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Homebirth Midwifery, Prenatal Care
Prefer to Listen? Find the accompanying podcast episode on the Unschooled Homebirth podcast, Episode 59, wherever you get your podcasts!
What happens during prenatal care doesn't stay in prenatal care, it actually follows you right into your birth and even predicts outcomes for birth. So today, let's talk about making a resolution to manage three aspects of your prenatal care as part your birth preparation.
Disclaimer: I do cover some aspects of medical care in this article, so I thought it was a good time to remind you that the information in this site is for informational purposes only and is not intended to replace the advise of your care provider. I would encourage you to use it to inform your choices, to empower you to make autonomous decisions in your care with your care provider. No agency or expert has approved the information I will share with you here, or anywhere, the only approval of the information I share with you has been from families who have gone before you to have births in their own power, who sometimes have to make hard decisions, but do so in their own power. To these families, I am in awe and indebted for their courage to birth this way and they drive my courage to share what I know with more families who are seeking this way of birth. So know that, you will not be supported by any Department of Health, by the AMA, by the CDC or the NIH by learning about homebirth here, but you will hear something different to use as you see fit.
So with that said, let's jump in, because one thing is see so often is that families think their birth preparation should be focused on birth, but this is a common mistake because preparation for birth actually starts during and throughout your prenatal care, things like making decisions about your care, how much or how little you need, who should provide that care, and who sets the expectations for your care and your birth.
Now I know you might be doing some of these things already, after all if you're reading this, you're probably choosing homebirth, but even with that choice and even if you have a great midwife, it's easy to fall into the trap of following routine prenatal care, simply because that's what we are used to, and everything happening in pregnancy and getting ready for a baby can feel overwhelming, especially if it's your first pregnancy, or even if it's not your first birth, but it's your first homebirth. So you do the routine things without much thought like filling out the paperwork, going through a health questionnaire, taking your pulse and blood pressure, maybe listening to baby, and sometimes this all happens without much question automatically thinking it's for the best interest of your health and your baby's health. And that might be so, and it might be what you ultimately choose as part of your care, but first you have to ask if you actually made the choice or are you just following routine protocol in your prenatal care because it just seemed the natural thing to do. As you know and probably experienced, most of the time, homebirthers do a lot of work and research in choosing a midwife, finding someone who's perspective of birth is like yours, so it's natural to believe her routine care is in your best interest. But even if that's the case, even though you may trust your midwife 100%, I am still going to encourage you to question everything about routines, everything about protocols, everything about policy, because that is your right and even your job as a parent.
I know this conversation might be somewhat surprising because as I said when you sought out a homebirth midwife, you likely chose her because you wanted a certain approach to your care, or maybe you thought you need her care, and you might want her expertise and her experience in something as monumental as pregnancy and birth, and I don't want to dismiss the importance of a knowledgeable midwife during pregnancy or birth, I am in full support of hiring a like-minded midwife to be your advisor and your resource during your journey. But here's the part you might not know until you've been though it, and after two homebirths and going through a year-long immersion in holistic midwifery, I do see both sides, and I can't help but point out that we are in a time where even homebirth midwifery has become a model of medical care and many families are not truly asked or informed about the routine offerings that a midwife presents during her care, it is expected that you accept them by agreeing to care. This means, when you put out your arm for your blood pressure without question, you may not actually be giving informed consent if you weren't given information about how and why your blood pressure might be used to manage your pregnancy and how your readings at any point in time may influence future decisions or presumptions about your birth. And this is only the beginning of where choices you didn't even know you should be making early on in pregnancy can affect your birth outcome.
What I also find an interesting development in the last decades of mainstream midwifery care is that midwives are quick to set expectations around the circumstances under which they will provide you care and attend your birth, in essence, serve as your care provider, but families are hesitant to do the same. This is a sure sign that midwifery has come under a model of medical care, which has happened as midwifery education and licensing and regulations have changed over time. It becomes a tricky thing to manage because licensing, expanded regulations and increased education options does provide more access to some families who might not find midwifery care otherwise, so this is the justification. but like most things in life, it does also come with a trade off, individualized care has experienced a sacrifice in being replaced with routine protocols and procedures that are intended to ensure safety over a wider population, the same fate that has fallen many aspects of society as we develop technology and rely on standardization for efficiency.
Standardized education, leading to standardized tests for licensure, leading to use of standardized protocols, leading to standardized care and a loss of the individual in the process. You've probably heard this story before, the US public school system being one obvious example, and of course mainstream medicine is another big case and point of this model at play. The industrial health complex is full of this approach, being enforced by the administration for efficiency and attempts to minimize risk of errors among staff, which is important, but it also means we lose the individual aspects of care in most cases and this is a loss for the patients and care staff alike, the ramifications of which are probably larger than the administrations are willing to admit. So whenever you encounter routine, standard protocols, I recommend you take a moment to ask and consider for yourself how this will affect you and your baby as individuals.
Expectations - Should you have them?
So let's come back this idea of expectations for a moment before moving onto the three aspects of your prenatal care to resolve to manage.
What do I mean by expectations? Well, first let's look at the expectations of most homebirth midwives today, now there are a range in which these expectations are set depending on the midwife, the state or country, the licensing and regulations she works under, so this is general and primarily from what I know of as standard practice in most states of the US.
Some of the common expectations you are probably aware of are the timing of the onset of labor, in other words, how many weeks you are when you go into labor, how close to your expected date of birth are you, not too early, but not too far over either. Next, is baby in an optimal position or is there a possibility of breech? How is the baby's size and growth, is it on the target that has been set? For some there might be parameters around gestational diabetes or group beta strep, whether you have to undergo screening and what to do in cases where a mom is considered positive. There may be expectations around how long you can be in labor at home before they have to transfer for induction, or how long you can labor with your water broken, they may have policies around cervical checks, monitoring fetal heart tones, taking your blood pressure and all the metrics they have to note in your birth record.
Any and all of these could impact the course of your labor and if you aren't the one who made the choice for these routines, but your care giver has made the choice for you, expected you to accept these routine procedures as her requirement to attend your birth, than you didn't make these choices, and the impacts on your birth are a direct result of your midwife's choices, not yours.
So when I am working with families in the Natural Birth Compass Program, we spend a fair amount of time understanding the concept of expectations and our response to them, because that can come from early childhood programming, so in the course, we take time to work on setting healthy expectations for themselves and their birth team.
When you understand what an expectation is and where it comes from, for instance the expectation about your blood pressure, you can have perspective on whether it's truly important for your care vs whether it's emphasized because it's part of the protocol and the documentation that your midwife keeps for every mother in her care, which is never a good reason for any procedure. So when you're getting your blood pressure checked at every visit, what happens if you had a stressful day or a poor night of sleep or didn’t drink as much water as usual so your reading is abnormal, and now you're stressed each time you get your blood pressure taken that it will be off again and that itself causes it to rise, now those readings are marked in your record and a part of your permanent care and will color everything going forward. Now everyone, including you, is hyper-focused on your blood pressure, which may continue to compound the problem.
Now you're wondering if there is a problem with you blood pressure, but if you decide that you don't want to accept routine blood pressure monitoring at every visit, how will you know if there is a problem, what if it gets missed? Making your own healthcare choices means you have to be prepared to take your health into your own hands, you need to know how to make your own assessments with your inner knowing, how to tune into your body and it's natural rhythms, because things like blood pressure fluctuate during the day and in response to certain conditions, and if you understand normal physiology and the rhythms of nature your body responds to, you will know if something is out of the ordinary and then you can work together with your midwife to uncover the cause or decide if you really do need to escalate your care to another level.
This is the key to a safe and confident homebirth.
So far, we talked about routine practices and a bit about how they arose in homebirth midwifery. We talked about expectations, those of your caregiver and why you should have some yourself. Now, let's turn to the three areas of prenatal care that you can make a resolution to manage for yourself.
Resolution #1: Know Yourself
The first one is to know yourself. What are your patterns, your interactions, your reactions to the world around you both before you were pregnant and now as your body is changing in pregnancy? What is your normal? For my students, we do this for an entire day and throughout the seasons, so they become very aware and intentional of things like how they wake up, how they respond to hunger, how their energy fluctuates throughout the day, if it does, and what all of this means for their inner health, their inner alchemy, how they are harmonized with nature's cycle, and what these signs they notice now might predict for their birth. These were influences our ancestral Wise Women would notice of the soon-to-be mothers in their care, but these skill of diagnostics have been replaced by the metrics we know today.
Even though on a fundamental level, we humans are much more alike than we are different, we all have unique patterns and characteristics, specific ways we interact with the world that have developed within us as a response to how we perceive our external environment. These are influenced by our physiology but also by our emotions as we learned about the world around us and the people and things in the world, our parents, siblings, teachers, friends, and everyone and everything in our lives.
These factors will influence your physiology and your body's response to pregnancy and prenatal care, so knowing your normal vs what your midwife's expectations are can become extremely important for your birth outcome. While more traditional midwives who practiced individualized care were very savvy to this, it isn't factored into modern, standardized midwifery education, so often this is overlooked in care practices, but if you know yourself and you are confident in your patterns, you can work together with your midwife if anything truly out of the ordinary arises to make a plan rather than leave yourself vulnerable to the system of care with no voice in the matter.
So number one of our three areas to be resolute in managing your care is to know yourself.
Resolution #2: Know Nature
Number two is something I talk about a lot, and is the foundation of the entire Natural Birth Compass approach, but isn't necessarily so commonplace in any part of life, including pregnancy and birth, and that is to learn to attune to nature's rhythms. This one dove tails from the first point of knowing yourself, because one major aspect and reason for knowing yourself and your normal is to be clear on your alignment with the rhythm and cycle of nature.
In essence, we are all children of nature and we function at our healthiest when we are in harmony with the patterns of nature within and around us - some obvious ones are sleeping at night, wearing warm clothes if it's freezing outside, more subtle rhythms that you may notice when you recognize them are the nature of being more active in the summer when the days are long and warm, and more conservative in winter when the days are short and cold, for much of the world the foods we eat change with the season, fresh vegetables and fruits being plentiful in spring and summer while root vegetables and beans are more available in the winter months.
When you recognize nature's cycle, you can then evaluate how well you harmonize with them and where you have areas you aren't so aligned, and these areas of misalignment can be responsible for aspects of health or wellbeing in life, in pregnancy, in the cycle of birth, which I won't get into today, but also relates to the same cycle as we are talking about here. Once you see these areas, you will have more insight into how you might restore your health, why a disease or imbalance may be present, even why a stall or obstruction in labor may be happening, because you know yourself and your rhythms and you know nature's rhythms that you should be harmonizing to, that the birth cycle harmonizes to. Once you know the normal flow and recognize normal patterns, and you identify where you struggle more often, as these patterns tend to repeat themselves, then you can recognize it and correct it before it becomes a complication. This is preventive medicine, this is what traditional midwives knew, this is what many traditional healing practices knew, even what Wise Woman mothers and grandmothers knew when they were the primary care givers in their homes. They followed nature and they knew when they or their children were out of harmony and how to correct it, this is why things like chicken soup used to work so well, because they knew exactly when to use chicken soup and what to add to the soup to help the body, mind and soul reharmonize.
Resolution #3: Build Connections Starting From Within
Now we have covered two of our three resolutions for your prenatal care for a better birth outcome: know yourself and know nature. That brings us to the third area to really focus on during your prenatal care and that is to form connections from the inside out. This is a critical part of the whole formula and I have my students go through several exercises involving this topic because knowing your areas of harmony and where you tend to fall out of harmony is only helpful in the context of birth if you have made the connections that will support you in your birth space. Ultimately, we are part of an interconnected web of life, though we feel and look as if we are individual, and we have autonomy in how we live, we are always connected to the greater whole and we are always influenced by the greater whole, by nature, by the rhythms, by the electromagnetic fields that probably connect us more than we realize at any given moment.
We've already talked about the primary factors of connecting to nature, to her rhythms, so here I want to talk more about our human connections and there are many of them to assess during your preparation - first and foremost is your connection inward with your own inner knowing. Your inner knowing is your ultimate guide in everything, and the compass within you that you come to trust in the Natural Birth Compass approach. Your inner knowing is so strong, even if you don't know it yet. This is true for all of us, for ourselves, for our loved ones, and if you hone it enough, for anyone and everyone you attune to.
Your inner compass always knows your true north, your way back to source, your recharge point and miraculous things can happen here when needed. But even better, when it's attuned everyday in everything you do, including during birth, you are guided toward your path as only known by your inner knowing. This is part of your intuition, something that isn't really a mysterious force once you understand where it comes from, the cycle it follows when you are harmonized. The more you recognize and harmonize with nature's cycle, the more second nature using your intuition becomes and the less mysterious it is, before you know it it's just natural and logical in a way that others who aren't so tuned in don't quite understand. Really it's just that you can now see the interconnected web of life and the pattern of nature, so you know what has been, what is here, and even what is to come in some aspects, like knowing summer follows spring, and will be followed by fall, or knowing the flower comes before the fruit. You know the patterns of animals and insects based on the seasons and the flowers and the fruits they interact with. There can be anomalies, a week in fall could feel like winter, but fall cannot come before winter, a flower may fail to produce a fruit, but you cannot have a fruit before a flower.
In the same way, when you know the pattern and how how your labor follows that pattern, you can know things like the movements of your baby through the birth canal, and you can recognize if something is off, because the pattern is off, and when you recognize it, you can correct it because you know where you need to go now you just explore ideas to get there, which may come from your inner knowing, or through experienced advise of your midwife, or a combination of all of these. Most of the time, when you do the work during your prenatal care, anomalies don't arise during birth, but when they do, the earlier you recognize a change in the pattern, the easier it is to reharmonize and this is important for feeling confident and safe in homebirth.
So connecting with your inner knowing and your intuition is primary, but also connecting with the external world, and in the case of birth, that is probably going to be focused on your birth partner and your midwife and other members of your team, like your doula if you are inviting one, or anyone else you are inviting into your birth space.
This connection outward with others takes practice for some, it takes time, and that's because it takes communication and trust. Learning to communicate in a way that is effective for you is a specific skill that is immensely important for birth, and much of life, something that is a common struggle for humans, but it is something that can be learned quite quickly if you have done the work to get to know yourself. This work requires going into other aspects of yourself as well that I didn't cover here, to learn how and why you communicate the way you do, so you can learn your strengths and challenges and establish healthy communication with your birth partner and your midwife, you can find more about the hurdles of communication in modern midwifery and healthcare in general in an earlier article.
To review, the three areas to make resolution to manage in your prenatal care are know yourself, know the cycle of nature, and strengthen your connections inward and outward.
Now that we went through all that, you may still be wondering how these three areas correlate specifically to prenatal care because you might still be thinking about prenatal care from the scope of the western medical approach, where we are concerned about weight gain, blood pressure, whether there's protein in your urine, and other routine prenatal care topics. It takes a while to reprogram our understanding of the natural event of pregnancy and the normal changes that happen to physiology and anatomy during pregnancy and birth, but as you start studying yourself and prenatal care from the perspective of nature and harmonizing with your natural human nature, and if you apply that to the birth cycle as it unfolds in it's natural state, you will see these patterns are repetitive, your normal patterns, your pregnancy patterns, and birth patterns are all the same, they just look different to the untrained eye to those who doesn't yet know they are already living the cycle of nature.
If we come back to blood pressure as an example, and we look at it through the lens of nature, when you know that blood pressure in healthy people responds to internal and external factors and is a reflection of harmonization in the body, tension and relaxation, sympathetic and parasympathetic, work and rest, you realize the body is constantly monitoring and adjusting to the harmony of internal and external factors, which could be influenced by things like emotional or physical stress, diet, hydration levels, blood volume, oxygenation and carbon dioxide levels, as well as changes in anatomy and physiology, such as happens in the blood vessels of mom in response to pregnancy.
If the focus is only on physical signs, this causes providers to assume that most of the high blood pressure seen in pregnancy is an early sign of pre-eclampsia and then the family is sent off to transfer to hospital care, we have failed to see a human who lives and interacts within an interconnected web of life, we have failed to understand the patterns of her life that could support a healthy return to homeostasis if we stepped back to get the holistic view, to see the connectedness we all have so much more than our internal physiology and anatomy. So I implore you to take your role as primary caregiver to yourself, to understand yourself holistically, to see your interconnectedness to the web of life, to feel your connectedness to the web of life, and only then consult with your trusted health advisors when you need guidance, when you need ideas and opinions from those with medical insights that you can apply to your holistic knowing to get the full picture, because we all can use the insight of medical trained advisors from time to time. At one time, doctors, from the docere - to teach, were acting in their true roles as teachers to help others understand their own health, in a time before we gave them the role of authoritarian over our health.
While there are experts in health of all sorts in the world, only we are the experts in ourselves, therefore only we truly hold the answers to our own health and wellbeing. That's the power of knowing yourself, harmonizing with nature, and seeing the connections within and around our individual self.
We started today with some insights into the medical model of care that has been appearing in homebirth, wandered a bit through expectations as set by caregivers and why it's important to think about your own expectations and then we talked about the three areas of your prenatal care that I hope you are making a resolution to work on during your pregnancy.
These are deep concepts here that really deserve contemplation and time and maybe a second time to read through or listen to the podcast version, because unlike western style learning, which is linear and builds upon itself, this is spiralic learning, the first time through is one out layer of the spiral, then as you read or listen again, you take the knowledge in deeper and deeper until it resonates within your inner knowing and becomes a part of you, a part of how you see and connect to the world. This is how your knowing of birth can really become second nature with everything you learn. Repeat again and again with the bigger, holistic view, with the interconnections now in your awareness and see what arises.
And if you're feeling a bit lost or confused, see what your heart is telling you, not your brain, step out of the western medical paradigm and see if you can feel the bigger picture. And then, reach out if you feel called, I am here, and I have a great network of wise women waiting to watch you flourish during your pregnancy, birth and journey to motherhood, all you have to do is ask.
If you would like to start to explore a new paradigm of homebirth preparation, download the free guide Three Cycles You Need to Know for a More Confident and Intuitive Homebirth, get your free copy by clicking here!
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