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  • Chicago Birthworks Collective

Serious About Home Birth With Midwife Sasha Bariffe

Find out what a home birth is like, whether you’re a good candidate, and what to expect before, during and after a home birth.

As an expecting mother or birthing person, you have options for how you give birth. If you’re considering or planning a home birth, being informed and knowing what to expect is crucial for a successful birthing experience.

A midwife is a wonderful resource for understanding and preparing for a home birth. We spoke with Sasha Bariffe, a certified professional midwife who serves families in the Milwaukee area, to hear firsthand what a home birth is like, how to know if it is the right option for you, how to prepare and what to expect as far as prenatal and postpartum care.

What kind of training does a midwife go through to be certified?

Midwives are trained and licensed professionals. They complete a national board exam and receive a license from their state. When you’re considering a midwife, you can check national and state credentials to ensure they are current. Even if you’re giving birth in a home setting, midwives are required to follow specific policies and procedures.

Sasha began her training in 2014 with a group based in Chicago. She apprenticed with seven different midwives, working alongside them to build her skills. The three phases of training included observation, acting as an assistant under a preceptor and acting as a primary midwife under supervision. After four-and-a-half years, she had honed all the required skills to become a candidate for certification and completed her certification test in December 2019.

What can I expect from prenatal care with a midwife?

The schedule for prenatal visits is similar to what you’d have with an obstetrician. Typically, you will see your midwife every four weeks until you reach 20 weeks of pregnancy. Then, you’ll have bi-weekly (every other week) visits until 36 weeks, and then you’ll move to weekly visits.

Due to the pandemic, some home birth midwives offer telehealth visits during early pregnancy. For lab work, you may have a home visit, office visit or go directly to a lab. As you move further into your pregnancy, you’ll likely have office visits. Sasha’s visits are typically 45 minutes to an hour in length, which is significantly longer than an OB visit.

Toward the end of pregnancy, your midwife may do home visits to make sure you have gathered all the necessary birthing supplies and have plans for setup and cleanup. If you go past your due date, your visits may increase to twice a week and include a non-stress test to monitor the baby’s heart rate.

How do you know you’re a good candidate for a home birth?

Midwives have seen an increase in inquiries during the pandemic. Many mothers want to stay away from the hospital and its policies. Others may fear being separated from their baby and don’t want to be restricted from having their doula or other support people as part of the birth team.

There are also many expecting mothers who look to a midwife and a home birth as an alternative to the hospital. They see it as an opportunity to give birth in a familiar space without medical intervention. When evaluating if a client is a good candidate for a home birth, Sasha starts by asking why they’re seeking this birth option. At her initial visit, she conducts a complete physical assessment and gathers a health history.

The ideal client for a home birth has a low-risk pregnancy and is willing to mentally and physically prepare for the experience. High-risk clients are not a good fit for a home birth. This includes expecting mothers who have a high-risk pregnancy, high blood pressure, insulin-dependent diabetes, asthma, heart conditions, are heavy smokers or have had a C-section within the past year.

Some midwives are open to clients who desire a vaginal birth after C-section. Sasha requires that the mother has at least 16 months between births and conducts an ultrasound to confirm where the placenta is and check the uterus scar. It’s also important to understand that if a mother goes into labor before a certain point, such as 37 weeks (depending on state regulations), it will be necessary to deliver at a hospital..

In these COVID times, a candidate for a home birth also needs to be willing to follow their midwife’s policies for masking, symptom checks and other safety guidelines. If a mother or birthing person has COVID symptoms when going into labor, they will likely need to transfer to a hospital to ensure their health and baby’s safety.

What do I need to do to prepare for a home birth?

Your midwife can outline a schedule and provide lists to help you prepare for your home birth. Near the end of pregnancy, you’ll be getting your home ready, finding a place to set up and making sure you have supplies on hand. Sasha usually brings all her equipment to show her clients what she will have at the birth, so the birthing person and their partner are familiar with her tools.

She also gives her clients a parent supply list to make sure those things are on hand. The list includes supplies like:

● A hose adapter (if planning for a water birth).

● Hydrogen peroxide for cleaning up blood.

● A gallon of distilled water for postpartum perineum cleaning.

● Three extra rolls of toilet paper.

● Two large plastic drop cloths or shower curtain liners for the bed or under the tub.

● Black plastic trash bags for garbage and laundry.

● Two fitted sheets and two flat sheets.

● Bath towels and washcloths.

● A couple of receiving blankets.

● Two plastic bowls in case of vomiting and for the placenta.

● Juice, coconut water or electrolyte drinks.

● Four Ziploc bags for the placenta, instruments, etc.

● One large cookie sheet to use as a tray for supplies (some midwives use it as a resuscitation board if the baby needs help after birth).

● A roll of duct tape to tape down sheets,drop cloth or liner.

● Diapers for baby.

● Calcium and magnesium if labor patterns become irregular.

● Olive or coconut oil.

Sasha also distributes postpartum instructions and her contact information. She makes sure her client reads them and knows where to find them to reference during the early postpartum period, either as a printed copy or a digital copy on their phone.

What is it like to have a home birth?

Your midwife will bring at least one assistant to the home birth. Sasha typically brings two other birth workers, such as another midwife and an assistant. They act as a team — one attends to the mother, another to the baby, and an extra person is present to assist, clean up and help in case of complications.

Your midwife will bring her equipment to your home. Many will have oxygen on hand — make sure to extinguish any candles before pushing. A midwife will offer patience to let your birth happen on its own time and in its own way while making your and your baby’s safety her top priority. She and her team can also act as protectors of your birthing space, ensuring it is calm and safe.

A midwife will need rest, food and hydration while she’s at your home so she can perform at her best. Your midwife is like a lifeguard, overseeing your birth and jumping in if she needs to save you or your baby in life-threatening moments.

It’s important that everyone in the room is clear about each person’s role, is educated about home birth and knows what to expect (especially in case of an emergency). Consider who will be at your birth and whether they will help or hinder if an emergency arises.

Near the end of your pregnancy, your midwife will discuss details such as what situations necessitate emergency help or a transfer to a hospital, how long it would take emergency medical services to reach your house and the closest hospital in case of emergency. You will also choose your preferred hospital if you need to transfer but it’s not an emergency. Sasha has her clients complete an emergency transport form and post it on the fridge for the birth.

After your baby is born, the midwife’s assistant will examine the baby, give you and your partner a moment with the baby and make sure the baby is warm enough. Your midwife will check bleeding and observe you. She will stay for two to four hours after birth (or longer if needed to ensure vitals have leveled out).

What can I do for pain management for a home birth?

One difference between a hospital birth and a home birth is pain management. If you want a natural birth, discuss with your midwife what that means to you, what it will feel like and how you cope with pain in everyday life. It’s important to create a concrete plan for what natural birth looks like.

Your support system will be helpful for pain management. Your partner, doula and other encouraging people can support you during labor and delivery. Sasha also highly recommends taking a comprehensive childbirth course to educate you on what happens to your body during birth. If possible, visiting a chiropractor, receiving acupuncture or getting a massage can help prepare your mind and body in your final days of pregnancy.

If a client brings up pain medication or an epidural during labor, Sasha believes it’s best to listen to what they want. If they want to go to the hospital and receive pain medications, that’s valid. She will ask, “What’s our next step? Do you want to wait a couple more contractions or start packing up for the hospital?” When a birthing person considers the time and effort it takes to transfer and check in at the hospital, they will often choose to stay home and focus on pushing the baby out.

How often will I see a midwife for postpartum care?

Unlike an OB who may only schedule a six-week postpartum visit, you will see your midwife frequently following your birth. She will return to visit your home 24 hours after delivery to assess the baby, conduct screenings and make sure there are no problems with feeding.

Then you’ll have a day three visit, either in your home or by phone, followed by a one-week check-in at home. After that, you’ll have office visits at two, four and six weeks postpartum. Sasha also checks in at three weeks postpartum with resources and a screening for postpartum mood disorder.

The most important aspects of a home birth plan are preparation and support throughout pregnancy, labor, birth and beyond. Knowing what to expect, gathering the necessary supplies and working with your certified professional midwife and her team will set you up for a safe, fulfilling birthing experience.

If you’re interested in a home birth or connecting with a midwife or doula, reach out to Chicago Birthworks Collective. Our group offers packages and services to support your home birth.

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