is an appropriate homebirth client?
The most important qualification, besides being in good health,
is for you and your support persons to have a commitment to
the concepts of having the baby at home. Those who choose homebirth
must be committed to being partners in their health care. This
means you choose a healthy life-style in terms of diet and exercise,
and are interested in learning about the process of normal pregnancy.
My role is to serve as an expert consultant regarding the normal
process, and to be responsible for monitoring the well-being
of you and your baby throughout the pregnancy. You and your
midwife work together to assure a healthy pregnancy, and I work
with you throughout the pregnancy to provide the type of pregnancy,
birth, and post-partum experience you and your family want.
What can you expect from your midwife?
You can expect your midwife to listen to you and to work with
you to meet your needs and expectations. I am always available,
via telephone or pager, for any questions or problems that may
arise during the pregnancy and post-partum period. I encourage
clients to call.
What do I expect of clients?
I expect clients to keep their appointments. If, for some reason
you are unable to keep an appointment, I expect you to call
and re-schedule. I understand that “things happen”,
and I will be as flexible as possible in meeting your needs
as far as appointment times are concerned. Since my over-all
goal is a healthy mother and baby, I expect you to make honest
efforts to maintain a healthy pregnancy life-style.
I encourage women to bring their partners and other children
to appointments so that we can all become familiar with each
other and learn to work together to make this the experience
the family wants.
What is included in our pregnancy care?
Once you have made your decision to seek pregnancy care with
me, I will make an appointment for an initial exam, which includes:
an extensive medical, obstetric and family history; a complete
physical exam, including pap smear and pelvic exam to evaluate
dating of the pregnancy; and drawing of blood for screening
lab work. Assuming this is all normal, the schedule of visits
is once monthly until the seventh month, every two weeks during
the seventh and eighth months, and weekly during the ninth month.
Around 36 – 37 weeks, I make a home visit. My primary
purpose in doing this is to be able to find the house without
problems once you are in labor. I also use this visit to sit
down and talk with the birth team and consolidate plans for
the birth. Since this visit also serves as one of the prenatal
visits, there is always some adjustment to the weekly appointment
When you are in labor, you notify me and I come and serve as
support to you and your chosen birth team, monitor the progress
of the labor, deliver the baby and stay afterwards until I am
sure that both you and your baby are doing well. I only rarely
perform an episiotomy, but I am capable of doing this if this
is necessary. I will repair any tears in the immediate post-partum
period, but my focus during the actual birth of the baby is
to help you to ease the baby out without any tearing.
During the first hour after the birth, I monitor the baby’s
adaptation to extrauterine life, and observe the mother for
any excess bleeding. I encourage immediate breast-feeding. After
the baby is done nursing, I do a complete physical exam on the
baby, including weighing, before I leave, and I use a bland
Vaseline-based antibiotic eye ointment on the baby’s eyes
to comply with state law.
Once I am assured that both you and your baby are stable and
have eaten, the exams and paper work have been done, and you
have gotten up and emptied your bladder, I will leave. I am
always available by telephone or pager for any questions or
problems. I will return on the third day to check both you and
your baby, and at this time I will do the first of the newborn
screening tests (this involves obtaining a specimen of blood
from the baby’s heel).
After this three day post-partum home visit, you and your baby
will return to the office for follow-up visits until two months
after the birth. I will facilitate your family planning wishes.
I do not give the baby immunizations, but will refer you either
to the Health Department of to a private physician for this.
The final visit includes a complete exam for both you and your
baby. I continue to be available throughout this two month post-partum
period for any questions or problems.
If at any time you or your baby develop complications, I arrange
for referral to an appropriate health care provider.
is the midwife’s educational background?
I am a Certified Nurse Midwife (CNM). This means that my initial
health care education is as a registered, and that I then successfully
completed a graduate-level course in midwifery, which made me
eligible to take a national certification exam. Having passed
that exam, I became a CNM. In addition, I am regulated in Texas
by the Board of Nurse Examiners (BNE), and comply with their
standards. In Texas, this means that I am registered as an RN
and as an Advanced Practice Nurse (APN). I am a member of our
local, state and national midwifery organization, and I comply
with continuing education requirements, both for nursing and
How many births have you attended?
I have attended over 800 births, approximately 100 in a birth
center and the rest at home.
Who comes to the birth?
Usually I and an associate midwife come to the birth. In the
unlikely event of two persons being in labor at the same time,
one of us would be at each birth. With my small caseload, this
rarely happens and there would be no way to predict who would
What sort of supplies/equipment do the midwives bring to a birth?
I provide all the medical-type equipment. This includes a Doppler
to monitor the baby during labor. I also have sterile gloves
and instruments for exams and delivery of the baby.
Should the woman be unable for some reason to maintain her fluid
intake, I carry intravenous (IV) solutions and the materials
needed to infuse them. I also carry medications necessary to
Although I am capable of performing episiotomy, I very rarely
do this, only when there is a need for the baby to be delivered
more rapidly. Occasionally, the woman may need repair of a laceration
after the birth, so I also bring local anesthetic and suture
materials. Any necessary repairs are done in the immediate post-partum
period, and inspection of the birth canal for any tears is a
routine part of the initial post-birth care.
I also carry oxygen and resuscitation equipment and am trained
in adult CPR and neonatal resuscitation.
What type of supplies are the clients required to obtain?
In the last trimester, the woman will be given a list of supplies
to obtain for the birth. Since I am responsible for the medical
supplies, the supplies that the clients provide are easily available
and include such items as a bulb syringe, betadine (providone)
solution, alcohol and cotton balls, etc. Items of clothing for
the baby and foods for the laboring woman are the client’s
decision. We always appreciate being fed ourselves, especially
if it has been many hours (and length of any labor is impossible
What if the woman needs to be transported to the hospital
My transfer rate is around 7% and my c-section rate is around
5%. The most common reason for transport during labor is the
situation of a woman who, for whatever reason, is not making
progress in dilation and is becoming exhausted. This is a midwife
judgment situation, and my goal is to have a healthy mother
and baby; I would want to have this woman at the hospital before
the baby is compromised by the mother’s exhaustion, making
medical care such as pitocin augmentation or analgesic/anesthetic
treatment effective and possibly permitting a vaginal birth.
Thus, not all transfers means a c-section. Once the decision
has been made to go to the hospital, I will notify the hospital
that we are coming in and for what reason, and I will accompany
the mother and her support team to the hospital to serve as
doulas (support) for the mother and family until the baby is
born. I provide hospital personnel with a copy of the woman’s
prenatal and labor records. The choice of hospital would depend
on where the woman lives and the circumstances of the transfer.
If I am transferring because of a problem with the baby, we
would go to a hospital with neonatal specialist facilities,
in the Hill Country, this means either Austin or San Antonio.
If the problem is for failure to progress, then more local hospitals
would sometimes be appropriate.
How can clients contact the midwife for questions or
problems outside of regular appointments?
I am on call 24 hours a day, seven days a week. I have a pager
and home and office telephones with answering machines. If you
need to contact me, I ask that you first try to reach me at
home. If I am not there, then I ask that you leave a message
on the answering machine with your phone number and then page
me. If I have not answered the page within 15 or 20 minutes,
page me again. (The Hill Country is filled with dips where signals
do not always transmit.) I encourage clients to contact me this
way with questions or problems; don’t hesitate to call.
Do not leave an important message on the answering machine at
the office, because it can sometimes be days before I am able
to check that machine, since I am not in the office every day.
What other types of health care services to I provide?
I also provide health care for well-women. This means complete
physical exams, pap smears, provision of methods of family planning,
and diagnosis and treatment of infections such as bladder infections
or sexually transmitted infections. I use a wellness model of
health care and provide counseling and education related to
life-style, diet and exercise. I care for women throughout life,
from birth to old age. I also have a library available to clients,
covering topics from childbirth, breastfeeding, infant and child
development, to puberty and menopause. I also provide information
and referral to other health care practitioners such as homeopaths,
chiropractors, acupuncturists, massage therapists and herbalists.