The Home Birth Mindset: How Prenatal Care is Unique
While my third pregnancy was my first time working with a home birth midwife, I am no stranger to midwifery care. I relied on midwives for prenatal care during my previous two pregnancies, too.
However, partnering with a home birth midwife was a different experience, even during the prenatal season. It took me a while to realize it – and to be able to articulate the contrast. But it happened during my 30-week appointment.
My midwife Melissa has a small office in an older downtown building that apparently doesn’t have air conditioning. This is only an issue when in the hallway of the building because Melissa has a window air conditioner in her office. Smart lady!
(Side note: Some home birth midwives do all or some prenatal appointments at their clients’ homes. Melissa visited my house once before the birth, obviously for the birth and several times after. More on that later.)
When I arrived for my appointment that day, I was a few minutes early. I could hear voices inside Melissa’s office, so I figured another client was finishing up her appointment. I waited in the hallway as patiently as I could. But it was mid-July, and I was quite pregnant, so I started getting sweaty and uncomfortable rather quickly. A couple minutes later, the door opened, and an unfamiliar face asked if I wanted to come in. Fanning myself with whatever scrap piece of paper I could find, I said yes.
Once inside, it didn’t take me long to figure out that the unfamiliar face was Melissa’s client, a lady even more pregnant than I was. Of course Melissa was there, and so was Candice, her assistant. But then I noticed another unknown woman. Turns out, her name was Katie, and she was a midwifery student who was working with Melissa to add to her required clinical experience.
I felt awkward at first, standing there during someone else’s medical appointment. Wasn’t this a violation of HIPAA or something? But she had invited me into the room. As I continued standing there, listening to the conversation focused on the other pregnant client, I felt myself wanting to join in, even though no one asked me a question or prompted me to say anything. I learned it was her first baby, and she was ready for labor to begin any day. Then she asked what number pregnancy this was for me, and I said third. And Candice remembered aloud that both of my labors had progressed fairly quickly. This was reassuring to the other pregnant lady because she was worried about having a long labor.
The friendly, relaxed banter went on for a few more minutes until the other client was ready to leave. I said it was nice to meet her and wished her luck with her birth.
As soon as she exited, the midwifery team of three focused its attention on me, declaring, “Your turn!” as I sat on the massage table that Melissa uses for belly checks. (No exam table or stirrups with a home birth midwife!)
They began asking me how I felt, if I had any concerns I wanted to discuss, what questions I had. That particular day, my only concern was that several people had told me that I didn’t look as far along as I was. While my previous anxiety had been that I was growing a 9- or 10-pound baby, the opposite was now a worry: “Was my baby growing and big enough?”
Katie did my belly check and assured me that my fundal height measurement was right on – exactly 30 centimeters. She and Melissa used their hands on my belly to feel the position of the baby and told me not to worry; he seemed an average size.
During my appointment, we talked about some other topics. I was especially curious to hear about what happens in the minutes and hours following the baby’s birth at home. Melissa took me through the whole process, step by step.
Just like with the client in the room before me, the midwifery team did not rush. During that and every appointment, they never made me feel like they were in a hurry, or that they were behind. How so? Because Melissa schedules appointments for one hour in length. The first time I visited with her, I found her long appointment times astonishing.
I had never heard of such a thing. In traditional clinic settings, 15 minutes is standard. Maybe 30 minutes if you’re a new patient or having an annual wellness check. Unfortunately, I also found the 15-minute appointment windows to be the case with the midwives I saw during my previous pregnancies and even with the hospital-based midwife I saw at the beginning of my third pregnancy. It felt like any other doctor’s office appointment, where the provider is running behind, and it seems her hand is on the door handle for the entire session. No wonder they get behind when they only allow 15 minutes for each patient.
One thing I learned from Melissa and from books I read is that the midwifery model of care supports longer appointments. In “The Essential Homebirth Guide,” authors Jane E. Drichta and Jodilyn Owen, both certified professional midwives (CPMs), write, “We believe each woman should be looked at as a whole and vital member of her family, her community and society. The midwifery model of care provides a platform for this holistic practice.”
They go on to discuss relationship development and how it is a key element in practicing home birth midwifery. “We like to think of our jobs as getting paid to fall in love with people over and over again,” Drichta and Owen write. “Parents report feelings of being heard, understood and felt within the context of this care. Trust develops and builds as personal stories, history and fears are shared with a loving midwife. Everything we humans do, we do best within the context of relationships. This includes putting the clinical picture of your pregnancy in its proper context.”
It’s not that I had bad experiences with midwives during my previous pregnancies. I certainly did not. I always preferred midwifery over obstetric care. And I developed good relationships with the midwives, especially during my second pregnancy. But there was something different – something very special – about Melissa and her team. Yes, the long appointments were awesome; Drichta and Owen call this “a tincture of time,” the remedy midwives prescribe the most. Yes, they used a fetoscope, rather than a Doppler, to hear the baby’s heartbeat. Yes, Melissa was always my primary caregiver; there was a never a group of midwives through which to rotate.
But I believe the biggest difference was the home birth mentality – the belief that the woman’s body knows what to do. This mindset affects the way Melissa provides prenatal care. Drichta and Owen beautifully capture this truth: “Midwives do not view prenatal care as a time to put information into your head, but as a process of exposing what you already know to be true.”
As I was devouring “The Essential Homebirth Guide,” I found myself wishing I had read it before I met Melissa. It was one of the best books I read during pregnancy. Another thing I gleaned from the book was that it’s common for midwifery visits to start with encouraging words and end with a hug. I can honestly say none of the previous midwives I saw hugged me. But Melissa did after my first appointment – and at the end of every session. I was surprised at first, but I realized that it was her nature and one of the ways she honors the midwifery model of care.
After that 30-week appointment, I started thinking about how women can treat each other. We can be snarky and judgmental, but what if all our encounters were more like what I experienced at the end of the other pregnant lady’s appointment? What if women embraced each other like home birth midwives do – as strong beings, confident in the capable female body?
No matter where women have their babies, I think there’s something to be learned from the home birth midwife’s mindset. “The midwifery model of care encompasses your whole family and, to a certain extent, your whole community,” Drichta and Owen write. “Expectant mothers are women first and pregnant second. We all have so many different facets of our identity. All of these aspects combine into a coherent whole and are honored under the midwifery model of care.”
Before I end, I would like to briefly mention how postnatal, or postpartum, care is also different and, in my opinion, better with a home birth midwife. Why? Because of the word home. My midwife came to my house for postnatal checks. She weighed the baby and checked him, much like a pediatrician would. I loved not having to take Vincent out to a possibly germ-infested pediatrician’s office.
She also cared for me – for my mental, emotional and physical well-being. It was wonderful. Seeing Melissa and talking with her helped me deal with the baby blues and reconnected me with that home birth mindset, reminding me that I am now part of a community of like-minded women who believe in the strength of the female body.
And the best part? Everyone is invited to join.