Birth Day Presence: Layers of Care and the Invisible Birth Bag
“What’s in that suitcase?” A common question from older sisters and brothers to-be when I enter the home on birth day. I like to show families what’s in there so that when things come out for use, they are familiar and not scary, especially medications and newborn resuscitation supplies.
But parents also want to know what I actually do at a birth. What is it like to have me present in your home when you’re in labor and giving birth? Am I more hands-on or hands-off? How much monitoring do I do? Who will be the birth assistant, and what will they do?
I like to describe the various roles I play as layers of care.
Childbirth educator - leading by example
When I was having babies, I leaned towards the wild side. I didn’t go for ultrasounds (except when I thought I might be having twins). I declined a lot of testing. I didn’t feel like I needed or wanted my midwife to do much monitoring during labor. I didn’t want to be told what to do, how to position my body or when to push. But I loved having appointments and bonding with my midwife, asking her questions and hearing her stories. And I did notice that my labors moved more efficiently and with less discomfort just having my midwife and/or doula-friend-birth-assistant present and my children cared for and out of the house or asleep. I wanted my husband to be present and awake but quiet and not touching me. He wanted the birth assistant to be someone we already knew and loved. At times I needed total privacy. I had (and have) a lot of faith in the normal and natural process of birth, and I trusted (trust) myself to know when all is well with me and baby and when we could use more support, monitoring, or intervention.
I believe that my highest calling is to meet my clients in this place of trust, inspire self-knowledge and self-awareness, and provide resources for a growing sense of confidence and empowerment. In this capacity, when I show up at a birth, my presence is quiet, meditative, and trusting. I may reflect and project a sense of safety toward nervous partners with an encouraging smile. I believe that the knowledge of how to give birth resides within the birthing person. The motherbaby’s being is the center of knowing and creating safety.
Doula - in the relational field
During three of my four labors, I experienced plateaus or stalls in my labor. I felt a lot of doubt, even some fear and distress. In those moments, I reached out for help. Sometimes I received a clear suggestion, sometimes a homeopathic remedy, sometimes a comforting touch. At other times I got, “I don’t know Nets. What do you want to do?”
We all have times when our internal resources feel like not enough. Sometimes we just need somebody to remind us that we have everything it takes. Other times a sip of water, plant allies, remedies, a familiar song, loving touch, or the felt sense of ancestral presence is what brings us back into alignment and flow.
In my doula capacity, this is the role I play. I use craniosacral touch, massage, homeopathic remedies, hydrotherapy, comforting and encouraging words, herbal formulations, guided visualization and more to support my clients’ return to themselves. Partners often play this role, too, as do doulas and other family members. Sometimes cultural congruity is a key component of trust and relaxation when someone is feeling ungrounded, unsure, or unable to let go.
Here is an article I wrote about partner roles in labor. And here’s one on what’s in my doula bag.
Birth assistant - the clinical-clerical role
Only the birthing person has knowledge from the inside. The rest of us can use our intuition and empathic capabilities, our intimate knowledge of the laboring mama, and our prior birth experience to feel out what’s going on. We can co-create safety through the relational field by staying calm and promoting the flow of oxytocin in the laboring mama.
And then we also have the layer of clinical tools for measuring and monitoring from the outside. Sometimes these tools come in handy. Sometimes they actually support parents’ ability to turn back to themselves, once they’ve been reassured that everything is okay by a blood pressure cuff, thermometer, cervical exam, or hand-held doppler machine. And they help me share the responsibility with my clients for the safety of mama and baby during pregnancy, labor, birth, and the postpartum period.
I also share the responsibility of monitoring vital signs during labor, birth, and the immediate postpartum with my birth assistant, who is usually another midwife. I choose my birth assistants carefully, prioritizing both their competence and their style of birth day presence, as described above. We generally monitor mama’s vital signs every four hours and listen to baby every half hour during active labor. During the pushing phase, we listen to baby more often. And after birth we discreetly take blood pressures, pulses, and temperatures and listen to baby’s breathing every 15-30 minutes or as needed, while prioritizing undisturbed bonding and breastfeeding as much as possible.
We write down everything we do and important conversations we have with our clients about their care options and the choices they make.
Records of labs and vital signs provide an important shared language with hospital and medical providers when we need them. These records are also crucial if we need to look back at what happened when complications have arisen. Good charting protects midwives and parents in the event of litigation and helps ensure that midwives can continue to practice, serve our communities, and be present for our families.
Midwife - holding the whole, ready to act
As an earthy, attachment parenting practitioner and homeschooling mother, I devoted myself to living by my values. I committed to composting, co-sleeping, and cloth diapers. No electric swing. No stroller. No bottles. No Advil or antibiotics. I hung the laundry out to dry, sourced my meat and dairy locally, sprouted everything. Pickled and practiced tai chi. As a midwife, I bring all that to the bedside. But I also bring pitocin and lidocaine, sutures and my cell phone.
I encourage my clients to make their own choices regarding testing, medications, interventions, and procedures. On principle, I nearly always begin with the least invasive, most natural option when my help is needed. But sometimes, we have to call 911. Or transfer to the hospital. Or use pitocin first and herbs later. Sometimes it’s hands on and hands in. That’s really why I’m there. To know when to help, and in which way, and how to do it skillfully, with as little fanfare as possible.
FAQ
What is the time and events before birth called?
Labor! Here is an article I wrote about getting through early labor and the time before your midwife arrives.
How do I become a Doula?
Attend a doula training, take a childbirth class, read books, listen to podcasts, join a community of birth workers, attend some births, complete your certification requirements, go! I trained through ALACE, now called ToLabor, BirthWorks International, and The Matrona.
Work with me
Don’t hesitate to reach out to me with all your questions about home birth and midwifery care. You can schedule a free consultation through my website or call me directly at 240-997-5319. I serve the Baltimore area of Maryland and York County, Pennsylvania.
Blessings on your journey!
~Nets Manela, Midwife (CPM, LDEM)
