How midwifery care works
When a couple is considering hiring a midwife to help them, the first step is to make an appointment for an interview. This gives couple an opportunity to meet the midwife, ask questions, and decide if midwifery care is right for them. The initial consultation also allows the midwife to ask her own questions to determine if the woman is a good candidate for midwifery care and home birth. The midwife will explain all that her care- plan includes, her fees, and her expectations. If the woman is healthy, responsible, and conscientious regarding her self-care, she is usually considered a good candidate for home birth.

After choosing which midwife the couple wants to hire, the initial prenatal visit is scheduled. At this visit the midwife will discuss the woman's medical history, perform a physical exam, arrange a payment plan with the couple, review the appropriate contracts, and request all relevant medical records from past care providers. Blood may be drawn for the standard testing, as well as any other lab work that may be necessary. The midwife will assess the woman's diet and nutritional status and make appropriate recommendations. All prenatal visits including the initial will include; a weight check, a urine check, measurement of the blood pressure, pulse, palpation of the abdomen to assess size and position of the fetus, and measurement of the uterine size in centimeters.

The care and respect that a midwife has for her clients is evident in how she practices. She takes the time to listen and expresses genuine interest in the well-being of each family that she helps. Over the course of the pregnancy, the client-midwife relationship becomes one of trust and mutual respect. The midwife uses education to empower her clients, and encourages personal responsibility in decision making.

The expectant mother comes to the midwife's office for her prenatal visits once a month until she is 28 weeks along in her pregnancy. Then she will come every two weeks until 36 weeks, then once a week until she delivers. Around 37 weeks, the midwife and her licensed assistant will give the woman a prenatal visit in her own home. The purpose of this visit is to meet anyone else who may be attending the birth, see where the woman's home is located, make sure all her birthing supplies are prepared and make recommendations if necessary, and discuss any matters relating to the eminent birth.

When labor begins, the midwife is contacted. After getting some important information, she and her assistant may decide to come right away or maintain phone contact until labor becomes more active. During labor the midwives monitor progress and the well-being the mother and baby, set up the necessary supplies and equipment, provide physical and emotional support and reassurance, gently give advice and recommendations where needed, and maintain the safety of all involved. The woman is encouraged to adopt different positions, and follow her body's cues. She is supported, honored, respected, and given loving guidance from those present. She is urged to eat, drink and remain active. Water is often incorporated into the labor and many times the birth itself. Floating in a warm pool of water is one of the most comforting things a woman can experience during the labor. It's ability to relax the mom greatly decreases her discomfort and often shortens the process. Whatever the chosen position, when the baby is ready to emerge the mother is encouraged to follow her own body's messages about how to push. The midwives are careful to try and prevent tearing and trauma to the tissues by facilitating a gentle emergence of the baby. The mother and father often help catch their child and bring him or her directly into their arms. The midwife takes care to interfere with the initial bonding period as little as possible and discreetly assesses the well-being of the newborn from the mother's arms.

If problems arise at the birth that can be addressed and resolved at home, then the midwife takes appropriate action. If the problem is one that requires outside help, the midwife makes sure that the mom and baby are stabilized and either the parents drive to the hospital or EMS is called, depending on the problem. It is extremely rare for a problem which is beyond the scope of the midwife's abilities to occur. The midwife is trained and prepared to resuscitate a newborn, stop a hemorrhage with medication and/or other methods, and treat a woman for shock. We can start an IV, suture a tear, and resolve shoulder dystocia. The nature of midwifery care has some distinct advantages in this area. A woman under a midwife's care is well nourished and pays careful attention to her nutrition and diet, she has a high level of trust in her body's ability to birth her baby and her level of fear is low, she is well informed about the birth process, and the continuous care she receives from the same care provider makes for an excellent relationship.

After the birth, the family is encouraged to bond with their new baby and the mom is given breastfeeding support if desired. She is urged to eat something soon after the birth and empty her bladder. The newborn is given a thorough examination from head to toe, weighed, and measured. An injection of vitamin K is given and antibiotic eye ointment is administered depending on the parent's wishes. After a few hours, when the family is resting safely and comfortably, the midwives leave with instructions to call with any questions.

The midwife returns to visit the new family the day after the birth, 3 days after the birth, 1-2 weeks after the birth, 4 weeks, and again at 6 weeks. The postpartum support a woman and her family receive from their midwife is invaluable. She can provide breastfeeding assistance, advice on baby care, and general postpartum issues. She is a welcome presence in the home in the days following the birth. She makes sure the woman is recovering smoothly and completely, and is always available to answer questions.


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