In recent months, more than one of my midwife friends has experienced a client or patient getting upset when they were not personally available on a certain day or days due to another birth, weather, personal reasons, or other circumstances. The midwives experienced feelings of guilt, anger, and/or hurt because they did what midwives are prone to do: they tried to be everything to everyone or felt bad when they set a healthy boundary.
 
Last week I went on my first real vacation in five years… as I was packing my bags, I battled guilt for going out of town when I had mothers due in a couple of weeks. At the same time, I was so excited for this special time with my family in a place that I love. Please do not think I abandoned my clients: I lined up two trusted midwives to cover for me if needed which is safe and appropriate care. I am now home from my restorative vacation and excited to attend their births!
 
I have been that emotional mother who was needy, loved her midwife so much, and could not wait to see her again. Had my midwife been unavailable for my birth, I would have been disappointed. Yet, I feel the need to remind folks that midwives are human too. We have families who love us as well as emotional and spiritual needs. We may experience physical limitations at times. And somewhere in the midst of everything else going on, we must complete tasks that are largely unseen but very necessary to our practice.

Witnessing a family be born... there just are not words for how amazing it is. It is holy. It is a privilege and an honor! But I will be honest. It can be really hard work. I have known so many midwives to burn-out and eventually quit because it is hard to set healthy boundaries in a profession that is expected to be warm, fuzzy, and always available no matter what. In fact, I have been complicit in creating such expectations.
 
I learned the hard way that I must put on my own oxygen mask before I can help anyone with theirs. I need to fill my cup before I can pour myself into yours. I am a better midwife when I am rested, fed, and cared for. I am a better- and safer- midwife when a mother is pushing out her baby if I let my assistant and the doula support a laboring mother while I take a nap during a long labor.  My assistant is a better- and safer- assistant if she does too in that scenario. Midwives, assistants, students, doulas, and partners all bring something to the table. If midwifery was a sport, it would be a team sport with the mother as the MVP!
 
I will not lie: it feels good when people call me a superhero and stroke my ego. But it does not feel good to experience guilt for wanting to take off my cape and be human for a day or a week. I will proudly leave my cape behind. I claim my humanity and my love for my own family; and my love for birth and other families. I am so glad I do not have to choose between them.
 
The work I do is dedicated to my ever-supportive husband Bill, my three children Elana, Jeremy, and Audrey who with their births sparked the fire for birth work that had smoldered since childhood, my Mom who experienced birth trauma and supported my midwifery journey in so many untold ways, to my Dad who paid off the balance due to my midwife when my husband was laid off shortly before the birth of our second daughter, to my past and present birth assistants Hanna, Ashley, and Nina, to the midwives who taught me along the way Wantina, Jennifer, Gay, Suzanne, Trinette, Bridgette, Heather, and Cathy, to the Indiana Midwives Association midwife members who hold me accountable and support me, to my SM friends who are always thinking about how to improve the quality of care we provide and have created a safe space to feel human, and last but not least, to the 300+ families who have invited me to be a part of their childbearing year and be witness to their sacred moment.
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 We have officially reached the dog days of summer! It's hot, really hot, and it is too easy to get dehydrated. Dehydration can be lead to headache, nausea and vomiting, dizziness, fatigue, preterm labor scares, and a lot of extra Braxton-Hicks contractions.

For this reason I recommend you make a concerted effort to increase your fluid intake every day, but especially if your summer plans take you outdoors to work in the garden or hike at the state park.

Consider the following:

• Water
• Pregnancy Tea: you might enjoy your pregnancy tea or raspberry leaf tea iced this of year. If you haven't received a bag of pregnancy tea from me yet, hit me up at your next prenatal!
• Coconut water (which naturally contains electrolytes)
• Smart Water (vapor distilled water with added electrolytes)
• Gatorade (the organic version is made with cane sugar instead of high fructose corn syrup)

Generally, we want you to consume caffeine or sugar in moderation, but at times the benefits of the added electrolytes in Gatorade will outweigh the added sugar.

Also, we recommend having a few options from the list above, as well as juice if you like it, for labor as we want to be sure you have added fluid replacement for the work of labor. We don't believe in withholding food or drink in labor anymore than we would withhold from someone training for or running a marathon!



This post is to be used for informational purposes only and do not constitute medical advice; the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. 

If you do not have insurance or your insurance will not cover our services, a cash discount is available.  Many clients have reported that the cash fee is comparable to what their copays have been for a hospital birth with insurance.  Payment plans and discounts are available because we understand that paying out of pocket for midwifery services can be a big expense.  

Here is more information about what you are paying for.   

AVAILABILITY
In addition to spending an average of 1 hour at each prenatal appointment, the midwife spends a fair amount of time in her car driving to the office locations and home visits.  The midwife might spend anywhere from 3 hours to 2 days at a birth and is on-call for her client throughout care.  Phone calls, individual research, and responding to e-mails adds to the investment of time.
 
PERSONALIZED CARE
When you call your midwife, she answers the phone- not a receptionist.  Your appointments are designed to offer individualized care for you and your circumstances.
 
CLIENTS
Most midwives choose to limit the number of clients she takes to be sure that she is able to give her best to her clients and her family.  When she puts your due date on her calendar, she commits to being on-call for you: this includes arranging backup care for the possibility of two clients in labor at once or while on vacation. Scheduling a vacation requires turning away clients due within a month of the vacation or having a back-up midwife lined up.
 
SELF-EMPLOYMENT FACTOR
The rule of thumb is that a self-employed professional's income is only half of what they earn, after deductions for vacation and sick time, self-employment taxes, health insurance, and business expenses. Communication and travel expenses can be very high for a midwife, which means many midwives spend quite a bit more than half of her income on expenses.  I drive an average of 25,000- 30,000 work-related miles per year: this means increased frequency of gasoline fill-ups, maintenance, wear-and-tear, and new tires.  There are also routine professional expenses and equipment that needs to be maintained or replaced periodically.
 
TRAINING AND EXPERIENCE
It’s important to pursue continuing education, and continuing education units (CEUs) are required to renew certification every three years.  Neonatal Resuscitation and Basic Life Support (CPR) must be renewed every two years.  As with scheduling a vacation, in order to attend conferences and training opportunities, a midwife has to limit the number of clients she can accept due around the time she will be unavailable or hire a back-up midwife.  Conferences can be expensive and often require out-of-state travel.  Online midwifery schools cost $285 or more per credit hour.
 
INTANGIBLES
Being on-call requires a certain level of personal sacrifice from a midwife and her family.  This includes a willingness to be awakened in the middle of the night to go attend a labor and missing the occasional family event or holiday.  Shopping trips and dinner plans mean that a midwife must plan ahead in the event that she is called to a birth before it is over. Additionally, midwives who are also mothers must have childcare or transportion lined up for her children and a dependable vehicle gassed up and ready to go at a moment’s notice.

BIRTH ASSISTANT
We believe that two sets of hands are better than one, so a birth assistant is on-call for every birth. 
 
When you put it like that, you may be thinking, “Why would anyone want to do this job?“.  Because we love what we do, and we are honored to attend this important moment in your life!

One of my t-shirts states: "Water Birth Isn't Just for Mermaids".  While that is true, it may or may not be the right choice for every woman.

Common reasons that women may choose to labor in water include:

• Pain relief
• Feeling cocooned within the birth pool space
• Buoyancy from the water provides a feeling of weightlessness
• A larger sense of privacy
• A gentler transition for baby

While laboring in water doesn't guarantee you a pain-free labor, it can help to take the edge off.  Sinking into a deep pool designed for laboring in water gives the mother a small, private space in which to relax.  Some midwives report seeing fewer lacerations in the water however, the study of water births attended by CPMs in North American showed a small increase in perineal lacerations (vaginal tearing) when the mother birthed in water.

Some things to be aware of: sometimes babies born in the water take an extra moment to transition and may not cry right away.  Purple is a normal color for a baby who has not taken a breath yet; when baby does take a breath you will see baby's color transition to pink.  Studies have not shown an increase in infection for baby's born in water.  It is believed that air hitting the baby's face will stimulate baby to breathe and that babies will not try to breathe until then, but to be conservative the midwife likes baby to be gently brought up out of the water immediately.  The midwife may ask a mother to get out of the water in cases of possible fetal distress or if there is difficulty assessing blood loss following the birth. 

Concerns about infection due to the water birth have been brought up with the recent headlines about a baby dying of Legionnaire's Disease after a water birth.  Our practice has chosen to adopt the recommendations of the National Health Service in England.  We do not use pools which are filled in advance or spa pools that circulate the water.  A brand-new liner and lead-free hose are used for each birth and the pool is not filled until the mother is in active labor.

For more information, visit Comprehensive Review Affirms Safety of Waterbirth or talk to your care provider.

(updated November 2017 to better reflect current research)

The reasons that families choose to birth at home vary, and are often multi-faceted.

Birthing at home statistically reduces the rates of interventions such as cesarean section and episiotomy, which is a reason many mothers consider it. Laboring and birthing at home can be a comforting experience for not only mothers, but fathers as well. It is easier to be uninhibited in labor in your own space, which is helpful to the birthing process.

Water birth is another common reason for seeking out home birth, as many hospitals do not offer water birth. Laboring in water can provide pain relief in labor as immersion in water provides a feeling of weightlessness and the ability to easily change positions. Some mothers choose to stay in water to push, which may help reduce the rate of perineal tears.

For parents with other children at home, home birth is an option that allows the children to be involved as little or as much as the family chooses. This can facilitate a smoother transition as a growing family. Sometimes an older sibling is given a special job such as announcing the baby’s gender immediately after birth, cutting the cord, or dressing baby in her first outfit.

Recovering in the comfort of your own home is another reason that families choose home birth. While it is true that you are provided meals in the hospital, family and friends can (and should!) be willing to set up a meal train. You can also set back some freezer meals during pregnancy to feed the family while you recover and bond with the newest family member. A postpartum doula or mother’s helper is another option if you wish to be at home while having additional help.

Immediate postpartum care for mom & baby and a 2-day postpartum visit are provided in home as well.

This blog post was originally written for the Evansville Birth Network blog and posted on October 14, 2014.