Labor & Birth

We’re Here 24/7

When labor starts, your midwifery team is available 24/7. Alma midwives follow a rotating call schedule to ensure you’re cared for by a rested provider who’s fully focused on you and your baby. This approach supports safe, attentive care and reflects our belief in sustainable, relationship-centered work.

Early Labor

In early labor, one of your midwives will come to your home to check in and assess how things are progressing. Together, you’ll decide whether it’s time to head to the birth center (or have your home birth team arrive), or if it's best to continue resting at home.

You’ll be encouraged to rest, eat, and hydrate during this phase. Whether you birth at home or in our center, you’re welcome to create a calming space with music, candles, snacks, family, and anything else that helps you feel grounded and safe.

Some clients choose to hire a doula for additional early labor support—let us know if you'd like help finding one.

Active Labor

Once active labor begins, you’ll be fully supported by our team. Your midwife, assistant, or doula will use comfort techniques tailored to you—like position changes, water immersion, massage, birth stools, peanut balls, movement, and more—to help your labor progress and reduce discomfort.

We believe in privacy and uninterrupted space. If you prefer to labor quietly or inwardly, we’ll check on you gently and respectfully while still closely monitoring your well-being and your baby’s.

How We Monitor Labor & Safety

At Alma, we prioritize mobility and presence. You won’t be tethered to machines—instead, your safety is supported through hands-on, attentive care. We monitor you and your baby regularly using time-tested tools and our trained senses, staying close and present throughout your labor.

Alma MidwiferyMonitoring Low-Risk Labor 

  FETAL HEART TONES
  Fetal Heart Tones (FHT): fetal well being is assessed with a hand-held doppler which will allow the laboring person 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 CAREMonitoring Low-Risk Labor

  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
  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

When it’s time to push, you’ll choose the position that feels right—whether that’s in the water, on a birth stool, in the shower, on the bed, or even outdoors in our courtyard. Birth unfolds where it needs to, and we’re here to support that process.

We don’t use stirrups and we don’t rush pushing. This gentle, responsive approach helps reduce the chance of tearing and allows your body to lead.

Whenever possible, partners are invited to catch the baby with the midwife’s guidance and place them directly on your chest. It’s a powerful, uninterrupted moment—and we do everything we can to honor it as yours.