​Recently during a birth, my client commented on how hands off I was. I took that as a huge compliment.  

I've attended many hospital births. At every birth I attended except one, all the doctors were very hands on, stretching vaginal tissues as baby's head came down, reaching hands in to grasp baby by the shoulders to bring baby out, or worse yet, placing both hands on either side of the baby's head and applying traction to pull baby out. These were births where there were no indications the baby needed any help to get out.  

Being hands on, intervening in the physiological process of birth, can have negative impacts. Pulling on a baby's head can cause nerve damage to the shoulders, and/or face. Placing hands in to stretch tissues may actually stress and weaken the tissues compared to letting them stretch gradually around baby's head.  Placing hands in to pull baby out by the shoulders can lead to tearing when there normally wouldn't have been tearing or it may make a tear worse.  

There are times I need to use my hands to help baby navigate its way out. A shoulder could get hung up on the pubic bone, or baby's torso could be larger than the head leading to the need to help baby out. Often in those situations, simple position changes to open the pelvis in different ways are all that is needed to help baby out. It is rare that I actually have to use my hands to help baby. In fact, I have only needed to use my hands to help baby out twice in the births I've attended in my own practice so far.

I firmly believe birth works best when it is not interfered with. I am mindful of this at every birth I attend. I don't want to disrupt physiological birth unless baby lets me know they need help, and then using an intervention that involves my hands is a last resort when other options have not worked. Balancing my knowledge, and intuition with trust in birth helps me keep my hands off unless there truly is a need to use them to help baby.

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.

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.

Part of my services as a midwife is filing for the birth certificate.  In accordance with state law, I am required to file for the birth certificate for any birth I attend as the primary midwife.  

​Just as in other states, Kansas collects demographic data such as the highest level of education for each parent, what job and industry each parent works in, if there was prenatal care and so on.  I like for my clients to know what information the state wants so I ask them to fill out the application that I use to file for the birth certificate.

I file online. I actually prefer this for several reasons. The biggest reason I like to file online is that my handwriting is not an issue, no one has to try to figure out if I wrote an e or an a.  I also like to file online because I can print off a sample copy of exactly what the birth certificate will look like so the family can look it over and correct any errors before I do the final submission with the state. I am able to print an official birth confirmation letter which may be helpful or needed to get baby on health insurance.  As part of filing the birth certificate, I also include information about any newborn tests I may have done like the critical congenital heart defect screening so the state has that information and doesn't need to contact the parents about the newborn tests.

Kansas is actually pretty fast in getting the birth certificate completed and available to parents. Kansas has birth certificates ready in about 10 days, and if you are really in a hurry, you have the option of driving to the office of the Department of Vital Statistics and getting a copy even sooner in person. You do have to pay a $20 fee to get the birth certificate.  You can request it by mail, or online, or in person if you need it sooner than 10 days after birth.

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