When should we let people know labor has begun? I get this question a lot from clients, especially if this is the first baby, AND I have some strong opinions to share.

​I personally don't think announcing labor has begun is a wise idea at all. I have many reasons, backed up by experience.
 

• There are a lot of preconceived notions out there about labor. There's the idea that labor shouldn't take a long time, and that it never slows down or stops. So, if labor doesn't match these preconceived ideas, expect to be fielding a lot of texts and phone calls from friends and family who are concerned that something is seriously wrong.
• Announcing labor has begun and then not answering calls or texts may just bring unexpected and/or unwanted visitors to your door because they are concerned and want to make sure everything is ok.
• Announcing labor has begun might get shared with people you had preferred not know.  
• Announcing labor has begun may end up on social media for all the world to see, which might not be the way you wanted to announce your baby will be arriving soon.
• Instead of being able to focus on labor and birth, you may find you are so busy answering texts and calls that labor stops and we get to try again another day, or Dad may not be able to give Mom the support she was expecting and counting on
• The blue light emitted by electronic devices may interrupt oxytocin flow, not to mention the stress hormones produced as a result of having inquiries about how labor is going. Interrupting oxytocin is a guaranteed way to have a longer, less efficient labor.
• Expect to be contacted at all hours of the day and night. People seem to forget basic manners about when it is appropriate to make a phone call or send a text when they know someone is in labor. Just like being pregnant seems to invite public comment from total strangers, knowing labor has begun seems to give people the expectation that everyone has the right to know what is going on.

​
I have been at a birth where Grandma shared online that labor had begun. After 24 hours with no baby, she was getting quite irritated by all the inquiries she was getting. I have attended a birth where it was announced to the extended family that labor had begun. When the parents decided to turn off the phones, the family decided to drive to the house to check on things. Neighbors who see on social media that labor has begun will ask me for updates if I step outside to get some fresh air, or they see me going to my car.  

Labor and birth are hard work, and there's no reason to make it any harder than it needs to be. I honestly think the best plan is to wait to announce anything until your baby is here, and you are ready to take phone calls and have visitors.

I opened an email to see that "giving birth is more risky than skydiving". This email also goes on to state that "it's one of the most dangerous things our patients will ever experience." I realize the sender is trying to get me to sign up for a class on obstetric emergencies, but really?!!

Let's put this in perspective. Women have been giving birth for a heck of a lot longer than humans have been skydiving. So, just from a risk over time consideration, there isn't a correlation. The percentage of the US population who has done at least one skydive is significantly lower than the percentage of the US population who has given birth at least once. Why would someone compare birth with skydiving? That's like telling you not to eat broccoli because you might be in a car accident.

There is an element of risk to pregnancy. There is risk when you walk outside your front door. There is risk every time you get behind the steering wheel of a car. Risks can be reduced but not eliminated entirely. If you are a human being, risk of part of the package. If birth is so "dangerous" then why have humans proliferated so successfully?  

For the majority of women, birth is not an emergency. Yes, there can be truly serious situations that can be an emergency but they are not the majority of births. Playing on fears of the minority of cases that are emergencies to get my money for a training course doesn't impress me and it actually ticks me off. As a midwfe, I truly believe pregnancy and birth are not medical conditions to be managed. I feel birth works best when we trust the process and do not try to manipulate or manage it.  

Using dramatic, scary wording does not impress me. It actually makes me wonder what kind of care is being provided that would make birth more risky than skydiving. Needless to say, I will continue to educate myself so I am prepared for the times when birth needs help.  I will not add drama or fear to birth, especially in the times it does need help.

There seems to be a myth floating around that if you have hired a midwife and are going to have a home birth, you don't need a doula. As a home birth midwife, I strongly disagree. I think hiring a doula when you are planning a homebirth is just as important as when you are planning to have a hospital birth. A lot of the reasons are the same, but I have a few more reasons when someone is planning a home birth.

​Reasons I recommend a doula include:

• You have not done this before so it is helpful to have someone familiar with labor and birth right by your side once it starts getting big enough you can't ignore it.
• Doulas have skills and tools to help you navigate the challenges of labor well. These include comfort techniques, positions to help baby navigate the pelvis and so on
• Dads like to fix things, but labor isn't something they can fix. It can be challenging to see Mom in pain and not be able to take it away. A doula can support Dad as he supports you, and can show him ways to support you if he's unsure of what he can do that will be helpful.
• If labor is long, a doula can spell Dad so he can get some rest and then come back rested and ready to support you.
• A doula is a calm, reassuring presence. Having that presence can help Moms navigate labor with less stress, which can lead labor to progress faster and more efficiently.
• A doula is there just to support you and Dad, they are there for you in the moment without being distracted by needing to make clinical assessments, listen to baby, set up for the birth and other things.

If the concern or hesitation about hiring a doula is that the doula is going to take the place of Dad, or keep Dad from supporting Mom, I think this video by David Arrell explains how doulas can actually help Dad step up even better than without a doula to support Mom.

Being a doula is hard work. It is physically and emotionally demanding. If I have to doula a client, I am afraid it will be at the expense of my midwifery skills. I want to bring my A game to the moments of birth when it is vital, but if I've had to do the work of a doula as well as a midwife up to birth, I'm going to be tired, and not as fresh as I want to be to be my best.  ​

To paraphrase Forrest Gump Labor and birth is like a box of chocolates, you never know what you are going to get!  You can have a great understanding of the process, but until you are in it, you truly don't know what it will be like for you. Having someone who will come alongside you and support you will help you navigate labor easier. Labor can be compared to hiking the Grand Canyon. If you want to hike to the bottom and  back up, doing it by yourself is way more challenging than having a trail guide to lead you. A doula is very much a trail guide for labor and birth.

In my years doing birth work as a doula, as a midwife's assistant, as a midwifery apprentice and now as a midwife, I have never once heard someone say they regret hiring a doula. I HAVE heard plenty of people say how much they wish they had hired a doula.  

I'm here for another rant of sorts.  I've written about what a bargain a home birth midwife is, but I feel it's time to go a bit deeper into my perspective as a midwife.

When you hire a home birth midwife, you are getting so much more than just a care provider.  You are getting direct access to me to ask questions or share concerns.  My clients have my direct phone number so they get me instead of an answering service or voicemail system. When you hire a home birth midwife, that midwife alters her life during the time she is on call. I don't travel more than an hour away from my home, and if it appears labor may happen soon, I often will limit my travel radius to only around town. I will change plans at the last minute, break commitments and sometimes miss family events and celebrations.

Being a midwife costs me personally. There are the tangible costs such as equipment, supplies, education, maintaining certifications, maintaining a reliable car, having a cell phone, computer, internet etc. There are also intangible costs such as my time, ability to commit to events with family and friends, hoping I don't have to miss or reschedule doctor appointments that can't wait and scheduling all my regular health care appointments during my planned time off, as well as not being able to travel outside the area. There is behind the scenes time spent researching the answer to a client's question, keeping up with the latest recommendations and research, filing required documentation with the state, maintaining my equipment so it is ready for a birth, and much more.

Being a midwife has value which can be seen in the tangible aspects, but the biggest value in my opinion is in the intangible aspects. What is it worth to have 24/7 access to your provider, to know your provider will be close by and ready to drop everything and come at a moment's notice regardless of what they are doing?

I value myself as a midwife and I love serving clients who recognize my value as a midwife.

The maternal mortality rate in the USA has made the news again, and for the usual reason.  It has continued to increase significantly during 2021. This really bothers me. The rate was double that of some European countries, and triple that of other European and Asian nations. We can wring our hands, finger point and blame it on Covid among other things but the sad fact is that the US has been and continues to do something wrong.

I've written about almost losing my sister after the birth of her son, and how that prompted me to become a midwife. The fact that nothing has changed, and has only gotten worse just breaks my heart.  The CDC has said up to 80% of maternal deaths could have been prevented. When Serena Williams had her baby, she had issues that would have been fatal if she had not been able to advocate strongly for herself, and what makes her story even more concerning is that she had a known history of blood clotting issues and she still wasn't taken seriously when she began experiencing symptoms.

There are many components to the maternal morbidity crisis. I have some ideas to reduce the impact of some of those components and in turn reduce the maternal morbidity rate.

• Listen to mothers, after all they are the ones who know their bodies the best.
• Take mothers' complaints seriously and don't ignore them.
• Have more frequent postpartum checkups.
• Give all postpartum parents paid time off with no exceptions.
• Provide postpartum doulas to help mothers in the first feew weeks after birth.
• Have more midwives. In states such as Kansas with large rural areas, having providers close by instead of expecting women to drive over an hour for care will make a huge difference in outcomes.
• CPM, CNM, MFM and OBs working together as a team so care can be provided by the appropriate provider and smoothly transitioned if something changes.
• Train and equip EMS to handle birth and newborn emergencies instead of hoping the emergency happens close enough to a children's hospital that they can send the ambulance.

These are things that need to be done at the local level and nationwide.  Some of these suggestions will take time to implement such as training more midwives. Some have already been recommended like more frequent postpartum checkups but have yet to be common practice at the local level, and in many areas across the country.  Some can be implemented pretty quickly such as training and equipping EMS and other emergency services for birth and newborn emergencies.  Even addressing one thing on my list will improve outcomes and change the maternal mortality trajectory. It's time to take action instead of sitting around bemoaning the fact that maternal deaths continue to rise in the USA.