Editor’s Note: Good Morning! It is with the greatest of pleasure that we launch the new Ask A Midwife column here on OBE with the midwives of Plum Midwifery joining us monthly to answer your questions about pregnancy and childbirth.

I’m honored to introduce you to Joanne Daviau, Amy Kelly, Emma Gledhill and Jessie Shannon, as well as the team of second attendants and students from Plum Midwifery. This warm crew of women has been caring for women and babies during pregnancy and birth for a collective 50+ years and I am completely inspired by their stories, experience and expertise.

Today, we kick everything off with the Top 5 questions that are asked of midwives and invite you to submit your questions to the Plum Midwifery team at askamidwife@ourbigearth.com

On the first Friday of every month, they will be here on OBE answering some of those questions and guiding you through the magic and reality of pregnancy and childbirth with insight and knowledge.

Enjoy!

Hello, we are the midwives of Plum Midwifery and are looking forward to offering insight into your questions about pregnancy and childbirth. Women often come to us with a wide array of questions as they make their way through pregnancy. But, there are a few that nearly every woman asks. Here are the five that we most often find women wondering about, as well as our professional perspective on each.

Q: Can I lie on my back?

A: If you are in your 1st and 2nd trimester that is before 28 weeks this is usually not a problem if you are comfortable. Most women ask this question because they have woken up in the middle of the night panicked because they have found themselves on their back and have heard that women should never sleep on their backs.

The main concern with being on your back in later pregnancy is that your growing baby inside the uterus can put increased pressure on the vena cava, which is the main source of blood return to all vital organs of your body. When this is problematic women often feel light headed, faint or nauseas, as women experience what is termed hypotension which is a drop in blood pressure. Women will naturally get out of this position before there are any affects on the baby.

During the last month of your pregnancy one of the main reasons to avoid sleeping on your back is that the baby can enter your pelvis; hence the term “your baby has dropped”. If you sleep on your back this can encourage the baby to also lie in this same position. If your baby drops into your pelvis in this position this may cause your baby to be in a less than optimal position for labor.

What you can do? If you find yourself starting the night lying on either your right or left side but waking up on your back, you may want to position a small wedge such as a small pillow under where your hip may end up if you happen to roll onto your back. This will hopefully be uncomfortable enough to wake you up and prevent you from ending up on your back.

One of the key factors is optimal positions and this begins in pregnancy. As mentioned above, lying on your back can encourage the baby to also lie on her or his back creating a less than ideal position for baby to enter the pelvis in. Please see link below for information on ideal pregnancy positions and methods used to encourage optimal fetal positioning prior to labor beginning HERE.

Q: Can I see a doctor as well as a midwife?

A: Midwives are primary health care givers, specialists in low risk maternity care covered under your medical services plan since 1998. In Canada, a midwifery model being followed is that of community-based independent regulated midwives skilled in providing care from early pregnancy to six weeks postpartum and including attendance at both home and hospital births. It is this model that shows the lowest medical intervention rates without compromising outcomes for mothers and babies (Ministry of Health March 1998).

Women and families now have a choice of caregiver for the duration of their pregnancy, labor, birth and post partum. Women can choose either a midwife or a doctor for their care. Because midwives are part of the health care team and are primary health care givers, medical services plan does not cover both practitioners for the same care.

However, if you are being followed by a midwife and care exceeds the scope of practice of a midwife, she can refer you to someone like an obstetrician. In this situation a midwife and an obstetrician work closely as a team. An obstetrician specializes in high risk pregnancies, labors and births.

Would you like more information on how midwives function in the health care system? The College of Midwives of British Columbia has specific guidelines that midwives follow in the provision of care to women and families. Please visit the website for more information on how midwives are trained, their scope and guidelines to practice HERE.

Q: Are Home Births safe?

A: The following is an excerpt from the Home Birth Handbook for Midwifery Clients Revised March 2009 and available from all midwifery offices and from the College of Midwives of British Columbia.

Home birth involves careful screening of women by their midwives to determine suitability and coordination between midwives and other health care providers. Home birth is provided within a broad support system that includes hospitals, physicians and emergency services.

The Home Birth Demonstration Project (HBDP) was incorporated in the Midwives Regulation of the Health Professions Act, which established midwifery as a self-regulated profession in the province. The goal of the project was to evaluate home births with registered midwives in the first two years of regulated midwifery in British Columbia.

The HBDP facilitated coordination among maternity care providers to ensure that the necessary support systems for planned home birth were in place. The project also collected an analyzed data from all of the planned home births, including those where transfer to hospital was required, attended by registered midwives from January 1, 1998 through December 31, 1999.

The project’s independent evaluation team conducted an analysis and evaluation of these two years of data, and recommended that home birth services continue to be delivered to a well-screened low-risk population of BC women by registered midwives with training in emergency management, the necessary equipment and supplies, and access to ambulance and hospital back-up services.

To read a home birth news release article, click on site HERE.

While home birth continues to be an option for low risk midwifery clients, not all women will be comfortable choosing a home birth, or be good candidates for a home birth. Ongoing evaluation for the presence of risk factors is an important aspect of midwifery care throughout pregnancy, labor and birth.

Information gathering is important when choosing place of birth and only then can women and families make an informed decision about place of birth.

Sometimes a woman will choose a home birth but realize in labor she may not be comfortable at home and may choose to go to hospital, likewise a woman may choose a hospital birth but may decide in labor that she wants to stay home. Midwives are prepared for both options and in the end, as long as everything is progressing normally and women are in the low risk category, it is important for women to have their baby in their chosen place of birth.

After 11 years of regulated midwifery in the province of British Columbia (and longer for other provinces in Canada and world wide) home birth continues to be offered as a safe option for birthing women.

Q: How long will it take? When are we going to get there?

A: This is the question of the hour and of the day when a woman is in labor after many hours of what seems to be taking forever. It’s like a long car ride – sometimes a bumpy one when we’re wondering when are we going to get there? How much longer? Partners usually ask this one wanting to know the rendez vous schedule plan with their baby.

It’s not an easy one to answer as labors and births are so variable from one to the other with so many factors involved, such as whether this is a first baby or not, whether the baby is in an optimal position or not, the size of the baby, family history and how relaxed a woman is.

Q: Should I be concerned because I have some abdominal pain sometimes on both sides and low down?

A: This is most commonly known as round ligament pain. This is usually uniform discomfort located on both sides and low down abdominally caused by the stretching of the ligaments specifically the round ligaments supporting your uterus as your baby grows.

Pain will come and go, may increase depending on certain activity and sleeping positions. Ensuring proper posture at all times during your pregnancy can help minimize the discomfort associated with ligament stretching.

You can refer to optimal posture described in the link above on optimal fetal position. In addition, as your baby goes through growth spurts early in pregnancy and often again between 28 and 32 weeks gestation, this dull ache can increase. It is however important to differentiate between normal and abnormal pain and to report to your care giver any cramping that is increasing in severity, pain on urination, frequent urination, vaginal bleeding or unusual discharge or at any time you are concerned.