Continuity & Trust
When pregnant individuals and their families are able to get to know their maternity care provider over the course of months, seasons, and many conversations throughout their pregnancy, a trusting and caring relationship can be built slowly over time. At Tidelands, individualized hour-long prenatal visits allow ample time to discuss in depth a client’s wellbeing, questions, hopes, and concerns, and any relevant testing and treatment options. These appointments also allow for a relaxed setting in which we can get to know one another and develop a trusting relationship by the time of the birth. This relationship can serve to ground families during what can be a challenging and largely unknown transition, making them better able to have their wishes known and to feel safe and cared for.
Support, Not Control
Midwives believe that birth usually happens best without intervention, and when laboring moms and families feel safe and well supported. While giving birth in a hospital environment can feel like the hospital “rules” trump the wishes and desires of the birthing family, midwifery care emphasizes a model of informed choice. In this model, the midwife offers research-based evidence, personal experience, and maybe even recommendations, and then the client decides what works best for them taking into account this information together with their own values, beliefs, life experience, and preferences.
During labor, midwives encourage movement, eating, and drinking hydrating fluids. We prioritize the comfort of the laboring mom and trust her intuition along with our own. We catch babies in many different positions, and work around laboring mothers to get the information we need to keep moms and babies safe–including vital signs, fetal heart rates, and exams. When clinically warranted, we may take on a more directive role–and even during these times we still prioritize the experience of the family by maintaining a calm, respectful, and supportive environment.
Fewer Medical Interventions
As compared to care with an obstetrician in a hospital, those in midwifery care experience fewer medical interventions during pregnancy, labor, and birth (including ultrasound, lab testing, vacuum/forceps delivery, episiotomy, medications, anesthesia, and cesarean section). Meanwhile, maternal and newborn outcomes for low-risk pregnancies remain similar across settings (hospital vs. birth center vs. home) and provider types (obstetrician vs. midwife).
This decrease in unnecessary interventions may be due to an overall different outlook on pregnancy–obstetricians tend to approach pregnancy and birth from an illness perspective, whereas midwives tend to view pregnancy and birth as most often normal, physiological processes that bodies know how to do. That is not to say that midwives do not screen for illness–they do so consistently throughout pregnancy, from a client’s initial acceptance into care through their labor and birth and into the postpartum period. This continuous screening and risk assessment are what make midwifery care safe.
Continuous Labor Support
Studies show that one-to-one labor support improves birth outcomes and lowers the rates of unnecessary interventions for mothers and babies. In hospitals, despite the hard work and best wishes of nurses, nurse-midwives, and obstetricians, this model of care is rarely available due to staffing and time constraints.
Midwives outside the hospital setting provide one-to-one labor support that begins at the onset of active labor, until a few hours after the birth of the baby. This support includes clinical care, physical support, suggestions to improve maternal comfort or make labor more efficient, and clear and respectful communication in response to client questions and concerns. If the need arises to transfer to the hospital during labor, Katherine goes with clients until they are settled. She may stay until the birth of the baby or leave to rest and return for the birth, depending on the circumstances and the client’s wishes.
Some clients may also wish to hire a doula, who is able to provide support during early labor as well as active labor and birth, and is entirely focused on the mom’s physical and emotional wellbeing since she is without any clinical responsibilities. Midwives love working with doulas!
It is widely recognized that both the experience and the efficiency of labor are optimized when a laboring mother feels safe, supported, and comfortable. Having more control over the birthing environment is one of the most common reasons for seeking a home or birth center birth.
During labor and birth, midwives work to create a calm, intimate, supportive, and minimally intrusive environment. Clients are encouraged to adjust the lighting, temperature, smells, and sounds to their comfort. Midwives encourage frequent position changes, laboring in water, and eating and drinking fluids to stay energized and hydrated–and we work around laboring mothers and bonding families to obtain vital signs to ensure everyone is safe.
Midwives recognize that it is not just a baby being born, it is a new family! At Tidelands we believe that making family members feel informed and engaged (where desired and appropriate) can serve to strengthen these foundational relationships. To this end, we encourage partners and other support people to attend visits and get their questions answered. We also welcome and involve siblings in appointments, and even at the birth–under supervision–when it is desired by clients.
With midwifery care, clients often find comfort by laboring in water–whether in the shower or a labor tub. Many also choose to give birth to their baby in water. Water birth is widely recognized to be safe, provided there is access to clean water.
Frequent hour-long postpartum visits in client homes and in our office support a normal and complete recovery from birth and a healthy transition to parenthood. During these visits, we offer routine newborn testing including the newborn metabolic screening and a congenital heart defect screening, as well as weight checks, breastfeeding assistance, and physical exams and lab testing for both mother and baby.
Tidelands provides two home visits to all new families during the first week after birth–the first at day 1-2 and the second at day 3-5. Three additional office visits are offered at 1-2 weeks, 3-4 weeks, and 6-8 weeks postpartum.
What Licensed Midwives Don’t Do
Epidural analgesia: Though we would love to offer our clients the option of epidural analgesia during labor and birth, this type of pain relief requires the skills of an on-call anesthesiologist as well as additional fetal monitoring and proximity to an operating room, none of which we have access to out of the hospital setting. Meanwhile, most of those who are interested in an unmedicated birth are able to work with the intensity of labor and give birth without analgesia. In the event that a client changes her mind at some point during labor and decides she does desire pain relief due to a long or difficult birth, transfer to a hospital is always a supported option.
Cesarean section, vacuum extraction, & forceps delivery: These forms of operative delivery require the advanced skills of an obstetrician, as well as immediate access to an operating room. In the event that one of these interventions were necessary, the midwife would transfer with the client to a nearby hospital.