home birth week : an interview with briana blackwelder, a midwife

Can you explain exactly what a home birth midwife is and what you do?

A homebirth midwife is a maternity care provider that works with women and their families during pregnancy and postpartum to achieve the healthiest outcomes possible and to give birth in context of their lives. Usually this means that the woman labors and gives birth surrounded by her support people of choice (friends + family) in the place that is most familiar and comfortable to her, usually her home. A midwife is also someone that has lots of experience attending births and helping women to labor naturally, and a midwife has an abiding belief in the power of women to give birth to their children and to become mothers in the way that's right for them.

Summarizing what I do is pretty difficult, but I'll try to be brief. I provide nine months of prenatal care and even pre-pregnancy counseling. I come to the client's home when she is in labor and help to 'set the stage' for a peaceful birth as well as monitoring all physical conditions of mother and baby. I call another midwife or apprentice once labor is well underway, and I assist the mother to give birth and attend to her and her baby's well-being, ensuring a safe passage from pregnancy to postpartum. I stay for several hours after the birth to make sure everyone is stable and clean up the house. I visit the woman after she's given birth in her home on the first and third days postpartum, and we see each other for 6-8 weeks or until she is 'back to normal'.

How does it differ from a OB/patient relationship and birth in a hospital setting?

Care during pregnancy is entirely individualized to each woman and may include all testing that would be done through a typical obstetrician, or an entirely technology-free pregnancy if the mother so desires. Our appointments can last hours and a relationship of trust and friendship is built over the 9+ months. The focus of the pregnancy and birth is not merely on the physical, it's also about facilitating the developmental stage of life that motherhood is. We don't really have a place in our society to even discuss that transition, it seems many women are focused on diaper bags and strollers. I have watched many women and their husbands/partners become closer, better communicators, more at ease with their roles and relationships, and surrender to the changes inevitable in life. This is often the most important part of giving birth, and all the emotional preparation for that transformative moment can help parents experience birth for what it ultimately can be. 

What are three things about your job that bring you  joy and fulfillment?

Participating in the creation of families is truly joyous, it is one of the most exalting things we can do as people. Being a witness to women at their most powerful, getting to watch them learn that surrender can be their greatest strength, seeing them finally 'get it', feeling like I've actually made a difference in people's lives, and seeing women leave my office happier or at least with a better appreciation of life's processes. I love helping women through especially difficult births, ones that I know wouldn't have happened in a hospital or even with another midwife, getting to do that for them and give them the credit is the most fulfilling thing I can imagine. 

What kind of education, training, and skills are required to practice midwifery?

Requirements differ from state to state and in different countries, but I completed a 4-year program and apprenticed with several midwives. The skills required for the credential I carry (the CPM, certified professional midwife) are standardized by the North American Registry of Midwives and include everything needed for basic midwifery practice and well-woman care. I also had to complete a test after I met all of the training requirements in order to receive the CPM certification. Every 3 years, to renew my credential, I must do continuing education, participate in peer review, and keep skills up to date.

What kind of services do you offer women in your care and what are the costs involved?

A homebirth roughly costs anywhere from 2-5k depending on where you live. I charge $3000 and that includes a mid-pregnancy ultrasound, all lab work, birth kit with disposable supplies used at the birth (cord band, chux pads, peri bottle, all sorts of clean-up supplies, etc.) and a waterbirth tub & setup. I also include some really good prenatal vitamins from New Chapter, as well as commonly helpful herbs and other supplements as needed. I have a lending library at my office with books on everything from preconception to parenting, which my clients have access to during the course of their care. Prenatal care is the same schedule as an OB; visits every 4 weeks until the third trimester, then every 2 weeks, then every week the last month. When women go beyond 40 weeks, we see each other quite often, sometimes every other day. Usually there are at least 3 home visits aside from the birth (around 36 weeks, 24-hours postpartum, and 3 days postpartum) any other additional visits are also included as needed. I'm available by phone anytime day or night for 6 weeks surrounding the woman's due date, and before and after those weeks, I'm still quite available although I don't make any promises. Basically it's a killer deal. One local midwife's accountant calculated that she made about $1.25 per hour (not including recovery time). Having a midwife is luxurious!

What are the three hardest aspects of your job?

The schedule: long hours, being on call, not being able to leave town within 6 weeks of someone's due date. Feeling emotionally drained from doing lots of deep processing with women; hearing their concerns, griefs and worries. Bad outcomes, which affect me as much as the parents sometimes.

What are your personal beliefs regarding women and their bodies and birth?

Women are designed to do this work; and, although it is work, it can be the most fulfilling
accomplishment in a woman's life to grow a baby and give birth to her child. There is a belief that women's bodies are broken, that our physiologic norms are an inconvenience, that we need technology and medicine to give birth, and that aesthetic standards are the greatest thing that we can achieve with our bodies. I believe that feeling wonderful in our own skin and allowing our bodies to take the shape of a mother, to grow heavy with new life, gives us a far richer experience of what it means to be female. To accomplish the greatest human feat imaginable, reproducing another person, is a life-affirming achievement unique to women. 

Do you have any recommendations (articles, books, documentaries, etc...) for women who would like to learn more about home birth?

Ina May's Guide to Childbirth by Ina May Gaskin (information and stories)
Pushed Birth by Jennifer Block (exposition of birth in the US today)
Birthing From Within by Pam England (preparation for a conscious birth)
Baby Catcher by Peggy Vincent (full of stories)
(the articles under the resources section are very good)
{the sidebars are full of great information}

The Business of Being Born (on netflicks)
Birth Into Being-Russian Waterbirth Experience (also updated version Birth As We Know It)
The Other Side of the Glass (birth experiences and effects on fathers and babies)

You can find Briana's website for her practice, Fern Midwifery, here. She also has a blog that is full of sweet photos of new brand new babies and interesting articles, which you can read right here

Thank you, thank you, Briana! You are such a wonderful friend and midwife, my life is truly better because I know you. 

XO Rachel


(V.Kerr) School Time Adventures said...

Wow, Bri this was really well written! Thank you for being such an amazing midwife!

Kate said...

Reading this makes me (almost) want to have a wee bairn.

That is quite a feat Briana. ;)

amy said...

Beautiful! All the elements you mentioned about what it means to be a midwife, Briana, are the reasons I couldn't imagine giving birth without one. Your clients are lucky women and it is clear that this is for you, as with many others of the competent and wise women in your field, is more than a career; it is a calling.

You know you've fired on all cylinders when you get Kate to mention interest in reproduction. And you made me think, for a brief moment, that pregnancy is more than its challenges, which is a thought I seldom entertain anymore :)

I wish all women who didn't know about their birth options could read this. I can't imagine someone not wanting to at least learn more after reading about this different, beautiful path.


Briana said...

Thanks everyone. I'm honored to know you wonderful women as well. Kate, I count it a true success that you considered wanting a babe.

Kate said...

This is a video my husband Neil & I made dedicated to Bri.