When to ‘Call The Midwife’: more adventures in the life of a homebirth midwife.
When is the best time for the midwife to arrive? My preceptor and mentor, Faith Gibson, is fond of saying: ‘ten minutes before she’s needed’. Homebirth planning is a bit different than hospital birth planning. This is partly because the care is so individualized and often times we are not just looking for specific signs and symptoms of labor, and/or a specific labor pattern.
When is the best time to call the midwife? When is the optimal time for the midwife to arrive? Different midwives all have different preferences round this. Individual preference can be based on lifestyle, how busy her practice is, what communication technologies she uses, their family size and structure, what kind of emotional support she provides the laboring woman and how she manages sleep disturbance.
There might also be different standards of care related to the midwife’s responsibility of making assessments during labor. For instance, in Canada the Registered Midwife is required to stay in the women’s home to make assessments if she is dilated 5 cm or more. While wisdom dictates this, I was once told sternly by a client’s cousin, that had a homebirth herself: “don’t leave my cousin alone in labor when she’s 7 cm. That’s what my midwife did, and I thought it irresponsible.”
How can we know when it’s time to call or time to go the the client’s home? Some of my clients worry about this, not wanting to awaken me for a false alarm or not knowing if it’s the ‘real thing’ yet.
I reassure them that ‘it’s ok, not to know’. Sometimes we only know with some hindsight when a labor started. I give my clients instructions to call me if something is happening (contractions, nausea, they think their ‘water broke’) or if she is worried or concerned about something (for instance, the baby is not moving as much as usual). Then when she calls, we have a conversation, I ask more questions, she gets her questions and concerns addressed, I also get a ‘feeling’ for what is going on from her tone of voice and demeanor, and then we make a plan together.
Sometimes that plan is for me to come to the home, sometimes it’s to talk again in an hour or two, or if something changes. I have a lot of interesting and some humorous stories on the variation of how this all unfolds.
Recently, I had a client whose two previous children were born without the primary attendant. In both cases, the attendants couldn’t be faulted. The first baby came in the hospital after the nurse told her “if you push like that again, the baby is going to come before the doctor gets here”. The mother found this amusing, laughed and the baby popped out. Second baby came quickly, before the midwife could get there, arriving within minutes — planned homebirth. For her third, I took it on as a personal challenge to get there in time. The husband called me after she had 2 contractions, I was there within 20 minutes, her labor was 2 hours total, from first contraction to the time of birth.
One time, my client expecting a second baby for planned homebirth, called me at 9:00 am in the morning to say she’d been having contractions since around 5 AM. I was surprised she had not called sooner, given that her first labor was succinct (about 6 hours). I thought I’d better head over to her home, but she insisted that her call was only a ‘heads up’ and that she didn’t need me to come yet. Well, being 20 minutes away and another 20 before I could clear out my schedule for the day, change my clothes, pack up my car, finish breakfast and be on the road . . . I decided to head her way and hang out at a local coffee shop. I had my assistant meet me there.
Sure enough the next phone call was from her husband, saying it was ‘time’. My assistant walked in first, informing me that the baby was ‘crowning’ (the birth within minutes/seconds). Husband said, ‘we’ve prepared for the birth in the next room’. My gentle reply was ‘well actually, the baby going to come right here’. And, she did. 15 minutes from husband’s phone call to the birth, moments after my arrival. I was pleased that day that I’d followed my instincts and put myself 10 minutes away.
More variations on this theme to come . . . I’m off to check on someone, maybe in labor.