A Look into the Empowering World of Home Birth with a North Dakota Midwife, Part 2 | Dickinson Birth Photographer
Part Two of this lovely interview with Midwife Chelsea Smith.
Can you discuss any unique or innovative techniques you use during labor and delivery to ensure a safe and comfortable experience for the mother and baby?
All of our clients are mobile and unmedicated. First and foremost, we focus on prenatal and labor nourishment, hydration, and movement. Throughout the duration of care, we listen closely to what mom and baby are telling us (through listening to the body, the sounds and words, heart rate, positioning, etc) in the only way that they can. There are a variety of tools that we utilize to walk within the space softly, but also with rigor and care.
We offer a variety of comfort tools including: massage and therapeutic touch, hydrotherapy, rebozo, homeopathies, and non-narcotic pharmaceuticals. We can also offer things like sterile saline injections for the relief of back pain in labor.
How do you help families prepare for the possibility of transfer to a hospital during a homebirth? In what circumstances do you decide it’s time to transfer to the hospital?
From our very first meeting, we challenge all clients and families to consider not only their fears and desires, but also their best case expectations and worst case scenarios. Though unexpected situations are rare for healthy moms and babies, they can happen. We acknowledge that unexpected things can happen, but that doesn’t mean that we walk in fear of the unknown. Having these honest and open conversations together beforehand helps guide me as the midwife in figuring out how we can best serve the mothers and babies in our care – no matter what circumstances may unfold. Trust, open and honest communication, and preparation are of the utmost importance in preparing for a home birth in our practice.
In labor, we are skilled in recognizing normal variations of labor against those that are not normal. We listen intently to what mom and baby are telling us, in all the ways they can. So long as mom and baby are good, then we will not intervene. If there are signs of significant stress for mom or baby, we acknowledge these signs with our clients and discuss all options available to them (including going to a place where she and her baby may have more support) so she may openly and wisely choose. In the event a transfer is wise or prudent to ensure the safety of mom and baby, we support our clients in those spaces. Sometimes, what our babies are telling us what they need may be different than our own desires. This may be the nature of navigating any relationship between two people – including that of mother and child. We travel with our clients to ensure open and clear communication is used to help her expanded in-hospital team understand the situation, circumstances, and client’s wishes. We are there for as long as our presence is desired by the client. When she and/or her child are done utilizing in-hospital resources, we pick up where we left off in their plan for their care (so long as it is within the nurse-midwifery scope of practice). Just because we are honoring what your body and baby are asking of you, that doesn’t mean that the whole plan is gone! Everything is figureoutable.
“We recognize that sometimes mothers and fathers are in different spaces and have different needs and desires for their experiences. We are there to support those differences.”
Can you talk about the role of the father or partner during a homebirth and how you support them in their role?
Another midwife had the words to embody how I believe strong families should be built, and I will share that with you:
We know women are the foundation of every strong community. Women can do impossibly difficult things and create life and love from nothingness.
However, Fathers are the most often the most vulnerable person in a pregnancy. He has gifted his beloved with a literally, physical piece of himself. He cannot force his beloved to eat well, sleep well, hydrate, move her body, and not stress. She is powerful. He must trust her with this perfect, wonderful piece of himself – the best parts of them both – as she navigates the world without him.
The work she puts into this piece of himself he has gifted her – her labor – is the embodiment of the trust she reciprocally places back into him as her equal. He should be among the first to receive and touch this gift of love and trust they have mutually placed in one another.
We recognize that sometimes mothers and fathers are in different spaces and have different needs and desires for their experiences. We are there to support those differences. But we believe in building strong families. It is not our intent or desire to replace the father within the birth space. He should be there side by side with his beloved – the mother of his child – seeing what she sees and welcoming their child together. The team they have build around one another is there to support them both and make sure there are skilled eyes and hands to recognize and support those little nuances that they may not see in the moment. They can be completely enveloped in the experience together while feeling safety and support in those vulnerable, beautiful, and awe-striking spaces of bringing forth life.
How do you incorporate evidence-based care into your practice, and what resources do you use to stay current on the latest research?
We offer the medical standard of care for every single one of our clients. At each visit, we take the time to discuss a variety of different topics relevant to where they are in their journey. We thoroughly discuss all of the risks, benefits, and alternatives (including the alternative to decline) of the tools discussed and offered at that time. We look to the future and discuss those things they will be asked to choose for themselves and their babies before we get there so there is plenty of time to privately contemplate, discuss, research, and decide.
With state licensure and national accreditation, there are rigorous continuing education requirements to ensure we are up-to-date and providing evidence-based care. The resources that we utilize include but are not limited to: the American College of Nurse-Midwives; the American Midwifery Certification Board; the American College of Obstetricians & Gynecologists; Up-To-Date; Evidence-Based Birth; the Midwives Alliance of North America; the American Academy of Family Physicians; the American Heart Association; and the Association of Women’s Health, Obstetric, and Neonatal Nurses. We also meet all practice requirements and expectations at the state, boards of nursing, and national midwifery certification board levels.
Can you discuss any cultural or linguistic considerations you take into account when working with families from diverse backgrounds?
Religious, cultural, and linguistic considerations are discussed in depth at the consultation, and first prenatal visit levels to ensure we are supporting all of our clients to the best of our ability. We respect and honor clients where they are and what their vision of health and wellness looks like, especially from the religious or cultural lenses.
Although I (as the midwife) am not fluently bilingual, we have an abundance of unique resources at our disposal to meet those unique needs including contracted in-person or virtual linguistics support.
How do you work with families to capture and preserve memories of their birth experience through photography?
In preparation for birth, we talk a lot about what their vision for their birth experience looks like, and within that includes photography and labor and/or postpartum doula support. There is beauty in labor – in those intimate and sacred spaces. There is so much divine beauty in birth. It brings my heart so much joy helping women see just how *powerful* they really are! Birth photography in its essences celebrates the imperfect perfection of our life’s experiences. It is raw and real. Reflecting visually and through storytelling (even if it is privately to ourselves) on those experiences is powerful and innately engrained in the humanness of giving life.
Birth photography is so completely underrated.
“Birth photography is so completely underrated.”
Can you share any tips for families who are considering a home birth for their upcoming birth, in terms of preparation and choosing the right provider?
First and foremost, when you’re inviting someone into your home to share those intimate spaces, you need to feel safe and taken care of. Even if you can’t put those feelings into words, you must follow your intuition and instincts! There is value in sitting down and sharing space, getting to know each other a little bit better to make sure we are a good fit for one another. The beauty of this work and the community that we live in is that there is literally someone for everyone. I am passionate about helping people find their people, even if it isn’t with us.
What are some common misconceptions about home birth that you would like to address?
Home birth is illegal.
No. It is not. Much to the chagrin of some health professionals who have a limited understanding of home birth, home birth is not illegal in North Dakota or Montana.
Home birth is unsafe.
False. Studies that investigate statistics and outcomes for relatively low-risk candidates in the community setting are no different than those within the hospital setting. Statistical data indicates that planned well home birth is as safe as hospital birth, though it is not appropriate for every pregnancy. When birth emergencies or poor outcomes happen in hospitals, the birthplace is seldom called into question. During home birth, if the same situation or outcome occurs, the choice of location is always called into question. No human being – including your midwife – can guarantee a “normal” birth or predict the birth outcome of mother and child. Acceptance as a client for home birth in no way constitutes any such guarantee. We offer the expertise to help you balance the inevitable and undeniable risks of childbirth, however small, including unexpected injury and death of mother or child. We use the skill, tools, resources, and teams at our disposal to reduce risk to mother and child as much as possible.
If you have a midwife who says they are licensed, they are lying to you and/or did something wrong and got their licensure revoked. Therefore you are not safe!
False. There are many midwives who offer invaluable services to our communities in North Dakota and Montana. Each of us has our own unique gifts, no two exactly the same. What we all share is a passion for supporting mothers and their families, and supporting relatively low risk physiologic birth.
Our unique toolkit includes medical tools and resources due to the support of licensure. Home birth midwives help create and hold space for safe birthing in your home while maintaining the home environment. The midwife carries equipment to the home, including but not limited to: tools that help listen to and monitor the wellbeing of mom and baby; oxygen, suctioning, and breathing supplies; select medications and intravenous support; and perineal repair tools. The midwife is trained and experienced in resuscitation. There are fewer unnecessary interventions at home, which ultimately invite fewer complications.
Licensure notes that an educational and skill standard has been met. No matter what profession you work in, no matter what setting you work in: If you do not meet the standard, care for people to the best of your ability, or you engage dishonest and untruthful behavior there is always the risk of having your licensure revoked. State licensure and national accreditation can be investigated and are available as public record.
“There are fewer unnecessary interventions at home, which ultimately invite fewer complications.”
How do you handle emergencies during a home birth?
In the event an obstetric emergency arises, we have medical tools to support mother and child to either stabilize and remain in home or stabilize and transport to the nearest emergency facility if needed.
In addition to traditional supportive tools, the midwife carries medical equipment to the home, including but not limited to: tools that help listen to and monitor the wellbeing of mom and baby; oxygen, suctioning, and breathing supplies for mom and baby; select medications and intravenous support (ex: postpartum hemorrhage medications and tools); and perineal repair tools. The midwife is trained and experienced in resuscitation and obstetric emergency identification and intervention.
There are fewer unnecessary interventions at home, which ultimately invite fewer complications.