Philosophy
Our practice style is smack in the middle of the birth option spectrum with “DIY, movement or Free Birthers” on one edge and the “technological, highly medicalized model” way on the other extreme. This is the sweet spot, or for you yoga fans: madhu. Known unsafe practices, “going out-on-a-limb” or ignoring risk factors may leave pregnant individuals, babies and midwives in danger and on the other end of the spectrum over use of drugs, surgery and technology can also do harm. We are satisfied here in the middle and can offer the best of both worlds!
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 you in an attuned & focused way.
Alma Midwifery
Monitoring Low-Risk Pregnancies
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 Pregnancies
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.
“I had the experience of a lifetime at Alma, they gave me everything I needed to have a truly natural and supported birth. The atmosphere is just incredible and my birth team was awesome.”