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Bethany's Blog

Twin Home Birth: A Story

8/25/2021

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Midwife Note: Planning a twin home birth requires a very narrow set of parameters to be met before it can be considered. In this situation, both Jalissa and her babies met all of the requirements to continue with the plan to give birth at home.  The midwives also have their own requirements-for us, this means we need a dedicated team of 4 midwives
willing and able to attend the birth, and a hospital-based care provider who is willing to be a backup
should a transfer become indicated at any point. 

Now that all is said and done, we know they made a perfect choice or these babies would have been
the first set of twins born in a vehicle while en route to the hospital!
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Contributed by Jalissa Rose
Rose Twin birth story
💜💜

I had been having contractions on and off during the night for the past few weeks. I would have them during the daytime here and there as well, but they always stopped. Aside from one night around 34 weeks where they lasted several hours, the ones at night always just stopped themselves, too. 

Starting on Monday (the 2nd) of this past week, I was just feeling exhausted. I'd been pretty tired coming into those final weeks, but I was so tired and just had this feeling that I needed to sleep as much as I could. I also started slowly losing
my mucous plug, but I know that can regenerate and so that alone isn't necessarily a sign of labor coming soon. 

 
Regardless, I was feeling like my body was preparing. Looking back, it totally was. How amazing! 
 
Tuesday night, the 3rd, I thought maybe the babies were coming. The contractions were more intense
and felt a little different than they had been feeling. But eventually they stopped, and I was able to go back to sleep. 

 
Wednesday came, I again took it easy and rested when I could, and in the evening we went to a family birthday party.
We had noticed the day before that my belly seemed to have 'dropped,' and a few people at the party
actually mentioned the same thing! 

 
We got home and went to bed, and around 2 AM I woke up with some pretty strong contractions. I tried to just keep sleeping, but after only just a few I was really uncomfortable and decided to go try to rest in the bath instead. 

The contractions continued while I was in the bath, I was having a hard time getting comfortable in there too. I found a semi-comfortable position leaning over the edge of the tub, I folded my arms and rested my head on them and
was able to fall asleep like that for a bit. 

 
I woke up to a big movement from one of the babies, and the strangest feeling - one that I had felt before - when my waters had broken with my other kiddos. It is hard to explain. Surely you couldn't have heard anything from the outside,
but I felt in my belly/heard in my body what sounded like someone popping their gum. 

 
The hard thing was, I had been sleeping and woke up to that so I wasn't 100% sure that's what it was or if I was having a dream or something. Also, I was in the bathtub and I didn't actually feel anything else happen,
so I didn't think my waters fully broke but yet it seemed like something had happened,
I just wasn't really sure what to think or how to know for certain! 

 
My contractions continued and as I got out of the tub and walked across the bathroom, I noticed there was a little something running down my leg. Not much, but definitely something. But then I wasn't sure if it was amniotic fluid
or if I had just accidentally peed a little 😬🤣 it was around 3:30 AM by this point, and I decided to message my midwife. 


I asked her if that could possibly have been my waters breaking, and if there was any way that I could know.
I let her know about the contractions, but that they were still pretty inconsistent. 

 
She told me that I could try laying down for 20-30 minutes, and then standing up to see if any more fluid came out
as one simple way to possibly determine if your waters had broken. So after we were texting, I went and set a timer
and laid back down. My contractions continued, I got up when the timer went off but didn't notice more fluid. 

 
I was conflicted on what I should do from there - I was so tired and wanted to keep sleeping but I just couldn't get comfortable in bed. So I ate a snack, went back into the bathroom, and just kind of wandered back and forth in the dark between there and our room. I figured that if I stayed up and moving, snacking, etc and the contractions continued -
that would give me a better idea on if this was the real deal or just a little bout that would pass like the others. 

 
Around 4:30 AM, I started actively tracking my contractions as they were moving from very uncomfortable to painful.
They still weren't always super consistent, but they were fairly close together and feeling intense enough
that I felt at this point like they weren't going to stop. 

 
At 4:45 AM, I texted my midwife again to let her know what my contractions were doing. I felt like this was real labor,
but I also was afraid to jump the gun and have it be a false alarm. Within about 5-10 minutes from that text though,
I had several more contractions back to back. She asked me a few questions, I let her know that yes, they were strong enough that I needed to make noise and breathe through them and yes, Baby A felt even lower in my pelvis.
I told her that if this wasn't the real thing, I would be surprised because they were really getting painful. 

 
She had suggested a little earlier that I drink some magnesium and hop in the shower. So after I had messaged her that last update, I turned on the shower and was going to head downstairs to the kitchen to mix up my magnesium drink.
But every time I would try to walk, it felt like I'd take a few steps and another contraction would come.
I decided maybe I should not try to walk all the way downstairs, and that I should just get into the shower instead. 

 
Chris was sleeping, I had woken him briefly a while before to let him know I was having contractions again,
but that I wasn't sure if it would amount to anything. I had wanted him to keep resting,
especially since I didn't know if I was actually in labor or not. 

 
But now, I figured it was time for some backup so I woke him up, got him up to speed,
and asked him to make me the magnesium drink. 

 
In the meantime, my midwife and I had messaged again and she suggested the idea of coming to do a cervix check
just to see if I was actually dilating and in labor, and if so, then we would know to call in the other midwives and family, etc. 

 
I told her that sounded great, and at 5:15 AM she let me know that she'd be heading our way in a few. 
 
I got into the shower and stood kind of bent over with my head resting on the back wall, the hot water falling
on my lower back - the contractions were strong in my belly but also in my back, like they were with Olivia and Arlo. 
Any time I would get into a more upright position, another contraction would come - even if I had just had one.


If I had any doubt before that shower on if this was actual labor or not, I didn't have any doubt now!

We had planned for several midwives, our photographer, our children, and several of our family / friends to all attend
the birth. So at this point while we weren't sure yet on if it was time for everyone to actually come, I thought it would
be a good idea to at least give a heads up to the photographer and our moms. So at 5:30 AM, Chris sent them
a message letting them know that the midwife was on her way to check things out and that we would keep
them posted after on if it was time to head this way. 

 
Meanwhile, I started to feel worried. I was feeling so much pressure in my pelvis
and was quickly moving up to a pain level of probably like an 8 or a 9 on a scale of 10.


In my head, I was wondering if I would be able to do this. 
 
'TWINS, Jalissa Ann, at home, what were you thinking?! You think you're going to be strong enough for this?!' 
 
Every contraction was like fire in my body, Chris was being so sweet and calm and helpful. 
 
"How can I help?" He asked. "Do you want me to touch you?" 
 
I asked him to spray the water right onto my back. I had asked him earlier to turn on my worship playlist,
but then after a few songs I asked him to turn it back off. 

 
The contractions were coming so fast and so strong now, I was making lots of noise through them
and had even started to cry here and there. 

 
In my head, I kept imagining hours and hours more of labor at this intensity.
I had labored all through the night with Arlo, surely there was a long road ahead of me still. 

 
At one point I even said out loud something along the lines of, 'maybe this wasn't a good idea, I don't know if I can do this!' 
 
Chris reminded me to breathe deep and just kept encouraging me. 
 
I told him - I have to stay calm. I cannot lose control. You have to remind me to be calm, I can't cry. Please, when I'm having a contraction, remind me that it will only last a minute or two. Remind me that it will be over soon. 
 
He did - he kept his cool so beautifully 💙 somewhere during this time, he said he felt like he should fill up the bathtub,
so he got that running, but any time he was away I asked him to come back by me. 

 
Knowing what I know now, it makes sense that I was feeling concerned and uncertain
and really doubting myself during this time. 

 
I wasn't just in early labor anymore, I was already in the transition phase! 
 
Our midwife arrived right around 6 AM. Chris had told her to just go ahead and let herself in and come up to our bedroom.
I heard her come into the bedroom and near the bathroom door, I don't exactly recall if she and Chris had a conversation or not at that point but I think once she got there and heard the way I was laboring through my contractions, I heard her asking Chris where the supplies were at and then heard her opening things up.
(Midwife note: when I heard Jalissa, I was opening up bags with one hand and calling the other midwives with the other!)


Within minutes she came into the bathroom and told me that they were going to have me move from the shower
into the bedroom and onto the bed so she could check my cervix.
(Midwife note: I was able to grab hearttones on both babies before Jalissa moved out of the shower).


I was scared to try and walk there, my body was doing the same thing as earlier where any time I stood up
I had another contraction, and also I was feeling now like I needed to use the toilet.
So I couldn't imagine walking anywhere, but I didn't have a choice. 

 
They helped me into the bedroom and had me lay down sideways across the foot of the bed,
where the midwife had laid out a place for me.


Almost as soon as I layed down she asked if she could go ahead with the cervix check, I said yes.
She kept reminding me to breathe, to slow down and keep my breathing and my sounds low and slow. 


Chris was on the floor kneeling next to me, I remember holding onto him so tightly. I wasn't looking at him, or anyone,
but I liked hearing his voice. He was so calm and so close. 

 
When my midwife checked me, I asked if I was dilated at all. I want to say she said I was about a 4-5,
but that it was really interesting as baby A's head was literally just right there.


This made a lot of sense to me, because I was feeling a crazy amount of pressure and suddenly feeling like the baby could come out at any time. I could even tell that my body was starting to have that pushy sensation.
But I was also a little shocked - I never actually imagined I could be that close to delivery! 

 
And then the fact that I was only dilated to about 5, I really started to worry. 'So I DO have a long time left to labor!' I was thinking. 'But why then am I already feeling like I need to push? Is something wrong?'

(Midwife note: the baby was SO low-+2 station-but the cervix was like a band around the baby's head.  It was like
the baby dropped onto the cervix so quickly that the cervix couldn't get out of the way.  Jalissa reported that whatever
I was doing to the cervix felt better-I'm sure it was pinching, and with fingers pressing against it, was helping it move
out of the way of baby's head.)


Sure enough then, with probably only the first or just a couple of contractions after the cervix check,
my body started to push. 

 
My midwife reminded me to slow down, to breathe. 
 
But I couldn't stop. 
 
"Tell them to come!" I told Chris about our moms. "Tell them to make the calls and come. But don't leave me." 
 
He assured me that I could keep holding onto him, that he could send the text with one hand and not have to go anywhere. So at 6:14, he sent them the text - "Come!" 
 
I asked my midwife if I could push - I told her I didn't think I could stop it. She told me that if I had
the overwhelming urge to push that I could go with it. 

 
So I did, and right away I asked if the baby was coming already because it felt like she was coming
and my midwife told me that yes, she could see her head. 

 
I kept pushing, and she was out! It was 6:15 AM, just 15 minutes after my midwife had arrived!
 
Immediately I felt such relief in my body. 
 
My midwife layed her up on my chest right away. She was breathing well, she cried, she was perfect! 
 
"Thank you Jesus," I said as I snuggled her there. 
 
Chris was able to snap a quick picture to capture the moment. And at 6:16, he sent the follow-up text to the fam,
"baby A is here!" 

 
After a quick maybe minute or two, if even, my midwife told me - okay, I know this is going to seem crazy,
but we need you to get up now.

 
We had discussed this prior - the plan was always that I would need to get into an upright position after Baby A was born
to encourage Baby B to stay vertical and move down into birthing position.

 
I asked if I had to lay the baby down or if I could keep her. She told me that if I could safely hold her, I could, that they would help me if needed. So as I held one arm strongly across our baby, my midwife and Chris held the other and helped me stand up. 
 

I stood there holding her, cord still attached, just in a state of complete euphoria.
 
"What's her name?" Chris asked me. 
 
Ruby was the first name we had picked out for Baby A, and was the plan for months until we changed our minds a month or two ago and chose a different name. But in the past week or two, we discovered that we mutually missed the name Ruby and decided that we would wait until she was born to decide for sure. 
 And as soon as she was here, I knew. 
 
"Ruby," I said. "She's Ruby, I feel it." 💜 
 
Chris was able to grab another quick picture here and this one is my favorite. You can just see the love hormones just pouring out as I stood there with her, absolutely exhausted and absolutely in love 🙏🏼 

 
Meanwhile, my midwife had clamped her cord and asked Chris if he wanted to cut it. He did, and then my midwife continued monitoring Baby B's heart tones - which were perfect! 
 
[[PS - what rockstars she and Chris are! None of us ever imagined it would be happening this fast, but they handled it SO wonderfully.]] 
 
I started having contractions again while I was standing there with Ruby.
I remember wondering how long I would have to labor before Baby B would be born.


We could tell with the doppler that she was moving down, but I was feeling a little apprehensive remembering how intense the last contractions (that I had only JUST finished having!) were, and imagining hours more of them.
But it's not like I had a choice, and we had another beautiful baby to meet 🥰 

 
With only just a couple of contractions standing there, I started to feel the urge to push again. 
 
My midwife noticed and asked me if that's what I was feeling on that last one. 
 
I told her yes, and she calmly told me to slow down and let my body work to bring the baby down. 
 
I don't remember all of the details from this part on super clearly - at some point in this time I layed Ruby down,
another midwife arrived, and they helped me move from standing to on my knees. 

 
My body had been pushing on its own again, like it was with Ruby. 
 
Almost as soon as I got down onto my knees I was having another contraction and I could feel the baby coming. 
 
I remember wondering what it was going to feel like birthing a breech baby. 
 
But, turns out she had turned, and at 6:30 AM she was born head first, just 15 minutes after Ruby!
The placenta (their 2 placentas had fused together into 1!) came right out then too. 

 
Baby B wasn't as quick to cry as her sister, she didn't need to be resuscitated or anything but she wasn't quite as pink
and she was a little quiet. I believe the midwives had me turn her over onto her belly and encourage her a bit.
It didn't take her long to perk up! (Midwife note: Baby B continued to be super chill, but looked and sounded great!)

 
We weren't immediately sure on her name and decided to just wait a bit until we felt certain on which to choose. 
 
Chris got a couple more pictures right after Baby B was born, and at some point the midwives helped me to lay down
on the bed. They let Baby B's cord pulse until it was finished, and then Chris cut that one too. 

 
Somewhere in this time, some family and our photographer arrived and Chris brought the kids in. 
 
Olivia and Arlo had been sleeping down the hall, we hadn't woken them for the births since everything
was happening so fast and since Gibsyn wasn't with us - Chris's mom picked her up on her way here
and then they all got to meet the babies. 

 
People started coming in as they arrived and saw us with the babies already born and they were like, "WHAT?!" 🤣
We were all shocked and of course they were wondering how this had all played out! 

 
My midwives took care of me, checked out the babies and the placenta, all of that good stuff as
Chris and I layed in our bed, our kids and our family around us. 

 
Eventually, Chris and I decided to stick with the name we had chosen in the last few months for Baby B,
Charlotte (Charlie for short)
💜 
 
After the babies were born is all a little bit of a blur for me - I remember everything, not like I was blacked out or anything, but some of the timeline I'm not certain on. I think I was just in complete awe of it all! 
 
We are so blessed - we know God's hand is on us all and in our life and we see the evidence of his love in every day,
and in every part of this beautiful experience! 

 
Since it all happened so fast we didn't end up having it photographed, or sharing the actual births with our family and friends like we had intended. The babies simply came too fast for everyone to be able to get there in time! 
 
But it was absolutely perfect, and I believe it all played out just the way our Father intended 🤍 
 
Chris, you are my best friend and the most rockin', absolutely beautiful man in the world. I couldn't be more thankful to have you as my husband, the head of our family, and the father of our children! I am so glad we got to experience this together. Thank you for being such a strong and steady support for me through the whole process! You totally almost delivered at least one of our babies and there's no doubt in my mind you would have navigated it beautifully.
 
Thank you, from the bottom of our hearts, to all of our midwives! From the prenatal care, the delivery, and the care after
the birth - we have loved partnering with you and are so grateful for all of the different care and knowledge you bring!

 
Our family have been so wonderful helping with meals, our big kids, all of the things -
we are so beyond grateful for your love and support! 

 
And all of YOU here who followed along with our journey, encouraged us, and prayed for us, thank you! We love you! 
 
God is so, so good 🤍🙏🏼
-----
Thursday, August 5, 2021
4:30 AM (approx): active labor begins
5:15 AM: decided to have midwife come
6:00 AM: midwife arrives
6:15 AM: Ruby is born
6:30 AM: Charlotte is born
-----
Ruby Lynn Rose: 6 lbs 2 oz, 18.5 in long
Charlotte Jo Rose: 6 lbs 2 oz, 19 in long
Born at 37 weeks & 1 day

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L: The incredibly amazing placentas that had fused together.
R: Jalissa with Baby B (Charlotte!), immediately following her birth.
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National Midwifery Week 2017: Celebrating Midwives

10/3/2017

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Welcome to Shiphrah Birth Services Blog!  Please feel free to check out and share the posts on this blog.  I love feedback, so if there’s something you want to see, hit the contact me button and let me know.

This week marks National Midwifery Week and, as a midwife who has utilized midwives for my own care, I couldn’t let it pass without writing about midwifery.
 
Midwives are becoming increasingly popular as women as a whole are starting to call for individualized care, tailored for their specific needs.  Midwives, as common as we are becoming, are still somewhat of a mystery to many people.  Midwives are sometimes confused with doulas (doulas are not healthcare providers) or considered 'less than' when it comes to providing care.  The truth is that midwives are highly-trained and skilled individuals who provide care to women in their childbearing years and beyond. 
 
You can read two different wordings of the Midwifery Model of Care here and here.  What you’ll notice in both is a focus on individualized care for each woman, not a cookie cutter approach to pregnancy, labor and birth.  Midwives are trained in normal, physiological processes, especially when it comes to pregnancy, labor, birth, and the postpartum period.  Midwives are also trained to recognize when things arise that are no longer part of the normal, physiological process and are able to make referrals when advanced care is needed.  Midwives strive to provide individualized care, which in turn fosters good communication and trust.
 
Midwives provide annual exams, family planning, prenatal, labor, birth, and postpartum care.  Midwives are appropriate prenatal care providers for low-risk women with low-risk pregnancies. 
 
My own experiences with midwives include the care of Certified Nurse Midwives (CNM’s-primarily in-hospital providers) during my first pregnancy and birth, and the care of Certified Professional Midwives (CPM’s-out of hospital providers) for my next three pregnancies and births.  My appointments were never cut short as my midwives always took time to answer my questions, as well as to check in on more than the baby’s heartrate and what I was measuring that week.  Midwives care about the whole woman, and take the time to make sure you’re healthy and well emotionally and physically.  The support of my midwives during my labors was invaluable, and I so appreciate the time they took to be with me as my body was working to bring my babies in to the world.  My midwives always treated me respectfully, and gave full informed consent about any procedures they offered. 
 
Midwives are a wonderful part of our healthcare in the United States and Iowa is fortunate to have midwives in most parts of the state.  I highly recommend midwifery care and hope that you find you love midwives as much as I do.
 
Have you used the services of a midwife?  Tell me in the comments what you loved about your care!

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Home Birth Myths:                Myth 4-Home Birth is Messy!

9/8/2017

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Welcome to Shiphrah Birth Services blog!  Thank you for joining me in my Home Birth Myths series.  So far, we have addressed home birth legality, safety, and the idea that home birth is just a trend.  This week we’re going to talk about the messy side of birth!
 
Myth #4: Home Birth is Messy!
 
Believe it or not, this is one of the hang-ups some people have when they’re considering a home birth.  Credit where credit is due, this usually comes from the male half of the expectant couple.
 
The concern here seems to be that birth, in all of its wonder, is far from clean.  I’ve heard people worry that there will be bodily fluids strewn throughout the house, and they picture placentas sitting in a bowl on the counter, used instruments sitting on their dresser, and a general unclean environment after the baby is born and the midwives leave.
 
Here’s the truth of the matter.  Birth IS messy.  Along with labor, you might (and usually do) see blood and other bodily fluids.  When baby comes, there’s more of that plus a placenta.  However, there’s something that many people forget to factor in.  Midwives.

Midwives are experts at containing messes while they’re happening so that the end ‘mess’ is manageable.  Midwives clean up the used chux pads, the bloodstains (we love peroxide’s magic!), the instruments, and the trash.  We even take care of your placenta, getting it ready to go if you’re having it encapsulated, putting it in the freezer if you’re saving it, and disposing of it if keeping it is not in your plan.  We help the new mom shower or bathe and change the bedding so that she can get into a nice, clean bed.  We also make sure to start a load of laundry before we leave, so used towels and cloths aren’t sitting around.
 
Along with cleaning up the birth mess, we clean up any messes we’ve made such as dishes that we used while at your home.  We also want to make sure that the mom, after all of her hard work, eats and drinks to replenish her energy.  This means that oftentimes before we leave, we’re in the kitchen, fixing mom some eggs and toast or another high protein meal.
 
So, is home birth messy?  It may be for a short time but when the midwives leave, the only evidence that a birth happened will be mama snuggling with her newborn baby.  And maybe a placenta in the freezer.
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Home Birth Myths-Myth 3: Home Birth Is Just a Trend

9/1/2017

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Welcome to Shiphrah Birth Services blog!  Thank you for joining me in my Home Birth Myths series.  So far, we have addressed home birth legality and safety.  This week we’re going to talk about another myth.
 
Myth #3: Home Birth is Just a Trend
 
A common perception about home birth is that only certain groups of people have their babies at home, or that it’s a short-lived fad.  These perceptions usually stem from a lack of knowledge about home birth and why women choose to have their babies at home.  These opinions come in the following or similar statements and often come from mistaken impressions about groups of people:
 
  • Only Amish women give birth at home.
  • No wealthy woman would give birth at home.
  • Only rich women give birth at home.
  • No college-educated woman would give birth at home.
  • Only high school dropouts would choose to have a home birth.
 
There are many more variations of the above statements that simply are not true.  This is another myth that will require us to dig into studies to find accurate information.  Let’s get started!
 
The Midwives Alliance of North America (MANA) study that I referenced in Myth 2 is, once again, one of the best sources when it comes to statistics surrounding home birth.  This comprehensive study shows the following:
 
  • 92% of women who choose home birth are high school graduates
  • 58% are graduates of a 4-year college
 
This particular set of numbers is interesting to many people, especially those who assume that choosing home birth means you are uneducated and not very smart.  This belief often stems from those who haven’t yet learned that home birth is shown to be a safe option for low risk women.  The fact that college-educated women choose home birth is a fact that can influence the opinion of legislators who otherwise might prefer to make laws restricting the ability of women to legally choose to give birth at home.
 
The high school and college statistics also show us that it’s not just Amish or Mennonite women giving birth at home.  While many home births do take place in the Plain Community, home birth is not exclusive to the Amish or similar sects.   
 
The MANA study shows the following about payment methods for home birth:
 
  • 64.4% of women self-paid (Please note that this does not mean they do not have health insurance)
  • 24.2% utilized private health insurance for their home birth fees
  • 8% of women who gave birth at home were on Medicaid or similar state insurance
  • 3.4% paid with other methods
This information does not give income status of the women who gave birth at home, so my comments on this will be made from personal experiences with home birth clients as well as inferences from the above data.
 
Iowa Medicaid does not currently cover home birth providers so women who are lower income and on Medicaid are paying out-of-pocket or denied access to a home birth because of the lack of coverage.  Women who do have non-state insurance may choose to submit their costs to their insurance company and see if they can be reimbursed.  Some midwives in Iowa do accept insurance and utilize a biller who can help clients determine what kind of coverage they’ll have.    Most insurance companies will not cover 100% of the cost of home birth but many will pick up some of the cost.  Christian healthcare sharing companies usually cover home birth.  Samaritan Ministries is the best of all of them as they cover home birth without question and without requiring a deductible be met.  Home birth expenses are also considered qualified expenses for Health Savings Accounts (HSA) and Flex Spending Accounts (FSA).
 
The information from MANA as well as what I’ve seen in Iowa indicates that women across all socioeconomic groups are choosing home birth, with middle class women having more accessibility from a financial standpoint.  That said, many home birth clients do qualify for state insurance but because they believe home birth is the best option for them they will find a way to pay their midwife.
 
MANA also touches on the statistics of first-time vs. non-first time moms choosing home birth:
 
  • 22.3% of women choosing home birth have never given birth prior to their current pregnancy
  • 77.7% of women choosing home birth have given birth prior to their current pregnancy
  • 9.2% of women choosing home birth have been pregnant 5 or more times
 
This is a pretty straightforward observation.  Women who are pregnant for the first time choose home birth at a lower rate than non-first time moms.  From a personal experience standpoint, this is often because women learn about home birth as an option after they’ve given birth, or they feel more comfortable giving birth at home after having already had a low-risk pregnancy and birth.
 
Who else gives birth at home?  Let me preface this by saying that one should never make important life choices based on what celebrities choose to do, but I thought you might enjoy seeing some of the actresses, singers, and models who have given birth at home with a midwife in attendance:
 
  • Mayim Bialik (my personal favorite-a neuroscientist, actress, AND chose home birth?!)
  • Melora Hardin (The Office, anyone?)
  • Maya Rudolph (her first labor and birth went so fast that her first home birth was an unplanned home birth!)
  • Alyson Hannigan (Most notable as Lily, from How I Met Your Mother)
  • Julianne Moore
  • Meryl Streep
  • Demi Moore
  • Pamela Anderson
  • Cindy Crawford
  • Ricki Lake (you might know about her birth from her documentary Business of Being Born)
  • Alanis Morissette
  • Jennifer Connelly
  • Gisele Bundchen (your husbands might know of her husband-Tom Brady)
  • Maria Bello
  • Nelly Furtado
  • Lisa Bonet
 
I hope that helps give a better picture of who chooses home birth.   If you have had a home birth and want to offer your insight, please feel free to comment on the blog post.
 
Source:
Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
 
 


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Home Birth Myths:                Myth 2-Home Birth Isn't Safe

8/25/2017

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Written by Bethany Gates, a Certified Professional Midwife and Certified Doula. 
Bethany provides home birth midwifery services, as well as doula services to women giving birth in a hospital setting.

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Welcome to Shiphrah Birth Services blog!  Last week, we kicked off a series that delves into myths surrounding home births by addressing the myth that home birth is illegal.  This week we’re going to jump into another common myth about home birth.

Myth #2: Home birth Isn’t Safe.

This is a much debated topic and, because it is a big topic, this post may become lengthy though I’ll try to be short and sweet while presenting the data.
 
I want to start with a word about home birth midwives and their training.  Most home birth midwives are trained through the apprenticeship model, meaning they have trained for several years with a home birth midwife.  They attend prenatal visits, labors, births, and postpartum visits with the midwife from the very beginning of their training.  As time goes on and they advance in their knowledge and skills, they move from the assistant midwife role to the primary midwife role, with the midwife supervising.  Apprentices also choose to self-study midwifery texts or may enroll in programs with specific plans of study.  Many midwives choose to become a Certified Professional Midwife (CPM), which involves showing proof of the specified clinical training requirements.  This certification includes proof that you have met the clinical requirements and have passed the 8-hour exam.  CPM’s are required to recertify every three years, and must stay current on neonatal resuscitation (NRP) and CPR certifications.  CPM’s are also required to show evidence of a specific number of continuing education credits before they can re-certify. 
 
CPM’s are unique because they are the only providers specifically trained in out-of-hospital birth.  This means that these midwives need to be especially attuned to the realm of normal, and they are trained to recognize signs that indicate something is moving outside of the range of normal.  This knowledge and training is what helps midwives recognize the need to transport the expectant mother from a planned home birth to a hospital setting before an emergency situation happens (it is important to note that most home birth transfers occur due to long labors and the client desiring pain relief.  I’ll share more about this when we share the studies).  Midwives are trained to manage complications such as hemorrhaging, dystocia, cord prolapse, newborn resuscitation, shock, etc.  Midwives in Iowa attend births in pairs, or with a skilled birth assistant who has been trained to manage complications.
 
When we start talking about home birth safety, I want to note that home birth is not the best option for every woman.  Studies repeatedly show that a planned home birth is most safe for low-risk women who also have a skilled midwife in attendance.  Women who have high-risk factors would likely be referred to a hospital setting.  Unassisted birth, while a choice a woman is free to make, is not statistically shown to be as safe as a midwife-attended birth.

Now on to the studies!  The United States has historically relied on home birth studies performed in other countries, due to the comparatively low number of out-of-hospital births that take place in the United States.  However, in 2014 a landmark study was released by the Midwives Alliance of North America (MANA) that detailed the safety of planned home births in the United States.  This study was performed using data collected from 2004-2009, and totaled a number of 16,924 planned home births. 
The main findings are detailed below:

  • 5.2% cesarean rate for women who planned a home birth (1), compared to the national average of 32% (2).   
  • 11% intrapartum transfer rate, the majority were transported for Pitocin and/or epidural.
  • 87% VBAC rate (1), compared to a national rate of 60-70%.
  • 4.5% of women received oxytocin and/or an epidural (1) compared to the estimated national rate of 57% (3) and 61% (4) respectively.
  • Early neonatal mortality rate of .41/1,000 (1) compared to the U.S. average of 3.28/1,000 (5).
 
This particular study is the only one of its kind because it’s the only U.S. study that looks just at births that are planned out-of-hospital births.  This is a big deal!  Just a few years ago, there was a study published that claimed out-of-hospital birth was unsafe, and that the mortality rate was higher than that of births taking place in the hospital.  This study was faulty because it relied only on birth certificate data, which meant that it included ANY birth that took place out of the hospital.  This meant that planned home births were included in the same numbers as unplanned home births and planned unassisted home births.   
 
The MANA study, however, shows that planned home births of low risk women, attended by CPM’s, are just as safe as hospital births and lead to lower rates of medical intervention.  This compares with out of country studies where midwifery care is much more common.
 
I know not everyone enjoys researching studies, but I hope this has given you more solid information regarding evidence of home birth safety.

Sources:
1. Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009 http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
2. https://www.cdc.gov/nchs/fastats/delivery.htm
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947469/
4. https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf
5. https://www.cdc.gov/nchs/products/databriefs/db169.htm
 


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Home Birth Myths:                 Myth 1-Home Birth is Illegal

8/18/2017

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Written by Bethany Gates, CPM

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Welcome to the maiden post of Shiphrah Birth Services blog!  Thank you for visiting my website. 

My name is Bethany Gates, and I am a Certified Professional Midwife (CPM) and a Certified Doula.  I provide home birth midwifery care for women planning a home birth, and doula services for women desiring a hospital birth and wanting the support of a doula.
 
Because home birth has only recently re-emerged as a mainstream alternative to hospital births, I thought it fitting that I start this blog by introducing a series of posts that address the common myths surrounding home birth.  The first myth I want to address is one of the most common objections you’ll hear when talking about home birth.  Keep in mind that as I am based out of Iowa, I am addressing this post with Iowa law in mind.  Every state has its own laws regarding the practice of midwifery so if you’re not in Iowa, please research your own state laws.
 
Myth #1: Home birth is illegal.
 
This is one of the biggest objections to home birth that you might hear when looking into a home birth.  It is a common misconception that only Certified Nurse-Midwives (CNM’s) can attend home births in Iowa.  However, with 50 different states that have the freedom to make their own laws, there are 50 different possibilities for addressing the legal status of CPM’s and direct entry midwives. 
 
There are several common approaches states take when it comes to home birth and home birth midwives.  
Approach 1: States require midwives to apply for and receive a license to practice legally in their state.
Approach 2: States offer a license for midwives who wish to apply for one, but do not require a license to practice (this is most notable in Minnesota).
Approach 3: States do not address midwifery in their law at all and midwives practice without state regulation/rules.
Approach 4: States specifically list midwives as providers in their law but do not offer or require a license.

Iowa fits in the third approach, where the Iowa Legislature has never passed a law regulating home birth midwives.  There are some people who believe that non-nurse midwives could be charged with practicing medicine without a license, but in 2013 an Iowa judge ruled that midwifery is not the practice of medicine or nursing, and stated that because Iowa has no law regulating CPM’s or traditional midwives, a midwife should not be charged with practicing medicine without a license.
 
The number of Iowa women who give birth at home each year has increased from 370 ten years ago to over 500 each year!  The vast majority of these births are attended by Certified Professional Midwives or traditional midwives (apprentice-trained, but have not gone through the certification process).  At this time, there are no CNM’s who attend home births in the Cedar Valley so home births are attended by CPM’s and traditional midwives. 
 
As of 2012, the United States out-of-hospital birth rate averaged 1.36% with some states seeing as many as 6% of births taking place outside of the hospital.  Iowa ranges between 1-2% of all births taking place at home.  The number of out-of-hospital births continued to rise. 
(https://www.cdc.gov/nchs/data/databriefs/db144.htm#x2013;2012%3C/a%3E)

My next post will address another common myth about home birth: Myth #2: Home Birth Isn’t Safe.
If you have a myth or question about home birth that you would like me to talk about, please contact me.


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