What really happens at a home birth?
I thought that it would be beneficial to briefly summarize the process of a home birth from the perspective of a student midwife/midwife’s assistant. So, below I have laid out some of the most common procedures and occurrences that a mama could expect from a home birth without any complications.
Typically, the midwife will assess the mama’s labor progress from the moment the mother contacts her exhibiting signs and symptoms of labor. This could be either a short or long span of time, depending on the length of early labor. The midwife usually likes to arrive at the mama’s house either during active labor, or when the mother expresses the desire for the midwife (and sometimes birth team) to be present.
The midwife and her team, if applicable, will arrive at the laboring mama’s house and bring all of the necessary equipment inside (prenatal bag, birth bag, neonatal resuscitation equipment, etc.) Most of the time, the midwife will look for the mama and access her labor progress either through a cervical check (if she and the mama feel it’s necessary) or just through accessing the mama’s verbal and physical cues. Depending on how far along the midwife feels the mama is, she and her birth team may begin to set up for the birth by going through the birth kit and bags to lay out the necessary tools, some of which include sterile gloves, gauze, an umbilical cord clamp set, a Doppler for listening to fetal heart tones, etc.
For the most part, it is ideal to leave the laboring mama alone during active labor if she appears to be coping well. However, the midwife or a doula from the birth team may also step in and assist the mama if necessary, or help find ways to get the partner or other family members involved (this could be through physical assistance, encouragement, etc.).
If the mama has rented a birth tub, the partner or another family member will usually have had set it up beforehand, and possibly even filled it (if the tub has a built in heater to maintain the temperature of the water). If not, the midwife will suggest that it be filled up right before the mama wants to go in it. Birth tubs, showers, etc. are especially great right before and during the transition period, when the mama is finding it more difficult to cope with contractions. From here, the birth team waits patiently for baby to come, while intermittently monitoring fetal heart tones and charting down important information.
Once the contractions become really strong and seem to build on one another, the birth team checks fetal heart tones more frequently to make sure that the baby’s heart rate is recovering after each contraction, which is often a good indicator of his/her health and well-being. Whether the mama is in the water or not, the midwife will stay close by once baby’s head begins to descend, and will often educate the partner or family member on how to maneuver the baby once he/she is born (for instance, if the partner or another family member wanted to catch).
Once the baby is born, if the mother has not already claimed her child, then the midwife/partner/family member will guide baby to mama and typically put them chest to chest. Remember, the baby is still attached to the placenta via the umbilical cord at this point, so he/she can’t go very far! In a home birth setting, if everything is looking normal and the baby appears to be healthy and breathing, the cord will not be clamped until after the placenta is born and the cord has stopped pulsing. This can happen either in the water or out, depending on the scenario. During this time, the birth team quietly observes as mama and the partner and/or family admire the baby. If the mama is in the water, the partner, midwife and her team will often work together to maneuver the mama out of the tub (slowly) and onto the bed so that the midwife may check the mama for any tears and repair, if necessary. At this point, the team will most likely either observe/chart, conduct the newborn exam on the infant, or begin to perform other duties. Such duties include dismantling and cleaning the birth tub (if applicable), blood typing the placenta, cleaning up any messes, filling out the commemorative birth certificate and blood typing card, cooking food for the couple/family, starting laundry, cleaning the kitchen, etc.
The goal is to make it as easy on the mama/couple as possible, as they should be spending their time with their new baby rather than having to clean up their home. Once all of this is done, the midwife and/or birth team will go over postpartum care instructions and make sure everyone is happy and healthy before heading home. The mama/couple can usually expect to see their midwife again within 24-48 hours, and then for some additional postpartum visits as well.