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 your wellbeing, questions, hopes, and concerns, and any testing and treatment options relevant to your pregnancy. 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 your birth. This relationship can be grounding for 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 with minimal 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, midwives offer research-based evidence, personal experience, and sometimes recommendations–and clients decide what works best for them, taking into account this information together with their own values 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 rooms, 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. If a medical complication arises, 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 childbearing 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 is 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, or until everyone is healthy and stable and ready for a nap. This support includes clinical care, physical support, suggestions to improve maternal comfort or encourage labor to be more efficient, and clear and respectful communication in response to client questions and concerns. If the need or desire 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 because she does not have any clinical responsibilities, she is entirely focused on the mom’s (and partner’s) physical and emotional wellbeing. 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 choosing 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 and/or birthing in water, and eating and drinking fluids to stay energized and hydrated–and we work around laboring mothers and bonding families in order to obtain vital signs to ensure everyone is safe.
Midwives recognize that it is not just a baby, but also a new family that is being born! At Tidelands, we believe that including family members so they feel informed and engaged (where desired and appropriate) can serve to strengthen these foundational relationships. We encourage partners and other support people to attend visits and get their questions answered–all family structures are welcomed. We also love to involve siblings in clinic appointments, and even at the birth (under supervision) when this is desired by clients.
Whether in the shower or the tub, water can provide both relaxation and comfort during the intense sensations of labor. Many clients also choose to give birth to their baby in water. Water birth is widely recognized to be safe, provided access to clean water.
Frequent, hour-long postpartum visits in your home 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 screening, including the newborn metabolic screening and a congenital heart defect screening. In addition, midwives provide breastfeeding assistance and perform weight checks, lab tests, and physical exams for both mother and baby.
Tidelands provides two home visits to all new families during the first week after birth–the first about a day after birth and the second at day 3 to 5. Three additional office visits are offered at about 2, 4, and 6 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 outside 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 an epidural. In the event that you change your mind at some point during labor and decide you 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 became necessary, the midwife would transfer with the client to a nearby hospital and an obstetrician would take over the client’s medical care for the remainder of the birth.
After hospital transfer during labor, clients resume their postpartum care with Tidelands.