Were your babies born in a hospital? If you’re like the majority of women in the United States, you didn’t even consider another option. But a small number of women today are choosing to give birth at home.
Only around 1.36 percent of births each year happen outside of a hospital. But that number continues to rise. And as more women choose to give birth at home, the demand for midwife care is growing.
For many soon-to-be mothers, the services offered by home birth midwives are an important factor in their choice to deliver outside the hospital.
Avoiding unnecessary intervention is key to the midwifery model of care. The approach of a home birth midwife is rooted in the belief that “pregnancy and birth are normal life events,” according to the Midwives Alliance of North America.
Midwives also often focus on providing individualized information and education to women. They also offer continuous care throughout labor and delivery. For a mother, that means that she builds a strong relationship with a provider. The same person will attend to her during every prenatal appointment and throughout her delivery.
For a home birth midwife, this personalized level of care means a life of always being “on call.”
Always being ready for a birth sometimes makes for a challenging day-to-day life. But for midwives like Celesta Bargatze, a certified professional midwife at Nova Birth Services in Tennessee, it’s a rewarding career.
Here’s a look at a day in the life of a midwife.
Bargatze’s mornings usually start around 9 a.m., when her first prenatal appointment begins.
Like an obstetrician, the midwife schedules regular appointments with her clients to check on the progress of their pregnancies. But unlike an obstetrician, Bargatze schedules an hour or more for each client.
“When a client arrives, usually I’m waiting for her, instead of the other way around,” she says. That’s part of the philosophy of a home birth provider, to provide highly individualized care. If it’s inconvenient for a client to come to the office, Bargatze will even make occasional home visits for lab tests or consultations.
Prenatal appointments usually last for an hour or more. In a standard appointment, Bargatze will do a few tests like taking blood pressure and checking a urine sample. But most of the time is just spent catching up.
“I want to know how they’re feeling,” she explains. “Everything from physical aspects to emotional aspects. I want to know what they’re concerned about and any fears they might have.”
For example, today one client is worried she won’t be able to have a home birth. She’s afraid of having to transfer to a hospital. “A lot of that is fear of the unknown,” believes Bargatze. “So I talked with her about our backup doctors. I explained what would happen if she needed to be transported to the hospital.”
Between clients, Bargatze sorts through lab results. One mother has a high white blood cell count, so she meets with the office nurse practitioner to discuss the results and get a second opinion. “Having a nurse practitioner who works with our office is really helpful,” she says. “She helps us look at symptoms and come up with holistic solutions for our clients.”
After lunch, Bargatze leaves the office to pick up her youngest kids (ages 1 and 4) from their babysitter. She plays with them for a half an hour. Then they both go down for a nap. While they sleep, she works on charting and returning phone calls. Several clients have called with questions about diet or medication, so she calls them back to discuss the issues they’re concerned about.
At 3 p.m., Bargatze’s two older daughters (ages 7 and 9) come home from school. That’s Bargatze’s signal to put work aside. She spends the afternoon focusing on her kids. At any moment, she knows she could be called away if a client goes into labor.
Sure enough, a call comes in that evening. It’s shortly before Bargatze’s husband gets home. Bargatze talks with the client while cooking dinner.
She advises her to drink plenty of water, eat a good meal, and to call if her contractions get stronger.
Deciding when to leave for a birth is one of the trickiest parts of Bargatze’s job. “There’s constantly that tension,” she says. “Maybe she’ll be in labor, but then stops. Maybe she won’t think she’s in labor, but I have a feeling she is. Sometimes I’ll go and sit outside her house in my car, so I can be close if she needs me. I try to listen to my intuition.”
In this case, the early evening call is just the warmup. The mother doesn’t think Bargatze needs to come yet. Tonight, she’s able to have dinner with her family. She calls a neighbor to ask if she can watch the kids in the afternoon, in case she’s still at the birth.
She makes sure her bags and equipment are ready and in the car. She lays out her scrubs and shoes and packs lunches for her kids. Bargatze always tells clients to sleep during early labor, but she doesn’t always take that advice for herself.
Usually, it’s right around the time when she finally lies down that her phone rings. It’s time.
Bargatze throws on her scrubs and shoes, and she’s out the door in minutes. On the way to her client’s house, she calls her assistant and her partner midwife. Her team will attend the birth with her.
When she arrives at the house, her first step is to assess what’s going on. She checks vitals for mom and baby. She also checks how everyone is doing emotionally. She encourages the mom to relax, and she reassures her partner that everything is going well.
When her assistant arrives, they work together to prepare the space. They set up the birth tub and fill it with water. Most of Bargatze’s clients choose water birth because it helps with pain management. As the tub is filling, Bargatze and her assistant set out supplies and equipment so everything will be ready if it’s needed.
Once everything is set up, the midwife can relax a bit. “I let the mom do her thing, and we monitor. I try not to interrupt the family. I don’t want to make them feel like they have to accommodate me or do anything for me, so I try to stay out of sight as much as possible and just listen and watch.”
When Bargatze thinks it’s getting close to time, she’ll call her partner midwife to come join them at the birth. She measures this by how the mother is acting and feeling, more than by physiological measures. “Most moms go through a point when they think it’s never going to happen,” she explains. “When they’re in transition, they think the baby is never going to come.” That’s when the midwives know it’s almost time to push.
As labor enters the pushing stage, each attendant has a role. The assistant acts as a doula, helping the mother with comfort measures like back pressure. The second midwife charts progress and hands Bargatze equipment as needed. Bargatze is right there watching the baby, making sure there aren’t any issues.
Often, the family has a plan for who they want to catch the baby. Sometimes, the mother wants to do it, or her partner wants to. Other couples prefer the midwife to do it. Bargatze makes sure that every aspect of the birth plan is followed, by guiding the mother to reach down, or inviting the partner to join her as the baby crowns. Sometimes, she has to intervene a little to help the baby out. She might suggest that the mom try a different position, or manually help the baby’s head rotate slightly.
After the baby is out, the midwives’ focus is on monitoring without intruding. Bargatze observes to make sure the baby is breathing and that the mother isn’t bleeding too much. She checks the baby’s pulse through the cord. She waits until the cord has stopped pulsing to clamp it.
She puts a hat on the baby to help keep it warm while the mother holds her baby and delivers the placenta. “I’m very watchful, while also giving them space and protecting that space,” she says. “We wait to see when mom and baby are ready to move to the next phase.”
After a water birth, the next phase is to move the pair out of the tub and onto a bed. They help the mother dress, and they perform the newborn exam on the bed next to the mother. Bargatze tells the new parents what to expect during the postpartum period. She gives them a sheet of instructions about newborn and postpartum care that she’s already discussed with them in prenatal appointments.
After mother and baby are comfortable and settled, the midwives’ job still isn’t done. They need to take care of the cleanup. They empty the birth tub, wash laundry, and clean. They put away equipment and take care of any other mess that happened during the birth. Once the house is as clean as it was when they arrived, it’s time to go home.
Bargatze still holds prenatal appointments the morning after a birth. But if she has time, she’ll go home and rest first. If her husband is home, he’ll get the kids ready for school so she can rest until it’s time to go back to the office and meet with today’s clients.
A home birth midwife may still be an unusual career choice. But Bargatze knows she’s making a big difference for those who choose her as a provider.
“Every woman should have this opportunity,” she believes. “Every woman should have access to care that’s individualized and compassionate and empowering.” And as long as she can offer that level of care to women, the challenges of her on-call life are well worth it.