Gail provides hospital labor support in rare situations where expectant mothers have a supportive physician and a hospital with protocols that allow patients to have some degree of control over their birthing process.
Q. At what stage of pregnancy does your care usually begin, how many visits do you usually have with a client, and when does your care usually end?
A. When I began in 1974, labor support usually consisted of just going to the hospital with friends and childbirth class couples to provide physical and emotional support. I provided back rubs, information and encouragement. As the years passed and I gained more insight and experience I evolved into providing: childbirth education and helping couples formulate their Birth Plan (i.e., their choices) for (1) the ideal birth and (2) the next best choice(s) depending upon circumstances.
I began meeting with the couples and their physician at 36 weeks to discuss their Birth Plan, to develop a team relationship, and to explain why and how my presence could benefit all. I began going to the couples home in early labor to monitor Fetal Heart Tones, to do vaginal exams, and to help the couples stay home as long as safely possible.
This normally required 4 visits with the couple, plus at least 1 visit with their physician, plus childbirth classes (If I was their teacher, my classes were normally 6-8 weeks in length, that is, 6-8 visits).
Q. If home visits are part of your usual labor support care, please provide some information about how home visits fit in your overall pattern of care.
A. In the beginning home visits and hospital visits were a way for me to make sure that I could find my way to the couples home and also get to the hospital, even in the middle of the night. Now, home visits have also become a potential way of keeping couples home as long as possible, thus avoiding many problems that can arise due to excess medical intervention triggered by time-dependent protocols.
Finally, in many cases — as part of a wide range of labor support services, I can provide postnatal care to mother and baby, since our hospitals have initiated policies which discharge mother and baby from the hospital — often within six hours of birth. That, in and of itself, isn’t a bad policy, but there often is no follow-up on mother and baby for six weeks.
Q. Describe your responsibilities in relation to the responsibilities of your colleagues and of the client’s family.
A. I do not take anyone’s place. Husband is usually primary support person. I provide a range of services — anywhere from simple back rubs to delivery of the baby — all depending upon my relationship with the doctor and hospital staff.
I continue to do professional labor support for several reasons. Not only does this help my clients, it also helps me to keep current on hospital protocol. It is good public relations to interact with hospital personnel — to show them what a good birth can be. By doing this I am helping to create positive changes in the "regular obstetrical routine" — thereby helping untold numbers of women who receive obstetrical care at that hospital in the future. So, my role is also advocate for change.
Q. What range of care can you provide for clients in:
(i) the antepartum period?
Answer:
- Childbirth education
- Nutritional counseling
- Formulation of a Birth Plan
- Confidence building in their own abilities, as related to birth and parenting
- Meeting with physicians
- Providing information about various tests — what the test means — pros and cons
- Help formulating questions to ask physician and hospital — as relates to their Birth Plan
- Counseling on personal and sexual relationships
- Referrals to other caregivers, as appropriate
- Referrals to other resources, e.g., someone to help with meals after the birth
- Networking with other couples in the same situation — so they know they are not unique
(ii) the intrapartum period?
Answer:
- Attendance in the home during early labor
- Monitoring of fetus and mother
- Vaginal examinations — determine dilation (kept to a minimum)
- Adjustment to the hospital setting
- Clarification and interpretation, of unexpected situations
- Independent information about alternate options that might be utilized
- Physical and emotional support
- In some situations, I am able to provide normal or near normal midwifery services
- Continuity of care throughout the entire labor; often through several shifts of personnel
Note: Physician protocols, hospital protocols, and even insurance company protocols, in my opinion, now effectively inhibit me from providing truly independent advice or support (physical, mental or spiritual) during labor in a hospital setting. Hence, I feel that I would just be misleading any potential labor support clients by offering to provide (what they would perceive to be effective hospital labor support) the services I feel that are necessary for them to obtain a hospital birth according to their wishes. There may be rare circumstances when this can occur. But I will not provide labor support services any longer unless there are extremely favorable indicators and promises from physician AND hospital admisistration that I will be allowed to perform my true function as montrice.(iii) the postpartum period?
Answer:
- Checkup for mother and infant
- Help with family adjustments
- In some situations that is the extent of my involvement, in others I provide the same care as I would to a home birth couple:
- Next day visit
- Check mother and infant
- Check for jaundice
- Make sure baby is feeding well
- Three day visit
- Check for breast problems
- Evaluate breastfeeding
- One week visit
- Neonatal screen, [PKU] (first screen is normally done in hospital)
- Three week visit
- Check mother and baby
- Six week visit
- Pap smear Contraceptive counseling; cervical caps; diaphragms