn care options?

When you interview potential midwives, it is good to ask if they offer routine labs, ultrasounds, and newborn care options (vitamin K, erythromycin, newborn metabolic screening, hearing screening, CCHD screening). Some midwives offer them as part of routine care, and others would refer you to your primary clinic for these services. Informed consent and shared decision making is at the heart of midwifery care. Prenatal visits will be an opportunity to discuss the pros, cons, and alternatives, and make a decision together about what is the best choice for you and your family. If you’d like to decline testing or newborn options, you can! It is your choice and it shouldn’t be a fight! But it can be nice to know what options will be available to you, since there may be some that you want for yourself or your baby.

If the midwife you choose doesn’t offer the newborn screening options (metabolic screening, hearing screening, and CCHD) most midwives who offer these options are willing to see babies outside of their practice for these screenings. You can find providers who offer these services here: http://minnesotamidwives.org/MCCPM/Newborn_Hearing_Screening.html

Does insurance cover it?

Sometimes! There isn’t an easy yes or no answer, since it is really plan dependent. Most OOH midwives are out-of-network and will be covered based on your out-of-network benefit levels. Many of the birth centers are in-network and are covered at that level. Some midwives bill insurance, and others don’t. Midwives who offer insurance billing usually can do a benefits check to give you a better idea of what you can expect to be covered. If you have an HSA or flex spending plan, those funds can go towards paying for your midwifery care. The vast majority of the time, even paying 100% out-of-pocket for your home birth is less expensive than the out-of-pocket costs for a hospital birth after insurance processes the claim. The Childbirth Connection is a good resource for comparing costs by birth place from a national level.

Brand-new homebirth family.

Can I have a doula and a midwife?

Yes! Many out-of-hospital midwives encourage each woman to consider having a doula at her birth. Doulas provide continuous emotional, physical, and informational support before, during, and after birth. Many midwives offer this kind of physical and emotional support as well. However, unlike midwives, doulas don’t provide any medical care. Doulas are great at offering comfort measures and supporting both the laboring woman and her partner from early labor until after baby is born. Be sure to check out the Childbirth Collective for free parent topic nights and ample opportunities to meet with and interview doulas.

How do I find a midwife who works in a home birth or birth center setting?

Check out the midwife listings on the Childbirth Collective, view members of the Minnesota Council of Certified Professional Midwives, and check out this comprehensive list of midwives from Minnesota Families for Midwifery. Most practices offer a free consultation to see if the midwife and family are a good fit, that is a great opportunity to ask any additional questions you may have about out-of-hospital midwifery and birth!

Kate Saumweber Hogan is a certified professional midwife and licensed midwife, serving Minnesota and Wisconsin. She is the owner of Twin Cities Midwifery where she provides prenatal, home birth, newborn, and postpartum care. She sees families at clinic spaces in Minneapolis and White Bear Lake, and lives in south Minneapolis with her husband and nursing daughter, born at home in the water in December 2012.

Review: Ina May’s Guide to Breastfeeding

by Angie Sonrode

As a self-professed lactivist and lover of midwife Ina May Gaskin, I picked up her book, Ina May’s Guide to Breastfeeding, with high expectations and a curious mind. Thankfully, and not surprisingly, I was not disappointed.

I have read many books on lactation and this one may have just taken the top spot on my bookshelf. This book is well-written from a warm, tender voice and chock-full of helpful, easy-to-follow information that is very reader- (and tired mother)
friendly. In addition, it is peppered with real
women’s stories and experiences.

Ina May knows how to grab your attention. On the first few pages she states, “You probably wouldn’t have picked up this book if you didn’t already have some idea of the benefits of breastfeeding and the possible undesirable consequences of feeding artificial milks to babies as a first choice.” This statement sets the tone of the book, as one clearly in favor of breastfeeding but it is also not her intention to pass judgment on mothers. She has found a way to promote breastfeeding with honest, well-rounded facts, while breaking down the components of breastfeeding so anyone giving it a go does so well informed.

One of the reasons I liked this book so much is that Ina May clearly understands not just the biology and physiology of breastfeeding, but also the social, economic and emotional factors that go into a woman’s breastfeeding experience. She touches on women in the workforce and their pumping dilemmas, sexuality and breastfeeding (yes, it’s possible to have a very normal and active sex life while lactating), and the connection of sleeping arrangements and the success of breastfeeding. While other books on parenting and breastfeeding have included some of these topics, none that I have read have managed to complete the puzzle— meaning that there are many, many factors that contribute to a mother/baby duo’s success or failure with nursing.

My favorite chapter in the book is titled “Shared Nursing, Wet- Nursing, and Forgotten Lore.” In this gem of a chapter Ina May discusses the benefits of community involvement in breastfeeding no matter the size of the community. She discusses induced lactation which is when someone that has lactated in the past re-lactates— including grandmothers and aunts, and also sympathetic lactation, which is when someone who has never lactated before can begin to produce milk if there is a need or she is in situations that raise her levels of oxytocin (a doula or midwife are examples).

Ina May also talks about the importance of recognizing that when a family suffers an infant loss, the effects of lactation need to be addressed and incorporated into the healing process. This is something often left out when helping parents in this unfortunate situation.

The book ends with Ina May talking about America’s “Nipplephobia” and the ramifications this has had on our breastfeeding rates and success stories. She goes into detail about how the U.S. was the only country in the world to vote against the WHO/Unicef Code of Marketing of Breast- milk Substitutes and that this decision has had an escalading effect on our meager breastfeeding rates. This is something we are still paying dearly for, with long-term effects.

When a society works hard to hide all aspects of nursing and breasts it in turn hides the primary reason women have breasts at all. If a culture of women and men grows up only seeing bottle-feeding it makes sense that this would be their perception of “normal.” Likewise, if a woman struggling with breastfeeding (as many new mothers do before they get the hang of it) is sent home from the hospital with formula samples she is much more likely to use

them than had the samples not been introduced.

I recommend this book to anyone interested in learning about the wonders of breastfeeding as well as those looking to further their lactation education—couldn’t we all?

Angie Sonrode is a birth doula and lactivist whose business is called Continuum Birth Services because she truly believes it takes a village. She is the mama to four wonderful children.

Breastfeeding: Just Get Out There!

by Liz Abbene

Making the decision to breastfeed is fabulous, but following through with that commitment is something many new mamas struggle with. One of the big obstacles mamas face is breastfeeding outside the home and in public places. While this is definitely different from nursing in the comfort of your own home, it shouldn’t be a source of stress or interfere with breastfeeding goals.

The first step to easily nurse in public is the same as nursing at home: get comfortable. This is a physiological requirement of breastfeeding. If you are uncomfortable, your body will not release the hormones essential for lactation. Many women are uncomfortable with the idea of exposing their breasts while nursing, but the reality is that when you are feeding, the baby actually covers up the majority of your breasts. Test this out at home—sit in front of a mirror during a breastfeeding session to see how little of your breast is actually revealed. Most likely you will not travel with your nursing pillow, so practice different positions that you can do without one or try nursing in a carrier to hold baby in place.

Another key element to successful breastfeeding in public is to dress appropriately. Usually all this requires is wearing clothes and a nursing bra that open easily for nursing and that provide you with the coverage you are looking for. Some women are very comfortable exposing bare skin, while others prefer not to. Either way is completely fine—personal comfort is what is important.

There are many types of nursing shirts available in stores or online. While they may be helpful, it’s not practical to completely replace your entire wardrobe. Instead, invest in several nursing camisoles which can be worn under shirts or sweaters. Another option is to wear a nursing bra and a stretchy tank or camisole under a regular shirt. Pull up the top layer, pull down the stretchy second layer, and open the nursing bra. Viola! You can nurse easily and discreetly.

Some mamas like to cover up with a blanket, shawl, or a nursing cover designed specifically for this purpose. Nursing covers are usually a piece of light fabric with a strap worn around the neck, and are designed to make it easy to see your baby while feeding.

Baby carriers such as slings and wraps can be great for nursing too, giving both coverage and support for the baby. These tools can be helpful, especially in the beginning when you and baby are getting the hang of things or with an older baby who is easily distracted by other things in the environment.

Once you’ve practiced a bit at home, get out there! The only way to really master the art of breastfeeding in public is to do it. Start by going to a friend’s home or a quiet coffee shop with comfy chairs. Going to the movies is a fantastic place to get used to breastfeeding outside the home—it’s dark and everyone is facing the opposite way.

When you’re getting baby started at the breast, try not to look around the room to see if anyone is watching you. Most likely, they’re not, and you’re apt to call attention to yourself by looking around. Maintain eye contact with your companions, and try to getting baby to the breast as quickly as possible. Do your best not to stress about it, and before you know it, you’ll be nursing with ease in every situation!

Liz Abbene, founder of Enlightened Mama, is a birth doula, birth doula trainer, Lamaze childbirth educator, breastfeeding counselor, wife, and mama to four amazing children.

Breastfeeding behavior…Is this normal?

Editor’s Note: This article originally appeared in a print edition of Collective Thoughts from 2010.

by Amber Moravec, DC, FICPA

Breastfeeding has many obvious benefits. A common motivation for families is the nutritional value. Less obvious benefits to the baby are structural. Regular nursing at the breast aids the baby in cranial re-shaping and complete molding of the mouth, jaw, and tongue. Feeding at the breast induces rhythmic, deep breathing that supports the development of baby’s diaphragm, which is often tense from the birth process and/or under developed at birth. A tight diaphragm can cause increased incidence of crying or spitting up and can contribute to digestive issues like reflux and colic.

All is well when things go right, but parents often encounter situations after birth attendants or birth assistants leave. Normal, attentive parents start wondering… does every baby do this? Is this just a phase they will outgrow? Should I alert someone about this?

Some common behaviors and patterns in baby that warrant assistance from someone with experience in nursing or newborn care (such as a midwife, doula, pediatric chiropractor, cranial sacral therapist, or lactation consultant) are:

A nursingpattern of pulling away, latching on, pulling away
Prefers nursing on one breast over another
Jerks at the torso while nursing
Cries after nursing
Cries of frustration while latching
Spits up a notable amount after every feeding

The above observations and behaviors can be a sign of structural or functional distress, meaning that spinal misalignments, tight muscles, or ligaments (often due to restriction during the growth or birth process) can be causing discomfort for baby. Particular nursing positions or sleeping postures may also lead to distress in an infant’s growing body.
Baby’s diapers offer a guide to how well nursing is going. Adequate numbers of wet and poopy diapers say baby is getting enough to eat. Baby poop provides keen insight into their internal processes. After the meconium passes, exclusively breastfed babies should have mustard yellow, seedy stools that are loose in texture, with the consistency of pea soup or small cottage cheese-type curds. The odor should be mild and not unpleasant. Other textures, colors, or odors of poop should be considered abnormal.

An infant’s complaints can also stem from food sensitivities. Dairy and wheat are leading culprits when it comes to food allergies. Unless there is a strong family history of wheat/gluten issues most practitioners suggest starting with dairy elimination. Dairy tends to cause more problems and it is generally easier to remove from your diet. Restrictive dieting can be both difficult and overwhelming. This limiting diet will last a minimum of 15 days; to give both mom and baby time to purge the allergens from their systems and to respond to the absence of the irritant, if not longer. I recommend finding a professional who will provide you a list of alternative foods and strategies for success to aid you during that journey.

In many ways, breastfeeding is nature’s way of helping baby work through the residual effects of the birth process. The most experienced moms will often need four to six weeks of dedicated feeding at the breast to find a natural rhythm (every baby is different). Obstacles can happen to everyone, but in the end, a happy, content, healthy baby is a great payoff!

Dr. Amber Moravec, DC, FICPA is the mother of three beautiful children. She is a certified maternal and pediatric chiropractor and has completed extra coursework on the techniques and protocols of care for newborns, children, and pregnant women. Her practice is Naturally Aligned family chiropractic.