Every birth is different, so of course every home birth is different!
The home birth process starts with selecting a midwife or a team of midwives that you feel comfortable with. For many women there is no choice as there may only be one midwife practicing in her area. Most midwives offer an introductory visit in which you get to meet each other and decide for certain whether you both wish to continue in partnership during the pregnancy.
Once this has been established you midwife will meet with you on a regular basis antenatally. For first time mums this usually involves a booking visit at the end of the first trimester (14 weeks or so).
However, if you wish to avail of an early scan or early fetal assessment tests in a hospital, you may need to book in with a hospital at this stage too. Your second visit will probably be your booking visit in your local maternity hospital.
Most hospitals now recognize that women will book in with them even when they are planning a home birth. Your third visit may well be your developmental scan (if you chose to avail of it). Some midwives suggest it and some do not.
After that your visits will primarily be with your midwife unless you need to go into hospital for special tests.
Your midwife will visit you once a month until about your 32nd week and then once a fortnight until your 36th week. From then on she will come once a week and as the end of the pregnancy draws closer she may come every few days especially if you go over your guess date. If you go 10 days over your guess date she will refer you to your local maternity hospital for evaluation. If all is well you will usually be able to continue with the pregnancy until the 14th day at which point your midwife will usually refer you for an induction in the local hospital.
However, your midwife will have discussed and suggested many self help measures before you get to this stage. The visits are fairly similar for second and subsequent mums – fortnightly and weekly visits just start later Antenatal visits are a great time for your midwife to meet you and your family and get used to the set up in your home.
Over the 8 months or so the two of you will form a strong relationship, which for many women lasts a life time. Many midwives become firm family friends. When I talk of my midwife my eldest son immediately says her name and tells them how she knew him in my tummy!
If you are having your baby with a hospital team of midwives , every effort will be made for you to meet as many of the midwives as possible during your pregnancy, as when you go into labour you will be assigned two of the midwives on duty at that time.
Antenatal visits in the later stages of the pregnancy will be carried out in your home, but the earlier ones are shared between the midwives and your GP. The schedule of visits and post dates practices are the same as those observed by the SECMs. One slight difference is that ENTiNOX and OXYGEN tanks will be delivered to your house a few weeks before your due date so that they can be there ready and waiting for your midwives on the big day if necessary.
If for any reason you need to be transferred to hospital care antenatally, your midwife or the midwifery team may still be able to provide you with your postanatal care – you should discuss this in advance with your midwife so that you are sure of exactly what will happen after your baby is born.
When you get those first sensations that your baby is ready to make a move its best to call your midwife and tell her that things may be moving and that she may need to be on call that day.
This helps the midwife schedule her day to suit your needs. The same applies to if you are part of a hospital team. This first call offers a nice opportunity to chat with your carer before the labour becomes more intense and takes all your attention. At this point, you may want to notify those that might be taking care of older siblings and any other people you hope will be present at the birth. Many mums let other women friends know too via a birthing circle so that they can spend some time sending out their best wishes to the new mother and baby.
If you are planning a water birth, it is wise to start making preparations for where the pool is going to be and putting on the emersion heater to make sure the water is hot when you need it. As your labour progresses you and your birth partner (s) will be in communication with your midwife. Your midwife may well call in and see how you are the baby are doing.
If she feels that the labour is progressing well and is fairly advanced she will stay – if not she will ask you what you would like her to do and may well leave for a while to return in a few hours. Once labour is seriously moving your midwife will arrive. She will check your well being and also the baby. Once she is assured that all is well she will set up her equipment, usually in a place where you cannot see it! Most midwives just stand back and let the labour progress at its own pace. At designated time intervals, or when she feels it is necessary she will check on you and the baby. Midwives rarely perform internal examinations unless you request it, preferring more to listen to the mother and how her breathing and movements changes. Midwives rarely ask you to push – asking you rather what sensations you might be experiencing.
On one of my births the midwife said nothing to me during the labour (on my request) and I remember her asking my husband way far away, in another world “Can you heat up some towels” … and I knew she felt the baby would soon be born. Just by watching me another midwife knew I had the urge to release the baby and encouraged me. Some midwives will offer relief and support in labour in the form of massage, homeopathy or sheer positive belief! Others carry gas and air. Most midwives advocate laboring in a birthing pool to help not just with pain relief but also with helping you centre yourself and find your own personal space from which to bring new life into the world. Many women also choose to have a doula with them for their birth – another woman who is just there for them and who will support her right through the process.
When it comes close to the birth, the midwife will dim the lights and if you are having a birth outside the birthing pool she will have prepared an area with plastic sheeting in place so as not to soil the surface you plan to give birth on.
Many women choose the floor or cushions or kneeling with their head resting on their partner´s lap. Some women just stay in the bathroom. If you are having a waterbirth you will probably be kneeling and your baby will just float up to you when he or she is born. Sometimes the midwife needs to assist the mum a little if the cord is short so that the mum can sit back and hold her newborn. Once the baby is born the midwife will ensue that the baby is immediately put skin to skin – either on your back or your tummy until you are ready to hold your baby.
All immediate checks will be carried out with your baby in your arms but not until you and your baby has got to know each other. Of course if your baby needs assistance this will be provided straight away. Midwives do not cut the cord until well after the cord has stopped pulsating and the baby has had a first feed.. When you get the urge to deliver the placenta your midwife will help you and encourage you. Midwives rarely do a managed third stage. Most homebirth couples keep the placenta to plant under a tree. A few brave souls eat them! When you are ready to move your midwife will help you dress the baby and at this point will check the baby´s well being and weight him or her. The midwife will not wash the baby unless you particularly want her to. She will help you shower and get dressed, get you something to drink or eat. If you need sutures she will do them ….And then comes the best bit of all … your own bed with your new family!
Some couples with older children have them present for the birth, some children contrive to be there others do not. It is best to make plans for them to be and not to be there so that you can go with what feels right at the time.
Your midwife will stay for several hours celebrating with you and helping your partner get things sorted out in the house. If you have your baby in one of the hospital schemes, one of the team will come and visit you for 7 days if you are a first time mum and for 5 days if you are a second or subsequent mum. You will need to take your baby to a GP or the maternity hospital on day 3 for a full check. Most SECMs come for 10 days after the birth and every day they will check on the baby and you and make sure that breastfeeding is fully established.
Sometimes mums or babies need to transfer to hospital care either during the labour or just after the baby is born. It is becoming more common practice for your midwife to be able to go with you, and certainly your midwife will be in close contact with you during your hospital visit /stay. If you are able to be released early your midwife may be able to provide you with postnatal care. If you have a caesarean birth it is important to know in advance if your midwife will be providing you with care afterwards. If you or your baby needed hospital care during your pregnancy labour or afterwards, you may feel disappointed or sad that things did not go the way you had planned. It is important that you get to talk things through with your midwife afterwards and with other women who have had the same experience.