There are times when we need to transfer during birth.  If baby lets us know they are not happy, or Mom is having challenges and things have moved outside of normal then it can be time to seek the care and help a hospital offers.

Here are the things I want my clients to understand:

• I want the best possible outcome for Mom and baby, that's why we transferred.
• Hospitals have tools that I do not have, and those tools will be helpful or necessary for the situation.
• I value the skills and expertise of the hospital providers, and I am grateful they are able to help.
• If hospital policy allows, I will stay with Mom at the hospital through birth and for a short while after birth.
• If hospital policy does not allow me to stay, I will be available by Skype or another platform if preferred.
• ​I do not have privlieges to practice midwifery in the hospital, so I will shift into more of a doula role providing labor support. I will assist as much as hospital staff are comfortable with. This varies among hospitals.
• Hospitals have protocols they have to follow, and they may not have much wiggle room within those protocols. The protocols may be in place to allow the hospital to be more efficient, or may be required by the liability insurance of the hospital. If we have time, we will go to a hospital that does not have protocols prohibiting a desired outcome such as VBAC.
• I will share pertinent information from the chart, and provide lab results to hospital staff to facilitate a smooth transition, and to make sure they have all the information they need to provide the best care they can for Mom and baby.
• I will provide postpartum care once Mom and baby are released from the hospital.

Hospital care can be beneficial and lifesaving when labor and birth move outside of normal, and I am thankful we can turn to them if needed.  I know transferring is stressful.  I will do my best to make the transfer as smooth and stress free as I can.

There are times when we need to transfer during birth.  If baby lets us know they are not happy, or Mom is having challenges and things have moved outside of normal then it can be time to seek the care and help a hospital offers.

Here are the things I want hospital staff to understand:

• We recognized the need for help and appreciate that the hospital has tools that are not available at home.
• We all want both Mom and baby to have the best outcomes possible, that's why we transferred.
• Everyone is tired so a little more time may be needed to process what is being done, what is being recommended and what options are available during the transition from a home birth environment to the hospital environment.
• If the client is asleep, please come back at a later time to make introductions and to discuss care, or have these conversations with family members who are present. If there are going to be several practitioners coordinating care, it would be helpful in the first hours to meet with one or two practitioners that can explain everything instead of trying to meet everyone.
• The client and family may need to have medical terminology explained, and may ask a lot of questions to understand what is being recommended and to make fully informed decisions.
• The midwife wants to be as helpful as possible. She has important information such as lab results, and a record of how labor was progressing she can share with the medical team. She will provide labor support, and would be happy to help as much as the hospital staff are comfortable with. She is not trying to take over for any of the hospital staff, and truly values their skills and expertise.
• The client may have made decisions regarding newborn procedures or other things before birth, and may wish to stay with those decisions unless the situation calls for changes. Please ask the client's preferences.
• The midwife will provide follow up care after Mom and baby leave the hospital. ACOG recommends at least two in person postpartum appointments in the first six to twelve weeks.  My standard is to do four. I will track baby's weight and provide breastfeeding support as well as monitor my client's recovery.

​Transfers are stressful for everyone involved. An understanding and collaborative effort on the part of everyone involved will result in a smoother and less stressful transfer.  I look forward to the day when home birth is recognized as an acceptable and legitimate option for low risk pregnancies by medical providers in the area I serve.

I am always looking for solid resources that help me stay up to date with the latest evidence and recommendations so when I read Real Food For Pregnancy by Lily Nichols, RDN  I was blown away. I learned so much from her book that I incorporated some changes into my practice regarding labs, and my nutritional recommendations for clients. 

It used to be assumed that protein needs during pregnancy stayed the same throughout, but a recent study shows that as the pregnancy progresses, the amount of protein needed also increases. A 2011 study has shown that outcomes are improved when mothers supplement with higher levels of Vitamin D than the 600 IU/day that is currently recommended. The mothers body is amazing, if the diet doesn't provide everything baby needs, then the body will start pulling nutrients from the mother's body. This can impact the mother years after pregnancy, so eating to support both Mom and baby in pregnancy is important not just for pregnancy.

If you are curious to learn about prenatal nutrition more in depth, and learn what the latest evidence shows, I highly recommend reading Lily's book. It's easy to read, the information is easy to understand and her recommendations are easy to implement. She even has a small section with recipes to try. Knowledge is power, and in this case knowledge is vital. We are what we eat, and babies during pregnancy get the building blocks they need to grow organ systems, and be ready for life outside the womb from what Mom eats.  Eating in a way that supports the pregnancy appropriately will make a world of difference for baby, and for how Mom feels during pregnancy, as well as Mom's health in the years after pregnancy.

I am a home birth midwife. I would not be attending home births if I did not feel they were safe. No one who cares for pregnant women wants to have a bad outcome, and home birth midwives aren't any different. If anything, I am more vigilant because I recognize I am not equipped to handle serious complications. 

Home birth was the standard in the US until about 100 years ago. Home birth is still fairly common in many European countries. In the Netherlands, 30% of births are home births. There have been studies through the years looking at the safety of home birth. Many of these studies had flaws, like including unplanned home births, and home births without a trained birth attendant. Recent studies have been better designed, and the data used has been better screened to reduce including births outside the criteria set for the study.  

​The newest study affirms that home birth is just as safe as hospital birth for low risk pregnancies, and that mothers and fathers are more satisfied with the home birth experience than the hospital birth experience.  Having a home birth also increases the likelihood that breastfeeding will be successful compared to birthing in a hospital. The latest study also matches the conclusions drawn from a 2018 study.  As we get more data, the evidence just keeps growing that home birth is a safe option.  

As I wrote in an earlier blog post, I became a midwife because of hospital care that needlessly put a mother's life at risk. In the US, our maternal mortality rates keep rising which means there is something seriously wrong. I can change that, one client at a time, one home birth at a time.

​What value would you put on having the experience you want instead of the one you are forced to have due to insurance requirements and constraints.  

It's rare for insurance to cover a home birth and not everyone has the money just sitting in the bank to cover a home birth midwife's fee. How can you find the money to cover a home birth? I have a few suggestions.

• Start saving for a home birth in a regular savings account. This option is available for everyone and can be a great way to get a head start on funding a homebirth, or to supplement HSA funds if needed. You can start funding the birth before baby is more than a twinkle in your eye.
• Use your Health Savings Account if your employer provides that option for you. HSA money can be spent to cover costs related to birth including home births. 
• Use a gift certificate. Some midwives may offer gift certificates so family and friends can support you in getting the birth you want. If the midwife doesn't offer gift certificates, she may be willing to if asked.
• Add funding for the home birth to your wish list for a baby shower.  
• Let family and friends know you are working to fund a home birth and would appreciate any help they can offer including financial help.
• Declutter and have a yard sale or sell things online.
• Bartering for all or a portion of the midwifery fee may be an option if the midwife is open to barter. 

Births are life changing events, just like weddings. Couples will plan out the details, and make the investment to have the wedding they want.  Births should be no different.