In-home Care

Midwifery Today, Issue 148, Winter 2023
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Originally published in Midwifery Today, Issue 59, Autumn 2001

I have always attended the families I care for in their own homes. I’m not sure when the initial concept of doing this was instilled, but in-home care has always served me well. I never liked going to the “office” when I was a child, be it the office of the dentist, doctor, or any other care provider. I felt scared, out of control, and like something was being “done” to me. Perhaps these early childhood memories have influenced how I care for others.

I have never believed there was one better way of providing care. I am practicing what feels most comfortable to me.

What exactly is in-home care? In-home care involves going to the home of each individual you care for, equipped with all you need to provide that care. In-home care means that ou are now the guest in that home, an attitude that creates a non-clinical dynamic. This attitude of care makes you a friend and ally which puts the family in control. It also gives you, as the midwife, a broad perspective of how the family lives, the dynamics involved and what you have available to work with for a homebirth. The more you visit, the more you become incorporated into the natural flow of that family. The family members become familiar with you and you with them. You become comfortable with one another, which helps to promote trust, balance, and awareness toward better birth.

In-home care does have some drawbacks. I spend a lot of time driving, for example. On an average prenatal day I spend five hours doing prenatals and two to two-and-a-half hours driving. Whereas group prenatal care provides the advantage of women coming together and creating a network of support, in-home care provides the opposite—with its own built-in isolating factor. However, to make up for this, in-home care provides one-on-one care, creating an intimacy that bonds midwife and family in a very deep way. Women who choose me are looking for the devotion of particular care that is provided by my coming to them.

I believe that women of childbearing age should network and connect with each other. There are many ways to create this dynamic: Birth to Three groups, potluck weekly for new moms and prenatal exercise classes are just a few ways to provide this dynamic. By creating a forum in which to network, I can provide in-home care while also knowing that the social aspect is available. This social aspect is especially good for the postpartum time when women need the extra support.

It is a great thing to go to a home knowing that you are on an equal level with the family. Instead of them having to make changes to accommodate you, you accommodate them on whatever level is required. I attended a family that was two weeks postdates. I checked in every day or so. The two-year-old would lay out pillows for his mom and reach into my basket of equipment, pulling out a Guatemalan pouch that contains the fetoscope. He would place it in just the right spot to listen to the baby and inform me of what is going on. How did he know this? He was present every step of the way in his living room, on his floor, and in his own environment. That sort of comfort level is priceless.

Another demonstration of being on this equal level comes from the deep trust families feel in their own homes. Sitting on beds, I’ve listened to incredible personal stories from both women and their partners that made me wonder whether it would be possible to be so honest and open if we were not in a home setting.

You can tell a lot by how people live—their beliefs, their interests, their habits, their lives. By going to their homes repeatedly you get a true sense of who they are dealing with and what level they are on regarding birth. A midwife may have different ways and ideas, but by being in the home, she learns to accommodate the beliefs and ways of the family she is attending. Little things, such as putting items away in the proper place, may make a postpartum mom feel like she can rest after birth knowing her world is intact. This can be so helpful to the partner who wants to be with his family but “needs” keep everything together. An attentive midwife can meet this need because she knows just where an item goes, or how to fold, or what to fix for dinner, or when to provide a bedtime story. The list goes on. Providing care in the home gives the midwife the opportunity to observe and to serve in a family sort of way. This intimacy of service is my favorite part of the work.

Good organization is an essential requirement for a midwife who provides in-home care. This entails hauling around equipment and having all the right handouts, lab slips, referral numbers, and so on. Good organization also involves having a dependable vehicle with plenty of gas, and scheduling flexibility. You may be longer at one home than expected. The next woman is not simply in the next room waiting, she is clear across town. The families I serve understand this, and my assistant and I almost always call if we are running late.

Unusual situations occur when I do prenatals out of my home. For example, a lot of people want to see how I live. And in one case, a mom with seven other children preferred to leave everyone at home and come to me in order to have that time to herself. Nothing is written in stone. Versatility is good and change can breed new perspectives. In-home care is a concept much the same as that held by the old family doctors who would travel from house to house. It is a sweet way to give care and one that is appreciated by many moms who have a hard time getting to and from appointments.

Pregnancy and birth involve a huge psychological factor. I want to provide a nurturing, safe place for families to grow and to be empowered by the experience of bringing forth a child. All of us who attend birth must search for and find the way that works best for ourselves and the families we attend. In-home care helps me define who I want to be and what I want to promote. It creates an environment where I can focus without interruption. At home my phone rigs off the hook, the kids are in and out, and it is a consistent hub of activity. Although this also may be true in the home I am visiting, the flow going on around is it that family’s flow and my concentration is on them and not diverted. This has helped me immensely to treat each family individually and serve their needs and desires.

Sometimes I think I love in-home care because I am the type of person who drinks in information slowly. When you are out of your environment, you experience things differently. You are altered in yourself because you are in a social place. At home you relax, let down your guard, and become more yourself. I see people more clearly at their homes. I like being the guest and serving them on their turf. This is where the baby will be born. The more I watch, the more I learn and the better I understand.

In-home care is a vital tool for midwives. Often the more I learn the less I will intervene because I know the nuances of each family and know what is normal for them.

I enjoy my prenatal days, driving around and spending the day out and about. I love seeing the whole family, how people create their personal space, and the styles of each individual. I love the tea and cookies while the kids run around and the smell of bread baking and soup simmering on the stove. What a great gift in-home care has been to my life as a midwife.

About Author: Jill Cohen

Jill Cohen lives in Mill City, Oregon, with two of her four children. After 20 years as a lay midwife she returned to school to become an RN. She is currently working in a small rural hospital as a primary OB nurse. She was the associate editor of Midwifery Today magazine from 1990 to 2007. View all posts by

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