Vaginal Examinations in Labour

Vaginal examinations are often taken for granted in labour. Many women would be led to believe they could not birth a baby without having a vaginal exam, but the truth is, if a baby is going to be born vaginally, it will be born regardless of whether a vaginal exam (VE) has been performed. That said, there are some really good reasons why your midwife or obstetrician might recommend one (or more). VEs are mainly done to obtain information that is relevant to that particular labour or the circumstances of the labour. It might be suggested:

  1. To determine if a woman is in labour, because it is not helpful to the woman or her support people to spend many hours in a delivery suite when labour hasn't yet started.
  2. To confirm whether the baby is coming down bottom first or head first.
  3. To determine whether the head is engaged deeply in the pelvis, and perhaps the position of the baby (although I believe this isn't really relevant until later in labour)
  4. To assess the progress in labour, which, combined with an assessment of the position of the baby, can help midwives and obstetricians to suggest positions and movements that can be helpful for encouraging the baby to turn naturally.

A lot of information can be obtained from a VE, but that is not to say that at every VE, your midwife or obstetrician will obtain all of this information: sometimes, it is only important to know that your cervix has opened more, whereas other times it will be more important to track the position of your baby's head.

I would do a vaginal examination:

  1. If the woman asked for one, perhaps because she would feel more reassured to know that she is progressing well in labour, or if she wanted to know the exact position of her baby to guide her movements and positions in labour;
  2. To reassure her that yes, labour is progressing really well, if she is feeling that it is all too much and she is at the end of her tether (although this very rarely happens as most of my clients attend a Calmbirth (R) course);
  3. Always before providing medical forms of pain relief (except nitrous oxide gas). This is because it is important to know that a woman is in labour before giving an epidural, but it is also important to know that she is not very close to birthing her baby, as this would mean that the epidural would take full effect after the baby arrives. It is also important if morphine is used, that we know that the baby is unlikely to make an appearance shortly.

It's not my practice to do a vaginal exam:

  1. Frequently if the woman is in early labour, as it is discouraging to hear, "You're 1cm" when this was the case 12 hours before, despite contractions.
  2. If I thought the woman was fully dilated. In this case, I wait for the urge to push to intensify, so that it is present during the entire contraction and is an irresistible urge. At that time, the woman is most often fully dilated and we see the baby's head very soon. Doing vaginal exams to confirm that a woman is fully dilated can often lead to premature pushing, before the baby's head has descended deeply into the pelvis. This early pushing - often directed - can lead to more tearing. And nobody wants to tear if it can possibly be avoided!

What to pack for your hospital bag

It can be really helpful to have a hospital bag packed by about 36 weeks, just so that it is ready to go to hospital when you are. Women planning a homebirth will also pack a hospital bag just in case a transfer is needed in labour. For the most part, women stay in hospital up to 48 hours after birth. This means that you really don't need to bring very much in the way of changes of clothes. So - what to bring?

Clothes for labour

Hospitals provide gowns, but many women prefer to wear their own clothes, or even no clothes. The best clothes to wear in labour are loose, baggy t-shirts, a dressing gown (if you are cold), tracksuit pants and so on. Nothing tight or restrictive, and nothing you can't take off quickly if you want to. It's also a good idea to wear old clothes, not your best new outfit. Bring a couple of pairs of underpants for labour.

Toiletries

Tooth brush, tooth paste, shampoo, conditioner, moisturiser, deoderant etc - whatever you normally use. You'll also need 2 packets of maternity pads. Ie, not panty liners or thin menstrual pads, but heavy-duty maternity pads.

Underwear

Breastfeeding bras, lots of dark-coloured, loose underpants.

Clothes for the hospital stay

Again, whatever feels comfortable. Nighties, singlets, buttoned tops, loose clothes, tracksuit pants etc. You're best to pack lightly, as anything that's needed can easily be brought in from home by a relative or friend. Slippers, shoes etc - whatever you normally walk comfortably in. After you have a baby, your feet often swell a bit, so loose shoes are the key. Hospitals can often be cold places, so give some thought to layers of clothes so that you can layer up or down as you need.

Things for labour

Food and drinks, massage oil, aromatherapy, homeopathics, herbal medicines, pillows, photos / visualisation aids, CDs / iPod, anything that makes you feel 'at home'.

For baby

Babies are small ... and therefore easy to pack for! The hospital will supply baby clothes while you're in hospital. Some hospitals provide nappies; others don't. Best to check with your hospital. In geberal, you'll need two outfits to take your baby home in. Why two? babies are notorious for pooing and weeing through outfits and this way you can have a change of clothes if you need them. You'll need singlets, mittens (if chosen), nappy wipes and nappies. In winter or cooler weather, you'll also need a beanie.

Visit my website to learn more about private midwifery care and birth support.

Breastfeeding: Benefits for Babies

Early breast milk is called colostrum, and is rich in antibodies and nutrients that help a baby's immature immune and digestion systems. Colostrum is present in very small amounts, but this is actually perfect for babies as they have very small tummies when they are born. as your milk comes in, your breast milk changes as your baby grows and it becomes slightly more watery and plentiful, to match your baby's growing size. By the time your milk comes in, it has the right amount of fat, carbohydrate, water and protein to help your baby continue to grow. 

Breast milk is easy to digest - and hence, you'll find your breastfed baby will want to feed more often. This is a good thing, as it helps to regulate your body make enough milk.

Breast milk helps your baby fight infections. This is because any infections – such as a cold – that you may have, you will form antibodies to. These antibodies will be present in your breastmilk and will help to protect your baby.

Breastfed babies experience fewer digestive concerns such as diarrhoea and constipation.

They also experience fewer health issues such as respiratory infections, asthma, eczema, allergies, obesity and Type 2 diabetes. They are less likely to miss days from school owing to infections, so there is a social and educational benefit too.

Visit my website to learn more about my services.

Ten Tips for a Normal Birth

  1. Choose a place to birth where you're most comfortable and that supports normal birth. This may be at home or in a hospital.
  2. Choose a healthcare practitioner who supports normal birth. Many women have found that care provided by midwives includes less interventions and more labor support.
  3. Don't request or agree to induction of labour unless there's a medical reason. Allowing your body to go into labour on its own is usually the best sign that your baby is ready to be born. Allow your labour to find its own pace and rhythm.
  4. Move around freely during labour. You'll be more comfortable, your labour will progress more quickly, and your baby will move through your pelvis more easily if you stay upright and respond to your labour by changing positions
  5. Think carefully about who will be ideal to support you during labour and birth
  6. Ask that your baby's heartbeat be monitored intermittently so that belts, cords and wires do not tie you to a machine or specific place.
  7. Eat and drink as your body tells you to. Drinking plenty of fluids during labor will keep you from getting dehydrated and give you energy.
  8. Use non-pharmacologic pain management strategies such as baths and showers, massage, hot packs, aromatherapy, focused breathing and other comfort measures
  9. Don't give birth on your back! All-fours and kneeling positions are more comfortable, increase the effectiveness of your contractions and enable you to work with gravity. Push when your body tells you.
  10. Keep your baby with you after birth. Skin-to-skin contact keeps your baby warm and helps to regulate your baby's heartbeat and breathing. Keeping baby with you in your room helps you to get to know your baby, respond to your baby's early feeding cues and get breastfeeding off to a good start.

Visit my website to learn more about my services.

Natural birth in hospital?

Here are some ideas to birth naturally in hospital: Read, read, read. Books, websites, any written info from your care provider ... read it all. You also need to know the difference between facts presented to you in an honest and unbiased way, and facts that are being filtered through hospital policy. This is where women benefit from having a private midwife by their side.

Be assertive As with most human relationships, a great deal can be resolved with a calm, respectful and firm manner. Know what you want and why you want it. Engage a private midwife to assist you with obtaining relevant and impartial information.

Listen. If you are choosing to use a hospital and an obstetrician for your birth, then you acknowledge that their presence, education and experience have some value.

Be Flexible. Understand that sometimes things don't go the way we had planned. There might be some occasions where you'll be happy to accommodate the hospital policy, and other times when you'll want to stand your ground.

Ultimately, it is true that the most important aspect of birth is safety and a healthy mother and baby. But that doesn't mean the other aspects are unimportant, and I believe you can have a great birth - and a safe birth - in any location.

Visit my website to learn more about my services.

Do obstetricians and midwives attract different clientele?

New research has suggested that women who see themselves as active participants in the birth of their first child, and prefer a collaborative role with their healthcare provider are more likely to opt for a planned home birth with a midwife. On the other hand, women who perceive their role in the birthing process more passively and are more fearful of birth are more likely to seek obstetric care for a hospital birth.

Women's answers indicated whether they perceived the Mother’s Role as active or passive, the Provider’s Role as dominant or collaborative, and the Delivery Experience as fearful and painful, or as a positive occurrence.

Women who perceived their role as active, the provider’s role as collaborative, and the delivery of the child as a positive experience, were more likely to prefer midwifery care, birth at home, a vaginal delivery and the avoidance of pain medication.

The more painful and fearful a woman expects her birth to be, the more likely she is to prefer a caesarean to a vaginal birth.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care and birth support.  Visit Melissa's website to learn more about her services.

What causes a long labour?

First, it's probably worth saying that a "long" labour is subjective. What is long for one woman may be fine for another. A woman's perception of the duration of her labour will be affected by many factors such as hunger, dehydration, tiredness, support, encouragement, the environment, interventions, being cared for by one midwife who is known to the woman and trusted by the woman, her expectations of labour and birth, her preparation for labour and birth and so on. There can be many things that can cause a labour to be longer than hoped for. These include things like:

  • First baby: first babies can sometimes take longer than second and subsequent labours
  • The position of the baby: a posterior baby can sometimes (not always) mean a longer labour.
  • The positions you adopt in labour: upright positions may speed the process of labour
  • Hydration levels: if you are dehydrated, it can cause your contractions to weaken, and this can slow the labour
  • Being cared for by one midwife: continuity of carer has been shown in research to result in shorter labours
  • Birthing in the environment that feels safest to you: home or hospital, it doesn't matter. It's about where you feel safe. When you feel safe, you will labour better
  • Feeling ready for birth and motherhood

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

6 essential tips for a natural birth

Choosing a natural birth can be the most empowering and transformational experience in a woman’s life. In our culture, childbirth is viewed as a medical event and an emergency waiting to happen. We only have to turn on the TV and we witness birth being portrayed as a major emergency, and thank goodness those doctors were there to save the mother and baby. As well as this, when we ask our mothers about their births, we're bound to hear more horror stories. Forceps, stirrups, the dreaded episiotomy. Shaves, enemas, being bound to bed, not allowed to get up, let alone even sit up. Nothing to eat or drink. Husbands were not present. Is it any wonder that we are so fearful of birth?

Fear guides many birth experiences and results in the overuse of interventions and medications. As a result many women feel out of control and disempowered by their birth experience. It doesn’t have to be that way.

The following suggestions will help you prepare to have the best birth experience possible:

1. Understand the process of birth If you understand what is happening with your body during labour, you will have more confidence in the birthing process. Knowing that everything is as it should be, is the key to “letting go” and allowing birth to happen normally and naturally.

2. Good nutrition Good nutrition is essential to good health. The food we put in our mouths today will build the cells of tomorrow. In pregnancy, the food we eat also builds our baby, so we have an added responsibility to ensure that nutrition is optimal.

3. Exercise Birth is a physical event. Staying fit can minimise pregnancy discomforts and ease the birth process. Walking or swimming and prenatal yoga are very beneficial to the health of you and your baby.

4. Relax Your body instinctively knows how to birth your baby and it releases hormones that help you through birthing.  Fear, tension and anxiety can interfere with the natural process by inhibiting labour hormones and increasing fight / flight hormones.  I recommend Calmbirth to all women who plan a natural birth.

5. Address fears and concerns We are constantly bombarded with negative images and stories of childbirth. Over time these messages can become ingrained in our way of thinking. It is important to recognise our attitudes and beliefs and understand how they shape our experiences. Any negative thoughts or beliefs about childbirth can be explored prior to giving birth.

6. Care provider

Your choice of care provider has a great impact on the sort of birth you will have, despite points 1 - 5 above. Having a supportive care provider throughout pregnancy and birth is critical in positively influencing the outcome of your experience.

Birth is natural and women have done it for centuries. But in today’s society, a birth without preparation may not be the one you envisioned. You have all the resources available to help you prepare for the birth experience you desire.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

First time mums and homebirth

What a great choice!  Discuss your situation with your midwife for more advice. Generally, first babies are ideal for home births. Why? Most first births go really well with the care and support of a midwife.  In the hospital system, a first-time Mum stands a 25% chance of having a caesarean, a 25% chance of needing forceps / vacuum, and only a 50% chance of a normal birth.  Compare this with the chance of a normal birth at home with a private midwife (around 90%) and you can see why there is such a benefit to planning to birth your first baby at home.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

 

Continuity of care

Private midwifery is the oldest form of continuity of midwifery care.  Recent research has demonstrated that this form of care – where a woman is cared for by the same midwife throughout pregnancy, birth and the postnatal period – is beneficial for women and families. It results in increased satisfaction with the birthing experience and enhanced safety.  When multiple care providers are involved in a woman’s care, the chance of errors is high because care is provided in pieces. When a woman is cared for by one midwife, she has one point of reference, no conflicting advice, she can develop trust and a sense of security and the birth will generally proceed naturally.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

 

Why is choosing a care provider one of the most important decisions you will make in your pregnancy?

A woman’s choice of care provider for pregnancy and birth is one of the most important decisions she will make. This decision has the most important influence on how her birth will go and how she will experience her care.

Some things to consider when deciding on a care provider are:

  • What sort of relationship would you like to have with your care provider? Are you merely looking for physical check ups in pregnancy and someone to turn up for the last few minutes of the birth? Are you wanting to be cared for by strangers who do not know you or your wishes for birth / would you like to feel nurtured? Would you like to know the person who will assist you in birth?
  • How much information do you expect to receive? Are you happy with “It’s normal” in response to your questions, or do you need more information and a better understanding of your situation and progress and health?
  • Do you wish to be actively involved in the decisions made about your care or are you happy to leave all decision-making up to others?

It may take some time and energy to find the right care provider for your pregnancy and birth. It is very helpful to interview several midwives and obstetricians before deciding on the one that is right for you.

What about place of birth?

There are three options for place of birth: home, birth centre and hospital. Midwifery care is available at all three locations. Obstetricians generally work only in hospitals, however a few will attend birth centre births. Knowing where you would like to birth your baby can help you in choosing a care provider.

What should I look out for when I am interviewing care providers?

One of the most important issues to consider really doesn’t need much consideration at all. How do you feel about your care provider at the end of the initial consultation? It’s a gut feel. You can trust your gut.

You will want to ask your care provider about his/her practices to ensure that their practices are consistent with what you’re wanting for your pregnancy and birth. If waterbirth is important to you, you need to find a place of birth and care provider who can provide this. It’s best to find this out at the initial consultation stage rather than at 38 weeks.

You will also want to explore your care provider’s philosophy on pregnancy and birth to ensure that there is a match with your own.

Are there any poor reasons for choosing a care provider?

Yes! And I hear them very often. It is not wise to choose a care provider because:

  • They are close to your home / office
  • Your mother used them
  • You feel you don’t have any other choices (there are always choices; it’s not a question of resources, it’s a question of resourcefulness)
  • They are female / they are male.
  • Your GP recommended them (unless you are sure of the basis for that recommendation and you agree that they are right for you)
  • They are cheap
  • They do an ultrasound at every visit
  • They delivered you
  • It would offend Aunt Bessie if you didn’t go to Dr X
  • Although you don’t like the person, you’re sure they’ll be fine on the day (your gut is always right)

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Pets and home birth

I am sometimes asked about pets and home birth.  I am an animal lover and I think that our pets are an important part of our families, so my views below might be a tad biased, but here goes: I find that most pets are fine during a home birth.  You'll know if your cat or dog loves the water a bit too much (so much that they'd hop in the birth pool with you), and in this case, some people prefer to have their pets in a separate room.

Dogs always seem to know what pregnancy means (ie, that a baby is on the way) and seem to be protective of the pregnant woman throughout her pregnancy.

I think dogs tend to know when labour is about to begin, and sometimes their behaviour changes very subtly.

During labour, dogs tend to be quiet and respectful, and I find that cats just tend to do their own thing.

If you have other pets, such as fish, rabbits, chickens, birds and so on - these animals tend to be fine during home births.

The main things with pets would be to ensure that they have enough water and food, and if you think they might need their own support person, to consider this ahead of time and have someone handy in case they are needed.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Holistic midwifery care

Holistic midwifery care is care that assesses and incorporates the needs of the pregnant woman, rather than merely focusing on her pregnancy.  A midwife who is working holistically will be interested in a woman’s family, her health and medical history, her previous births, her emotional well being, any fears that she may have around birth and parenting, her work life, and her relationships. A midwife who is working holistically will tend to see women for longer appointments, around an hour each, so that there is plenty of time to get to know each other and for the woman to feel safe and comfortable and supported.

A midwife who works holistically believes in the mind-body connection.  When we consider pregnancy and birth, a holistic midwife will understand that issues in life can impact a woman’s pregnancy, and s/he will recognise when fears, uncertainty and doubt are affecting a woman’s labour.  The midwife works with the woman through her pregnancy and birth holistically to help the woman to birth naturally, safely and calmly.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Fetal heart rate monitors - reassurance?

During pregnancy, it is very normal for women to crave reassurance that their baby is healthy.  The purpose of regular antenatal care is to ensure the health and well being of the mother and baby, but for some women, it is this period between visits with their midwife or doctor that concern starts to build.  Is the baby ok?  How do they know? Some women purchase or hire fetal heart rate monitors (dopplers) to keep track of their baby’s heart rate.  They feel that if they can hear a heartbeat, all is well and they feel reassured.  Midwives and doctors general recommend against this practice.  But why, if it provides women with reassurance?

When a midwife or doctor listens into baby with a doppler (or pinards), they are interpreting several aspects of the baby’s heartbeat, and they are putting this piece of clinical information together with the other aspects of the antenatal visit to create a complete clinical picture of the health and well being of the mother and baby.  It is simply not as simple as listening to the baby’s heartbeat in isolation and without reference to the overall health and well being of the woman.

As well, the interpretation of the baby’s heart rate and rhythm requires a degree of clinical training.  The mere presence of a heartbeat is not necessarily reassuring, and by the same token, it is very common for there to be some difficulty in locating the heartbeat and in differentiating the heartbeat from the other sounds that emanate from the uterus.

So, if midwives and doctors recommend women do not use monitors to reassure themselves of their baby’s well being, how can a woman feel reassured?

The simplest and most effective way for a pregnant woman to monitor her baby is to monitor the baby’s movements after 28 weeks of pregnancy.  A healthy baby moves, and often quite a lot!  Monitoring the baby’s movements after 28 weeks, and reporting a reduction in movements to your midwife or obstetrician is by far the safest and most effective way to monitor the health of your baby between appointments.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Pre-labour: what to expect?

Pre-labour is a topic that has come up recently with some of the women I have cared for.  In particular, women have asked what the difference is between pre-labour and labour itself. I'll start by saying that pre-labour has many names: false labour, early labour, practice labour and prodromal labour.  I like the terms pre-labour or practice best as they describe the phase of labour (ie, before labour starts) and the purpose (practice for labour).

Many women experience pre-labour, but not all women will experience it.  For women women, the very first contraction is the start of active labour and from that point, their baby arrives very soon.  However, for most women, a period of contractions occurs as the body warms up for labour and as the baby shifts into a more favourable position for birthing.

Practice labour can last a while.  Several hours, several days, even a couple of weeks.

It is characterised by contractions that are irregular in frequency, intensity and duration.  This means that there is no pattern to the contractions that persist for more than an hour.  Some contractions will be long, while others will be short; some will be quite intense while others will be very mild; and some till come close together while others will be spaced apart.

They can feel like strong Braxton Hicks contractions or strong period pain.

They may also become more apparent when you are active, and die down when you rest.

When labour starts, there will be a regular pattern to the contractions and they will not be affected by your level of activity.

In terms of your body, practice labour is the time when your baby is moving to an optimal position for birth and it is a time when your cervix is softening, thinning and opening a little.  So we bring respect to this process, understanding that it is the key to a healthy start to labour.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

Knowing Your Midwife

For many women, pregnancy can be an emotional rollercoaster.  Many women experience excitement, joy and hope, but also fear, uncertainty and even disappointment and sadness. The relationship a woman develops with her midwife is important to a woman as she journeys through her pregnancy, birthing and in the early weeks with her baby.

It has been shown that women who are cared for by one dedicated midwife for the duration of their pregnancy, birth and early newborn period find this form of care to be highly satisfying.

It is about having one person who shares in your pregnancy, who listens as you share your fears and concerns, who shares information with you and who supports your decisions and choices.

When a woman knows and trusts her midwife, there is a shift of power towards the woman as she feels a greater sense of control over her entire experience.  She becomes aware of her choices and options, she feels confident to make her own decisions and she goes to her birth feeling confident, informed and supported.  She knows who will be caring for her on the day, and she knows that her midwife knows everything that is important to her for her birth.

There is no sense of being a number in a busy system.  There is no need to repeat yourself at every visit.  There are no lengthy waits for appointments.  Each appointment takes around an hour, so there is plenty of time to get to know one another.

Private midwifery care is an option that more and more women are asking for, although it is only accessed by a small number of women.  Yet research shows that this care model, in which a woman is cared for by one midwife from early pregnancy though to birth and post-birth care, offers numerous benefits to women and babies. These include a greater chance of a spontaneous birth without stitches, feeling in control during labour and exclusive breastfeeding with minimal chance of postnatal depression and baby blues.  Private midwifery care also means much less requirement for pain relief in labour, fewer inductions of labour and of course a much lower chance of needing a caesarean.

The care I am describing - where a woman knows and chooses her midwife – is available for both home and hospital births.  If private midwifery care is available in your area, you may decide that is what you would like.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

My pregnancy is high risk. Can I have a midwife?

Yes, midwifery care may well be an option for you.  Your public midwifery options may be limited as public hospitals will generally steer higher-risk women towards obstetric care.  However, private midwives can care for women of all levels of risk in consultation with an obstetrician for the issues that may need obstetric input.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

How do Midwives Work?

It's a common question I am asked! When people ask me what I do, I tell them I am a midwife. The next question is usually, “Oh, so you’re a nurse?”. “Not quite”, I reply, “a midwife – I care for women though pregnancy and birth and with their new baby.” Then they really look puzzled. “That's not what an obstetrician does?" “An obstetrician is a doctor who specialises in caring for women with complicated pregnancies and births. A midwife specialises in caring for women who are having healthy pregnancies and births.” By that stage they’re well and truly confused and I start to wonder what we need to do to promote midwifery as a care option for all women.

The term midwife means ‘with woman’. Midwives work in partnership with women through pregnancy, birth and the postnatal period. Midwives can provide care to women from the time that the woman discovers she is pregnant, right up until her baby is 6 weeks old. In fact, women who experience a normal, healthy pregnancy and birth may not see a doctor at all! Eligible midwives are able to order all the necessary tests and scans during pregnancy and may refer directly to an obstetrician if their services are necessary.

Midwives provide education, clinical care, assessment, planning, support, advice and information, as well as doing all the routine checks of mother and baby.  Most importantly, though, a midwife's role is to develop a relationship with the woman and her family along the pregnancy, fostering feelings of trust, respect and safety for the woman and her family.

Midwives advocate measures throughout pregnancy and birth that promote normal birth: that is a birth without interventions. Midwives and are experienced in such things as water birth, active birth, and so on.

Midwives are also specially educated to know if anything is out of the ordinary, and they can get help from obstetricians. In pregnancy, midwives see women at intervals so that any issues that may present can be dealt with before they cause any major issues.

Women who are cared for by one midwife from pregnancy through to birth have better outcomes in terms of safety, lower rates of intervention and satisfaction with their experience. Midwives too prefer to work in this way, getting to know each family individually.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

How do midwives monitor the baby's heart beat in labour at a homebirth?

Midwives monitor a baby's heart beat in a home birth, as well as ensuring the health of the woman giving birth.  The usual method of monitoring a baby at a homebirth is for the midwife to use a doppler.  This portable and light-weight piece of equipment is water-proof, so the woman can be in any position and also in the bath or shower while it is in use. Current guidelines recommend that a baby's heart beat be listened to every 15 minutes in the first stage of labour, and after every contraction during the second stage of labour.

Some women are keen to avoid ultrasound, and the hand-held doppler does use ultrasound.  in lieu of this, the midwife can use a pinnards stethoscope, however this can only be used on land, so it would require the woman to leave the bath or shower so that the midwife could check on the baby's wellbeing.

If the midwife detected anything untoward in the baby's heartbeat at home, s/he would arrange for the woman to be transferred to the hospital where a CTG monitor could be used to give more information abut the health of the baby.  This is the same process that a birth centre midwife would employ.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

What equipment do midwives bring to homebirths?

Typically, midwives bring a range of safety equipment and supplies to a birth. These include:

  • Oxygen for mother and baby
  • Suction equipment
  • Suture material and local anaesthetic in case of any tears (generally there are no tears) 
  • Medication to stop any excessive bleeding after the baby is born
  • Vitamin K for the baby
  • A doppler to monitor the baby’s heart beat
  • Blood pressure equipment
  • Urinalysis sticks
  • Scales to weigh the baby
  • Resuscitation equipment for the baby
  • An oxygen mask for the mother
  • A catheter in case the mother is unable to pass urine
  • General equipment such as gloves, needles and syringes, sterile water and normal saline, gauze, cotton wool, tape, cord clamps (unless the family prefer to use a cord tie) and so on. It’s quite a big kit when it’s all put together.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.