Home Birth

This page is organized chronologically, so as you scroll down, you'll find a timeline of what to expect in our work together and things you'll need to prepare.

 

 

Initial Visit

At our initial visit, we'll chat about you, how you're feeling physically and emotionally, when you had your last period, whether you'd like to order an ultrasound or have any kind of genetic screening, and anything else that comes up. Please print the forms and bring them to our first prenatal appointment.

Paperwork

Lab Work

I offer prenatal blood work around 12 weeks, gestational diabetes screening around 28 weeks, GBS screening around 36 weeks, and additional lab work as needed. The only lab work that I require for you to be in my care is a screening for blood type and Rh factor, and screening for blood borne pathogens.

Genetic Screening

We'll discuss genetic screening at your first or second appointment. When considering genetic screening, I recommend reflecting on your family background, your race and ethnicity (some groups have higher risks of certain issues), and ultimately, what you will do with the information. Some people feel anxious unless they know that their baby is okay. Some people would terminate a pregnancy if their baby had a serious problem that would be incompatible with life. Some people would not terminate a pregnancy, no matter what. If you choose not to undergo genetic screening, you can opt for the 20 week "fetal survey" ultrasound, which will identify most problems if there are any.

If you're interested in genetic screening, I recommend Non-Invasive Prenatal Testing, a blood draw that draws fetal DNA from a pregnant parent's blood. Some people also choose this test because they want to find out the sex of the baby prior to the 20 week ultrasound. I can offer this test, or you can have it performed at a maternal-fetal medicine department of a local hospital, where you can also meet with a genetic counselor if desired.

Ultrasound

If you're unsure of how far along you are, I would recommend going for an early ultrasound. These are most accurate in your first trimester and can help pinpoint your due date. It's not relevant information at this point in your pregnancy, but it becomes important towards the end of your pregnancy.

For example, if you're not as far along as you think, then when you're actually only 41 weeks we might think that you're 42 weeks. This can involve unnecessary stress for you and sometimes, medical intervention such as induction. On the flip side, you may be later than you realize. If someone goes into labor before 37 weeks gestation, but their provider thinks that they're beyond 37 weeks, there's a risk of them birthing a preterm baby outside of the hospital. While I'll be measuring the growth of your uterus (which roughly tracks with your weeks of pregnancy), it's helpful to have this information if you don't know when your last period was.


20 Weeks

Right around this time you'll go for a fetal survey ultrasound, if you're opting to do one. Now is also a good time to sign up for a childbirth class as they tend to fill up fast.

Baby Registry Ideas

People are going to start giving you lots of stuff, including lots of stuff you don't need or don't want. Additionally, there are often local resources for getting things you do need inexpensively. Having a baby registry is a great way to get some of the more expensive items.

Some tips:

  • Get newborn clothing as hand-me-downs. Babies grow out of newborn sizes quickly. If you want new items, ask for 3-6, 6-9, or even 12 month sizes. You'll need them faster then you think! Go for organic, or brands that don't use flame-retardant chemicals on their fabrics.
  • If you're cloth diapering, ask for new diapers, or look for gently used cloth diapers in parenting groups on Facebook, local parenting listserves, and Craigslist.
  • Some babies HATE bouncers and rockers and all the soothing gadgets and some babies love them. As they tend to be more expensive, try to get them used so that if your baby doesn't like them, it's easy to pass it along.
  • Consider what you're going to need in the coming year. Winter clothing? A bathing suit? Ask for seasonal items. Winter gear can be pricey if you're buying it in season!
  • Some out of the box ideas:
    • Amazon gift cards
    • Uber Eats Boston food delivery
    • Meal delivery service
    • Contributions to cover home birth costs
    • Newborn photo session
  • And what about you?
 "22 Weeks," Sara Neff, Flickr CC

"22 Weeks," Sara Neff, Flickr CC

28 Weeks

Here's when we begin bi-weekly appointments. At your 28 week appointment I'll offer screening for gestational diabetes. 

Gestational Diabetes Screening

Birth Supplies

Please order your birth supplies kit by 35 weeks so that it's ready for the 36 week prenatal appointment. This is a custom kit through In His Hands, which you can find via the link or by searching my name under the "Midwife Birth Kits" menu option. Feel free to remove items that you already have, or to include items you might need (like oral vitamin K).

Optional items that can be added to the birth kit include:

  • Oral Vitamin K
  • Foot printing ink
  • Sitz bath herbs (and basin if desired)
  • An Eldon card (recommended for Rh- and Type O clients, to quickly get your baby's blood type)

Additionally, please have these ready for your birth:

  • A pack of pads for postpartum bleeding
  • 2 gallon size freezer bags for the placenta
  • 2 large trash bags
  • 1 mattress cover
  • A set of sheets that can get dirty
  • A set of clean sheets
  • Comfrey or witch hazel pads
  • 1 digital thermometer
  • 2 rolls of paper towels (I recommend Viva brand)
  • 6-10 wash cloths
  • 2-3 towels
  • 5 flannel or cotton receiving blankets
  • Snacks and food!
    • Electrolyte drinks (I'm a fan of Drip-Drop powder)
    • Chopped fruit
    • Energy bars
    • Honey (to mix with water for an energy boost)
    • Food for your family and birth team (if you have a long labor, everyone will need to keep their energy up)

If you're planning a water birth:

  • Birth tub (inflate around 36 weeks to make sure it has no leaks)
  • Tub liner
  • Hose
  • Hose adaptor
  • Sub pump
  • Fishnet (to quickly scoop out icky things)

Preterm Labor: Warning Signs

Preterm labor refers to contractions with softening and opening of the cervix prior to 37 weeks. These contractions are different from the painless tightening “Braxton-Hicks” contractions that you may already have noticed.

Signs to watch out for would be contractions coming in a pattern of at least every 10 minutes for at least an hour. They may feel like cramping or discomfort in the lower abdomen, and/or back pain.

Someone might notice a change in their vaginal discharge, and in some cases, their water might break and fluid might keep dripping out.

Some common situations can cause increased contractions.

  • Dehydration
  • Activity
  • Nipple stimulation with breastfeeding
  • Sexual stimulation

If you think you might be having regular contractions prior to 37 weeks, try:

  • Hydrating: Drink water and see if that changes how you feel
  • Laying down: If you were active, resting could change things
  • Getting up: If you were resting when they started, see if being active changes them
  • Discontinue any nipple stimulation, including breastfeeding, until we have a chance to make a plan
  • Discontinue any sexual stimulation

If contractions continue and you suspect you might be in preterm labor, call me. And, if you think your water has broken, call me.And as always, if you have any questions or concerns, we can discuss them.

30 Weeks

Your To-Do List

  • Take a childbirth class
  • Start to envision your birth. How do you want to feel emotionally? What sounds do you want to hear? Will you have children there, and who will care for them? How do you want your space to look?
  • Surround yourself with positive affirmations
  • Consider hiring a doula
  • Start thinking about your postpartum support plan
 Peter Dahlgren Flickr CC

Peter Dahlgren Flickr CC

36 Weeks

At your 36 week appointment we'll be looking at how you've prepared your home for birth. At this appointment I also offer screening for Group B Strep. And, we'll be seeing each other weekly now... almost there!

Your To-Do List

  1. Organize birth supplies
  2. Prep and freeze postpartum meals
  3. Designate a friend to organize a meal train for you (recipe ideas here!)
  4. Install carseat
  5. Write a to-do list for your partner or support person including:
    • Who to call (midwife, doula, childcare person, photographer, etc) and their numbers
    • Make the bed
    • Empty the washing machine
    • Set up the birth tub
  6. Write a list for your childcare person including:
    • Snacks and where to find them
    • Wi-fi password
    • People they can call if they need help
  7. Make a birth playlist or get your vibe right on Spotify or Pandora (I do recommend signing up for an account because commercials can kill the mood!).
  8. Gather your postpartum supplies and have them in a bin. Include a peri-bottle (there's one in your birth kit), an herbal sitz bath, an herbal afterpains tincture, ibuprofen, nursing pads, nipple salve, and a mix of heavy, medium, and light flow pads (check out the Lunapads heavy flow kit).

Group B Strep Screening

Options for Your Baby at Birth

Below are the choices that you have for your baby in the immediate postpartum. We'll talk about all of these in prenatal appointments, and I strongly encourage you to read through the links.

  1. Physiological cord clamping - I always delay cord clamping. Usually, by the time everyone is settled and nuzzled and cleaned up, a whole hour has passed by the time we get to thinking about the cord. If you want it cut sooner, that's fine, and if you want it cut never (a "lotus birth"), that's fine too.
  2. Vitamin K - Supplemental Vitamin K is given either as an injection or as oral drops about an hour after birth to prevent a rare bleeding disorder called Vitamin K Deficiency Bleeding. VKDB impacts 9:100,000 babies, but when supplementation is used, that number drops to 0.8:100,000 babies. You can choose either, or you can decline.
  3. Eye Ointment - Antibacterial eye ointment (erythromycin) is applied to the baby's eyes in the hours after birth. It's used to prevent blindness associated with chlamydia and gonorrhea. You can choose to follow the medical standard and use the eye ointment, decline it, or screen for chlamydia/gonorrhea in your third trimester and then make a choice.

Options for Your Baby in the First Few Days

Below are the choices that you have for your baby in the first few days of life. We'll talk about all of these in prenatal appointments, and I strongly encourage you to read through the links.

  1. Newborn Screening - This is a heelprick blood draw offered between 24-48 hours postpartum, and screens for roughly 30 different metabolic disorders that, if caught early in life, are treatable.
  1. Vitamin K - Supplemental Vitamin K is given to prevent a bleeding disorder called Vitamin K Deficiency Bleeding (VKDB)

41+ Weeks

Yes--lots of pregnancies go past 41 weeks! For the most part, these are normal pregnancies, and it's not unusual to hear that someone's mother or sisters also went to 42 weeks (or longer). Hang in there!

Boston_homebirth.jpg
 
 

Postpartum

I'll be visiting you in your home frequently during the first week postpartum. I visit between 24-48 hours, around day 3, around day 5, and then I'll see you at two weeks and at six weeks. More visits can be arranged as needed.

 
 

Birth Certificate

I will bring worksheets to your home that we will fill out. You will then bring these worksheets to the city hall of the municipality where you had your baby. See the form below to find out what kind of information the state requires from you.

Newborn Screening

This is a heelprick blood draw offered between 24-48 hours postpartum, and screens for roughly 30 different metabolic disorders that, if caught early in life, are treatable. States have different policies regarding the storage of infant blood samples. In NH, blood samples are destroyed after six months.