Pregnancy, Homebirth, & Postpartum Care

This is an overview of what to expect regarding the community birth care provided by this practice. I offer free consultations to explore my services, these may be held in person, via zoom, or over the phone.

• Initial prenatal visit in my office between 10-12 weeks. We will review your intake forms (sent via email prior to the first appointment), discuss your hopes and expectations for your care, collect lab work, and conduct a physical exam.

• You will receive education materials and a list of required homebirth supplies during your pregnancy. Additionally, you will be required to order the Bear Root Midwifery birth kit from Precious Arrows by 36 weeks. This kit includes necessary disposable items for homebirth.

• Routine prenatal visits every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, and weekly thereafter. These visits may be held in my office, in your home, or in a client’s home near you. Usually these visits will be held in a combination of these locations based on my schedule.

• 36 week homevisit: between 36-37 weeks we will have a prenatal visit in your home to finalize our plans for your birth and review transfer considerations in the case of an emergency. This visit is a special one, we will enjoy a meal together at your home that you have prepared for your birth team. I will bring the assistant I anticipate having attend your birth, and you are encouraged to have all your support people and birth team attend this visit. If you have a special birth plan or desires you’d like to make everyone aware of, this is a good time to have that written down to review. Clients are expected to have the required supplies and birth kit ready by this visit as well.

• For safety reasons, I will attend homebirths between 37 weeks and 42 weeks, if you labor before or after this time frame, we will discuss the best plan for hospital birth. Please note that there will be no refunds in this scenario.

• Postpartum care will be in your home the first 2 weeks. Clients receive a total of four postpartum homevisits, at 1 day, 3 days, 1 week, and 2 weeks.

• The 6 week postpartum visit may be held in your home or my office, as is convenient. These visits are important for mental health and physical assessments and are included in the global fee.

• Newborns will be receive a full newborn exam at the time of birth and standard medications/screening/weight checks will be offered over the first 7-14 days of life. Newborns are required to see a pediatric provider by 28 days of life for routine needs, and may be referred before that time if concerns develop. Please arrange care with the pediatric provider of your choice by the 36 week homevisit.

  As a solo practioner, there is a limit to the volume of clients I will take on for birth services in any given month. I will also plan vacations far in advance so that potential clients are aware of these. Given these considerations, I expect to be the midwife that attends your birth. However, there may be conflicts that arise such as another birth in progress, etc, that may necessitate one of my midwifery colleagues attending you for prenatal visits, birth coverage, or problem visits. You will need to agree to be attended by another midwife if needed, and understand that no refunds will be given in this scenario.

Safety

Our work together will be based on trust and relationship. This is fundamental to supporting safe community care and birth. Additionally, risk assessment and screening begins at our first contact and continues throughout our care relationship. This process helps determine that you remain healthy, and low-risk in order to receive community midwifery care.

If at any time you have or develop risk factors that complicate or rule out community birth &/or midwifery care with my practice, we will discuss the best plan forward for you and I will assist you in finding care with another provider if necessary, or refer you for consultation, evaluation, and planning with a physician colleague. This includes homebirth transfer to a hospital, if needed.

Regarding homebirth services, I have several important safety measures in place to ensure a healthy, empowering, and safe experience for the families in my care to include:

• Initial and ongoing screening for appropriate level of risk for community birth

• Emergency equipment and training to manage birth emergencies, postpartum hemorrhage, and neonatal resuscitation until handoff to a higher level of care can be arranged

• Trained and knowledgeable birth assistants, that engage in regular skills drills and trainings with the primary midwife

• Physician collaboration as needed

Client Responsibility

The safety of home birth for the appropriate candidate and with a skilled midwife has been confirmed in several studies (Hutton et al 2019; Scarf et al 2018; Olsen and Clausen 2023; Cheyney et al 2014; Zielinski et al 2014). Particularly for the birthing person, community birth care has been shown to improve outcomes and decrease interventions across the board.

Homebirth also allows clients to avoid risks that are more associated with hospital birth, and have an increase in autonomy and control in their pregnancy and birth.

Neonatal safety has also been shown to be equivalent to care in the hospital and is associated with increase in success with nursing/lactation. However in some studies, particularly in the US where home birth midwifery is less integrated into the larger healthcare system, there may be an increase in the relative risk of perinatal mortality and morbidity, mostly for first time parents. The absolute risk of these outcomes remains low, affirming the safety of homebirth for the low risk client (Zielinski et al 2014).

Regardless of how risk is evaluated by the midwife, there can always be unforeseen events or emergencies that can result in the illness, injury, disability or even death to the birthing person or infant. Certain emergency services such as, but not limited to, cesarean birth, blood transfusions, and extended newborn resuscitation and support are not available in the home setting and will necessitate transfer to hospital. By signing this ICD document, clients are stating that they are assuming this responsibility and are aware that delays in care for emergency services are dependent on distance to the hospital from their home or birth location and that this may impact outcome.

Clients choosing community birth care are expected to be active participants in their care, continuously educating themselves regarding their care options and engaging with the midwife in decision-making. Clients also understand they are assuming responsibility for their choice to birth outside of the hospital setting and for any declinations of the standard of care, and the resulting outcomes of those choices.

In the wise words of Tanya Wills, CNM of the practice Manhattan Birth, “…in choosing homebirth, you are going against the predominant cultural belief in the United States that hospitals are safest for everyone, regardless of statistical data or personal preference, medical history, or circumstance. When emergencies or poor outcomes occur in a hospital, the site of birth is seldom called into question. If a similar situation occurs at home, however, even if the outcome would have been the same in the hospital, the countercultural choice of homebirth is always called into question. If problems occur at home, you will invariably be questioned by family, friends, and professionals as to the wisdom of your choices. We ask you to honestly project yourselves into your worst-case scenario and examine how you would feel about your original choices after the fact.”

At Bear Root, we work hard with you to help you have a normal, healthy and empowered homebirth. However, it is not in our power to guarantee you a homebirth in general, or one without complications or transfer to the hospital.

Certain emergency services such as cesarean birth, blood transfusions, and extended newborn support are not available in the home-setting and will necessitate transfer to a hospital. By signing this ICD document, clients are stating that they are comfortable with this responsibility and are aware that delays in care for emergency services are dependent on distance to the hospital from their home or birth location.

Standards of care including prenatal testing, ultrasound, and newborn medications/screening will be offered, discussed, and a plan of care agreed upon. Clients who choose to decline recommended standards of care will be required to sign an informed-choice waiver for each of these decisions. There may be certain lab tests & care points that are required to remain under the care of Bear Root Midwifery, these will be discussed as needed and on an individual basis.