Musings of a Midwife-to-Be: Homebirth and Home Visits

One of my duties as a nurse at a birthing center is to go to our clients’ homes a day or two after they birth to examine them and their babies, answer questions and offer support. It’s always an interesting thing to me after seeing someone in the office for 9 months, on my turf so to speak, that I then get a glimpse of them in their own surroundings.

There is a complete change in in the caregiver/client relationship when the interaction occurs in the home rather than the clinical setting, a shift from being in charge to being a guest. I imagine that home healthcare and hospice nurses experience this every day, but it was a couple years into my own career as a nurse before I understood how going into someone’s home to provide care required a different mindset.

The biggest problem I had working in a hospital was the long list of rules to follow, especially in the labor and delivery arena which is so personal and special. There just wasn’t a lot of wiggle room to make each family’s experience unique to their needs and wishes. Often, because of hospital policy we do things that may not exactly fit the situation our clients find themselves in, and most people don’t know that they can be firm about what they want and don’t want regarding interventions in birth.

And really, it’s the same for any hospitalization. Hospitals have to set a standard of care, and develop policies for providing it, which is designed to fit the masses and not any one individual patient. The open gowns, IVs, round the clock vital signs, and any number other of interventions make patients feel like a cog in the wheel of hospital machinery instead of a person with specific needs and desires for care.

In a person’s home, they wear what they want, rest where they want, eat what they want and generally make the rules. No “Nurse Ratcheds” allowed, thank you very much. As caregivers, we must become partners with and be respectful of our clients, their space and their individuality. It is a relationship of equality. Sometimes this is a challenge, of course. There are instances where I know I’d like to be in more control of a situation, but that is not  how healthcare is meant to work, and I really do wish we could provide care more like we used to with lots of house calls and less reliance on hospitals.

 Because of my specialty, I notice this difference most when comparing a home birth and a hospital birth. I started out my career in a busy labor and delivery department, then moved to an in-hospital birth center. My L&D floor had a laundry list of rules from continuous monitoring, to ubiquitous IVs, to taking the baby to a warmer before letting Mom and Dad hold him/her. There was less of that in the Alternative Birthing Center and I figured that home births were probably similar to birth center births, but I was very much mistaken. There is a subtle but meaningful shift in care when you go into someone’s home to provide it. The first time I assisted at a home birth I was amazed, and surprised at the intimacy and respect it required. (And by the way, for those of you who have never seen or been part of a home birth….it is not what you’ve seen portrayed in movies of weird hippy types burning incense, banging on a drum and making placenta stew afterwards……you know you were thinking it.)

So much is learned by being in the home. You see how partners interact with each other, what kind of art they like, what kind of music they like, are they cat people or dog people…or even iguana people….all those seemingly small things that changes a patient from facts on a health form into a real person.

Photo by: Happy Birth Happy Baby Photography. Used with permission.

(Just a note on the picture above: The woman pictured is actually only moments away from giving birth at the time of the photo. In a gorgeous, light filled bathroom, with the windows open so we could hear the breeze rustling the trees and the birds chirping. Utterly peaceful and in surroundings that suited this particular couple.)

Now I know that home birth isn’t for everyone, either for safety reasons or reasons of choice, but that isn’t the point I’m trying to make. While I know its not likely due to time and financial constraints, I really do hope that healthcare can become more personalized again. That we can train more nurses, nurse practitioners, and general practitioners to allow for more home healthcare, not only for pregnancy and birth, but throughout the lifespan. Can you imagine what it would be like to go back a bit in time and have a family physician who makes house calls? To only utilize hospitals (and their expenses) when it is a true emergency?  To feel, as a patient, that you are an equal in making decisions about your health? We have strayed so far from that model of care that I wonder if we can find our way back.

5 thoughts on “Musings of a Midwife-to-Be: Homebirth and Home Visits

  1. birthnurse says:

    Well stated. Check out the American Holistic Nurses Association, they are working on getting person centered care back into the mainstream too!

  2. E says:

    LOVE this post!!

    I have to say, I think that part of the problem isn’t the over-abundance of policies in hospitals — it is that the policies put into place are just no good! Why have a policy that the baby must be put in a warmer before the mom or dad can touch it? It seems really unnecessary and detrimental to both parents and baby.

    You’re right, hospital policies should be put into place to promote good outcomes across the board — but some of the policies you talk about do EXACTLY the opposite! They seem designed more to cover the hospital’s butt than to do good. I think policy itself can be used in a really positive way in hospitals, but policies like that do nothing but detract from the patient’s experience.

  3. the velvet midwife says:

    And sometimes it is just a matter of re-orienting the staff’s priorities and traditions. Where I work, it is a struggle to get the concept of skin to skin to mean just that – some of the old-timers think that a blanket on mom’s belly is just as good, or even better because mom doesn’t get quite so ‘messy’. They somehow think they are doing mom a favor.

    • The frustrating thing for me is level of resistance to reorienting priorities and traditions, even in the face of research into helpful and unhelpful practices, but I guess we just have to keep plugging along and realize that even if its slow change will come.

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