Who 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 schedule.

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.

What 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 midwifery.

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 attend whom.
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 control hemorrhage.

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 to predict).

What if the woman needs to be transported to the hospital during labor?
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.