Meet Trailblazer Kim Woodard Osterholzer

Today we’d like to introduce you to Kim Woodard Osterholzer.

So, before we jump into specific questions about the business, why don’t you give us some details about you and your story.
I was first exposed to birth at the tender age of twelve when I witnessed a hospital birth via film, fainted, and decided I’d skip having babies of my own.

Three years later I met a doula and aspiring midwife, and informed her I’d never ever be needing her services. She inquired as to why, I described the film I’d seen, and she asked if I realized some moms have their babies at home with midwives. I said, “Hmm…” She then lent me the book, A Midwife’s Story, the true tale of a homebirth midwife serving the Amish of Pennsylvania.

I read it in a sitting and was hooked.

I was trained into direct-entry homebirth midwifery by a direct-entry homebirth midwife—the very midwife who attended my own homebirths—through an apprenticeship that spanned nine years and welcomed 123 beautiful babies to life. In 2002, I met the educational and experiential requirements set forth by the North American Registry of Midwives (NARM); submitted to the eight-hour, 350-question NARM examination; passed with a score of 89%; and became a Certified Professional Midwife (CPM). I renew my certification every three years. I earned the NARM Bridge Certificate in 2016.

I’m registered to serve in the State of Colorado as a direct-entry midwife and I’m likewise licensed to serve in the State of Michigan. I renew my registration and license every year.

To date, I’ve attended the births of 586 babies, including multiple vaginal births after cesareans (VBAC), seven sets of twins, and twelve breech births, with babies ranging in size from 5lbs, 4oz to 12lb, 3oz and born to mothers spanning a full spectrum of particulars and demographics. I’ve even had the privilege of catching a baby born to a woman I caught while I was still an apprentice! Best of all, I was the midwife in attendance at the births of my three grandchildren. My homeborn daughter, Hannah Simmons, is also a CPM with a thriving practice of her own.

The bulk of my service has been among the Amish populations of Central and Southwest Michigan, though I’ve primarily served the Colorado Springs area since my move here in 2014.

We’re always bombarded by how great it is to pursue your passion, etc – but we’ve spoken with enough people to know that it’s not always easy. Overall, would you say things have been easy for you?
Homebirth midwifery is simultaneously one of the most rewarding and one of the most challenging callings out there, and for so very many reasons.’

My path into my calling was an apprenticeship that spanned nearly a decade—the decade, ironically, when my marriage and two children were new—not necessarily a season ideal for embarking upon an endeavor that insisted I be continually ready to fly from my house for indeterminate periods of time.

I’ll share a bit of what I share in my book for aspiring midwives, One Little Life at a Time.

A homebirth midwifery apprenticeship in modern America is truly a thing all its own.

Homebirthing is first and forever about the vulnerabilities and incredible potentials of transforming families and their irreplaceable moments. I feel the way these transforming families experience their incredible, irreplaceable moments irrevocably establishes the foundation and springboard for their physical, psychological, and even spiritual lives.

Homebirth midwifery is about, is ever and always about, the reverent nurture and facilitation of these amazing transformations. There’s nothing in all the world like homebirth, and nothing in all the world quite like the sacred calling and charge of homebirth midwifery.

A homebirth midwifery apprenticeship is an apprenticeship to life. It’s an apprenticeship to death. It’s an apprenticeship to nuance and inconvenience and idiosyncrasy. It’s an apprenticeship to wisdom and common sense. It’s an apprenticeship to every single priceless mom and dad and baby you’ll serve while striving to learn. It’s an apprenticeship to each family’s absolutely individual event. It’s an apprenticeship to the depths of the apprentice’s own heart and soul, where all her motivations and aspirations and desires and dreams, both noble and otherwise, will be dragged into the light and examined. A homebirth midwifery apprenticeship is a revelation.

Yes, a homebirth is one of the most significant, most intense, most gorgeous, most magical things a person will ever experience on earth, but a homebirth midwifery apprenticeship isn’t for the romantic or the easy-going. Though a homebirth midwife radiates tenderness and embraces nature and unleashes passion, homebirth midwifery itself isn’t any of those things.

Homebirth midwifery is a stick-note on the bathroom mirror reminding your husband he’s home alone with the children and, no, there’s nothing besides peanut butter available for breakfast. Nor is there fresh laundry, though you don’t bother writing that. Homebirth midwifery is long drives at odd hours through inclement weather. Homebirth midwifery is sleeping under tables or curled up on chairs or along lonely roadsides while waiting for tow trucks—if sleep is to be had at all. Homebirth midwifery is feeding and watering while neglecting to eat and drink. Homebirth midwifery is peeing in a back yard during an ice storm because Mama’s been in the bathroom for eons and there isn’t any sign she plans to come out. And then it’s discovering the paper you used while relieving yourself—that was sitting right there on the kitchen counter next to the door—had been a recent casualty of a plugged and overflowing toilet. Why it was there on the kitchen counter, no one will ever know. Homebirth midwifery is unbrushed teeth and flyaway hair and grungy underwear attempting to appear professional during a transport. Homebirth midwifery is finding that delicate place between necessary intervention and deleterious interference. A midwife of yesteryear, Valerie El Halta, once called it intercession. Homebirth midwifery is sharp wits and thick skin and gentle hearts and steely nerves. Homebirth midwifery is looking death right in the eyes and defying him to the uttermost—usually managing to snatch our charges from his clutches though, occasionally, his unthinkable demands must be surrendered to and accepted after all.

There will be challenges. There will be obstacles. There will be opposition. There’s no way to pause life a second while you just quick knock this thing out. But if this is what you’re called by God to do then, with your sweaty hand squeezing His, you’ll learn to do tomorrow yesterday already and dive on in.

While wifing a cop and youth pastor, mothering and homeschooling two home-born kids, arranging the details of four mission trips with groups of teenagers and ministering to the female teenagers within those groups of teenagers, renovating two homes, moving households five times, enduring twelve throat surgeries, supporting my husband through a career change, and—ever and always—cooking and cleaning, tidying and laundering, I attended the births of 123 babies and singlehandedly created and executed my entire midwifery study curriculum. Through the thirteen years afterward my husband and I purchased and cleared a piece of property, began building our dream house, lost my husband’s mother to cancer, lost our builder to—well—to issues, discovered my husband had cancer, and lived outside while working furiously to finish the house before winter. I then lost my husband to cancer, continued homeschooling my children, tried desperately to sell my home through four dismal selling seasons, saw my daughter, Hannah, graduate and enter the mission field, welcomed Hannah back again to finish her midwifery apprenticeship, sheltered two spectacular exchange students for one lovely year, sold my house for nothing, filed bankruptcy, moved with all four kids into a 1,000 square-foot rental, saw my son, Paul, graduate and join the Army and deploy to Afghanistan, met and married my new husband, Steven, turned my practice over to newly-married Hannah, and packed up for a move to Colorado, all while day-in and day-out tending to the care of 372 brand-new babies and their mothers.

Hannah’s done much the same as Kim, attending a birth on the virtual eve of her wedding, plunging straight back into birth attendance from her honeymoon, attending births three days before and three weeks after the birth of her first daughter, taking a technicality of time off for both her daughters’ births—answering calls and texts within hours of their arrivals and spending the first year of each girls’ lives attending births with them strapped to her chest for better or for worse, whether paid or unpaid, in sickness and in health, with neither rain, nor snow, nor sleet, nor hail keeping her from her appointed rounds.

Because a homebirth midwifery apprenticeship is as homebirth midwifery is—a refining fire.

I’m a Certified Professional Midwife (CPM). Certified Professional Midwifery is a limb upon one of two branches of the tree that is American midwifery. One branch of that tree is Certified Nurse Midwifery (CNM), a Registered Nurse’s master’s degree. The other is traditional or direct-entry midwifery. CPMs are direct-entry midwives who’ve submitted themselves to the scrutiny and standards of a body of fellow midwives for the purposes of personal accountability and quality assurance. In states that license midwives, the CPM is generally the criterion. At the time of this writing, there are just over three thousand CPMs actively practicing in the United States.

Though homebirth midwifery isn’t currently legal in all fifty states, between one and six percent of the American populace living in each and every one of those states chooses to birth at home. That means many of us have practiced with questionable legality through the courses of our careers, though the statistics of homebirth midwives shine with equal or better mortality (death) rates than hospitals, with far better morbidity (disease and injury) rates than hospitals, as well as with well over ninety-seven percent of clients beyond satisfied with their experiences.

There are a handful of midwifery schools in existence, but private apprenticeship with an experienced midwife of good reputation is still required. Unfortunately, such apprenticeships are notoriously difficult to secure. First, an aspiring midwife must find a homebirth midwife near her. Second, that aspirant must find a homebirth midwife with a nice, busy practice near her. Third, she must find a homebirth midwife with a nice, busy practice near her who’s willing to train an apprentice. Fourth, she must find a homebirth midwife with a nice, busy practice near her who’s willing for her to be the apprentice the midwife trains. We receive far more queries regarding apprenticeships than we could ever hope to facilitate in a lifetime of practice. Taking an apprentice tends to be a costly, exhausting, and risky endeavor for a homebirth midwife which, unfortunately, is why so many gifted midwives eschew it.

If I select you as my next apprentice, it’ll be with the trust you’re deadly serious in your desire to become a homebirth midwife, with the trust you’re ready to serve my clients to the best of your ability, and with the trust you’re ready—you and your family—for the work, for the study, for the strange and grueling hours, for the cost, for the sacrifice, and, yes, for the joy your apprenticeship most surely will be and will bring you.

The first thing you’re to know and to remember—to always remember—is, in welcoming you within the circle of my practice, I’m trusting you with what I’ve been entrusted with—the priceless lives and moments of the families I’m honored to serve. Though you’ll be welcomed with the aim to garner knowledge and experience and skill, the very second you enter the presence of any one of my clients, your primary task is to serve and bless—and to serve and bless according to my own definition of serve and bless. Be mindful, initially, you’ll likely have little to offer a birthing family I won’t already be providing. This means your attendance at a woman’s birth will benefit you far more than it will benefit her or her family. Keep that in the fore of your mind, and be ever so grateful.

We’d love to hear more about Birth at Home Midwifery Services.
I tend to families throughout the childbearing year!

Below is a description of the care I provide the families I serve, taken from my most recent book, Homebirth: Safe & Sacred.

The Midwifery Model of Care

The wonderful outcomes enjoyed by the majority of homebirthing families flow from a deeply basic understanding of and trust in the processes of carrying, birthing, and nurturing babies that midwives term “The Midwifery Model of Care.”

Midwives understand and trust the carrying, birthing, and nurturing of babies are profoundly sacred and transformative processes and, for all the births a midwife may attend over the course of her career, the birth she’s attending at any given moment will never, ever happen again.

Midwives understand and trust the processes of carrying, birthing, and nurturing babies has the power to affect those who experience it in uncountable ways for the duration of their lifetimes.

Midwives understand and trust the carrying, birthing, and nurturing of babies are remarkably normal processes that most commonly occur without incident or the need for intervention.

Midwives understand and trust that because the carrying, birthing, and nurturing of babies are remarkably normal processes, what birthing souls require most is sensitive, respectful attention as the process unfurls.

Midwives also understand that the way people are treated by their health care providers has a direct effect on their outcomes, with the accessory factors of race, sexual orientation, religious belief, income level, size, and age bearing heavily upon the quality of care they’re likely to receive.

The word, doula, means to serve.
The word, midwife, means with woman.

While a doula is not a midwife nor a midwife a doula, most midwives in America feel very strongly that the roles of each are inextricably entwined.

Though midwives do indeed possess the knowledge and skills necessary to negotiate the thrills and challenges that arise from time to time in the midst of birthing, since the greater percentage of women are able to give birth to babies spontaneously with a similar ratio of babies arriving vigorous and thriving, most of a midwife’s time may simply be spent examining, reassuring, heartening, explaining, soothing, feeding, watering, wiping, tidying, and charting. Midwives do a lot of admiring, too.

Midwives provide continuous, individualized care that acknowledges, promotes, and safeguards the process of childbearing for low-risk moms and babies. Midwives are also adept at recognizing potential issues from afar and circumventing those issues well ahead of their full manifestations. When such prevention proves inadequate, midwives will facilitate the transfer of mom and baby to the hospital, continuing to care for them en route in order to make sure they arrive in stable condition. In 2019, Canadian researchers looked at the outcomes of babies born to women who planned homebirths but lived more than thirty minutes from a hospital with the capacity to do a cesarean. They found no statistically significant differences in Apgar scores, perinatal mortality, and emergency medical service usage.

The care provided by a midwife is a compilation of her education, skill set, experience, and intuition—a portion of which is medical and calls for the use of medical equipment. But chief among a midwife’s competence is her ability to connect with her clients and create a safe space for them to be drawn out, to be heard, to have their experiences validated, and their needs expressed and met. A midwife teaches, encourages, inspires, empowers, and entrains with her clients as she supports and serves them. A midwife’s best tools are her ears, her heart, her hands. Midwives individualize the care they provide, allowing the results of their measurements and assessments to be influenced and tempered by the determinations, the beliefs, the hopes, the desires, the histories, and the dreams of the women she’s tending.

A midwife’s commitment truly is to be with the women she serves—with them creating environments ideal for the carrying, birthing, and nurturing of their babies, then standing sentinel over them and those environs as woman after woman loses herself in consummate metamorphosis.

A Handful of Specifics

While there are many things unique to what homebirth midwives do to ensure the families in their care enjoy the best possible outcomes, a few of those things are worthy of a closer look.

Elizabeth Davis, Dr. Sara Wickham, Anne Frye, and Ina May Gaskin—to name my favorite few—have written and lectured extensively on the subject of physiologic birth and its many benefits to the blossoming family. Trusting and yielding to the process of growing and birthing and nourishing new life inspires a delicious ebb and flow of hormones that do so much more than simply promote optimal childbearing. When families approach the experience open to immersion in that trust and all that issues from it, the hearts and souls of each involved are primed to coalesce in almost astonishing ways, triggering the integration of the baby, not only into superb physical health, but into a state of emotional and social vigor that will see the nascent being through the duration of his or her lifetime.

The principal pillars I consider this inimitable system to stand upon are the facilitation of undisturbed birth, the preservation of the waters, the optimal clamping and cutting of the cord, the provision of immediate and sustained skin-to-skin contact with mother and dad, and the provision for an uninterrupted hour or two following birth.

Undisturbed Birth

Making space for undisturbed and gentle birth is central to the excellent outcomes the clients of homebirth midwives regularly experience, and it begins with recognizing the mysterious, miraculous milieu that sparked the genesis of the child so many months before promises also to be the very magic that will bring the child to and through his or her birth.

Novelty. Vulnerability. Love. Respect. Intimacy. Passion. Agony. Ecstasy. Triumph.

Those aspects belonging almost solely to the human experience bloom best in the soil of privacy and, in the context of labor, usher mom and baby and dad into the altered states of mind culminating in such
glorious birth the glow of it stands to warm and illumine long after.

I guess you could say the excellent outcomes the clients of homebirth midwives regularly experience begin and end with the mysterious, miraculous milieu that sparked the genesis of the child.

With that in mind, midwives work assiduously with the families they serve to make and preserve spaces conducive to undisturbed, spontaneous birthing.

The family provides the sanctuary the mother would like to birth within, then they fill it with whatever best creates the ambiance desired. That may include candles, music, essential oils, flowers, a birthing pool, a stack of warm blankets, a pile of pillows, and most special loved ones. Sometimes it includes nothing but themselves and all they’re most familiar with.

The midwives contribute by endeavoring to support the family as unobtrusively as possible, honoring the environment they’ve crafted. Using hushed tones and slow movements, they encourage food and drink, and advocate movement and rest and surrender by turns while employing their carefully cultivated powers of observation in order to reduce clinical assessments of vitals and progress to that which is essential—minding the flavor of the family and the rhythm of the labor ever and all the while.

Always working with the design.
Always working with.
Always with.

Preservation of the Waters

The amniotic sac is a remarkably designed entity that lends itself with near perfection to the endeavor of nourishing and protecting the well-being of the pre-born child.

The determination to preserve the integrity of the amniotic sac is the determination to preserve the protection it provides—protection from infection, protection from umbilical cord compromise, protection from the forces of labor, protection even from the mother’s pelvis and musculature.

American homebirth midwives only very rarely rupture amniotic sacs. Most of the time the sacs release on their own as mothers labor, but sometimes babies are born fully enclosed within their waters.

There’s hardly a thing more breathtaking than to witness a little life spiraling into the light with her lovely lavender body suspended in a perfect teardrop of her fluids—her turgid, turquoise coil of cord encircled with ribbons of ruby vessels swirling around beside her.

If the waters don’t release even when the child comes fully forth, a fingertip may be pressed gently between her rosebud lips till the sac pops. All then that remains is to peel the shimmering swath of tissue from her face as her cries ripple and ring through the room.

Optimally-Timed Cord Clamping and Cutting

Speaking of the turgid, turquoise coil of cord with its ribbons of ruby vessels, George Malcolm Morley, MB, ChB, FACOG composed a stunning article in 2003 called, “Neonatal Resuscitation: Life that Failed,” in which he describes the importance of leaving the newborn baby’s lifeline unclamped and uncut during and after his or her birth.

Dr. Morley reminds us the unborn child grows within his mother’s womb in a sub-oxygenated state and therefore bursts forth into daylight, as we’ve already mentioned, a lovely shade of purple. The first infilling of his wee lungs sends a glorious wash of pink the length and breadth of his untouched skin while the surges of warm blood flowing to him from his placenta aids the expansion of those lungs, flushing and “activating” a more mature functioning of the rest of his little organs.

Dr. Morley describes this process as that of “natural resuscitation,” and admonishes its dependence on the “copious perfusion” provided by the bolus of placental blood coursing to the baby in great waves following his birth. This “transfusion” is “regulated and terminated reflexively by the child and results in a blood volume optimal for survival.”

“Immediate cord clamping,” the doctor goes on to say, “produces major deviations from natural resuscitation: placental oxygenation, placental acidosis regulation, placental glucose supply, and placental transfusion are all abruptly aborted and the child is subjected to a period of complete asphyxiation until the lungs (begin to) function… The immediately clamped newborn has, in effect, been subjected to a massive hemorrhage, losing up to 50% of its blood volume.”

He goes further to state that when a child is balancing along the knife-edge of stability through or upon his birth—something providers may or may not be fully cognizant of—immediate cord clamping has the power to “seal its fate.”

A researcher Dr. Morley cites in his article, T. Peltonen, states, “On the basis of these observations, it would seem that the closing of the umbilical circulation before aeration of the lungs has taken place is a highly unphysiologic measure which should thus be avoided. Although the normal infant survives… under certain unfavorable conditions, the consequences may be fatal.”

There are a number of short and long-term benefits to keeping the umbilical cord intact including fewer babies requiring resuscitation, fewer babies requiring neonatal intensive care, fewer babies suffering inadequate hemoglobin levels through the first year of life and, in turn, fewer children suffering learning and behavior issues.

Another benefit optimal cord clamping and cutting provides—with the term, “optimal,” being one Dr. Nadine Edwards and Dr. Sara Wickham suggest as possibly more appropriate than the term, “delayed”—dovetails with our next point of discussion. Babies whose cords are left alone are far more likely to be allowed hours to bask naked and unafraid upon their mothers’ warm, bare breasts following their births.

Most midwives recognize the value of preserving the vital connection between babies and their placentas, and work industriously to honor it. Many also realize all that clamping and cutting cords once they’re “finished pulsing” does is disrupt the unrepeatable, irreplaceable process of bonding and integration.

Immediate and Sustained Skin-to-Skin Contact

Immediate and sustained skin-to-skin contact after birth is all about the stabilization of newborn babies and the promotion of bonding and integration.

Nils Bergman, MD and his wife, Jill, developed what the world has come to know as Kangaroo Care. Kangaroo Care embodies the endeavor to expedite the stabilization of newborn babies as they transition to life outside the womb via the body of their very own mothers. When naked babies are placed wet and squirming on the naked breasts of their mothers, the nervous systems of each instantly begin a synchronistic dance that rapidly equilibrates babies’ temperatures, pulses, blood pressures, and blood glucose levels.

Initially, Kangaroo Care was employed on behalf of premature babies born in countries without access to advanced care systems, but it didn’t take long for the Bergmans to realize continuous time skin-to-skin with mothers—and dads, actually—is a fundamental requirement of all babies.

Recognition of the virtual imperative of immediate and sustained skin-to-skin connection between mother and babe is ubiquitous among homebirth midwives and comprises, in concert with the preservation of the umbilical cord, one of the primary reasons so very few homeborn babies require extensive resuscitative efforts, much less transfer to hospital neonatal intensive care units.

An Uninterrupted Hour or Two Following Birth

“Sensations fire and wire the brain. During breastfeeding all the senses work together to make pathways and circuits into networks. So, taste and smell, as well as sight and sound and warmth and touch and pressure and balance and movement are integrated.” —Jill Bergman, Doula; “For Full Term Babies”

This marvelous system of integration creates what the Bergmans call “secure attachment” and engenders life-long physical, emotional, and social health.

Skin-to-skin communion also lends itself to an infant’s increasing intelligence and the development of a mother’s protective instincts. “The number of hours of skin-to-skin contact baby receives in the first day of life will determine his mother’s sensitivity to his cognitive development and emotional security even a year later. This also predicts the attachment relationship and social intelligence.” —Jill Bergman, Doula; “The Importance of Skin-to-Skin Contact for Every Newborn”

This period of time is vital. It’s far more than eating, as there’s only a teaspoon or so of colostrum in a newly-birthed mother’s breasts. The baby is soothing himself after all the sudden changes caused by his birth and, even more importantly, he’s bonding indelibly with his family.

This quiet spell in the bed is a wonderful time for a family to enjoy a meal together while admiring the baby and marveling over his birth. In the meantime, the midwife will be puttering about nearby, tidying things up, putting things away, filling out paperwork, checking on the firmness of the birthing mom’s uterus and the quantity of her blood flow, and assessing the mother’s perineum for tears until the family indicates the baby’s through nursing and ready to be examined.

Once the midwife has examined the baby and displayed his placenta to his parents, the baby will enjoy a spell of skin-on-skin with his dad while the midwife sees mom to the toilet and shower and back. Then she’ll reassess mom’s uterus and blood flow, evaluate her vitals, and tuck the trio into bed. At the third to fourth hour after the birth of the baby—as long as both are doing well—the midwife will go on home. By this time, most moms and babies—and very oftentimes dads—will be sleeping peacefully, so the midwife simply locks the door and pulls it closed behind her.

What to Expect When Tended by a Midwife
Continuity of Care

Chief among the many splendid benefits enjoyed while enveloped in the care of American homebirth midwives is the opportunity afforded the mother-baby dyad to be tended before, during, and after birth by a single provider.

When one person is gathering and assessing vitals, readings, reports, and measurements, that one person becomes intimately acquainted with her charges, and is thereby uniquely poised to detect and interpret even the most subtle of shifts. Then also her subsequent recommendations will be consistent, and any necessary sharing or transferring of care with or to other providers will be accomplished more effectively and efficiently.

Conscientious Preventative Care

Accented by this stand-alone system of consistent care is the midwife’s ability to assist those they serve as they work to achieve the best states of health and well-being possible in order to experience the pregnancy, labor, birth, new parenting, and season of recovery they hope for.

An expectant woman’s midwife will work with her to customize a plan for getting great rest, mindful exercise, top-notch nutrition and hydration, and to achieve an ideal state of mind and soul—all positioning the mother-to-be to embrace and enjoy what stands to be one of her life’s grandest catalysts for transformation.

Prenatal Care

After gaining assurance families are making fully informed decisions to experience pregnancy, birth, and postpartum in the home setting, midwives take the plunge with them into prenatal care. The care journey described in this and the following sections is typical for American midwives, but many variations may be experienced, both in the United States and between the United States and elsewhere.

From the 10th or 12th week of pregnancy through the 28th week, midwives and their clients meet for visits once every four weeks. From the 28th week through the 36th week, they meet every other week. Then, from the 36th week till the birth of the baby, meetings are kept weekly.

The visits usually last an hour or two, though the first visit may take a bit longer as, besides making a first physical assessment, portions of it will be spent filling out and signing policy papers, reviewing health history forms, and collecting blood samples for laboratory work-ups.

The 28th and 36th week visits are often longer, too, as samples are gathered for second rounds of lab work and additional sets of paperwork are filled out and signed. Usually the 36th week meetings are home visits where supplies and the spots in houses where families plan to birth may be inspected. Many midwives offer a short childbirth education class to first-time parents at the 36th week as well.

Midwife visits include assessments of urine for leukocytes, blood, protein, nitrites, ketones, and glucose. Weights, blood pressures, fundal heights, estimations of fetal sizes, fetal heart tone rates and variabilities, and positions and presentations of babies and how they relate with the pelvis of their mothers are measured. A great many questions are asked about how often babies move, how active uteri are, what vaginal secretions are like, how diets and appetites are, how moms are sleeping, whether moms are exercising, if moms have sprouted any varicosities, and how easy it is for mamas to empty their bladders and evacuate their colons. Other questions are asked such as whether moms are experiencing swelling, headaches, dizziness, visual disturbances, or any sharp pains in their heads, chests, abdomens, or legs.

Time is spent then exploring how women are doing emotionally and psychologically, and spread throughout the visit are considerations of women’s questions and concerns, as well as discussions regarding drink, food, supplements, exercise, and the pursuit of complimentary therapies such as chiropractic care, physical therapy, massage, and acupuncture.

All along the way midwives provide a variety of reading and viewing materials, as well as abundant time to discuss what expectant mamas have on their minds or in their hearts.

Birth Care

Exactly when a midwife heads out to attend a woman’s birth depends on which of her babies she’s expecting.
If she’s a first-time mom or a first-time vaginal birther, that’s usually when her contractions are coming every three to five minutes, lasting sixty seconds or so, and have been following such a pattern for about an hour.
If a woman’s had a baby vaginally before, midwives usually make their start when contractions are coming every eight to ten minutes, lasting forty-five to sixty seconds, and have been doing so for an hour.

Of course, a midwife just never can predict how things will go with a woman, regardless how many babies she’s had or hasn’t had. Depending on what the midwife finds when she arrives, she may wind
up going back home for a while, but when a woman calls for her midwife to come see her in her labor, she responds.

The first thing a midwife does when she arrives is take a reading of both the mom’s and the baby’s vitals—chiefly, maternal blood pressure and pulse and fetal heart tones—the latter usually through a contraction. She assesses the woman’s pattern of contractions, then, especially if the woman is a first-timer, the midwife may ask to check for cervical effacement and dilation, to assess the station of the baby, and to confirm that the presenting part of the baby really and truly is its head.

The midwife then sets up her gear and the woman’s supplies and tucks herself away in some corner of her house—within ear-shot—to get started on the paperwork.

Usually the midwife isn’t too needed until the woman feels like she could push. By and large moms and dads work beautifully together through their labors and births—very much the way they work together through the courses of their lives.

Every half hour to hour the midwife assesses the baby’s heart tones for rate and variability. She also makes sure the woman is eating and drinking, resting if possible, peeing often, handling her contractions well, and moving along about as expected. Should she not move along as expected, the midwife explores why, as well as what may be done to alter that, if altering that would be appropriate.

When the mother begins to feel like pushing, the midwife will encourage her to let her body do the bulk of the work without adding too much oomph to its efforts in order to keep the process gentle for both her baby and for her unfurling tissues. Midwives keep a close eye on the baby as he makes his way along his warm, dark path, checking the rhythm of his heart every five to ten minutes while the woman breathes,
breathes, breathes him steadily toward the light.

And at last! With a rush of laughter and spray of tears, he slips into his father’s or his mother’s hands! Though sometimes he slips into the hands of his midwife.

The midwife spends the next three to four hours receiving the placenta, checking and re-checking the pair’s vitals, assessing the condition of the woman’s uterus and blood flow, examining and repairing her tissues as necessary, assisting with nursing, tidying up messes, fetching food and drink, examining the baby from head to toe, helping the mother toilet and bathe, and finishing off the paperwork.

Midwives are careful to depart only when the mother and baby are stable and all tasks are completed.

Postpartum Care

As with prenatal visits, typical postpartum visits provided by American homebirth midwives last from one to two hours, with second visits taking a bit longer to allow for collections of blood samples for the Newborn Screen. Midwives generally visit newly-birthed families between twenty-four and thirty-six hours, at the fourth to sixth days, at the tenth to fourteenth days, then at six weeks post-birth, providing all goes well.

Any time additional visits are needed—be they prenatal or postpartum—they’re readily provided.

The first postpartum visit is the most thorough. Assessment of the baby’s pulse and respiratory rates are made, his heart and lungs sounds are carefully assessed, his oxygen saturation levels are measured, his temperature is taken, his color is examined, his navel and cord stump explored, and he’s hoisted to the sky for a weight check. The midwife then turns her attention to the mother and takes a reading of her blood pressure and pulse, makes a survey of her uterus and an assessment of her blood flow and afterpains, and checks on how well her hinder parts are healing. Throughout the visit the state of the breastfeeding relationship and the condition of the mother’s breasts are discussed, as well as how both mother and baby are sleeping and eliminating, and how well the mother is eating and drinking and feeling emotionally and psychologically.

The following visits are similar, with discussions expanding to include the resumption of the mother’s activities. At the six- week visit the midwife examines the mother’s core and pelvic floor musculature and instructs her as to the furtherance of its rejuvenation. The midwife also offers the mother a thorough well-woman exam at this visit, including a pap test.

Many midwives offer twelve-week visits as well.

Transportation to the Hospital

Midwives invest one hundred percent of their heart, knowledge, intuition, skill, and sweat in keeping the families they serve at home as long as there truly is hope for a good, safe birth there, and their statistics attest to their notable ability to do so.

Still, midwives begin to consider transport a while before it’s vitally necessary to transport. The idea is for it never to be vitally necessary to transport.

Midwives work hard to discern through the mists of exhaustion, hope, and dread when the goal of birthing safely at home has slipped beyond likelihood, and to come to grips with that understanding before the only options remaining are to transport the mother and/or baby to the hospital by ambulance and/or to require emergency treatment upon arrival there. Midwives also work hard to keep the families they serve a well-informed and active part of the decision-making process.

If a midwife’s presence isn’t required to keep mom and/or baby stable and/or if the baby’s birth isn’t imminent, everyone usually drives to the hospital in their own vehicles. If her presence is required to keep mom and/or baby stable and/or the baby’s birth is imminent, she’ll ride with the mother and/or baby with her gear at the ready. Those qualifiers also determine which hospital is utilized. If time allows, the group heads for the hospital of preference. If time presses, the nearest hospital is the unquestioned destination.

The midwife does her best to phone ahead to the hospital to let them know they’re on the way, how to prepare, and, if appropriate to the situation, to request a member of the labor and delivery staff to be on hand at the door upon their arrival.

The first order of business upon arrival is an assessment of the mom and/or baby. The midwife passes the family’s charts off to the staff as the way forward is determined. At that time, providing the state of the mom and/or baby allows for discussions of such things, the family’s specific concerns and desires will be voiced.
When a midwife takes a family to the hospital, it’s because they need something she can’t provide. That doesn’t mean the family must automatically agree to all the hospital routinely provides the hosts of folks they take care of. Often, transferred families are able to enjoy many of the things they’d looked forward to at home, especially mother or father-assisted birth, optimal cord clamping and cutting, and immediate and sustained skin-to-skin contact with their newborn.

Midwives stay at the hospital until the baby’s born, the nursing relationship is well-established, and the mom and dad are ready—physically and psychologically—for her to leave.

Midwives still generally come visit the new family between twenty-four and thirty-six hours postpartum wherever they are and, once they’re back snug in their home, resume regular midwifery care. Post-transfer postpartum care is usually a little more involved as everyone will need to process what happened.

In Case of Emergency—
Training, Skills, Equipment, Plans

The efficacy of a homebirth midwife isn’t just ensconced within her expertise in facilitating the facets of physiologic birth, but also within her rigorous training, finely-honed skills, specialized equipment, and carefully crafted contingency plans designed to mitigate a full spectrum of complications and emergencies possible during childbirth.

Homebirth midwives are educated and trained to know and oversee normal physiologic pregnancy, labor, birth, post-birth recovery, and well-woman care. The hand-in-glove component to this education and training is simple. If what a midwife witnesses doesn’t fall within the range of normal, and she’s unable to effect an adequate resolution of the issue, she’ll secure appropriate medical intervention.

Thankfully, often when a measure of medical intervention is called for, midwives are able to effect adequate resolution, literally “in house.”

When hospital-based medical intervention is required, most times the demand is non-emergent. However, homebirth midwives are trained and equipped in the management of immediate threats ranging from pregnancy induced hypertensions or preeclampsias; uterine and/or placental ruptures, abruptions, and disruptions; labor dystocias; any manner of destabilized vitals, be they maternal or neonatal; any malpositions or malpresentations; cord prolapses or other cord issues; shoulder dystocias; any maternal and/or neonatal cardiopulmonary issues; postpartum hemorrhages and/or placental delivery issues; infant malformations; and any measure of maternal and/or neonatal birth injuries.

Midwives have access to laboratories and to ultrasound technology. Midwives possess a vast array of equipment for assessing and monitoring both maternal and neonatal well-being, as well as for conducting resuscitations, halting hemorrhages, and repairing tears.

As stated before, there’s ample evidence to show that, as long it’s possible to reach a hospital where a cesarean section may be performed, should cesarean be deemed necessary, home is a safe place to give birth.

What’s the most important piece of advice you could give to a young woman just starting her career?
Evaluate your motivations. This absolutely cannot be about you.

Contact Info:

• Website: kimosterholzer.com
• Instagram: instagram.com/kimosterholzer
• Facebook: facebook.com/KimOsterholzer
• Twitter: twitter.com/KimOsterholzer
• Other: safesacredbirth.com

Image Credit:
Brezi Merryman, Love Is Photography, LLC

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