First of all it doesn't happen very often that two people need you at exactly the same time. Two women may go into labour on the same day but one woman can have her baby in a few hours and there is still time to get to the other birth. With a two person midwifery practice we can split up when needed. All the midwives in Edmonton help each other out whether it means filling in as the primary care midwife or the back-up midwife.
I am happy to show clients what equipment we bring to a homebirth either at the "Preparing" prenatal class or privately. We all carry portable oxygen tanks with masks for mother or baby, plus infant resuscitation equipment consisting of a "bag and mask" and a manual suction device. We also have intravenous supplies and drugs to handle a postpartum hemorrhage.
Routine ultrasounds are not recommended but there are times when they can be helpful such as bleeding at any time in the pregnancy, to confirm twins or to find out if a baby is in a breech position.
Midwives keep the same prenatal record as physicians. We check blood pressure, height of the uterus, position, heart rate and movement of the baby and we get you to check your urine for protein and glucose. This usually takes the least amount of time and the rest of the appointment is yours to ask questions and discuss any issues that are uppermost in your mind.
After the birth we make sure the mother is stable, that is her blood pressure is normal, she has a normal amount of bleeding, and we check her perineum for any tears or lacerations. We also check to make sure she is getting off to a good start with breastfeeding.
The placenta is checked to make sure it is whole and that no pieces where retained. The size, weight, shape, color, and vessels in the cord are noted. If you are interested we give you a "tour" of this wonderful organ that you grew and that nourished your baby for nine months.
It's important for mother and father to have lots of time with their baby after the birth so when the baby is healthy we wait to do a head to toe physical assessment till an hour or two later. The baby's weight, head circumference, and length are measured and then we start at the baby's head and working our way down check the baby's neurological, cardiovascular, respiratory, and gastrointestinal systems.
The Apgar scoring is done at one, five and ten minutes after birth. It is a subjective evaluation of the baby's adaptation to life outside the womb. A gentle physical assessment is completed and you may choose whether you want eye drops for the baby and the Vitamin K injection. We ask that you have enough information about these two medications to decide whether you want them or not. The baby is monitored at the postpartum visits at home in the first week with a PKU test being done between day 3 and 7. This test involves taking a blood sample from the baby's heel.
Getting mothers and babies off to a good start with breastfeeding is very important to us. We will come as often as needed to help with any problems. We will refer you to a lactation consultant or a doctor who specializes in breastfeeding difficulties if you need more help.