Are you interested in getting the best value for your dollar? Would you like to have individualized maternity care?  Home birth midwifery care may be just what you are looking for.

Midwives have clients, not patients. Midwives do not offer assembly line care, instead they specialize in individualized care. Midwives want their clients to be fully informed so they can make the best decisions for themselves as an individual. Midwives want clients to ask questions, to share things they have learned and to be collaborators in their care. Midwives give generously of their time. Instead of a 10-15 minute appointment, you may get an hour or more of the midwife's sole focus at each appointment. In the area of Kansas I serve, if you have your baby at the hospital, whoever is on call is the doctor that will attend the birth. If you have been seeing an obstretrician for care, this may be a doctor you have never met before. Midwives don't pop in just in time to catch the baby and then leave shortly after.  With midwifery care, the midwife you hire is the midwife who will be at the birth (barring unusual situations). Midwives may spend several hours or even days supporting a client in labor, and will stay after birth for a few hours to be sure everyone is stable and doing well. Midwives do more than just a 6 week postpartum, most midwives will do 4 or more postpartum visits with the first two or more in the client's home. Some midwives have options to provide all their care in the client's home. When was the last time your doctor offered to come to your home?

If you don't have insurance and have to pay outright for a hospital birth in Kansas, you will be paying just shy of $11,000. My fee is less than 1/3 of that.  For many people, my fee is less than the insurance deductible they would have to pay for OB care and a hospital birth. You are not locked into using only the providers covered by health insurance, you can choose to pay directly for the provider you want. Choosing a provider is a bit like buying a car. You can get the base, no frills model or you can pay more to get extra options. With a home birth midwife, the cost is actually less to have more options and care tailored to you and your unique needs and situation. Home birth midwifery is luxury care, especially when compared to the assembly line care so prevalent in American maternity care.

Maternity care focuses on Mom and baby during pregnancy, birth and postpartum which is wonderful and necessary. However, Dads often get overlooked or ignored which I feel is a disservice to the family.  Just as birth brings changes for Moms, it does for Dads as well.  There are a lot of resources devoted to supporting Mom and baby, but not so much for Dads.  So I decided to share my favorite resources for Dads.
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• Childbirth classes- these help everyone understand how pregnancy and birth work.
• The Birth Partner by Penny Simkin.  This is a great resource for ideas to help with labor support.
• Welcome to Fatherhood: The Modern Man's Guide to Pregnancy, Childbirth, and Fatherhood- written by David Arrell, a Dad to Dads. I love the suggestions and ideas in this book.  It's written with a humorous touch but has rock solid advice.
• Dude, You're Gonna Be a Dad written by John Pfeiffer.  Another great book to read, written by a Dad to Dads.
• The Sears Baby Book written by Drs Sears and others.  If you are unsure of how to care for a newborn, or just want to get an idea of what that will be like, this book explains things well. 
• welcometofatherhood.com offers classes on birth, and caring for mom and baby in the first 3 months postpartum as well as individual coaching.
• Postpartum Support International-because 10% or more of Dads will struggle with postpartum depression or anxiety after baby is here.

While Dads are often more in the background in the immediate postpartum, their needs are no less real or important than Mom or baby.  I hope one day to share a list of resources for Dads that has at least twice as many resources as this list.  

Posptartum is, in my opinion, the most important and overlooked time in maternity care in the United States.  Medical care has made great strides in taking care of newborns, but taking mare of Moms seems to be an afterthought.  I have seen this play out time and again with friends and family.  Baby comes, they have all the newborn appointments, but not a single check on Mom until the 6 week visit with the OB.  We can do better for families, we need to do better for families, we HAVE TO do better for families.

The American College of Obstetrics and Gynecology updated postpartum care recommendations in 2018.  They now recommend that women be seen by a provider at 3 weeks postpartum in addition to the 6 week postpartum.  Why the change?  Well, they are finally acknowledging that too many mothers are dying in the postpartum period from childbirth related issues, 50% or more of all maternal deaths in the US occur in the  postpartum period.  The hope is that by checking on mothers at 3 weeks, more issues will be caught sooner, and mothers can get vital help sooner.  Whie this recommendation has been out for a few years,  women in the areas I serve are still not being seen before 6 weeks.   Being seen once at the 6 week postpartum is even the practice at teaching hospitals which I would expect to be implementing the latest recommendations as soon as they come out. 

In my midwifery practice, I see clients in person 4 times in the 6 weeks after birth.  The first two visits are at the client's home because I want the client to be able to rest and focus on recovery in the first few days after birth instead of dragging themselves and a newborn out to get care.  By seeing my client so soon after birth, I am able to help with any nursing issues, assess bleeding, and be sure my client isn't going into preeclampsia in the postpartum period.  I have a better sense of how my client's recovery is going with those visits than if I waited to see them at three weeks after birth.  

I want my clients to thrive during the postpartum period.  For me, that means seeing them twice in the first week after birth, as well as two more visits in the first 6 weeks postpartum and making myself available by phone to them.  I feel strongly that mainstream medical care is failing women in the postpartum period, and it shows in the maternal mortality rate.  I can make a difference, one client at a time.​ 

Labor can take awhile, especially if this is the first birth.  I anticipate 24 hours of labor for a first time birth, and I have served clients whose labors have lasted longer than 48 hours.  Sometimes a Mom who has had previous short labors can be in for a longer labor than she expects.  As a midwife, I want my clients to have the tools they need to handle a labor that goes on for a while, so I encourage all my clients to be prepared for a long labor.

My biggest tip is to ignore labor as long as you can.  The less energy and attention you give it, the more you will have to pull from when you really need it.  I've had clients use many different techniques to ignore labor.  Some go shopping, some cook or bake, I've even served a client who played video games.  

Keep your routine normal.  If you are in labor and it is your normal time to go for a walk, then go for a walk (you might want to go for a shorter walk, or have a pace that is slower than your usual pace).  If it is time to go to sleep than get in bed and try to get some sleep.  Even if you aren't able to sleep but you can rest and relax, that will be beneficial and let you have energy for the long haul. 

Keep your activity levels low key.  Labor is not the time to head to the gym to try a new HIIT workout or go outside and thatch your 1/4 acre lawn.  By being mindful of your activity levels, you will be in a better place to have the energy to finish labor strong.  When you are worn out at the end of labor, it can create challenges in the immediate postpartum such as increased risk of hemorrhage, difficulty getting up safely to use the bathroom, and you may not have the energy to truly soak in that you have a brand new baby in your arms.

Eat and drink.  Long labors require lots of calories to keep going.  I don't expect clients to eat full meals, but I do want clients to eat. Small, frequent snacks are what most clients do so have some easy snacks and light food on hand.  Some ideas are fruit, yogurt, cheese, jerky, crackers and nut butters, nuts etc.  Drink plenty of liquids to stay well hydrated.  Have a grazing mindset, and eat something every half hour when you are awake.  I also like it when whatever you are drinking has some calories.  Watered down electrolyte drinks, coconut water or homemade laboraide are fine ideas.  If you want to drink juice or soda, I'm fine with that too.

Sleep.  I know it sounds hard, but you can sleep during labor.  I've been at many births where the client is able to doze off between contractions.  I always find it interesting that if Mom is really tired and lays down, labor slows down.  The body recognizes the need for sleep and accommodates it.  If you can't sleep, but you can rest and relax between contractions, that is so very beneficial to replenish energy and get through to the end with some reserves.

Pace yourself.  To make it through a 24 hour or longer labor with some reserves to finish strong, you need to pace yourself.  By that I mean being active and working with your labor for an hour or two and then laying down to rest or sleep for 30 minutes to an hour.

Change the energy.  Long labors require stamina, endurance and sometimes a breath of fresh air.  You can go for a walk, talk to someone on the phone, take a bath or shower, write a letter to your baby, anything that builds you up, nurtures your soul and gives you a change of pace.

Long labors are not unusual, and do not mean something is wrong.  Unmedicated labor has its own pacing and for the vast majority of births, it's not a lickety-split pace.  Being prepared for a long labor will pay off  for you if your labor is like the majority of labors, and if it is fast you can still pull from the preparations you have made to get you through with plenty in the tank at the end.
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Nursing works better when you are prepared. Both Mom and baby are learning how to work together to have successful nursing.  Even if Mom has nursed a baby before, there is a learning curve because her newborn hasn't nursed before. 

I have some suggestions of things you can do before baby is here to be prepared for breastfeeding.

• Attend a few La Leche League meetings to learn more about nursing and connect with other nursing Moms
• Read books on breastfeeding.  I recommend The Nursing Mother's Companion by Kathleen Huggins, and The Womanly Art of Breastfeeding by Diane Wiessenger.
• Check out online resources on breastfeeding.  I like kellymom.com, llli.org, and ibconline.ca.
• Watch videos of babies breastfeeding.  I highly recommend the videos on ibconline.ca.
• If you have friends or family who are nursing, ask them if you can watch them nurse their baby and ask them questions about what helped them with nursing.
• Attend a class on breastfeeding. Some hospitals offer classes, doulas and childbirth educators may also offer them as well.
• Know what the local breastfeeding resources are in your area: lactation consultants, lactation educators, LaLeche League leaders.
• Have access to a breast pump.  This can be a handy tool to soften your breast before baby latches on if you are dealing with engorgement.
• Consider getting a pillow that has been developed to assist with supporting baby while nursing such as a Boppy.

 I hope you find something useful on my list to help you and baby on your nursing journey. 





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