midwife home-visit

We had our first exploratory meeting with one of the three midwives who take on homebirths here in Tromsø this late-morning, and I was very invigorated by it all.

The idea of a homebirth actually started in Taiwan when we were pregnant with Leona, but wasn't right for us there (in terms of access to midwife as well as our home environment). Thankfully, though, we had the option of the Friendly Birthing Center an hour away and a good doula for us, and so we - generally - got a great birthing experience.

This time a home birth was something I wanted to explore again, while also gaining a full understanding of the hospital option of course. A big reason is Leona. Though, my mom is our back-up plan if it turns out she needs me too much while I am giving birth, as she can pop by and take her out or home to her place for some hours if necessary (Leona often needs me a lot but hopefully after me being home full-time the three or so weeks before birth it can help alleviate some of that pressure, otherwise I think it will be hard to focus on the birth and myself, which is important to me).

Anyhow, so last week at my check-up I asked my midwife at the center what the hospital environment was like here, as well as the standard procedures in terms of arrival and throughout the entire birthing time and after, both regarding me and baby.

It sounded really, really good, from what she said - that my wishes would be listened to basically (SOP is to ask upon arrival if I have any specific wishes and go through these etc.), I could birth in whatever position I wanted, the birthing environment is comfortable, not sterile, where you can dim the lights, have a water birth if you wish and conditions allow, etc.

But I still wanted to set up a meeting with the homebirth team, and so today was the day.

Initially Judge was a bit nervous about the thought of a home birth, due to communication barriers and him not being sure he would be able to provide the support I need as perhaps he wouldn't understand everything they were saying. But after meeting with her, he is now more nervous about the thought of a hospital birth, and I myself am leaning even stronger towards home than before.

First of all, the midwife explained that though technically we can birth in whatever position we want, in actuality it can very much depend on the midwife you get, as in recent years they have started assisting in the perinium not tearing using specific methods, and thus the mother has to sit in a specific position. So if you get a newer midwife that is only familiar with this, she may be less open to you doing as you feel is right for you.

She also explained that there are certain things that are done out of standard procedure that they do not necessarily tell you about beforehand, because it is so standard, like a shot of pitocin after you give birth in order to avoid excessive bleeding - the shot is given not based on need, but based on that it is standard procedure - everyone gets the shot, so I would not be consulted about it, but rather while I was in the just-given-birth daze I would be told I was going to get a shot and bam, the shot goes in my leg.

Also, since it is a hospital setting, they have their systems and procedures, so if we enter that environment we need to be aware we are in their system...there are internal checks and monitoring etc. that we of course could ask not to have done, but it could create more stress than it is worth at the time, so it is something we need to be aware of - this was one of the things in Taiwan that I 'caved' about, and just asked for minimal rather than none, otherwise things would get too complicated.

She next mentioned that not all midwives are happy about getting a 'Birth Preferences' letter from the mother - but that usually they juggle patients around between whoever is on shift so that if you come with such a letter you get a midwife that feels this is not a negative thing, if one is available.

Lastly she mentioned that perhaps only 20% of the midwives could perhaps take on an English birth - and so that would then limit us in terms of openness to our wishes, potentially.

Hrm. Not as rosy as I had gotten the impression of.

Luckily all three homebirth midwives work at the hospital and so she is putting us in contact with the midwife that - if we choose a homebirth - most likely will be our primary midwife, so we can arrange with her to head up to the hospital for a tour and to go through all the SOP points that the midwife at the clinic perhaps didn't think to mention - because the homebirth midwife understands a lot regarding what a ... researched? ... mother may want in a birth, if she doesn't want to just follow the midwives' or doctors' lead and procedures as the professionals they are.

I think as long as I know the SOP I can find a balance between following my wishes and following the guidance of the midwife, if we choose a hospital birth (as long as there isn't something that totally goes against what I feel is right - but I highly doubt it will, unlike the SOPs of Taiwanese hospitals).

In terms of a homebirth she said they always try to be two who come - both for the support between themselves as well as for their own experience-gaining (as there are only a few home births each year up here), but that of course each of them can be there alone as well if it pans out that way. So there is usually a primary, a secondary, and then a back-up if one or both of the other two can't make it.

She also said that they are really there just on the perifery to ensure the safety of the mother and child - that sometimes they will arrive and leave without barely even having touched the mom or baby, as the parents choose to take on all the tasks themselves. And of course if we wish guidance or help, they will provide that as well. They follow our lead. And if everything is progressing well and I feel fine about things as well, we can elect not to have any internals done - as she agrees they can sometimes do more harm than good, and that dialation is not necessarily a signal regarding how much longer one has, as things can change slow or fast no matter. Yay!

She even has a tub for a waterbirth if we want, but I feel filling it up with water and ensuring the right temperature could cause more stress than it is worth, so choose to not have that option at home.

They also provide really good follow-up, with visits daily the first week if we feel we need it. And leading up to it we plan it all out in terms of 'what-if' scenarios (when we would head to the hospital), what the risks of a home-birth are, and all that jazz, that we sign an agreement of sorts where we say we understand and will listen to the midwives if they feel a home-birth is not right anymore, etc. I feel really happy about this, because I am comfortable with their judgement. They also provide weekly check-ups the last month before birth.

Because of all of the above, and it being outside the standard health system, a home birth is financially more expensive than a hospital birth (hospital = NOK 0, home-after-subsidy = NOK 3,000), but it is not a large sum, and so not an issue for us.

Oh, and she asked me about my experience breastfeeding Leona, and I mentioned I am still breastfeeding several times a day and sometimes per night, and her reaction was that it was a positive/natural thing - and we discussed a bit about nursing both of them after birth (colostrum important for new baby etc.), and I was so happy! Not at all like the 'you should consider weaning as it can bring on labour' comment I got from my clinic-midwife. Makes me trust her all the more ;)

Exciting stuff!



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