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Homebirth Midwifery, Prenatal Care
In France today, prenatal examinations are compulsory during the third, sixth, eighth, and ninth months. Some doctors and women find it useful to schedule additional check-ups. In any case, it is the style and not the number of prenatal examinations that appears to determine the nature of their influence. All too often such consultations treat pregnancy as an illness. The routine course of these sessions frequently leads to more problems than it solves. ~Michel Odent, Birth Reborn
Prefer to Listen? Find the accompanying podcast episode on the Unschooled Homebirth podcast, Episode 68, where you get your podcasts!
Why Prenatal Care Needs a New Paradigm
In this excerpt, Dr. Odent is talking about a new paradigm of prenatal care and a very different approach to birth that our conventional system might call backwards, and yet his birth center has achieved that have been seen in very few places in the world in regard to women's satisfaction with their birth, extremely low numbers of interventions and c-sections, so we know there's a lot to be learned here.
Even beyond that, I think it's time we asked the question, how can we continue improve the state of birth and prenatal care for families? I'll start by asking you the question, who are your prenatal visits for? When you set up your visit schedule with your midwife, who was that ultimately for? You, your baby, your midwife? I know this might sound like an odd question and you may not even be sure how to answer it and that's because we need to talk about your prenatal visit schedule. After this episode, I hope you will have the confidence to be the one in charge of making your prenatal schedule for yourself and your baby, and no one else, because that's what we do here, question the routine and get back to what matters for your unique journey. So the essence of prenatal care and a new paradigm for prenatal care is our topic today.
This is important for a few reasons. First, prenatal visits are a significant use of time during pregnancy and you want to make sure you are using your time, your irreplaceable time, priceless time, you want to make sure you're using it wisely, right?
This is also important because prenatal visits have the power to set the tone for your pregnancy and your belief in yourself and your homebirth because it's things that come up in prenatal care that often result in the cascade of events that ultimately lead to the dreaded unnecessary transfer of care, so as many moms will learn during their pregnancy, it's really essential that you know why you are going for prenatal care, why you go for each visit, what you want out of each visit, and how much prenatal care you really need.
There's one the other thing that comes to mind right now, that I think makes this not just important for your experience, but vitally important for the safety of your pregnancy and your baby's birth. The big, giant, elephant in the room is that in the US, prenatal care has not fulfilled on it's promise and this is causing a major problem in the health and wellbeing, even the safety, of our mothers, because what we know, clearly at this point in history, is that more prenatal care hasn't made birth safer for mothers, which means it hasn't made birth safer for families. Now I don't like to bring up fear based ideas here, I see my work as focused on building up the confidence of self-empowered families and I never want my work to scare people into making choices I think are best, because that induces the kind of anxiety that leads to complications in the first place. But I think it is quite clear that, in the US anyway, more prenatal care, more technology, more hands-on, more eyes looking inside the body and the womb, more blood work, ultrasounds, and the whole menu of services involved in pregnancy care hasn't led to better outcomes for families in the US, as we still have one of the highest rates of maternal harm and loss around childbirth, and that is devastating for families.
Exploring a New Paradigm
What I see as the best way out of this situation, is to empower families to be so much more involved in their prenatal car. I don’t just mean having dads go to prenatal visits and ultrasounds, I mean having families take over the control of their prenatal care and even direct their prenatal care, because in doing so, families become more attuned to their needs and to their baby's needs during pregnancy and birth, and I am going to much deeper into what all this means.
So, to get us started on that exploration, my question for you is, who are your prenatal visits for? Who orchestrated the schedule of your visits and why? Was the schedule made by and for you based on what you need to support your pregnancy or did your midwife give you a routine schedule that she follows for all her clients, and one that means you're taking time off work or loading up the kids to go for your visits, rushing in 5 minutes late, needing to use the bathroom, but waiting because you know your midwife will want you to pee on one of those sticks to see your protein levels and all the metrics that go on from there.
All of this business from scheduling prenatal visits often causes more stress, which we know is not healthy for pregnancy. So if the schedule you have been given for monitoring your progress in pregnancy is just one made out of routine, is it benefiting you? Is it nurturing you? Is it supporting your pregnancy to be the best experience it can?
If it's not, why are you going along with it, because I will tell you, one effect of this type of prenatal care that not even not all midwives are aware of, they're just doing what they were trained to do, but the result is, if you're unconsciously and unquestioningly following what your care provider is telling you to do, which most families do because it feels normal and it seems to make sense to go for routine visits, and it all seems okay during the first couple of trimesters when everything goes along pretty smoothly and it doesn't feel like anything can go wrong, or like things won't come up in later pregnancy because you're undergoing the routine care that everyone recommends, and following that routine, recommended schedule must mean you're doing everything to prevent complications, right?
Since prenatal care is so routine today, few families ever question why the schedule is the way it is, why those compulsory visits that Dr. Odent references were set up on such a specific timeline, does every family really benefit from following the exact same prenatal schedule. If we're being honest, we all know people who did everything for their homebirth and still ended up with unwanted interventions or even a homebirth transfer, that in the end, was probably unnecessary.
The End Result of Failing to Think Beyond Routine
One of the concerns I have for continuing to follow routine in regard to prenatal care, that not many people are talking about is what's happening at the level of the subconscious. What is often occurring behind the scenes, at the level of the subconscious is that you're unconsciously being programming to follow the directions of your care provider. For most people, this programming began long before pregnancy, we've been trained to follow authority, especially in regard to health care for our entire lives. By the time we are pregnant and begin midwifery care, we don't question as deeply as we should because we're following our subconscious training. If that continues during your prenatal care, it will also continue during your birth.
While some care providers are fully aware of this power, few homebirth midwives are aware of this influence they have, they're just doing what they were trained to do, and truly trying to act in the best interest of the families they are serving. So their focus is to check off the boxes during your labor and birth that they think keeps birth safe, that they're told keeps birth safe, the things that they're accountable for during a birth. This way they feel more in control of preventing complications. For many midwifery practices, this can feel like it's the most essential part of their care, which I believe is the result of our modern midwifery care becoming more and more of a medicalized approach with all the weight and burden of the outcome of birth on their shoulders. This has flipped prenatal care backwards and put it in the hands of the care provider rather than in the hands of the family, even though we all agree that birth isn't a medical event in most cases.
We're beginning to see the impacts of this as we see a growing number of families choosing to opt out of the system and choosing to freebirth or hire independent, unlicensed midwives. Meanwhile, the conventional prenatal care system continues to follow the old paradigm, managing prenatal care in order to manage birth, because that's what they still think will keep families safe, will keep birth safe, because that's what people still think is the most essential part of their care. For some families it is, families who want someone else to be in charge and make decisions for them because they aren't ready to handle those decisions, families who didn't get enough education or didn't get the right education, so they don't recognize the programming in their subconscious, so they can't possibly recognize what's going on in their prenatal care or how it will affect their birth. So we so need midwives in practice who are capable of supporting families in that situation, who thrive in that approach to prenatal care.
A Look at the New Paradigm for Homebirth Families
For those families who are ready for something more, who are ready for the responsibility of their pregnancy and their birth, and the experiences they can have if they take that ownership, those families don't really thrive in that kind of system, and when they find themselves in that type of care, they start questioning themselves, they start questioning their intuition, and as their pregnancy progresses, they start leaving more and more of their prenatal visits feeling frustrated, confused, having more questions than answers.
This is probably why so many of the families who work with me end up changing their birth support before birth arrives. Not because their needs changed, but because they realized they were questioning the wrong things. It wasn't their intuition that needed questioning, it was the style of care they were getting and the philosophy of their birth team they were questioning. In asking deeper questions, they realized they were ready for something so much more than what the current, conventional model of homebirth midwifery is offering today.
As they start to explore who they really are, what they really want out of their pregnancy and birth, what they are really capable of, and who they want to become as they go through this birth, they realize they aren't just a routine person who is nourished by being measured, by being a series of metrics on a health record, simply getting their blood pressure taken and their belly measured every week, having superficial conversations about whatever is on the midwife's schedule for this week of pregnancy, and being sent on their way with an appointment card for the next visit at some arbitrary time that has nothing to do with what this mom needs to feel cared for and what she needs to be seen to embody herself as an individual going through a major life transformation.
Maybe you're lucky and you have a midwife you love rather than a whole midwifery group or the only midwife in town that you're settling for because it's still better than being in the hospital, but even if you love her and you have a great connection, it doesn't mean your prenatal care is being tailored toward your deepest needs, especially if it's still a routine schedule with aspects you dread even if you look forward to chatting with your midwife. But it might mean these conversations will be easier than for those families who work with a midwife they are not aligned but have to settle for, which happens for a number of reasons.
Regardless of your connection with your midwife, what if you took charge of your prenatal care schedule? What would that look like? What does that mean for your pregnancy and your health, for your baby's health? What would it look like to take a more sovereign approach to your pregnancy and find alternate means of measuring your health?
It might look like using your time that would be used for prenatal measurements to instead make time for meditation, or one of my favorites, a guided visualization to get guidance from your ancestors, or maybe going for a walk or a swim, or taking a nap. Any one of these activities, and certainly there are many others, any of these can be even more beneficial for the health of your pregnancy and your baby and the outcome of your birth than a routine prenatal visit. I know this might be coming up against what you have been told about how to assess your health, and you might have a lot of questions about the safety of changing your prenatal care and looking at a new paradigm, but think of it this way, which is more important, continuously checking your blood pressure to see if it’s going up, or doing things that help you keep a healthy blood pressure and help you keep a better attunement to your body so you can feel is something is going out of balance and then you make the intentional choice to consult with your care provider because of something you perceive in your well attuned intuition and instinct.
I’m not saying you shouldn’t ever have prenatal visits or any kind of monitoring, I think you should do what feels right for you in the moment. Here’s the key difference of what I’m saying, prenatal care shouldn’t be about having appointments and taking measurements just because that’s how we’ve always done it, or that’s what’s routine, or because your midwife had a bad experience around some pregnancy or birth related condition and now she is fearful of not monitoring for it. But you need to separate your needs for your pregnancy from any needs that are being put onto you from your birth team because of their protocols or their obligations to keeping a health record, or their fears about pregnancy and birth, or anything else that isn’t coming from in you.
When you are just following routine for the sake of routine, you are more disconnected from your body than if you were following your intuition to schedule your prenatal visits in a very intentional manner.
This is really pervasive throughout healthcare, we schedule routine pediatric visits, routine Pap smears, routine mammograms. Our healthcare system literally thrives, both financially and in the sense of the industry's ego, it thrives on people believing they routinely need someone to tell them if they are healthy or not rather than encouraging individuals to discover their own inner nature and intuition, learning about their own inner health, using their own inner compass and then intentionally consulting health care practitioners when they need them rather than relying on someone to tell you if you're healthy or not.
As I mentioned earlier, it’s often these routine visits that start the spiral into an unnecessarily complicated situation coming up, sometimes even to the point of a transfer of care in the case of homebirth, an induction, even surgical births. I know there will be those who think, but what about when complications are prevented because of a routine screening, what if that condition hadn’t been discovered, what if that ultrasound hadn’t been done or that doppler hadn’t been used, couldn’t some terrible outcome have been prevented because we used a test or a tool? Maybe - maybe skipping that screening could have resulted in a problem that could have prevented, but that is that person’s truth, would that be the same for you? Because it’s not the same for me and don’t think it has to be the same for you, and here’s why.
Remember earlier when I said being reliant on the routine schedule and screening causes you to become disconnected from your own body, dependent upon someone else to tell you if you’re okay or not okay? If you’re not dependent upon that, than you have to be more attuned to your body and your baby, you have to take on that responsibility, and when you do that you’re more apt to notice yourself if something of concern might be happening in your pregnancy or your birth and then you intentionally seek the screening or tests that you need with guidance from your care team. In a healthy healthcare system, that should be their primary role, not telling you whether you're healthy or not healthy.
This takes doing the work of attuning, I’m not saying skip your prenatal care and do nothing, instead I’m saying that when you don't need a routine visit, use that time to do something that intentionally increases your awareness of your body, your baby, and your health. As you continuously practice prenatal care that helps you attune to your pregnancy and your baby and to your upcoming birth, you become more perceptive to your current state of health, and here’s the real key, you also become more perceptive to your baby’s health and you no longer have to rely on someone to tell you when something might be wrong, instead you flip this equation around completely.
Flipping the Equation - The Power of The Wise Woman Tradition
If on the small chance something out of the ordinary comes up, you are the one who perceives it and brings it to your care team who can then work with you to explore the options to inquire about what’s going on, whether that’s checking on baby with a doppler or ultrasound or going for a consult with a higher level care giver, or seeking the support of another type of care altogether, maybe acupuncture, or herbal medicine, or chiropractic or whatever feels like the right next step for you. This is health care from the perspective of the Wise Woman Tradition, an ancient and wise way of managing health and health care, but this tradition cuts into the medical industry, and the income of the medical industry, so as a society, we have buried this knowledge and done a really good job of making people believe the care provider has the knowledge of health and therefore makes the decisions about your health care.
When we bring the Wise Woman Tradition back into health care, what we see is instead of a tool or technology, the doppler or ultrasound or the measuring tape or lab work, telling you there might be a problem at this once single moment in time, this snapshot of time, which may or may not actually be a problem at all (but certainly causes stress either way), instead, coming from the Wise Woman Tradition where you flip the equation, you perceive the problem and then intentionally choose the tools to use to dig into what you are feeling until you have the information you need, if you needed any at all.
This is a powerful way to carry out your prenatal care because you are in charge, you are stepping into responsibility for your health, for your pregnancy, for your baby’s health, instead of putting it in someone else’s hands and then reacting to information you are given at each visit. When you are stepping into responsibility starting in your pregnancy, then you will naturally step into the responsibility during your birth and you'll be more comfortable having your team out in another room or even down the street while you labor and birth, having them available only if you feel that you need their support or assistance.
This is how you can own your birth experience and have the undisturbed, peaceful homebirth you want, but it has to start in your prenatal care. It has to start with you taking responsibility for your health and what your prenatal care looks like.
Now let's cover some tips I have to help you build your confidence in managing more of your prenatal care.
Learning the Basics in a Practical Way
First, learn about prenatal basics in a very practical way, not that you have to go to midwifery school, or read textbooks on obstetrics, in fact I wouldn't recommend that at all, but it’s a good idea to learn some basics. This is something I cover within my childbirth course for those families who are savvy enough to start their education early in their pregnancy, so they can even learn how to do some basic testing at home if a need arises for it and they thoroughly understand why the range of tests that are offered are recommended at the specific times they are often done, so they can evaluate if they need to follow the recommended course or not based on a range of personal and health factors.
Many of the families I work with do end up opting out of a lot of the typical prenatal testing, but they choose wisely, not opting out just because they decide they want to avoid all medical testing as a blanket belief or as a statement against health care. They are going in fully informed and understand what a test is for whether it makes sense for them, and what to watch for if it does come up as an indicated test later in the pregnancy. Very few things in pregnancy actually have a specific time they have to be tested for, while a few things do, most testing can be done later if something comes up that raises a question.
If you’re not choosing to get started in childbirth education early or if you aren’t taking a class that covers these topics, it’s important to get this information from your care team early on or from a trusted resource, not just the internet, because that’s not always reliable as we all know. I'm not going to list out resources here, because it varies based on what a family needs, but you can reach out if you need help with finding resources that are reliable.
Know What Makes You Feel Healthy
Second, learn what helps you feel healthy, what helps you feel strong, and nourished and nurtured. So much of health is beyond the physical manifestation of what we can see on the surface or with tests, but today we aren't addressing these deeper aspects of what brings health in all levels of our being, aspects of health that we can't see on lab tests or on an ultrasound. Sometimes we can see the status of health so much earlier than the physical manifestation by assessing the health of our spirit, how are you uplifted and inspired in your life and your pregnancy, how are you connecting to the world around you, to nature around you, where might you be stuck in different levels of your spiritual being?
Also look at the level of emotional health you experience. How attuned are you to your emotions? How much do you notice your emotions? How would you rate your ability to respond to your emotional state in a healthy way, whether that's something you do personally yourself or with a friend or family member, or if it's through seeking help from an emotional support specialist?
It's also important to evaluate the holistic picture of how all the levels of your being are harmonized together, your spirit, your emotions, and your physical being, and how your holistic being harmonizes with the external world. These are all key indicators of health, often physical manifestations of our health start at these higher levels, so if you learn to start attuning there, you might be able to catch things before they become a physical problem.
I won't go into the specifics of identifying them here because that's a whole course in and of itself, and something we spiral through in the Natural Birth Compass Program and even my mini course, Circle Magic for Homebirth, because they are key indicators of health, and this is the level of health we should be starting from all the time, especially in pregnancy, or even earlier than that, during pre-conception and when actively conceiving, and certainly in the postpartum period, though hopefully you have developed a keen sense of your holistic being and all the elements within you and you're able to identify your personal key indicators of an impending imbalance before your baby is here so you don't have major struggles during the postpartum. I'm not saying postpartum will be a breeze, but it shouldn't be full of misery and trauma for anyone, yet another sign of a failing healthcare system that I'll leave for another time.
So to summarize all of this into a takeaway for you. At the essence your prenatal care should be about you, not pregnancy, not metrics, not lab tests, but about you. What bring you health? What makes you feel strong? What do you define as wellness? How do you feel nurtured, which is the foundation of creating health? When you have that level of health, on all levels of your being, your baby receives that level of health from you.
Once you have that clarity on what health and nurturing is for you, take that information and look at your prenatal care schedule. Where is it aligned with your needs, and where is it aligned to someone else's needs, what are those aspects where you are receiving some aspect of care not because you requested it, but because your midwife just scheduled it because it's just how their office always does it. Question if that's really serving your health and wellness and if not, what can you do instead to support your pregnancy and your baby. How can you become more responsible for your care if that's something you believe is important to your experience, to your health and your baby's health. Being intentional in your prenatal care and receiving care that's beneficial, and avoiding care that's harmful, even if it may not appear that way at first glance, is the surest way to a healthy, safe, and confident birth.
As I mentioned already, we know that a cascade of unnecessary interventions and stress often begins with a misdiagnosis or an overreaction to something seen on a routine test and not because the mother herself felt a concern. This is why one of my missions in everything I do at the Natural Birth Compass is to help families tune into their own awareness, to feel into their own inner compass, the name Natural Birth Compass is very intentional because that is the guide each of us has within ourselves when we open up and do the work to learn how to use our inner compass, to learn how to read it, to trust ourselves to know how to be guided by it.
So assess your prenatal care, check in with your inner knowing and your inner compass and see what it's telling you and if you need tools to feel more confident in your inner compass, your Natural Birth Compass, reach out, that's why I'm here.
It has been a pleasure discussing prenatal care with you and I hope you have gained some powerful insight into the next steps in your care. Until next time, wishing you a wonderful journey to your homebirth!
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