Intrapartum Care
The period of time from the first consistent labor contractions until after the placenta is born. This is the “big day”, the day we have been preparing for throughout the prenatal period.
Preparing for Birth
The intrapartum care I provide begins in the prenatal period as we prepare for the big day after countless detailed discussions and collaborations.
I encourage every family I work with to educate themselves by reading, watching homebirth videos, attending childbirth education classes and hiring a doula. Doulas provide extra comfort measures and are dedicated solely to supporting you and your emotional and physical needs without the clinical responsibilities that I have as your medical provider.
Early Labor
During the early stages of your labor, I am available by phone and text. As labor progresses, we discuss when the right time is for me to come to start monitoring you and baby and determine how you are both tolerating and coping with labor.
I aim to join you in labor when a pattern of active contractions has been well established. Although the timing of active labor differs from person to person, active labor is typically characterized by a pattern of contractions that are 3-4 minutes apart, lasting one minute for at least one hour though this is not an exact science. I appreciate the many variations of normal that occur during each individual labor process. The timing of my arrival is always a discussion that we have jointly and is based on clinical needs and well as your personal comfort and intuition overall.
Intermittent Monitoring & Emergencies
I practice using intermittent doppler monitoring as per ACOG’s protocol, which means I listen to your baby’s heartbeat in labor every 30 minutes for 1 minute in the first stage of labor, and every 5-15 minutes in the second stage.
This has been shown to be the most effective approach in assessing fetal well-being for low-risk pregnancies during childbirth.
I come to your home with a bag fully equipped to respond to emergency situations that may affect even low-risk pregnancies, including medications to treat postpartum hemorrhage and the ability to administer antibiotics and IV fluids.
Holistic Approaches
In addition to traditional pharmaceuticals, herbs, homeopathy, teas, oils and aromatherapy are all a part of my tool kit. Acupuncture, guasha and acupressure may also be helpful in longer labors or ones where more comfort measures are needed.
I believe that you and your baby have an innate inner sense of when labor will begin and the power to navigate this unique experience together
Safety & Precautions
Unlike hospital-based models of care, I do not perform countless vaginal exams or define progress based on the number of contractions or centimeters of dilation.
There are many variations of normal in childbirth. My job is to keep you and your baby safe by clinically observing how you and your baby respond to the birth process and identify variations of normal from deviations of normal. Processes which make your labor more “high risk” are better managed in a hospital environment where more surveillance and emergency care is available.
Safety & Precautions
I am certified in neonatal resuscitation procedures and protocols if your baby needs support taking their first breath.
Upon Arrival
As soon as I arrive, I begin to monitor your progress, evaluate how you and baby are coping with labor and guide you through the physical, emotional and spiritual experience of labor with the help of your support people and/or birth partner.
Because this is your home space, there are no limits on who can be with you in labor. Your whole family can be there to support you, including pets and younger children. Everyone who is present should be supportive of your birthing choices and honor the calm space that you have carefully prepared for and aimed to create.
Birth and Skin-to-Skin Contact
If you or your partner would like to “catch” your baby, I can help facilitate that. We can prepare for that moment beforehand or I can help direct you at the moment of birth.
Delayed cord clamping is a standard part of my practice and most of my homebirth babies attempt the “breast crawl” because of the uninterrupted, skin-to-skin contact that I honor for 1-2 hours post-birth.
Continued Care & Comfort
My license qualifies me to care for and evaluate your baby in the immediate postpartum and for the first 4 - 6wks of life. I know that the best place for a healthy baby postpartum is skin-to-skin and apart from the newborn exam, your baby is with you throughout this process.
I don’t leave your side for 2 - 4 hrs immediately postpartum depending on the specific circumstances of your birth. I want you to eat, walk to the bathroom and urinate without discomfort or pain. I am there to help with lactation and to make sure that baby is latching well. When it is time for me to leave, I make sure you are tucked into bed and you and baby are ready to rest your bodies after the momentous birth journey.
Hospital Transfers
If the clinical picture points into the direction of a hospital transfer, we will talk extensively about the safety of home vs hospital and why a transfer is recommended. I do not have hospital privileges and therefore cannot continue your care as your primary medical provider once we are in a hospital setting.
However, I will come with you to the hospital and give a full report to the staff before I leave. I will also fax all the necessary medical records they need to continue your care. I have friends and colleagues in several hospitals throughout NYC and transferring to a trusted provider is always preferred. However, it is always your choice when deciding where to transfer. In the event of a true emergency, transfer to the closest hospital is required.
