It's always so much fun to do home visits at the end of the pregnancy. We go to our clients' homes so we know how to get there when we aren't in a rush or when it isn't dark outside. It's a great way to see what the clients' homes look like, what they find important (books, collections, etc.), how sanitary the house will be, what kind of food they are really eating (compared to what they said they were eating) and to be able to see everyone in their own element. Kids, especially, are a delight to observe as they come to life in their own homes. Even the ones who are the most comfortable at the office are transformed surrounded by their own toys and things.
It isn't an inspection (like that). I don't want it to sound like that at all. But, in many ways, it is the culmination of information we have gotten during the rest of the pregnancy. Women show their soft/weak spots during the home visit. Invariably, they will apologize for the mess, even when everything is meticulously in order. We are often served snacks or meals - and we admonish it is the LAST time they are allowed to serve us!
What we do inspect is the Birth Kit.
We have clients order a birth kit from Cascade (each midwife has her own quirks for what she wants in there) and then supplemental items to augment the kit and then separate them into three bags (usually brown paper) labeled MOM, BABY and WARM. We ask moms to please not throw the box away because we use it at the birth - it's the best garbage bag holder.
(From memory) My Cascade birth kit contains the sitz bath herbs, a package of industrial strength pads, a bag of safety pins, two stacks of chux pads, a peri-bottle, an instrument soak (single use), two plastic-backed paper drapes, a baby hat, a footprinter, a paper measuring tape, cord care (herbal), small and medium sterile gloves (10 each)... is that it? I'm going to add a small bottle of betadine in case I need to catheterize a woman. Used to have that and never needed it, so eliminated it. Then, when I needed it, didn't have it. Hard to gauge what to keep and what to eliminate. I did get rid of the bulb syringe. Can't see getting that back in there.
Preparation includes taking the sitz bath herbs and making an herbal infusion and wetting 4-5 of the giant-sized pads. Not soaking, but not dribbling. After the tea is made, the herbs are strained out if the woman wants to do that (some prefer to keep them in) and then the pads wet. Then they are wrapped in Saran Wrap individually. Once they are wrapped, they are put into a bowl (cereal-sized or larger) and plopped in the freezer. When they are frozen, they can be taken out of the bowl and stacked back in the freezer to await the birth.
In the MOM bag, we put the oh-so-unattractive mesh panties (which should have been washed), the peri-bottle, the remainder of the sitz bath herbs, a something if mom wants to wear it after the birth (a tee shirt, tank top, pajamas, etc.), a copy of her insurance card in case of transport and, in the winter, socks.
In the BABY bag, nice baby hats (not the one from the kit), baby clothes, diapers, diaper covers, the cord care herbs and the paper tape measure are gathered together. Some mamas want socks for the babies, too. The baby's thermometer goes in here, too.
The WARM bag is the bag with towels, washcloths, a couple of hats, including the one from Cascade.
Two sets of sheets, two plastic drop cloths, AA batteries and 9-V batteries (back-ups for the midwives), loads of towels (especially if there is a pool involved), Rescue Remedy, 2 large bottles of peroxide, any herbs, essential oils or homeopathics the woman prefers (I carry a supply of stuff, too), film, camera, music, a video camera and other individual desires are gathered and put into the box that we keep for the trash during labor. The box also holds the remaining chux, gloves, drapes and stuff, too.
If a pool is involved, the client has to have a new hose (can't have been used even once due to gookies that live outdoors inside hoses and spigots). We talk about how to turn the water heater UP unless there is another kidlet in the house, then they have to be really careful about the water being so hot. We explain how it can take two hot water heaters full before the pool is filled (especially the Aqua Doula). We explain that it is easier to cool water off than to heat water up, so hotter at first is better. We explain "going to the river" if the client has a blow up fishie pool. "Going to the river" is my description of bringing hot water to the pool from the kitchen and dredging cold water from the pool to be replaced with hot. Sometimes we have a chain and it is always amusing as pots, tea kettles, coffee makers and microwaves are utilized to keep water in fishie pools warm. More and more, I adore Aqua Doulas. They keep themselves toasty.
We explain to dad/partner how to make the bed. Once labor seems to be going, take the nicer set of sheets and put them on the stripped down bed. Then take one of the drop cloths and put it over those sheets. Take the next set of sheets... the ones they don't really care about getting stained (they rarely are stained)... and put those over the drop cloth. Then, take the safety pins in the box and attach the whole shebang to the mattress (if the bed isn't a waterbed!)... sheets, plastic and sheets all get attached via pins to the mattress. This keeps everyone from sliding around if anyone is on the bed. If mom is on the bed, it isn't uncommon to have more than just a couple people there. We've slid around at births before and it ain't pretty.
After the birth, when mom gets into the bed to nurse after the placenta is born, she can be worry-free about not being totally cleaned up yet on the sheets. We wipe her off, but if she needs to be sutured, or if the placenta was just born, she isn't as clean as she would be with a shower. Once she gets up to pee and shower (usually at the same time), one midwife stays with mom and the other(s) strip the dirty sheet and plastic off the bed so mom can get into a clean and fresh bed when she herself is clean and fresh. It isn't uncommon for dad to climb in, too. Of course, we put chux pads down on the sheets no matter where in the process they are, too.
Before, during or after all the logistics discussions, we do a prenatal. Mom pees on a (urine) stick, we measure her fundus, palpate her 36-37 week baby and have a goodly discussion about the upcoming birth. We love when the cast of characters who will be at the birth is at the home visit, so we can talk about each person's roles and their worries or concerns about the upcoming birth. We talk about where mom thinks she might have her baby. We take a tour of the house, the kitchen, find where the bathrooms are and where the bags will be kept so that when mom is in labor, we don't have to bother anyone with where things are - they are free to be in labor and not in any entertaining mode.
We have brief discussions of food desires/needs, including mom's in labor and the midwives who will be hanging out for a number of hours in their home. For a long time, I took my own food, even carrying tons of it in my car, but families are so gracious and kind, I began to see my hoarding as my own food issues and got it all out of my car. I mean, stores are open 24 hours a day.
We encourage mom to have comfort foods on hand, whatever that means to her. Foods she enjoys eating when her stomach doesn't feel so good sits well for many women. I explain that most women in home births don't throw-up in labor, but if they do, it is not a problem at all... hard to be tense when you are barfing. Or laughing.
Common foods women choose in labor:
bagels and cream cheese
toast with peanut butter
peanut butter and jelly
Common foods the midwives request:
Sandwich fixings (turkey or chicken since this midwife doesn't eat red meat or pork)
bagels and cream cheese (almost 100% what we eat at shorter births)
Diet Coke (guess who asks for that)
We thank and hug everyone for being there, make sure there aren't any more questions or concerns and then pack up and head out after our 2-2.5 hour visit.
Just thought a little window into a home visit might be enjoyed.