Giving birth is something you should do in a hospital with a gynaecologist. Right? It is an option, there are so many possibilites! How about giving birth in a birth home with your own midwife? And did you know, for example, that you can also give birth in the hospital with your own midwife? Midwives Sarah Maes and Laure Depuydt tell us more about the options.
Anyone who chooses an independent midwife will want to give birth at home. It is an assumption of many women, but it is not correct. Certainly, independent midwives will be happy to assist you with labour and childbirth at home, if that suits you and if your pregnancy went smoothly. However, they can do much more for you, even if you want to give birth in a hospital. Or in a birth home. Or even when you are still in doubt. How does that work?
“Early on in pregnancy, we discuss with the women we guide in our practice what their wishes are and what is possible,” says midwife Sarah Maes of midwifery practice Amala in Brussels. “Couples who come to us are looking for personal care and one-to-one counselling. They want to inform themselves and make their own choices”.
Those choices are numerous when you are accompanied by an independent midwife. Of course you can give birth at home. “That’s always very special,” says Sarah. But she knows that not all couples in Belgium are comfortable with it. These women can also benefit from the guidance of an independent midwife, because in many places in Belgium their own midwife can also supervise the delivery in the hospital or a birth home, Sarah says. “As soon as labour has started, we come to the couple’s home or we meet at the hospital. There, we accompany them until the baby is born, together with a midwife from the delivery home. If there is an issue that occurs, we call in the help of a gynaecologist”.
What is the advantage of having your own midwife? Guaranteed one-to-one care during pregnancy and childbirth, says Sarah. “An independent midwife is there for you.” She doesn’t have to keep an eye on three other women in labour, which is something that as happens quite frequently in a delivery room. Sarah speaks from experience: “I worked half-time in the hospital and half-time as an independent midwife for a period of time and I noticed that my behaviour in the delivery room changed. I wanted to provide one-on-one care for women who didn’t opt for an epidural, but then I needed the help of a colleague to follow the other women, and that wasn’t always possible. A woman who wants to rely on her own strenghts needs a little more space and trust, and you have to be able to provide that as a carer. Often that time and undivided attention is not there in the hospital. Furthermore, there is less knowledge about this type of support and people tend to intervene too quickly in the process, while the woman’s body is made to give birth”.
Giving women time so that nature can work its way, that’s what midwives do, nods Laure Depuydt. She is a midwife in the Cocon, the first and only birthplace in Belgium within the walls of a hospital; the Erasmus Hospital in Brussels.
“The Cocon is the middle ground between home and hospital,” she says. “We are not in the delivery department. We really are a separate ward with two birth rooms. Think of luxury hotel rooms with a double bed, a bath, salt lights and where no medical equipment is visible – although of course it’s there, but hidden” she laughs. “A place where you can give birth in comfort with the support of a midwife who doesn’t stray from your side. But if there are complications, we can take the elevator to our colleagues and gynaecologists in the delivery room. For many couples that’s a reassuring thought”.
The Cocon also offers guidance to pregnant women from the moment they have a positive pregnancy test in their hands. Couples come in for monthly consultations seeking information, to measure the blood pressure and growth, to listen to the baby’s heart tones and to take blood samples for the NIP-test, for example. Ultrasound scans are made by a gynaecologist working under the same roof.
Many couples come to the Cocon where the partners have opposite wishes, says Laure. For example, the woman would like to give birth at home, but her partner would rather not. For the time being, their audience consists mostly of highly educated couples and artists, she noticed. Even though there are many women of Moroccan origin who choose to give birth at home. “They want a guarantee that they will give birth supported by women and in addition, the value of caring around the time of birth really lies in their culture”.
The Cocon is a real ‘hub’, says Laure. “It is a place where you get to know like-minded people who are in the same period of their lives and who are going through similar developments”.
Physical and mental guidance
Both Laure and Sarah also accompany a lot of couples who have had a traumatic first delivery. For example, there wasn’t enough communication about the pros and cons of interventions, or an episiotomy was made without consultation. Others experienced the delivery ward as very busy. “Most couples turned out to be totally unprepared for that first delivery,” says Sarah. “Their world opens up once they knock on our door, their experience and perception is so different the second time”.
This personal guidance does not only apply during childbirth, it is there throughout the entire pregnancy. Laure: “As midwives we don’t just pay attention to the medical side, we really take the time during consultations to get to know the couple. There is a lot of room for the psychological side: what does the expansion of the family mean for the household? How do you deal with siblings? But also: how do you deal with pain during childbirth? What are the advantages and disadvantages of epidural anaesthesia? What positions and postures can help you to give birth to your baby? And we also talk about work and sex during pregnancy, for example. The pregnant woman is at the centre of our care”.
Preparing for childbirth and childbirth time
Sarah nods. “We take the time to explain what is happening in your body. During pregnancy and childbirth, but also afterwards.” People are often so focused on the birth that the postpartum period is often forgotten. Anyone who gives birth in the Cocon or with a midwife in the hospital can then spend her first few days in the maternity ward. Another possibility is to spend those maternity days at home. Mummy and baby are then monitored by a midwife every day. “We try to give parents realistic expectations in advance, because your life really changes with a baby. Yes, there will be a pink cloud, but there will also be difficult moments, with sleep deprivation, physical discomforts”.
Knowing what will happen to you as parents-to-be is crucial, according to Laure. “If you know what happens during childbirth and how to make yourself comfortable, you will experience much less stress. Sarah agrees: “If you know what happens to your body and why you feel what you feel, you won’t be overwhelmed by it during childbirth and you can teach yourself how to deal with it”.
Of course, complications may occur during pregnancy, making it necessary to consult a gynaecologist. If, for example, a patient is diagnosed with gestational diabetes, if a baby appears to be above average or is in the breech position, women are referred to a gynaecologist. “At Amala, we work well with different gynaecologists from different hospitals,” says Sarah.
Support in case of risk pregnancy
After all, in principle, independent midwives only guide healthy pregnancies. But pregnant women with an increased risk of complications can in some cases also be monitored together with a gynaecologist, says Sarah.
Think of a pregnant woman who is overdue and is being induced, or a twin pregnancy. In agreement, your own midwife can then be present at the birth. “The gynaecologist is there and has the final medical responsibility”.
This quiet atmosphere is very important during childbirth, Laure agrees. “Your hormones do not work as well if you are tense, if you are distracted by a squeaky monitor or people walking in and out”.
Childbirth with complications
Even when complications occur during childbirth, an independent midwife does not leave the side of her couples, Sarah says. “I will continue to guard their cocoons and ensure the best possible birth in those circumstances. A great childbirth experience is so important”.
In that case, the gynaecologist on duty takes over responsibility for the birth and it is a hospital midwife who, for example, places an IV or ruptures the membranes. So what is the added value of an independent midwife in the delivery room? Sarah: “We are a familiar face. We know you and your partner, and we know what you think is important. We can look after your interests as well as possible. Suppose an assistant grabs the leg supports, then we would ask: didn’t you want to give birth lying on your side? Or when a medical intervention is necessary – an episiotomy, a ventouse (suction cup) – we explain what happens and ask: do you agree? This explanation and consent will improve the parents’ experience. It really is very rare that there is no time to explain a medical intervention.
Sarah remembers a woman who had to be induced prematurely because of heart problems. She had to have an epidural for medical reasons, but it did not work properly. Sarah did not leave her side and was able to help her cope with the unexpected pain. Even after the birth, her presence turned out to be a gift: “Because the baby was premature, it should not be skin-to-skin after the birth, the mother had been told beforehand. But once the baby was born healthy, the pediatrician allowed me to do so because he knew that I was keeping a constant eye on them. Of course it helps if you, as a midwife, have good relationship with the hospital staff “.
One step further
Laure nods: “That is what distinguishes us as midwives: time and attention. Moreover, our threshold is much lower than that of a gynaecologist. People can always call us – even at night, at weekends and on public holidays – with questions. We go the extra mile.
The question remains: doesn’t that cost a lot? Do you end up paying two bills when you give birth to a midwife in hospital? “It’s up to the hospitalisation insurance you have or don’t have,” says Sarah. “We discuss this during the first consultation, of course, and in the case of financial difficulties there are possibilities, because we want everyone to be able to receive this care. But make no mistake: a ‘normal’ hospital birth can also be very expensive. I know a midwife who says: you can use your maternity money to buy an expensive pram or personal assistance before, during and after the birth of your child”.
Sarah Maes is a midwife at the midwife practice Amala (meaning honourable mother, in Tibetan). She follows up pregnancies and accompanies deliveries at home, at birth house de Cocon, at the Erasmus Hospital in Brussels and at the Saint-Elisabeth Hospital in Uccle (Europe Hospitals).
Laure Depuydt has been working as a midwife in birth house de Cocon, which is part of the Brussels Erasmus Hospital, since 2016. Previously, she worked for several years as a midwife in England and at the midwife practice Zwanger in Brussel.