The Role of the Independent Midwife

Usually one of the first questions a midwife will be asked, is what is your role, and what will you do for me?

The role of your independent midwife is to look after you from the day you book in with her, and right up to when your baby is six weeks old.

If you choose an independent midwife as your LMC (lead maternity carer) the midwife will care for you from early pregnancy, during your labour, deliver your baby and care for you both for six weeks post partum, this involves regular home visits by your midwife.

As your LMC we see you on a regular basis through your pregnancy, monthly for the first trimester, fortnightly in the second trimester and weekly from 36 weeks gestation until your baby is born. The bonus of an independent midwife is she is generally the only practitioner that you will deal with (99% of the time) in your pregnant year.

Your LMC will book you into the hospital of your choice, usually within the area you live and arrange all your blood tests, ultrasounds, and also arrange obstetric referrals is this is required during your pregnancy. Obstetric referrals with an obstetrician is usually because the pregnancy has veered of the path of normal and midwives only deal with “normal” pregnancies, so if any complications should arise we have ready access to these specialists. A plan is put in place by the obstetrician which the woman and the midwife follow.

Your independent midwife is on call 24/7 but usually has a backup midwife to help out if the labour has been particularly long or your midwife can,t make her clinic because she is in the hospital with a labouring woman, the backup will then step in and help out. Due to the hours your midwife works, it is very important to consider if you have a question whether it is urgent and warrants a call in the middle of the night, or whether it can wait till working hours.

The second most common questions midwives are asked, is how much is this care going to cost me? Here is New Zealand we are very lucky so long as you are a NZ citizen or NZ resident, all your maternity care will be free. We are very lucky and proud to be able to offer this to our women of NZ.

The third most common question we are asked, is why do I have to come to my appointments with my midwife? Your appointments are very important. We need to monitor the well being of the mother and baby. We discuss any questions or issues that arise, we monitor blood pressure, assess that your baby is growing adequately and even listen to the babies heart beat. We arrange referrals at these appointments ie: blood tests, scans and specialist referrals. These appointments also help you, your partner and children and the midwife to get to know each other, so that when the time comes to have your baby, everyone is comfortable and you are not dealing with a stranger, because during your antenatal time you have built up a relationship with your midwife. As a pregnancy is 40 weeks long this affords the time for you all to build this relationship.

Some women build up such a great bond and relationship with their midwife so that when babies 2,3,4 come along, they choose to return to the midwife that cared for them in their previous pregnancy. It is wonderful for the midwife to have these women return to them.

Unfortunately, not all women and midwives get along. Sometimes there is a clash of personalities, but this is not a problem, as the woman can look for another midwife that offers what she is looking for. It’s great to have that choice.

The midwife client relationship can be complex and over your pregnant year we come to know you and your family fairly well, so it is important to choose the midwife that you are comfortable with….you not only bond with your baby, you also need to bond with your midwife and feel secure in knowing that you can trust her to care for you in the manner you expect.

Faq to West Auckland Midwives

Do I have to book into a hospital to have my baby?

No you don’t as long as you don’t have any past history that would prevent you having a home birth.

Do midwives do water births?

Most midwives are very happy to do water births, but ask the midwife you plan to book with first, as a small amount do not do them

Do midwives do home births

Again this is something you need to discuss with the midwife you plan to book with, because not all midwives offer this service.

When do I book with a midwife?

It’s important to start looking for a midwife as soon as you find out you are pregnant, as midwives can fill up very quickly. Usually between 6 – 8 weeks gestation

When will I feel my baby move?

This usually happens around the 19th week for first babies…and then it is very gentle fluttery movements that you are not too sure about, earlier 17th week for women that have had babies because they know and detect and little earlier.

When will I be scanned?

We do an early scan between 11 and 13 weeks which is a screening for down syndrome then again between the 18th and 20th week which is called an anatomy scan…this is to make sure that baby is developing at the right rate for its gestation…most parents want to know the sex of the baby and this is done at the anatomy scan. Sometimes we scan more often if we suspect the baby is too small or too big, twins, or if a problem has been picked up at the anatomy scan.

How do I know if I am in labour?

This question is discussed with your midwife. She will give you the information of signs and symptoms of labour usually 4 weeks before your due date.

Why do I have to have blood tests?
Blood tests give the midwife very important information in regards to your health at booking, your blood type, whether you have been exposed to sexually transmitted diseases such as Hep B or HIV. They also test for gestational diabetes later in the pregnancy and also ensure that your iron levels are good.

What should I do if I should start bleeding?
You should contact your midwife immediately ( even in the middle of the night) and she will make arrangements for you, either to go to your local hospital or to be scanned, unfortunately if it is a miscarriage there isn’t a lot anyone can do to prevent this from happening.

Is sex safe in pregnancy?
As long as you haven’t had any bleeding or other complications such as recurrent miscarriage then sex is perfectly safe and a normal part of your relationship, and no the baby will not be stabbed in the head as most fathers seem to think this is the case…your baby is perfectly protected.

When can I resume sex after baby?
Sex is ok so long as your are ready for it. Obviously if you have had stitches then it usually takes around six weeks to feel “normal down there” again, but you have to feel comfortable in resuming your sex life, so don’t rush it.

What can I take for contraception?
Again your midwife will discuss this with you post partum, she will give you options that you can choose from, its usually a good idea to also discuss this with your partner and decide which is the best for your both.

When will my periods start again?
Usually 4 – 6 weeks after the birth of the baby. For some breastfeeding mums they don’t get a period until they start weaning baby, but this is not rule of thumb as some breastfeeding mums can start their periods soon after the birth, so always use precautions if you resume you sex life.

Midwifery (Providing Care to Women)

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INTRODUCTION

Midwifery, profession that provides health care for women, especially during pregnancy and childbirth. Midwives (practitioners of midwifery) have assisted women in giving birth since ancient times. Today midwives deliver more than two-thirds of the world’s infants and provide many other gynecological services. Midwives care for women in developing countries where physicians may be scarce and in many developed countries such as the United States, Japan, and The Netherlands.

Midwives base their practice on the understanding that pregnancy and childbirth are natural processes and health care should be personalized to meet the needs of a woman and her family. While the practice of midwifery differs worldwide, most midwives provide prenatal care, assist the birth process, and offer emotional and psychological support to a woman and her family during the birth experience. In the United States a midwife may also perform gynecological checkups, including breast examinations and pap smears, provide birth-control advice, manage the specific needs of menopause, and, in some cases, serve as a primary care provider.

In the United States there are two formally recognized types of midwives: certified nurse-midwives and direct-entry midwives. Certified nurse-midwives (CNMs) are registered nurses certified by the American College of Nurse-Midwives (ACNM). Certified nurse-midwives are recognized by all 50 states and the District of Columbia. The ACNM requires that CNMs graduate from 1 of 45 ACNM-approved educational programs and pass a national certification exam. Some states have additional requirements for a professional midwifery license. In 1996 the ACNM opened the profession to qualified non-nurses who successfully complete an approved midwifery education program and pass the national certification examination. All ACNM-certified midwives are required to recertify every eight years.

Direct-entry midwives may be trained through informal apprenticeships or, increasingly, through more formalized degree programs at educational centers. Direct-entry midwives typically help women who deliver children at home. The practice of direct-entry midwifery is allowed in 41 states.

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BENEFITS OF MIDWIFERY

Midwifery benefits pregnant women in several ways. Midwives encourage women to actively participate in health care decisions. They teach women how to best care for themselves through proper nutrition and exercise, giving women greater control over their pregnancies and birth experiences. Many women find this level of participation satisfying.

Although most midwife-attended births take place in hospitals, midwives may also work in less clinical settings such as a home or a homelike, out-of-hospital birth center. This nonthreatening, comfortable atmosphere often helps a woman in labor feel more at ease and more in control of the birth process. In general midwives do not use invasive technology like obstetrical forceps in providing care during labor and birth. Minimizing the use of costly and sometimes painful medical tests and treatments appeals to many women.

During labor and birth, all of the midwife’s effort focuses on helping the woman deliver her child with confidence. The midwife carefully monitors the mother’s blood pressure, pulse rate, and dehydration levels, and the unborn child’s heart rate. Nurse-midwives are trained to recognize and prevent problems before they occur. In cases involving unexpected complications or emergencies, most midwives have arrangements with physicians to ensure that medical help is immediately available.

Midwives generally accept patients at low risk for complications during pregnancy and labor. They screen potential clients for conditions such as high blood pressure, diabetes, and a history of multiple births. Studies show that nurse-midwife care compares favorably to care provided by a physician for low-risk pregnancies. According to the ACNM, women who are under the care of a CNM are less likely to have a cesarean section (surgical delivery of the newborn through the abdomen) or an episiotomy (surgical enlargement of the birth canal) during a vaginal delivery. Moreover, babies born with the help of a CNM usually weigh more at birth and have an increased chance of surviving past their first year.

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HISTORY OF MIDWIFERY

The practice of midwifery has a long and distinguished history. The Greek philosopher Aristotle wrote of the wisdom and intelligence of Greek midwives. In the 16th century, French midwives were instrumental in advancing the field of obstetrics. The French midwife Louise Bourgeois, a noted teacher and author, was midwife to the French Royal Court for 27 years, delivering Louis XIII and six children of Henry IV.

By the 20th century in the United States, a shift in attitudes toward pregnancy and childbirth occurred. This natural process was viewed almost like an illness, best treated by a physician, preferably in a hospital. Despite the findings of a study in 1910 that obstetricians’ unsanitary procedures were more often responsible for the high maternal mortality rates of the time, many physicians blamed mortality rates on the practice of midwifery.

In response to these accusations, the School of the Association for the Promotion and Standardization of Midwifery was founded in 1931 to provide formal education for midwives. American nurse-midwife Mary Breckinridge founded the Frontier Nursing Service in 1925 to provide care for rural Kentuckians. In 1939, the service opened the Frontier School of Midwifery and Family Nursing in Hyden, Kentucky. A family nursing curriculum was added to the school’s program in 1970, and the name of the school was changed to the Frontier School of Midwifery and Family Nursing.

In 1955 the American College of Nurse-Midwifery (later renamed the American College of Nurse-Midwives) was established to develop and support educational programs, sponsor research, develop professional relationships, and participate in the international organization of midwives.

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Father-baby Care

Helping your partner and watching your baby being born is an over whelming experience. The second stage is hard work for mothers it’s a real effort, but there are ways you can help and be involved.

How you can help

Help your partner to get in to the position she feels is best, and support her there.

Talk to and encourage her all the time. Keep in physical contact so she knows you’re with her.

If you can see your baby’s head as it crowns, describe it to your partner or hold a mirror for her to see this will be a huge encouragement for her. How ever, don’t get in the doctor’s way, as she’ll need to monitor the baby’s progress second by second, and to check the birth of the head.

Announce that you have a son or daughter, not just a boy or girl. The words son and daughter express family feelings.

If the doctor agrees, clamp and cut your baby’s cord. This is the moment your baby really becomes an individual being.

If you feel like crying, don’t hold back. It’s one of the most emotional moments of your life.

When the baby is born, share with your partner in the first minutes of your child’s life.

By all means photograph or video your partner and baby, but don’t do this to the exclusion of helping them, They are more important than any thing else.

Who’s Who At The Birth

For a normal vaginal delivery, you’ll probably be attended by your obstetrician or obstetrical midwife some times, though, the delivery room may seem crowded with people they may include:

Nurses.

An assistant midwife.

The obstetric doctor on duty.

A pediatrician or a neo natal specialist, if there is a potential problem.

A pediatric nurse if your baby is premature.

Birth At Home

Some women are giving birth at home, though birth in the hospital remains the norm because it’s difficult to predict how your labor will progress.

Practical preparations

About a month be fore your due date, the midwife will let you know what equipment you need to have available, such as buckets, rubber gloves, and plastic sheets to cover furniture and carpets. She’ll provide all the medical equipment. Decide where in your home you want to have your baby and try to work out your expectations so you can discuss them with your midwife.

When you’re in labor

Call the midwife, who will come as soon as possible. She’ll probably have an assistant.

For pain relief, your midwife will provide demerol (obtained by prescription be fore hand), so you’re likely to try drug free ways of managing the pain first. You’ll probably be better able to cope at home, any way.

You’re more likely to feel in control of events as the midwife because in your territory, and that’s an important psychological difference for every one.

If there’s a problem

Talk to your midwife about when and why she’d recommend a move to the hospital. If that were to happen, you would go in an ambulance. In most in stances, the same mid wives who had attended you at home would care for you in the hospital.

After the birth

The midwife will stay for a couple of hours to make sure that you and your baby are comfortable and healthy, and will return later. You, your partner, and your new baby can spend your first few hours as a family together in your own home.

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What?s in Your Birth Plan? ? Planning Your Home Birth

What’s in Your Birth Plan? – Planning Your Home Birth

 Why do you need a birth plan?
There are many options available to support your home birth experience ranging from a water birth to hypnotherapy in birthing. The idea of a birth plan is to choose your preferred method of giving birth, and also to specify your views on interventions that will be offered to you. While many women do not have the birth that they planned, preparing a birth plan gives you and your partner a starting point when labour kicks in. Also creating a birth plan enables you to discuss all the options with your partner and midwife and confirm what your preferences are. This is important, as your partner may need to speak for you while you are focussed on your labour. Also if your midwife is aware of your birth plan she will also be able to ensure there is a midwife available to support a homebirth and adequately trained if you need assistance with a water birth. 

What to put in your birth plan?
This will be different for every person, and you will gain ideas about your ideal birth from antenatal classes and talking to mothers who have been through the process, or even your own experience if this is not your first child. Below is a template for a birth plan that covers the main areas to consider when planning your home birth.

How to put your birth plan together – try this template
The sections below are the common areas to consider when planning your home birth; you may come up with more requirements or may have no preferences on some of the sections below. You can use this as a guide to start your birth plan.

People present

You may only want your midwife and your birth partner present, or you may be happy for close relatives and friends to support you. If you specify this then your partner or midwife can tactfully ask people to give you some privacy if required during the birth.

Also consider any other children that you have and whether you would like them present and if they would like to witness the birth. Make a contingency plan if you think that it may not be a good idea for them to attend the birth. 

You may consider it helpful to have a friend or your mother present to help out, especially if you have a birth pool that needs to be filled.

A doula, acupuncturist or a hypnotist are also popular for home births.

Have the names and numbers of anyone that you would like at the birth available in case someone else needs to call them for you.

 Pain relief

If you have a home birth you can only use natural pain relief methods. Options to help you with your home birth may involve, the use of movement, massage, relaxation, acupuncture, hypnosis, aromatherapy, a TENS machine, or a birth pool. Your midwife may also make gas and air available for you, but remember that she may not arrive until the end of the first stage of labour or the start of the second stage of labour.

Immediately after birth

You want to keep your baby with you / Can take the baby away for examination

You want to keep the umbilical chord attached until it stops pulsating / Can cut the umbilical chord straight away

Partner wants to cut the umbilical chord

You want to breastfeed straight away

Third Stage – Placenta Delivery

You would like to deliver the placenta naturally / you would like an injection to help speed up the delivery of the placenta.

What if your birth does not go according to your birth plan?

Midwife Does Not Arrive on Time

In the vast majority of cases the midwife will arrive on time. If you feel that she will not make it then call 999. Ambulances can get through traffic a lot faster than a normal car and the paramedics are trained to assist childbirth.

What If There Are Complications

The midwife will only support your home birth if there have been no complications with your pregnancy and your baby is in the expected position and expected size for his age, so the risk of having complications in childbirth are minimised. The midwife will continually monitor your progress, and if concerned she will transfer you to hospital before any issues arise. This is something you will discuss with her when going through your birth plan. Many planned home births result in a transfer to hospital as the midwife will always err on the side of caution to ensure the safety of you and your baby.

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