Labor & Birth

 
 
 

Call Schedule

When your labor begins, the personal care and attention that you will have come to expect at Alma continues. Alma midwives are on call for you 24/7.  We believe in the “fresh horse” call schedule. Studies have shown that caregivers who have not slept for several hours (days) are more prone to error. The shift change is done every 24 hours to promote safe care practices. The call schedule honors our hard working midwives.  We practice the beliefs we preach about self-care, physical health, caring for relationships, down time, and restoration.


Early Labor

Early Labor will start with a home visit from one of your midwives to assess your labor. At that point, you will make a plan together on whether it’s time to come to the birth center (or have your full team arrive for a home birth) or if it is not quite time yet. We provide labor support during your active labor phase and hope that in pre or early labor you will rest, nourish, hydrate and wait for the big stuff to start. Through experience and research, we have learned that women do best surrounded by people they trust in a comfortable environment. Whether you’re birthing at home or in our birth center, your labor room can include candles, food, music, children, loved ones, and whatever you need to feel comfortable and safe. Some women hire a doula to support them in the hours (sometimes days) of pre or early labor; let us know if you would like this extra support.


Active Labor

Labor support from the midwives or your doula lessens the impression of pain, shortens labor, reduces the need for medicalization of birth, lowers the cesarean birth rate, and increases a mother’s positive feelings about their birth. A trained labor support person (midwife, assistant, apprentice, doula) will support you through your labor by using kind and encouraging words and touch and labor support tools like: use of water, change of position, birth stools, walking, lunging, resting with a peanut ball, massage, yoga sling support, endless pillows, acupuncture and many more modalities, all help you to open and give birth. Ask someone who has birthed with Alma to describe the support they received in labor. Our staffing allows you to be the lodestar of the day. Our attention is fixed on you, your baby and your mate (if partnered).  

Privacy is one of the best labor tools. Labor flourishes in an undisturbed environment! For some people oxytocin (the labor & love hormone) flow the best when they are left alone or with their partner. We honor such inward laborers. We will wait just outside the door and quietly tiptoe in to check on you & listen to the baby’s heartbeat. You may labor in quiet, darkness if desired. Alma labors are tether free!


How Alma Midwives Support & Monitor Laboring Person & Baby

Availability of free (untethered) movement increases spontaneous vaginal birth. How is safety monitored without being tethered to monitors? Our care is human directed versus technology/machine intensive. It requires us to be with women in an attuned & focused way... after all midwife means “with woman.”

 
 
 

Alma Midwifery

Monitoring Low-Risk Women


FETAL HEART TONES Fetal Heart Tones (FHT): fetal well being is assessed with a hand-held doppler which will allow the laboring woman to move about freely. The fetal heartbeat can be heard while the belly is underwater! The best way to assess the baby is to listen before, during, and after a contraction. Never will a laboring person experience continuous fetal monitoring and the tight bands they require in the accredited birth center setting.

PULSE Pulse: is palpated on the wrist the good old fashioned way: two fingers, your wrist, and a watch. Your pulse is an indicator of well being and is assessed every 3-4 hours and anytime we think our doppler may be picking up maternal pulse instead of fetal pulse.

BLOOD PRESSURE (BP) Blood Pressure (BP): is assessed with a BP cuff temporarily placed on your arm between contractions. This reading is more accurate & less distracting than taking it during a contraction. It is taken every four hours in a low risk person. It is removed after the blood pressure is taken.

DRINKING + EATING IN LABOR Drinking and Eating During Labor: a continuous IV is not required. IV fluid with antibiotics may be needed for a person who is group beta strep (GBS) positive, vomiting, fatigued, unable to drink, or if the fetal heart beat is too high or low. If an IV is required, the fluid is delivered & the tubing is removed. The better way to stay hydrated is to drink fluids in labor: water, labor tea, Recharge, coconut water, electrolyte drinks, smoothies, broth, juice. Most people eat during labor to keep their vigor.

NON-EPIDURAL PAIN RELIEF Non-epidural Pain Relief: in the out-of-hospital setting, epidurals are replaced with other pain relief techniques such as mind-body modalities, use of water, massage, continuous support, and nitrous oxide (also called gas & air). See section in FAQ for a full answer on pain-reduction support in labor.

SITTING ON TOILET Sitting on Toilet: we prefer having our laboring people use the toilet. The toilet is a great labor spot. Humans are used to “letting it all go” there. A urinary catheter can increase urinary tract infections. Occasionally, they are used for good reasons at Alma: inability to urinate in labor and to reduce bleeding in the postpartum. They are used and immediately removed to reduce the chance of infection.

OBSERVATION OF LABOR Observation of Labor: Intrauterine pressure catheter (IUPC) or external monitors are replaced with the watchful eyes & ears of an experienced midwife, who can often tell by gentle touch, listening, and labor progress how strong & effective the contractions are. No need to tether a person to a lead to get that information during a low-risk birth. This does require attunement to the laboring pair.

TYPICAL HOSPITAL CARE

Monitoring Low-Risk Women


CONTINUOUS FETAL MONITORING Continuous Fetal Monitor: external or internal (EFM) Continuous monitoring increases cesarean birth without improving outcomes for babies. They are used in the busy hospital setting and allow staff to remotely monitor multiple people from the nurses station. Continuous monitoring is necessary for high-risk, medicated (pitocin) labor, or if an epidural is placed. EFM consists of disc held over the belly with strap or is a probe attached to the baby’s scalp. Each heartbeat is electronically stored or sometimes is printed on paper. The baby’s heartbeat in relation to the contraction pattern provide information on the baby’s tolerance of labor.

PULSE OXIMETER Pulse Oximeter: allows for a continuous monitoring of the mother’s heartbeat. Differentiation from the maternal and fetal heartbeat are important in case the fetal monitor accidentally traces the mom instead of the baby. The laboring person’s pulse is able to be read remotely.

CONTINUOUS BP MONITOR Continuous Blood Pressure (BP) Monitor: is sometimes left on the laboring persons arm throughout labor and inflates at a set rate. It tightens as frequently as every 5 minutes when an epidural is placed and then hourly. This is vital equipment if a woman has high blood pressure. BPs are read remotely. Unfortunately, it may inflate during a contraction. Distracting!

I.V. DRIP I.V. Drip: most laboring women will have an IV site set when they are admitted to the hospital. An IV is necessary if a woman would like an epidural. It is placed with a needle that is removed & a plastic catheter takes its place, allowing for bags of fluid and medication direct access to the bloodstream. IV sites are usually in the arm or hand.

EPIDURAL Non-epidural Pain Relief: rates of epidural use are lower in the states with the most out-of-hospital options (like New Mexico), and up to 90% in areas where less out-of-hospital births are available. When a doula, nurse or midwife will not be by your side, an epidural may be necessary to allow the laboring person to relax and cope with labor. It can be a kind use of medication, but it is not without risk. An epidural labor is a bed labor.

BLADDER CATHETER Bladder Catheter: is a bulb & tube system to allow continuous bladder drainage for a bed-bound laboring person with an epidural.

CONTRACTION MONITOR OR INTERUTERINE PRESSURE CATHETER (IUPC) Contraction Monitor or Interuterine Pressure Catheter (IUPC): is a thin tube placed inside the vagina and threaded into the uterus to measure the strength of the contractions. The IUPC is taped to the person’s leg with another cord leading to the monitor. If an IUPC is not in place, a second belt holding another disc is placed on the uterus to measure contractions from the outside. The information is read remotely.
 
 
 

This kind of care increases the chances of a spontaneous vaginal birth without decreasing safety. Would you like to see a list of our medications, supples, instruments and birth support tools? Click here.


The Moment of Birth

In the second stage (also called pushing), people can be in the water, on a birth stool, in the shower, squatting on the floor, in the bed — the birth will happen wherever the baby decides they wish to be born. We have even had a few births outdoors in our courtyard! No stirrups are available for labor because they are not comfortable for an unmedicated person. By not cheerleading a women to push vigorously, vaginal tearing is reduced.

Most babies are “caught” by the partner with the midwives guidance and placed on your chest. This is the magical moment! See FAQ for a more detailed description of the tender care given to not disrupt birth - this moment belongs to the family!

 
 
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Alma Midwifery Labor & Birth.jpg